The use of inter-professional education (IPE) healthcare law and ethics scenario based learning sessions amongst nursing,midwifery and law students: An evaluation

BackgroundLitigation and disciplinary action taken by the Nursing and Midwifery Council (NMC) against nurses’ remains a concern with costs of claims against the NHS increasing by 72% over the five years up to 2015/16 with almost £1.5 billion spent in one year alone. Additionally, 5476 referrals regarding registrants' fitness to practice were made to the NMC in 2016–2017. The aims of this paper are to discuss how a pair of scenario based IPE sessions focussed on healthcare law and ethical topics were introduced as an addition to the existing nursing and midwifery curricula and to report the evaluation of these sessions.MethodsTwo scenario based sessions attended by nursing, midwifery and law students were delivered as an addition to existing nursing, midwifery and law curricula. The scenarios were based on real life cases and students collaborated to identify means of managing legal and ethical issues arising from the scenarios. These sessions were facilitated by lecturers from the schools of law, midwifery and nursing.FindingsAll attending students completed an evaluation questionnaire. Student evaluations indicated that the experience of working through the scenarios with their colleagues from other disciplines had enabled them to gain further knowledge and understanding around healthcare law and ethics. Student evaluations indicated a high level of engagement and interest in the subject and also drew attention to the supportive structure of the IPE sessions.ConclusionNurses and midwives continue to be called to account by both their professional body and in law for issues related to their practice. A way to enable students to consider this and aid their preparation for clinical and professional practice is through the use of clinically and professionally relevant healthcare law and ethics scenarios in IPE sessions.     

A retrospective analysis of ethics knowledge in physical therapy (1970-2000)

BACKGROUND AND PURPOSE: Purtilo, Guccione, and others have noted that increased clinical autonomy for physical therapists presents more complex ethical dilemmas. The body of literature examining physical therapy ethics, however, is relatively small and has not been analyzed. The primary purposes of this research were: (1) to use multiple perspectives to describe and analyze literature examining ethics in physical therapy from 1970 to 2000, (2) to develop a model to describe the evolution of knowledge of ethics in physical therapy during this period, and (3) to compare the proposed model with the evolutionary models proposed by Purtilo in physical therapy and by Pellegrino in bioethics. SAMPLE: The sample consisted of peer-reviewed journal articles cited in the MEDLINE or Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases between 1970 and 2000 or referenced in Ethics in Physical Therapy. METHODS: A two-phase mixed quantitative and qualitative method was used to analyze publications. In the quantitative phase, the author sorted publications into a priori categories, including approach to ethics, author, decade, country of publication, role of the physical therapist, and component of morality. During the qualitative phase of the research, the author analyzed and sorted the publications to identify common themes, patterns, similarities, and evolutionary trends. These findings were compared with the evolutionary models of Pellegrino and Purtilo. RESULTS: The 90 publications meeting inclusion criteria were predominantly philosophical, using the "principles" perspective; focused on the patient/client management role of the physical therapist; and addressed the moral judgment component of moral behavior. As predicted by Purtilo's model, the focus of identity evolved from self-identity to patient-focused identity, with increasing representation of societal identity. Recurrent themes included the need to further identify and clarify physical therapists' ethical dilemmas, the interrelationship between clinical and ethical decision making, and the changing relationship with patients. DISCUSSION AND CONCLUSION: Although knowledge of ethics grew steadily between 1970 and 2000, this retrospective analysis identified gaps in our current knowledge. Further research is needed to address the unique ethical problems commonly encountered in all 5 roles of the physical therapist; patient perspectives on ethical issues in physical therapy; variety in ethical approaches; factors affecting moral judgment, sensitivity, motivation, and courage; and cultural dimensions of ethical practice in physical therapy.     

An in-depth analysis of ethics teaching in Canadian physiotherapy and occupational therapy programs

Abstract

Purpose: The purpose of this study was to examine current approaches and challenges to teaching ethics in entry-level Canadian physiotherapy (PT) and occupational therapy (OT) programs. Methods: Educators responsible for teaching ethics in the 28 Canadian PT and OT programs (n?=?55) completed an online survey. Results: The quantity of ethics teaching is highly variable, ranging from 5 to 65?h. Diverse obstacles to ethics teaching were reported, relating to the organization and structure of academic programs, student issues and the topic of ethics itself. Specific challenges included time constraints, large class sizes, a lack of pedagogical tools adapted to teaching this complex subject, a perceived lack of student interest for the subject and a preference for topics related to clinical skills. Of note, 65% of ethics educators who participated in the survey did not have any specialized training in ethics. Conclusion: Significant cross-program variation in the number of hours dedicated to ethics and the diversity of pedagogical methods used suggests that there is little consensus about how best to teach ethics. Further research on ethics pedagogy in PT and OT programs (i.e. teaching and evaluation approaches and effectiveness of current ethics teaching) would support the implementation of more evidence-based ethics education.

• Implications for Rehabilitation

• Ethics educators in Canadian PT and OT programs are experimenting with diverse educational approaches to teach ethical reasoning and decision-making to students, including lectures, problem-based learning, directed readings, videos, conceptual maps and clinical elective debriefing, but no particular method has been shown to be more effective for developing ethical decision-making/reasoning. Thus, research on the effectiveness of current methods is needed to support ethics educators and programs to implement evidence-based ethics education training.

• In our survey, 65% of ethics educators did not have any specialized training in ethics. Ensuring that educators are well equipped to support the development of necessary theoretical and applied competencies can be promoted by initiatives including the creation of tailored ethics teaching and evaluation tools, and by establishing communities of practice among ethics educators.

• This survey identified heterogeneity in ethics teaching content, format and duration, and location within the curriculum. In order to be able to assess more precisely the place accorded to ethics teaching in PT and OT programs, careful mapping of ethics content inside and across rehabilitation programs is needed – both in Canada and internationally. These initiatives would help advance understanding of ethics teaching practices in rehabilitation.

     

A review of virtual reality technologies in the field of communication disability: implications for practice and research

Abstract

Background: Technology devices and applications including virtual reality (VR) are increasingly used in healthcare research and practice as tools to promote health and wellbeing. However, there is limited research examining the potential for VR to enable improved communication for people with communication disability.

Aims: To review: (a) current research using VR in speech-language pathology; and (b) the ethical and safety considerations of VR research, to inform an agenda for future research applying VR in the field of speech-language pathology.

Main contribution: This review reveals that there is an emergent body of literature applying VR to improve or develop physical, psychological and communication interventions. Use of non-immersive virtual environments to provide speech-language pathology assessment or intervention for people with communication disability has demonstrated positive outcomes, with emerging evidence of the transfer of functional communication skills from virtual to real-world environments. However, the use of VR technology and immersive virtual environments in communication disability practice and research introduces safety and ethical issues that must be carefully considered.

Conclusions: Research employing VR is in its infancy in the field of speech-language pathology. Early evidence from other healthcare disciplines suggests that VR is an engaging means of delivering immersive and interactive training to build functional skills that can be generalized to the real world. While the introduction of new technology requires careful consideration of research ethics and patient safety, future VR communication research could proceed safely with adequate engagement of interdisciplinary teams and technology specialists.

• Implications for rehabilitation

• Immersive virtual reality may be used in rehabilitation to simulate natural environments to practice and develop communication skills.

• The sense of immersion that can be achieved using virtual reality may promote the generalization of skills learnt during clinical rehabilitation to real-world situations.

• Ethical and safety considerations, including cybersecurity and cybersickness, must be carefully monitored during all virtual reality research.

     

Effectiveness of vestibular rehabilitation on concussion-induced vertigo: a systematic review

Background: Approximately 5% of all Americans have experienced a concussion sometime during their lifetime. The predominant symptoms associated with a concussion are physical issues, cognitive issues, emotional issues, and sleep disturbances; and one of the most common physical issues is vertigo.

Objectives: The purpose of this systematic review was to investigate the effectiveness of vestibular rehabilitation on concussion-induced vertigo.

Methods: Those databases that were utilized for search terms included CINAHL Complete, Proquest Medical Library, and PubMed. Each of these databases was examined from inception through the end of 2017. The search terms were ‘concussion’ OR ‘brain injury’ OR ‘head injury’ AND ‘vestibular rehabilitation’ OR ‘vestibular therapy’ AND ‘vertigo’ OR ‘dizziness’. The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence system was used to assess the evidence level of each included study, and methodological rigor was assessed utilizing criteria set forth in a systematic review by Medlicott and Harris.

Results: Seven articles met the inclusion criteria and were included in the qualitative synthesis. Six of the seven studies had an evidence level of less than two, and four of the seven studies had weak methodological rigor. Despite these limitations, this systematic review demonstrated that vestibular rehabilitation is generally an effective intervention for individuals with concussion-induced vertigo, even in the presence of visual disorders.

Conclusions: Vestibular rehabilitation should be considered as a component of the plan of care for individuals who experience vertigo following a concussion.     

A comparison of student performance between two instructional delivery methods for a healthcare ethics course

Healthcare ethics has become part of the standard curriculum of students in the health professions. The goals of healthcare ethics education are to give students the skills they need to identify, assess, and address ethical issues in clinical practice and to develop virtuous practitioners. Incorporating the medical humanities into medical school, for example, is intended to foster empathy and professionalism among students and to provide mechanisms for enhanced physician well-being. Yet, despite the long-standing inclusion of the humanities in nursing curricula, increases in the amount and kinds of scientific knowledge essential for clinical practice has resulted in the erosion of the “humanistic arts” from nursing education. One potential solution to this challenge comes with the increase in interprofessional education, where students in a variety of healthcare professions programs come together to learn about issues common to all healthcare fields.     

Reforming medical education: Preparing students for medical practice in the 21st century

Background: The shortcomings of traditional medical curricula have been debated, and reforms proposed, for decades. The faculty of Northwestern University Medical School addressed this need for major curricular change and implemented a totally new preclinical curriculum.

Summary: The new curriculum was predicated on a commitment to small‐group interaction replacing some, but not all, lecture‐based teaching. This hybrid curriculum contains the best elements of lecture‐based and $$sel directed, interactive learning. It does so through horizontal integration of the basic $$st ence disciplines into 3 courses spanning the first 2 years of medical school. Vertical integration of clinical disciplines into this framework occurred through a rigorous curriculum in communication skills, fundamental clinical skills, and problem‐based learning sessions. An experiential curriculum exposes students to the social, behavioral, and ethical foundations of medicine.

Conclusions: The feasibility of wide‐sweeping curricular reform involves inclusion of the faculty, reformation of the curriculum committee, and strong central leadership from the dean's office. The process by which such change occurs is examined in detail.     

Ethics and sexual health: Exploration of the ethical code of conduct for physiotherapists concerning sexual health in clinical practice

ABSTRACT

Physiotherapists have an important role in sexual health, but there are specific ethical considerations regarding sexuality and the practice of physiotherapy which require serious consideration. This article aims to illustrate how the professional ethical code of physiotherapy can serve as a tool for ethical clinical reasoning regarding sexual health in clinical physiotherapy practice. We analyse the ethical codes for physical therapy, in relation to a definition of sexual health and the declaration of sexual rights. The analysis outlines several ethical considerations crucial in dealing with sexual health, while also acknowledging the critical role of cultural context in any ethical analysis. We conclude that physiotherapists need to practise ethical reasoning and that the ethical code of physiotherapy can act as a point of departure for reflection on thought-provoking ethical dilemmas to improve the practice of physiotherapy and support clients’ overall health.     

The Evolution of Ethics for Community Practice

Abstract

Defining the community as client or partner requires a different ethical approach, an approach focused on the aggregate, community, or societal level. A discussion of rule ethics, virtue ethics, and feminist ethics transports the community practitioner beyond traditional ethical principles to consider a more contemporary ethical foundation for public health and community practice. Inclusion, diversity, participation, empowerment, social justice, advocacy, and interdependence create an evolving ethical foundation to support community practice. Collaboration among health care professionals and members of the organizations, communities, and societies in which they practice will facilitate the further development of moral thought and ethical theory to underpin community practice.     

Moving forward in occupational health physical therapy: the journey toward specialization in the United States

Abstract

Background: The Occupational Health Special Interest Group of the Orthopaedic Section of the American Physical Therapy Association has championed the role of physical therapy in the area of occupational health in the United States.

Objective: This article is a brief review of the role physical therapists play in occupational health, competencies for professional development in this practice area, and efforts to achieve physical therapy specialization in the United States through petition to the American Board of Physical Therapy Specialties.

Major Findings: Physical therapists have an important role to play in the health, wellness, and sustained function of the working population based on the numbers and types of injuries sustained in the workplace, and chronic problems common to working age adults. Physical therapists can help prevent injury and promote return to work through interventions including ergonomics, job modifications and transitional duty programs, functional testing, case management and communication, and care coordination with workers and other stakeholders. Practice analysis competencies are discussed as the foundation of professional development in the field of occupational health. This article also overviews petitioning materials for specialization.

Conclusion: Physical therapist specialization in occupational health may benefit workers and employers through injury reduction and improved or sustained abilities of the workforce following injury. Specialization will help to promote consistency within the field of physical therapy for external stakeholder recognition of skills, while also promoting knowledge transfer and diffusion of best practice. The specialization petition has not been approved; however the process is ongoing.     

Ethics in nursing: Progress on national nursing ethics summit

BackgroundIn 2014 a National Nursing Ethics Summit was undertaken to chart a future for nursing ethics in the United States.PurposeThe purpose of this study was to understand changes in the field over a 5-year period as a measure of longitudinal impact and identify recommendations for education, practice, research and scholarship, and policy.MethodsThis cross-sectional study used a mixed method design.FindingsNineteen participants from 15 institutions participated in the survey. The majority of respondents agreed or strongly agreed on their effort in promoting education (84%), contributing to scholarship (74%), creating a sustained environment for ethical practice (63%) and developing new initiatives (58%) in nursing ethics.DiscussionFurther investment is needed to establish a more broadly funded research agenda for ethical issues in nursing, improvement in evidence-based practice, and development of policy initiatives to promote ethical practice and infrastructure for sustainability and responsiveness to contemporary challenges.     

A survey of moral distress in certified registered nurse anesthetists: A theoretical perspective for change in ethics education for advance practice nurses

ObjectiveThe aim of this study was to examine the relationship between moral distress that may affect patient safety, and the clinical practice model, assessing ethical decision-making skills of certified registered nurse anesthetists (CRNAs).MethodsA survey using the Ethical Stress Scale (ESS) and the Ethical Assessment Skills Survey (EASS) was conducted with 134 CRNAs.ResultsResults indicated no significant effect of practice model on level of moral distress or perceived ethical assessment skill knowledge [Wilks's lambda = 0.952, F (6, 256) = 1.068, P = 0.382, n² = 0.02]. A statistically significant positive correlation existed between importance and skill (r = 0.275, P = 0.001). CRNAs felt skilled to manage the actions or activities they deemed important.ConclusionCRNAs who perceived a higher skill level in addressing ethical issues experienced lower levels of moral distress. Findings indicate content-specific curricula for the CRNAs need to be evaluated for ethical decision-making skill assessment content.     

The ethics of gene therapy

Recent developments have progressed in areas of science that pertain to gene therapy and its ethical implications. This review discusses the current state of therapeutic gene technologies, including stem cell therapies and genetic modification, and identifies ethical issues of concern in relation to the science of gene therapy and its application, including the ethics of embryonic stem cell research and therapeutic cloning, the risks associated with gene therapy, and the ethics of clinical research in developing new therapeutic technologies. Additionally, ethical issues relating to genetic modification itself are considered: the significance of the human genome, the distinction between therapy and enhancement, and concerns regarding gene therapy as a eugenic practice.     

The biopsychosocial barriers and enablers to being physically active following childbirth: a systematic literature review

Background: Physical activity brings significant health benefits. Childbirth presents many physical, emotional and practical challenges to women and is known to disrupt engagement in regular physical activity. However, the specific barriers and enablers to physical activity in the postpartum period have not yet been systematically identified. Adequate understanding of these issues is crucial before effective interventions can be developed.

Objectives: The primary objective was to identify the biopsychosocial barriers and enablers to physical activity following childbirth.

Methods: A systematic literature review of qualitative research was conducted. Relevant literature was sourced using five online databases (CINAHL, Maternity and Infant Care, MEDLINE, PsycINFO and PubMed) and primary snowballing. Studies which met the pre-determined inclusion criteria were critically appraised independently by research team members and then collectively discussed to reach consensus.

Results: A total of 391 potential records were identified. Following the application of eligibility criteria and removal of duplicates, six qualitative studies remained, all of which identified barriers and enablers to postpartum physical activity. Data demonstrated that lack of time and issues surrounding childcare were the most common barriers to physical activity, whilst a common enabler was social support. Reported benefits of physical activity in the postpartum period included improved mental well-being and weight loss.

Conclusions: A number of specific barriers, enablers and benefits were identified. Future research should aim to develop and evaluate postpartum physical activity interventions. Outcomes should be collected prospectively at multiple time points and more diverse participant samples should be recruited.     

Exploring the Dilemma of Ethical Issues Using the Lens of Seedhouse Can Help Oncology Nurses to Gain a Different Perspective on Caring for Older Adults with Cancer

ObjectiveTo explore ethical issues associated with older adults with cancer and the people who matter to them.Data SourcesA scoping review of the literature was conducted to inform the article using CINAHL, Medline, and Google Scholar databases using broad terms, older adults, geriatrics, cancer, and ethics.ConclusionOlder adults with cancer experience ageism, which stems from a range of uncertainties on best practice in care and treatment. By employing an ethical lens, decision-making by oncology nurses can be aided by creating and promoting autonomy through impeccable communication. Best interests for individual older adults with cancer can also be served by oncology nurses working in a way that serves needs first and acts in the best interests of the person and their family.Implications for Nursing PracticeThe article is of relevance to practicing oncology globally nurses because the framework can be easily used in clinical practice.     

A review of the physical activity levels of children with juvenile arthritis

Abstract

Background: Juvenile idiopathic arthritis (JIA) is a chronic disease characterised by synovial inflammation that may lead to permanent joint damage. Children with JIA may experience periods of reduced physical activity during an exacerbation of the disease and possibly after the active inflammation has resolved. The objective of this review was to establish the current physical activity levels in children with JIA.

Methods: A literature search was performed to examine the evidence surrounding physical activity levels in children with JIA. For inclusion in the review, studies had to measure and report levels of physical activity with either objective or subjective methods.

Results: Seven studies meeting the criteria were reviewed. A limited number of studies used objective measurements of physical activity, such as accelerometers. The results of these studies suggest that there is little difference in physical activity levels between children with JIA and controls. Studies that used subjective measurements such as self-reported or parental-reported questionnaires suggest a decline in physical activity in the subjects with JIA compared to controls.

Discussion: Due to the conflicting nature of the results and methodological issues in some of studies reviewed, it is not clear if there is a significant difference in physical activity levels in children with JIA compared to healthy peers. Given the known benefits of physical activity on the musculoskeletal and cardiorespiratory systems during childhood, further research in this area is required to assess physical activity levels in children with JIA.     

Physical exercise and depression

Abstract

Objectives: The objective was to review studies which used physical exercise as an intervention to treat major depression, focusing on methodology, mechanisms of action, types of physical exercise and treatment outcomes.

Methods: Perform a search of the literature in the databases PsycINFO and PubMed 2000–2010 with ‘major depression’, ‘exercise’, ‘outcome’, ‘physical activity’ and ‘aerobic training’ as search terms. The inclusion criteria were: RCT treating depression with physical exercise with no limitations concerning age, gender or medication status.

Results: Eight studies fulfilled the inclusion criteria and were included. Seven of the eight studies showed significantly improved mood and reduced depression. Physiological and psychological mechanisms may be more relevant to mechanisms of action than social factors. Physical exercise had the same positive effect as sertraline in two studies. Also physical exercise and sertraline given together in one of two studies had a positive effect. Three studies measured an increase in aerobic capacity, two with correlated mood improvements. One showed a correlation between increased muscle strength and reduced feelings of depression.

Conclusion: Physical exercise can be an effective treatment against depression. A mood enhancing effect of exercise was identified in the interventions regardless of the mechanism of action. There is a need for more highly controlled clinical intervention studies treating depression with physical exercise, focusing on increasing the knowledge about mechanisms of action, type of exercise, intensity and frequency of exercise.