The benefits of serving on a hospital ethics committee: a faculty perspective

Community hospitals ethics committees rarely have formal support from persons within the academic community. The author discusses a liaison between a suburban hospital system and a nearby university school of nursing that garners positive educational, service, and programmatic benefits, related to ethics, for both. The lessons learned and insights gained by a faculty member serving on the ethics committee are examined.     

Development of a hospital ethics committee: lessons from five years of case consultations.

The development and consultation experience of an ethics committee in an urban community hospital has been presented, and various approaches to case consultation have been considered. Our committee has concentrated on the clinical evaluation model. As expected, most consultations have centered on issues of withdrawing or limiting medical care. Most patients evaluated have been unable to clearly express their wishes concerning further treatments, highlighting the need for promoting advance directives. When resorting to substituted judgment, our committee has supported continued care in a majority of cases. Limitation of the consultation process to the attending physician has, in our experience, actually served to increase the credibility of the committee and has promoted acceptance of its recommendations. The committee's most useful function seems to be in assisting physicians and their patients in defining realistic goals and limitations of treatment. Within this context, the coming decade may find ethics committees concerned less with promoting the autonomous wishes of individual patients than with defining the limits of that autonomy against the competing demands of the larger society. Such a shift should be approached with caution.     

The role of the nurse on hospital ethics committees

Sound decisions are characterized by assurance of adequate information, multiple perspectives, sufficiently deliberate thought, emotional support for all decision makers, and legal acceptability. Each of these features can be enhanced by appropriate involvement of the nurse on an ethics committee. As a result, the nurse will be helping to assure patient, family, and professional participants that they have done their best under difficult constraints. Serving as a member of a hospital ethics committee is time consuming and challenging. Yet, it is one of the most important ways nurses can function in the role of patient advocate. The ethics committee can be the answer to the frustration that nurses confront every day when faced with increased technology, legislative inaction, and medical paternalism. Even competent patients are often manipulated when they want to refuse treatment. Patients and families frequently have the illusion of choice but no real choice at all. If an ethics committee can provide some meaningful avenue for the exercise of patients' and families' rights, then they are worth the effort.     

A tale of two studies: research governance issues arising from two ethnographic investigations into the organisation of health and social care

In a number of countries throughout the world attention is being paid to the ways in which health and social care research is undertaken and regulated. In the United Kingdom, new research governance frameworks are intended to promote improvement in research quality. This paper draws on our experiences of seeking research ethics committee approval for two investigations with the same research design, in order to address four governance issues: consistency within and between ethics committees; the assessment of vulnerable individuals regarding their suitability to participate in studies; the relationship between ethics and access; and ethics committee understanding of qualitative research.     

Admissions procedures of educational programs for the specialist in blood bank technology

A national survey of specialists in blood bank technology educational programs was performed to describe current admissions procedures. Programs generally were AABB approved for and accepted either two or four students annually from 10 to 14 complete applications which result from 25 to 50 inquiries. The program selection criteria usually included an evaluation of overall GPA, science GPA, prior blood bank experience, three professional references, and a non-standardized interview with the medical director, educational coordinator, and other faculty or staff. Admissions procedures were characterized by an admissions committee of four members differentially weighting the various selection criteria that often were not quantified through the use of a point value system. Programs reported that their admissions procedures were not quantified through the use of a point value system. Programs reported to their admissions procedures were objective enough and resulted in students of adequate quality, even though their procedures could be improved, possibly with more specific AABB guidelines.     

Role of the research ethics committee

Research ethics committees have an important role to play in ensuring the ethical standards and scientific merit of research involving human subjects. There are three important obligations placed on the ethics committee. Firstly, and most importantly, the ethics committee must ensure that the rights of research participants are protected. This is achieved by ensuring that individuals receive sufficient information, which can be easily understood, and ensuring that appropriate strategies are in place to protect participants from potential adverse consequences of the research. Secondly, the research ethics committee has an obligation to society which provides the resources for research and will ultimately be affected by the results. Thirdly, the research ethics committee has an obligation to the researcher. The research proposal should be treated with respect and consideration. The research ethics committee should strive to meet each of these obligations. All researchers should welcome the contribution made by research ethics committees to the research process because they help to ensure that research meets the high ethical and scientific standards expected by society.     

Practice what you teach: a case study of ethical conduct in the academic setting.

Nursing faculty teach ethics and ethical behavior in undergraduate and graduate curriculum. In this article, a case study is presented that illustrates a breach of ethical behavior and conduct in the academic setting by both faculty and students. The decision-making process used to resolve this dilemma by the chair, the associate dean, and a faculty member relied on a dialectic approach that looked at philosophical underpinnings, historical background of nursing ethics, and university- and schoolwide policies and procedures. The conversations facilitated the ethical resolution to the dilemma raised in the case study as well as the recognition of additional issues for consideration. The authors uncovered compelling questions that included, "What is meant by ethical conduct in the classroom?," "How do we teach it?," and "How do we practice it?" The purpose of this article is to begin the dialogue in search of answers to these questions.     

Competency outcomes for learning and performance assessment. Redesigning a BSN curriculum

In an atmosphere in which disgruntled students appeal to their legislators for intervention and faculty give few unsatisfactory clinical grades, the faculty of this state supported school of nursing began a two-step process to strengthen the assessment of students. The first step consisted of the appointment of a testing committee to provide faculty with ongoing assistance with test construction. The next concerned clinical evaluation.     

Nurses serving on clinical ethics committees: a qualitative exploration of a competency profile

The competency profile underlying higher nursing education in the Netherlands states that bachelor-prepared nurses are expected to be able to participate in ethics committees. What knowledge, skills and attitudes are involved in this participation is unclear. In five consecutive years, groups of two to three fourth-year (bachelor) nursing students conducted 8 to 11 semi-structured interviews each with nurses in ethics committees. The question was what competencies these nurses themselves say they need to participate in such committees. This article reports the aggregate of the 52 interviews in these five studies. Regarding knowledge, the article reports on health law, ethics and professional knowledge. Regarding skills, communication is mentioned, as are professional skills and skills for 'doing ethics'. An open and respectful attitude towards patients and fellow committee members is required, as well as commitment to patient care, committee work and professional ethics. The right attitude for a nurse in an ethics committee is said to include a reflective and perceptive attitude, along with an awareness of one's own limitations and convictions. A detailed competency profile for nurses' participation in ethics committees as outlined in the recommendations may serve nursing education, institutional committees and nurses themselves to meet the demands of nurses' preparation for clinical ethics consultations.     

Impacting Faculty Teaching and Student Performance: Nine Years' Experience With the Objective Structured Clinical Examination

Background: The impetus for administering the 2nd-year Objective Structured Clinical Examination (OSCE) came from the great variability in student performance observed by 3rd-year clerkship directors. Purpose: To document the effects of the OSCE on faculty teaching, student performance, and the curriculum over 9 years of administration of the examinations to more than 1,000 second-year medical students. Method: A 20-station OSCE was administered to all medical students at the end of their 2nd year. Using predetermined criteria, clinical faculty served as evaluators in each station. A mix of 1st-, 3rd-, and 4th-year medical students were recruited to serve as simulated patients. Faculty evaluators and examinees completed a questionnaire evaluating their experience with the OSCE. Students received a report card of their performance. Small-group leaders of the Introduction to Clinical Medicine course received feedback on their group's performance on each station compared to the class mean. Summative data on class performance was reported to the curriculum committee. The academic status committee received data on students who performed unsatisfactorily. Results: Faculty and examinee ratings of the OSCE experience were very positive. Over the 9-year period, student performance improved showing less variability and significantly fewer failed stations. Conclusion: The OSCE has proven to be a technically feasible, authentic evaluation method yielding valuable information for decisions regarding student performance, faculty teaching, and curriculum planning.     

Ethical climate in managed care organizations

Managed care organizations employ nurses as medical utilization reviewers; however, little is known about the ethical climate of these organizations. This study describes different ethical climates in which utilization review nurses work and the implications of these differences for nurse administrators. The nurse participants, although demographically similar across three managed care organizations, perceived distinct ethical climates across the organizations. Nurses were employed to make complex decisions regarding medical care utilization; however, none of the organizations had an ethics committee to help nurse reviewers in this decision-making process. The need for such committees, as well as clarification of a consistent and deliberate ethical climate by nurse administrators, is discussed.     

Introduction

Although concern about the clinical skills of medical school graduates is increasing, there is little consensus among faculty about what the essential clinical skills are for the general professional education of the physician. To identify such a common core of psychomotor skills, a survey questionnaire was mailed to faculty at the University of Washington School of Medicine. Forty‐three skills were determined to be essential for mastery by more than 60% of respondents. These results were then validated by a committee of clerkship directors who refined the list to 28 skills that should be required for graduation. These data are being used to specify educational objectives and to design clinical performance examinations.     

External monitoring of a data coordinating center: experience of the National Cooperative Gallstone Study

A Biostatistical Monitoring Committee was established to review periodically the procedures and performance of the data coordinating center of the National Cooperative Gallstone Study. The functions of this committee, the types of data coordinating center activities reviewed, the manner in which monitoring of these activities was carried out, and an assessment of the value of this committee to the study are discussed in this article.     

Hospice volunteer training for health science students: an academic medical center-hospice community partnership

Within the academic medical center providing interdisciplinary, experiential, longitudinal, and mentored learning experiences for students regarding hospice/end-of-life care is a considerable challenge. This article describes an innovative course for medical, nursing, and social work students taught as a partnership among the departments of family medicine, medical history/ethics and three community hospice programs. The goals of the course are: (1) understanding the hospice philosophy of care; (2) understanding that hospice care is an interdisciplinary team process; and (3) development of the caregiver skills of self-reflection as a form of self-knowledge while participating in the care of terminally ill patients. Achieving these goals is challenging for students (especially medical students) and faculty but highly rewarding. The development, implementation and evolution over the past 3 years of this hospice volunteer training course are discussed.     

Ethics committees in long-term care facilities

Biomedical ethical dilemmas occur in long-term care facilities (LTCFs), particularly in the absence of residents' advance directives. Ethics committees are required in hospitals and long-term care facilities accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), but many LTCFs do not have JCAHO accreditation. A survey of LTCFs in one county in a Southwestern state found that only 29% of those LTCFs responding had an organized ethics committee. This article discusses the purpose, membership, and meetings of an ethics committee in LTCFs. A sample process for resolving a biomedical ethical dilemma is presented. Nurses can initiate the development of an ethics committee using available resources or combining resources with other local LTCFs. The ethics committee should consider the education of all persons involved to facilitate resolution of clinical ethical dilemmas.     

From Onsite to Online: Lessons Learned From Faculty Pioneers

As the demand for online courses grows, academic settings that do not offer this option risk losing potential students to universities that adopt more innovative approaches to education. Understanding strategies that will prepare faculty to meet the challenges associated with this transformation is essential to developing a quality online program. Most basic to this transition is the philosophic acceptance of online learning as an educational method equivalent to traditional didactic lecture. Because the knowledge and skills associated with navigating Web-based tools and resources are perceived as a barrier by many faculty, focused efforts must be undertaken to assess faculty learning needs and to provide formal and informal education related to recommended teaching strategies and available technology. Collaboration with course design experts and participation in faculty work groups will facilitate acceptance and promote a sense of involvement. Administrative support is also imperative to produce satisfactory student outcomes that meet the needs for accreditation agencies, certification, or higher education standards.     

Assessing Advanced Communication Skills via Objective Structured Clinical Examination: A Comparison of Faculty Versus Self,Peer, and Standardized Patient Assessors

Abstract

Construct: The construct addressed in this study is assessment of advanced communication skills among senior medical students. Background: The question of who should assess participants during objective structured clinical examinations (OSCEs) has been debated, and options discussed in the literature have included peer, self, standardized patient, and faculty assessment models. What is not known is whether same-level peer assisted learning can be utilized for formative assessment of advanced communication skills when no faculty, standardized patients, or other trained assessors are involved in providing feedback. If successful, such an educational model would optimize resource utilization and broaden the scope of topics that could be covered in formative OSCEs. Approach: The investigators developed a 4-station formative OSCE focused on advanced communication skills for senior medical students, and evaluated the concordance of assessment done by same-level peers, self, standardized patients, and faculty for 45 students. After each station, examinees completed a self-assessment checklist and received checklist-based assessment and verbal feedback from same-level peers only. Standardized patients completed checklist-based assessments outside the room, and faculty did so after the OSCE via video review; neither group provided direct feedback to examinees. The investigators assessed inter-rater agreement and mean difference scores on the checklists using faculty score as the gold standard. Findings: There was fair to good overall agreement among self, same-level peer, standardized patient, and faculty-assessment of advanced communication skills. Relative to faculty, peer and standardized patient assessors overestimated advanced communication skills, while self-assessments underestimated skills. Conclusions: Self and same-level peer-assessment may be a viable alternative to faculty assessment for a formative OSCE on advanced communication skills for senior medical students.