Interprofessional collaboration has become accepted as an important component in today’s health care and has been guided by concerns with patient safety, quality health-care outcomes, and economics. It is widely accepted that interprofessional collaboration improves patient outcomes through enhanced communication among health-care providers and increased accessibility to services. Although there is a paucity of research that provides confirmatory evidence, interprofessional competencies continue to be incorporated into the curricula of health-care students. This article examines the ethics of (...) class='Hi'>interprofessional collaboration and ethical issues that arise from the mainstream adoption of interprofessional competencies and the potential for moral distress in nursing. (shrink)

Objective: To evaluate whether ethics rounds stimulated ethical reflection. Methods: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to stimulate ethical reflection and promote mutual understanding between professions but not to offer solutions. Questionnaires directly before and after rounds were answered by 194 respondents. The analyses were primarily content analysis with Boyd’s framework but were also statistical in nature. Findings: Seventy-six per cent of the respondents reported a (...) moderate to high rating regarding new insights on ethical problem identification, but the ethics rounds did not seem to stimulate the ethical reflection that the respondents had expected (p<0.001). Dominant new insights did not seem to fit into traditional normative ethics but were instead interpreted as hermeneutic ethics. This was illustrated in the extended perspective on the patient and increased awareness of relations to other professions. Regarding insights into how to solve ethical problems, the request for further interprofessional dialogue dominated both before and after rounds. Conclusion: The findings show the need for interprofessional reflective ethical practice but a balance between ethical reflection and problem solving is suggested if known patients are discussed. Further research is needed to explore the most effective leadership for reflective ethical practice. (shrink)

This article discusses the nature of interprofessional ethics and some of the ethical issues and challenges that arise when practitioners from different professions work closely together in the fields of health and social care. The article draws on materials from a conference on this theme, covering issues of confidentiality and information sharing in practice and research with vulnerable people; challenges for teaching and learning about ethics in interprofessional settings; the potential of virtue ethics and an ethic of care (...) for understanding and handling ethical issues in interprofessional practice; and the extent to which interprofessional working may be about surveillance and control. It concludes that the need to understand and handle ethical issues in interprofessional working is contributing to the revitalisation of professional ethics as a dynamic field of study. (shrink)

Background:Ethics education is essential to the education of all healthcare professionals. The purpose of this study was to evaluate an interprofessional approach to ethics education to all students across an academic health science center.Research objectives:The objectives were to (1) compare student perception of ethics education before and after the implementation of the campus-wide ethics program and (2) determine changes in student ethical decision-making skills following implementation of a campus-wide ethics program.Research design:This study was a quasi-experimental design with seniors graduating (...) prior to the intervention serving as the control group.Participants and research context:The setting was a comprehensive health science center in the southwestern United States. All students enrolled in the university participated in the intervention; however, 976 graduating students were used for evaluation of the intervention.Ethical considerations:Study materials for each survey were submitted to the university’s IRB, and the project was approved as exempt by the Committee for the Protection of Human Subjects. Student participation in the surveys was voluntary. No names or other identifying information were collected, and responses to the survey questions were kept confidential.Findings:Students’ perception of the adequacy of time spent on the ethics content in course instruction and practical training decreased from the baseline to the fifth-year survey. Students’ overall comfort level with their abilities to deal with ethical issues increased from the baseline to the fifth year. Student ethical decision-making skills were higher at the third-year evaluation for all indicators. For the fifth-year survey, responses were also higher scoring on all four indicators.Discussion:After participation in an interprofessional campus-wide effort on health professions ethics, students demonstrated higher ethical decision-making scores according to the Health Professional Ethics Rubric. However, their scores still did not reach the proficiency level identified in the rubric.Conclusion:Examination of the effectiveness of each part of the intervention is needed. (shrink)

Interprofessional education – students of different professions learning together, from and about each other – is increasingly common in health professional degrees. Despite its explicit aims of transforming identities, practices and relationships within/across health professions, IPE remains under-theorised sociologically, with most IPE scholarship focussed on evaluating specific interventions. In particular, the significance of a shared knowledge base for shaping professional power and subjectivity in IPE has been overlooked. In this paper we begin to develop a framework for theorising IPE (...) in allied health, by drawing parallels with a cognate area in which there has already been fruitful conceptual development: interdisciplinarity. Specifically, we offer a worked example of how the two areas may be brought into dialogue, by deploying Barry, Born and Weszkalnys’ conceptualisation of interdisciplinarity as a lens for understanding IPE. Following Barry et al. we delineate a number of ‘modes’ and ‘logics’ of knowledge-production that emerge both in IPE literature and in our own empirical study of IPE. Our empirical data are drawn from 32 semi-structured interviews with 19 allied health students participating in an IPE curriculum at one Australian university. Findings point to the emergence of interprofessional practitioner identities among students that have the potential to undermine traditional epistemological boundaries and transcend role-based distinctions in future health professions. We argue that Barry et al.’s ‘logic of ontology’ sheds light on previously unidentified processes of transformation within IPE, and offers a theoretical framework that can explain the importance of a shared pan-professional knowledge base for the reflexive individual construction of new interprofessional ontological subjects. (shrink)

Background There is continued need for enhanced medical ethics education across the United States. In an effort to guide medical ethics education reform, we report the first interprofessional survey of a cohort of graduate medical, nursing and allied health professional students that examined perceived student need for more formalized medical ethics education and assessed preferences for teaching methods in a graduate level medical ethics curriculum. Methods In January 2018, following the successful implementation of a peer-led, grassroots medical ethics curriculum, (...) student leaders under faculty guidance conducted a cross-sectional survey with 562 of 1357 responses received among students enrolled in the School of Medicine, College of Nursing, Doctor of Physical Therapy and BS/ MD Professional Scholars programs at The Medical College of Georgia at Augusta University. An in person or web-based questionnaire was designed to measure perceived need for a more in-depth medical ethics curriculum. Results The majority of respondents were female, white and mid-20s in age. Almost half of respondents reported no prior medical ethics exposure or training in their previous educational experience, while 60% of students across all degree programs reported an interest in more medical ethics education and 92% noted that an understanding of medical ethics was important to their future career. Over a quarter of students were interested in pursuing graduate-level training in medical ethics, with case-based discussions, small group peer settings and ethics guest lectures being the most desired teaching methods. Conclusions The future physician, nursing and physical therapist workforce in our medical community demonstrated an unmet need and strong interest for more formal medical ethics education within their current coursework. Grassroots student-driven curricular development and leadership in medical ethics can positively impact medical education. Subsequent integration of interprofessional training in medical ethics may serve as a vital curricular approach to improving the training of ethically competent healthcare professionals and overcoming the current hierarchical clinical silos. (shrink)

In this commentary on a previous Ethics and Social Welfare publication, the authors argue that inclusive and expansive dialogue about interprofessional ethics is more a matter of ??revitalizing?? traditional professional ethics than developing a new field. The dialogue will be most productive of care improvements if it incorporates the service user, includes both health and social care professions, and occurs across countries.

The main question examined is: How do nurses and other healthcare professionals ensure ethical interprofessional collaboration-in-practice as an everyday practice actuality? Ethical interprofessional collaboration becomes especially relevant and necessary when interprofessional practice decisions are contested. To illustrate, two healthcare scenarios are analyzed through three ethics lenses. Biomedical ethics, relational ethics, and virtue ethics provide different ways of knowing how to be ethical and to act ethically as healthcare professionals. Biomedical ethics focuses on situated, reflective, and nonabsolute principled (...) justification, all things considered; relational ethics on intersubjective, professional, and institutional relations; and virtue ethics on prephilosophical tradition and what it means to be good and to be human embedded in social and political community. Analysis suggests that interprofessional collaboration-in-practice may be more rhetoric than actuality. Key challenges of interprofessional collaboration-in-practice and specific conditions perpetuating dissension and conflict are outlined with specific education and policy recommendations included. (shrink)

In this article we attempt to situate nursing within the interprofessional care team with respect to processes of ethical practice and ethical decision making. After briefly reviewing the concept of interprofessionalism, the idea of a nursing ethic as ‘unique’ within the context of an interprofessional team will be explored. We suggest that nursing’s distinct perspective on the moral matters of health care stem not from any privileged vantage point but rather from knowledge developed through the daily activities of (...) nursing practice. Because of their position vis-à-vis patients and families in everyday clinical care, nurses cultivate ethical knowledge of at least two forms: (1) relational knowledge; and (2) embodied knowledge. Through the integration of these forms of knowledge, nurses develop a unique moral perspective and can make a meaningful contribution to the realm of ethics in interprofessional care. (shrink)

The first ethics casebook that integrates clinical ethics (medical, nursing, and dental) and research ethics with public health and informatics. The book opens with five chapters on ethics, the development of interprofessional ethics, and brief instructional materials for students on how to analyze ethical cases and for teachers on how to teach ethics. In today's rapidly evolving healthcare system, the cases in this book are far more realistic than previous efforts that isolate the decision-making process by professions as if (...) each is not embedded in a larger context that involves healthcare teams, hospital policies, and technology. The central claim of this book is that ethics is an important common ground for all of the health professions. Furthermore, when we recognize that our professions converge upon a common goal we will find less conflict and more pleasure in working together. (shrink)

Background Ethical dilemmas that arise in the clinical setting often require the collaboration of multiple disciplines to be resolved. However, medical and nursing curricula do not prioritize communication among disciplines regarding this issue. A common teaching strategy, problem-based learning, could be used to enhance communication among disciplines. Therefore, a university in southern Taiwan developed an interprofessional ethics education program based on problem-based learning strategies. This study described tutors’ experience teaching in this program. Aim To explore the phenomenon of teaching (...) and learning in interprofessional ethics education for medical and nursing students from the perspectives of tutors. Design Phenomenological qualitative research. Methods Medical and nursing students completed a 6-week interprofessional ethics education program moderated by either physician or nurse tutors. At the conclusion of the ethics education program, all 14 tutors were invited to participate in focus group interviews. Among them, six tutors (three nursing tutors and three physician tutors) participated in additional individual interviews. All of the contents from the focus group interviews and individual interviews were recorded and transcribed. Using the phenomenological approach, the phenomenon of teaching and learning in interprofessional ethics education were generated. Ethical consideration The study was approved by the Institutional Review Board. Findings Three themes emerged from the tutors' teaching perspectives, including the instructor’s motivation to teach, the use of narrative case scenarios, and the emphasis on improving interprofessional ethics communication. Discussion Problem-based learning creates an interprofessional communication platform in interprofessional ethics education. The phenomenon of value convergence between tutors and students, between different students’ professions, and between different students’ professional maturities is observed. Conclusion Problem-based learning is an effective teaching strategy for creating a communication platform for interprofessional ethics education. Ethic curriculum should emphasize motivating instructor, use narrative case scenarios, and focus on interprofessional communication. (shrink)

Discusses values from the perspective of different health care professionals and why teams and collaborations may succeed or fail.

Effective interprofessional collaboration depends upon establishing understanding that respects differences in values and beliefs, and thus differences in response to the multiplicity of patient/client/user needs. To facilitate the latter, this article suggests that health and social care students need a formal knowledge of the meaning of values and the varieties of systems within which values are expressed. Students need especially to understand the genesis of their own professional value system and to recognize the gap that inevitably develops between the (...) values of the professional and those of the society within which a professional may function. The conceptual framework that underpins the approach to teaching values to health and social care professionals advocated here is derived from key concepts identified from the literature relating to education for, and participation in, a democratic, multicultural, multifaith society. These are: tolerance, compromise and education for dialogue. Finally, it is suggested that professional educators must take seriously the tasks of educating for professional pluralism. (shrink)

Effective interprofessional collaboration depends upon establishing understanding that respects differences in values and beliefs, and thus differences in response to the multiplicity of patient/client/user needs. To facilitate the latter, this article suggests that health and social care students need a formal knowledge of the meaning of values and the varieties of systems within which values are expressed. Students need especially to understand the genesis of their own professional value system and to recognize the gap that inevitably develops between the (...) values of the professional and those of the society within which a professional may function. The conceptual framework that underpins the approach to teaching values to health and social care professionals advocated here is derived from key concepts identified from the literature relating to education for, and participation in, a democratic, multicultural, multifaith society. These are: tolerance, compromise and education for dialogue. Finally, it is suggested that professional educators must take seriously the tasks of educating for professional pluralism. (shrink)

Interprofessional collaboration involves some kind of knowledge sharing, which is essential and will be important in the future in regard to the opportunities and challenges in practices for delivering safe and effective health care. Nursing assistants are seldom mentioned as a group of health care workers that contribute to interprofessional collaboration in health care practice. The aim of this ethnographic study was to explore how the nursing assistants’ knowledge can be shared in a team on a spinal cord (...) injury rehabilitation ward. Using a sociomaterial perspective on practice, we captured different aspects of interprofessional collaboration in health care. The findings reveal how knowledge was shared between professionals, depending on different kinds of practice architecture. These specific cultural–discursive, material–economic, and social–political arrangements enabled possibilities through which nursing assistants’ knowledge informed other practices, and others’ knowledge informed the practice of nursing assistants. By studying what health care professionals actually do and say in practice, we found that the nursing assistants could make a valuable contribution of knowledge to the team. (shrink)

Definition of the problem Interprofessional learning of nursing trainees and medical students offers numerous opportunities for future cooperation aiming to provide high-quality care for patients. Arguments Expert panels, therefore, demand early integration of interprofessional teaching and learning structures in order to be able to achieve effective and sustainable improvements in practice. In Germany, interprofessional learning formats are increasingly used in undergraduate education of the two professions in selected—compulsory and optional—themes and courses. Conclusion So far, the field of (...) health care ethics has scarcely been taken into consideration. The article examines the situation of interprofessional ethics teaching in Germany and highlights its opportunities and limitations against the background of a pilot project. (shrink)

The purpose of this action research project was to examine the lived experience of university and community participants in ethical decision making in the setting of an interprofessional university-community partnership. The participatory framework for applied ethics presented by Prilleltensky, Rossiter, and Walsh-Bowers informed the research design. University and community participants in the 4-year-old partnership were interviewed about the ethical dilemmas faced in the partnership and ways of dealing with these dilemmas that often took place in the nexus of meeting (...) the community's and students' needs. An important aspect of making sound ethical decisions was the availability of multiple opportunities for discourse in an environment open to learning. (shrink)

Drawing both on cultural-historical activity theory and on a dialogical approach to discourse, this article expands a method of analysis developed by Engeström & Sannino to capture discursive manifestations of contradictions in an activity system. The data consist of recorded meetings of an interprofessional team working with persons living with both a mental handicap and psychiatric disorders. The mission of this team is to coordinate socio-educative and psychiatric work. A sequence taken from one of these meetings was submitted to (...) a step-by-step discourse analysis and examined how the participants negotiated and managed the obstacles met with in their daily work. The analysis showed how an initial obstacle presented as a conflict was gradually turned into a critical conflict and finally into a dilemma between two rules: professional confidentiality and transparency towards the patient. It showed how the participants collectively coped with this dilemma, and came to define it as a problem related to work organisation, and not only to interpersonal relationships. The study shows the importance of discourse processes in collaborative work and in fostering professional learning and focus upon discourse processes through which team members deal with obstacles in their daily work and to provide a fine-grained analysis of systemic contradictions. (shrink)

Many notions of interprofessional collaboration appear to aim for the ideal of trouble‐free co‐operative communication between healthcare professionals. This study challenges such an ideal as too far removed from the complex and contested relations of power that characterise the albeit skilful everyday social interactions which take place within healthcare practice, along with the associated pragmatic compromises made by disempowered practitioners. It is noted that these may be facilitated by modes of comforting myth and denial. To underline this point, psychiatric (...) illness diagnosis is used as an illustrative example of how a historically powerful societal discourse can become thoroughly entrenched. The influence of a paradigmatically dominant discourse is shown to extend beyond the repetition of narrative within open dialogue and debate and to continue as tacitly reflected patterns within unconsciously habituated behaviour and durable artefacts that crystallise future affordances and limitations on action. However, the authors conclude by introducing optimistic theoretical speculation around the dynamic social mechanics of reflexive awareness and creativity, as these emerge within moments of significant dissonance between dialectically interacting layers of individually internalised and contextually embedded discourse, conversation and direct experience. (shrink)

The author created a new course, called “Seminar in Public Health Law and Policy in an Interprofessional Setting” to address the need for interprofessional education to equip graduate and professional students for collaborative practice at the systemic and policy levels in the health care and public health fields. Despite important work being done at the clinical practice level, limited existing IPE models examine larger systemic issues. The course is designed specifically to enable students in social work, law, and (...) public health to recognize the reciprocal relationships between policy and interprofessional collaborative practice, including the need for understanding of the impact of team-practice work at the system and policy levels. (shrink)

Background: One of the barriers to interprofessional ethics education is a lack of resources that actively engage students in reflection on living an ethical professional life. This project implemented and evaluated an innovative resource for interprofessional ethics education. Objectives: The objective of this project was to create and evaluate an interprofessional learning activity on professionalism, clinical ethics, and research ethics. Design: The Brewsters is a choose-your-own-adventure novel that addresses professionalism, clinical ethics, and research ethics. For the pilot (...) of the book, a pre-test/post-test design was used. Once implemented across campus, a post-test was used to evaluate student learning in addition to a student satisfaction survey. Participants and research context: A total of 755 students in six academic schools in a health science center completed the activity as part of orientation or in coursework. Ethical considerations: The project was approved as exempt by the university’s Committee for the Protection of Human Subjects. Findings: The pilot study with 112 students demonstrated a significant increase in student knowledge. The 755 students who participated in the project had relatively high knowledge scores on the post-test and evaluated the activity positively. Discussion: Students who read The Brewsters scored well on the post-test and had the highest scores on clinical ethics. Clinical ethics scores may indicate issues encountered in mass media. Conclusion: The Brewsters is an innovative resource for teaching interprofessional ethics and professionalism. Further work is needed to determine whether actual and long-term behavior is affected by the activity. (shrink)

This article aims to explore the ethical issues arising from the sharing of information in the context of interprofessional collaboration. The increased emphasis on interprofessional working has highlighted the need for greater collaboration and sharing of client information. Through the medium of a case study, we identify a number of tensions that arise from collaborative relationships, which are not conducive to supporting interprofessional working in an ethically sound manner. Within this article, it is argued that the way (...) forward within these collaborative relationships is to set clear parameters to the professional-client relationship, paying full regard to the autonomy of both the clients and the professionals involved. We conclude that this approach to working will place the client at the centre of care provision and arguments used for not collaborating that are based on breaches of confidentiality will be negated. Using the approach offered, collaborative working will be not only possible but desirable. (shrink)

In June 2013, faculty from the University of Maryland Carey School of Law, along with students from the law school and several health professional schools at the University of Maryland, Baltimore, visited Malawi, in southeast Africa. While there, they met with faculty and students at the University of Malawi Chancellor College to discuss the possibility of establishing an ongoing collaboration between the two universities’ law schools. The starting point for our discussion was the potential establishment of a multi-professional, comparative health (...) law clinic that would focus on serving individuals living with HIV and AIDS. This goal would serve two objectives of the Law & Health Care Program at Maryland: to increase interprofessional education opportunities and to expose law students to more global health law issues. Establishing this clinic would also be consistent with two strategic objectives of the University of Malawi Faculty of Law: to establish links with other law schools providing clinical legal education, and to contribute to Malawi’s efforts to solve HIV/AIDS-related problems. (shrink)

In June 2013, faculty from the University of Maryland Carey School of Law, along with students from the law school and several health professional schools at the University of Maryland, Baltimore, visited Malawi, in southeast Africa. While there, they met with faculty and students at the University of Malawi Chancellor College to discuss the possibility of establishing an ongoing collaboration between the two universities’ law schools. The starting point for our discussion was the potential establishment of a multi-professional, comparative health (...) law clinic that would focus on serving individuals living with HIV and AIDS. This goal would serve two objectives of the Law & Health Care Program at Maryland: to increase interprofessional education opportunities and to expose law students to more global health law issues. Establishing this clinic would also be consistent with two strategic objectives of the University of Malawi Faculty of Law: to establish links with other law schools providing clinical legal education, and to contribute to Malawi’s efforts to solve HIV/AIDS-related problems. (shrink)

The narrative of the digital phenotype as a transformative vector in healthcare is nearly identical to the concept of “data drivenness” in other fields such as law enforcement. We examine the role of a prescription drug monitoring program in California—a computerized law enforcement surveillance program enabled by a landmark Supreme Court case that upheld “broad police powers”—in the interprofessional conflict between physicians and law enforcement over the jurisdiction of drug use. We bring together interview passages, clinical artifacts, and academic (...) and gray literature to investigate the power relations between police, physicians, and patients to show that prescribing data appear to the physician as evidence of problematic patient behavior by the patients, and to law enforcement as evidence of physician misconduct. In turn, physicians have adopted a disciplinary approach to patients, using quasi-legalistic documents to litigate patient behavior. We conclude that police powers have been used to pave data infrastructure through a contested jurisdiction, and law enforcement have used that infrastructure to enroll physicians into the work of disciplining patients. (shrink)

Many ideas grow better when transplanted into another mind than the one where they sprang up.

This paper focuses on a context where interdisciplinarity intersects with interprofessionality: the work of children's services professionals who address the needs of children identified as vulnerable. It draws on evidence and perspectives from two disciplines — educational studies and health care — to consider the issues and challenges posed by learning and/or working across disciplinary boundaries and why these have proved so obdurate.

Frequently heard among healthcare providers, administrators, students, and educators, especially within the context of interprofessional collaboration, is the phrase: learning with, from, and about the other. Our purpose in writing this article was to explore the relational aspects of interprofessional collaboration and provide a conversational perspective on how this phrase may be co-constructed by members of the interprofessional team, to achieve a contextual understanding for enhanced practice. It is through understanding and analysing the meaning of commonly held (...) words and phrases that we can begin to understand the differences between transactional ways of gaining knowledge and begin to understand how a transformational shift in attitude, identity, and practice can promote learning with, from, and about the other. (shrink)

Background: Prior research has explored reasons why health care providers may or may not choose to seek an ethics consultation. Although low-quality communication is evident in many ethics consultations, it is unknown whether poor communication in clinical settings is related to health care providers' requests for ethics involvement. Objective: To assess the relationship between self-reported ratings of health care providers' inter- and intraprofessional communication and ethics consultation requests. Method: This cross-sectional survey was conducted using a self-administered questionnaire of physicians and (...) nurses in six intensive care units at one academic medical center in the United States. The questionnaire assessed perceptions about requesting ethics consultations and how health care providers perceive communication. Results: Two hundred sixty-two participants (228 nurses and 34 physicians) responded to the survey (response rate 55%; 59% for nurses and 41% for physicians). Requests for an ethics consult were positively associated with perceived quality of interprofessional communication (r =.13, p <.05), but perceptions of the number of ethical dilemmas that occur on participants' units each month were negatively associated with the perceived quality of intra-professional communication (r = −.17, p <.01). Conclusion: The relationship that was hypothesized between perceived poor communication and increased number of ethics consultations was not borne out by these data. Indeed, we found the opposite; these finding suggests that good inter- and intraprofessional communication may promote the use of outside resources, such as ethics, when they are needed. (shrink)