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PubMed2001

Ethics counselors as a new priesthood.

The aim of this paper is to critically evaluate the thesis that ethics counselors constitute a new priesthood in the pejorative sense of this term. In defense of the thesis, an account is given of the diverse variety of fundamental ideas about ethics or morality. The underlying argument is simply that there is such a diversity of opinion about so many fundamental issues that most ethical appraisals, especially in committees, are probably very shallow and barely warranted. Following this negative work, an attempt is made to try to find some positive benefits from the work of ethics counselors. Some potential benefits are identified, but there is a need for empirical research in order to construct a more persuasive case for such work. In the penultimate section of the paper I addressed some of my own second thoughts about the discussion and some provocative suggestions that friends gave me about earlier drafts.

Decision Making↗
PubMed2001

Ethical and professional challenges posed by patients with genetic concerns: a report of focus group discussions with genetic counselors, physicians, and nurses.

Ninety-seven physicians, nurses, and genetic counselors from four regions within the United States participated in focus groups to identify the types of ethical and professional challenges that arise when their patients have genetic concerns. Responses were taped and transcribed and then analyzed using the Hill et al. (1997, Counsel Psychol 25:517-522) Consensual Qualitative Research method of analysis. Sixteen major ethical and professional domains and 63 subcategories were identified. Major domains are informed consent; withholding information; facing uncertainty; resource allocation; value conflicts, directiveness/nondirectiveness; determining the primary patient; professional identity issues; emotional responses; diversity issues; confidentiality; attaining/maintaining proficiency; professional misconduct; discrimination; colleague error; and documentation. Implications for practitioners who deal with genetic issues and recommendations for additional research are given.

Attitude of Health Personnel↗
PubMed2002

A survey of genetic counselors' strategies for addressing ethical and professional challenges in practice.

There is limited research about ethical and professional dilemmas that genetic counselors encounter in their practice and their strategies for addressing them. In this study, 454 genetic counselors rated the frequency with which they encounter each of 16 ethical/professional challenges identified and categorized previously (McCarthy Veach P., Bartels DM, LeRoy BS (2001) J Genet Couns 10(2):97-119). Over 40% indicated these issues occurred frequently: patient emotions, diversity, financial constraints, uncertainty, and colleague error. Two hundred and fifty-five respondents provided personal anecdotes describing exceptionally challenging situations and recommended strategies for addressing them. Most of their anecdotes involved informed consent, value conflicts, confidentiality, colleague error, withholding information, and resource allocation. The most frequently recommended strategies were further discussion with patients, consultation with other professionals, and referral to other health sources. Thirty-five respondents were unable to/did not offer strategies. Respondent demographics were not related to frequency of issues, type of anecdote, or recommended strategies. Practice, policy, and research implications are discussed.

Attitude of Health Personnel↗
PubMed2002

Optimising the reproducibility of a performance-based assessment test in midwifery education.

Despite problems concerning generalisability of test results - largely due to limited sampling of the task domain - and questions about test efficiency, the popularity of OSCEs in medical education has motivated the use of similar assessment methods in other health care domains. Purpose of this study was to investigate reproducibility of scores on an OSCE-based test in the relatively narrow domain of midwifery, as compared to the broad medical domain. The influence of global rating scales and adoption of a mastery-oriented test perspective on reproducibility of test scores was investigated in order to explore possibilities to increase test efficiency.A 3-hr, 6-station performance based test was administered to third and fourth year students at Kerkrade Midwifery School (the Netherlands). Students' performance was recorded using a station specific checklist and a global rating scale. For the 3-hr OSCE the generalisability coefficient based on checklist scores is 0.48. Based on global ratings alone, the generalisability coefficient is 0.61. Adjusted dependability indices are 0.85 based on checklist scores and 0.95 for global ratings respectively. Results suggest that even for small domains the problem of case-specificity remains a major impediment to high stakes performance testing. Findings furthermore suggest that use of global rating scales and professional expert judgements in professional competence evaluation is to be preferred to task specific checklists for reasons of reproducibility and efficiency in test development and administration. Adoption of a mastery oriented test perspective may reduce testing time requirements even further.

Certification↗
PubMed2002

Boundaries in the doctor-patient relationship.

Boundaries in the doctor-patient relationship is an important concept to help health professionals navigate the complex and sometimes difficult experience between patient and doctor where intimacy and power must be balanced in the direction of benefiting patients. This paper reviews the concept of boundary violations and boundary crossings in the doctor-patient relationship, cautions about certain kinds of boundary dilemmas involving dual relationships, gift giving practices, physical contact with patients, and self-disclosure. The paper closes with some recommendations for preventing boundary violations.

Ethics, Medical↗
PubMed2005

[Sexual abuse of female children and adolescents--detection, examination and primary care].

Epidemiological studies show a prevalence of sexual abuse experience among girls from 14-33%. Although indicators of abuse are unspecific, the combination of several findings may be indicative: Somatic signs may be sexually transmitted diseases, vulvovaginal complaints. Psychosocial nonsexual indicators are abrupt behavioural changes, running away from home, eating disorders. Psychosexual signs are hypersexualisation of the language and behaviour, disturbed body image and gender identity. Indirect evidence of abuse is given not only in cases of old vaginal and anal lesions but also in situations, where deep tears of the hymen in the typical localization at the posterior part can be found. The workup and care for children in whom there is suspicion of abuse but no clear evidence asks for highly competent professionals in a multidisciplinary cooperation including pediatric gynecologists, child psychiatrists, children-protection groups and other specialists to avoid on one hand unjustified destabilisation or even destruction of familial structures but to assure on the other hand, that the child victims are treated and followed after in a short and long term comprehensive medical and psychosocial care.

Adolescent↗
PubMed2005

The role of critical consciousness in multicultural practice: examining how its strength becomes its limitation.

Given the strengths of developing critical consciousness in multicultural practice, why do roadblocks persist? This article examines how the strengths of developing critical consciousness in multicultural practice can paradoxically become its limitation. Literatures from counseling psychology, clinical psychology, social psychology, social work, feminist theory, and critical theory are integrated in a discussion of the various components and strengths involved in working toward critical consciousness. This literature is then used to discuss some of the cognitive and affective limitations to achieving critical consciousness. Implications for practice are discussed.

Awareness↗
PubMed1994

Teaching psychologists and the new APA ethics code: do we fit in?

The new American Psychological Association (APA) ethics code (APA, 1992) creates dilemmas of both image and substance for teaching psychologists. Items specific to teaching psychologists reflect housekeeping matters of lesser importance and situations over which teaching psychologists have little control. Teachers of psychology are sometimes inappropriately grouped with other types of psychologists. Freedom of inquiry and communication are curtailed in ambiguous ways, and the standards expected of teachers in the academy are set a mediocre level. Although the new code contains some improvements over the previous code (APA, 1990)--especially in the areas of multiple relationships, prohibitions against sex with students, respect for differences among students, and authorship rights retained by students--numerous recommendations for future revision are strongly recommended.

Authorship↗
PubMed2005

Assessment of professional behaviour--a comparison of self-assessment by first year dental students and assessment by staff.

OBJECTIVE: A study was set up to assess usefulness and acceptability of a method of assessing professional behaviour of undergraduate dental students. SETTING: The first year preclinical course at the Department of Dentistry and Oral Hygiene, University of Groningen, the Netherlands. MATERIALS AND METHOD: A form was developed with an ordinal scale to assess undergraduate professional behaviour. A standard means of carrying out assessment was then undertaken and subsequently used to give feedback to the students at the end of each of three terms. The students' self-assessment was then compared to that of the staff. RESULTS: Descriptive analysis of the results was carried out per term. The response rate was 80-85%. The significant difference which existed between the scores of students and staff at the start of the study was reduced to reasonable agreement over two of the three criteria. CONCLUSIONS: The study indicated that the initial difference in assessment of their professional behaviour by first year dental students and by staff, was reduced by the forms and procedure used. This indicates the usefulness of the procedure as a teaching aid. The high participation rate confirms this to be an acceptable means of assessment of dental students' professional behaviour.

Attitude of Health Personnel↗
PubMed1993

Clinical role modelling: uncovering hidden knowledge.

Those responsible for the education of nurses are well aware of the need to reconcile the art and science of nursing so that future practitioners can be prepared to offer a humanistic and professional service to society. One way to assist students in this integration is to provide them with opportunities for role modelling as a means of discovering the knowledge embedded in clinical practice. A study of first-year undergraduate students undertaking a course which provides such opportunities in a number of practice settings was carried out to determine whether the observation of clinical role models does lead to knowledge discovery. The study, which used a grounded theory approach, indicated that the major aspect of nursing uncovered by the students through observation of clinical role models was that of provision of direct care. They articulated their values in relation to 'good' and 'bad' care and identified those attributes of nurses which they considered contributed to these care positions. In addition, they were able to recognize creativity and flexibility in practitioners and to relate these attributes to the ability to provide individualized, context-specific care. There was some uncovering of aspects of the nurse's role in maintaining their own professional competence, socializing neophytes into the profession and collaborating with the members of the multi-disciplinary health care team.

Clinical Competence↗