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PubMed2006

Interdisciplinary researching: exploring the opportunities and risks of working together.

The aim of this paper is to explore the issues that present both opportunities and risks when working in an interdisciplinary research project. As the research context changes in the social reform environment, some scientists suggest it is time to forge new scientific working relationships, to open up the boundaries between disciplines. Interdisciplinary research is an alternative approach for nurses who might develop different ways of working with health researchers from other disciplines. The ideas in this paper come from a larger, grounded theory study on interdisciplinary teamwork. The changing research context, the meaning of interdisciplinary working, collaboration, and competence, integrating different disciplinary perspectives, interprofessional learning opportunities, and the relevance for nurses are explored in relation to interdisciplinary researching. Interdisciplinary researching is complex and potentially risky; however, it does offer nurses the opportunities for professional growth, development, and research work satisfaction. Many nurses are already well-trained researchers and might consider developing roles as interdisciplinary research project managers as well.

Attitude of Health Personnel↗
PubMed2004

Surgical risk management: the value of a weekly surgical radio-pathological meeting.

BACKGROUND: Clinical risk management in surgery involves organizational practices focused on the prevention of adverse outcomes. The present study evaluates the value of a weekly clinical meeting involving surgeons, radiologists and pathologists as a model of clinical risk management within a general surgical department. METHODS: Data for all meetings conducted over a 6-month period were prospectively collected. Changes to previously reported pathology and radiology results, revisions to patient diagnosis, management and recommendations for subsequent patient care arising from the meetings were recorded. RESULTS: Data were collected for 18 meetings. One hundred and eleven patients were reviewed. Seventy-six patients had previously reported radiological investigations. Sixty-five patients had previously reported pathology specimens. Four per cent of radiology reports and 8% of pathology reports were amended at the meeting. Seven per cent of patients received a revised diagnosis. Twenty-seven per cent of patients had suggestions for changes in management. Changes to patient care arose from pathologist input in seven patients, from radiologist input in nine patients and from clinician input in 14 patients. Four patients were recommended for an alternative surgical procedure. Five patients were recommended for cancellation of a planned procedure. Adjuvant chemo/radiotherapy was considered for four patients. Referral to specialist surgeons was suggested for two patients. CONCLUSIONS: Weekly multidisciplinary clinical meetings allow early revision and refinement of patient diagnosis and management. As such, they are an effective pre-emptive incident monitoring system, facilitating regular audit and quality control as part of an overall strategy for surgical clinical risk management.

Disease Management↗
PubMed2007

Analysis of multidisciplinary lung cancer practice.

BACKGROUND: The aim of this study was to describe the activity of a lung cancer multidisciplinary clinic (MDC) and examine whether this model of clinical practice results in adherence to best-practice guidelines. METHODS: Prospective analysis of demographic and clinical data in 431 patients referred to a lung cancer MDC for the management of known or suspected thoracic malignancy. Adherence was documented to clinically relevant guideline recommendations concerning timely and evidence-based lung cancer management. RESULTS: Of 431 patients, 257 were diagnosed with primary lung cancer, mean age 68 years, 70% men and 90% current smokers or ex-smokers. Only 21% were referred with known malignancy and 28% were asymptomatic. Overall, 51% had stages I and II non-small-cell lung cancer, with this bias towards early-stage disease greatest in patients from rural areas. Histological confirmation of lung cancer was obtained in 92%. There was a high rate of adherence to international guideline recommendations concerning timely lung cancer diagnosis, staging and treatment implementation. Similarly, there was adherence to selected key evidence based recommendations for lung cancer management contained in national guidelines. CONCLUSION: Within a MDC, patients receive timely diagnosis, staging and treatment according to evidence-based guideline recommendations. The high proportion of patients receiving active treatment has implications for resource allocation. There is a referral bias towards patients with early non-small-cell lung cancer, particularly in rural patients, suggesting that further education about advances in metastatic lung cancer management is required. This study would support the establishment of regional lung cancer services with links to fully resourced MDC.

Adult↗
PubMed2007

Sudden cardiac death in the young: a clinical genetic approach.

The sudden death of a young person is a devastating event for both the family and community. Over the last decade, significant advances have been made in understanding both the clinical and genetic basis of sudden cardiac death in the young. Many of the causes of sudden death in the young are due to genetic heart disorders, which can lead to both structural (e.g. hypertrophic cardiomyopathy) and arrhythmogenic (e.g. familial long QT syndrome) abnormalities. Most commonly, sudden cardiac death in the young can be the first presentation of an underlying heart problem, leaving the family at a loss as to why an otherwise healthy young person has died. Not only is this a tragic event for those involved, but it also presents a medical challenge to the clinician involved in the management of the surviving family members. Evaluation of families requires a multidisciplinary approach, which should include cardiologists, a clinical geneticist, a genetic counsellor and the forensic pathologist directly involved in the sudden death case. This multifaceted cardiac genetic service is crucial in the evaluation and management of the clinical, genetic, psychological and social complexities observed in families in which there has been a young sudden cardiac death.

Adolescent↗
PubMed2006

Multidisciplinary team working: collaboration and conflict.

The aim of this paper is to report on findings identifying some of the difficulties encountered by the multidisciplinary team in the development and implementation of a care pathway for patients diagnosed with schizophrenia. Policy direction has shifted towards greater team working and blurring of professional boundaries. Moreover, there is greater need to deliver care according to set standards and for patients to reach particular outcomes of care. Care pathways are relatively new for psychiatry and will potentially uncover tensions within the team. Data were collected by participant observation and semistructured interviews over a period of 12 months on an acute psychiatric unit. The care team developed the care pathway and the process of development and implementation was observed through action research. Cross-sectional indexing was used to analyse the data, and themes were developed using interview and observational data collection methods. Clinicians argued strongly for clear role boundaries but also defended their perceived control over health care from other professions. The findings indicate that designing a care pathway for people with schizophrenia may produce conflicting perceptions from the team. Conflict may arise through professions being unwilling to accept plurality over roles, which may hinder progress in meeting the needs of patients. The findings also counter the impression that care pathways can be implemented with little impact on the team.

Conflict, Psychological↗
PubMed2006

What should other healthcare professions learn from nursing ethics.

This paper analyses the question what other healthcare professions should learn from nursing ethics, e.g. what should medical ethics learn from nursing ethics. I first analyse and reject all strong versions of the claim that nursing ethics is unique, because nursing is a unique practice. I then move to the question of whether the link between nursing ethics and nursing theory can be a model for other areas of healthcare ethics. I provide an analysis of the possibility of creating a theory of medicine and find that there cannot be a theory of medicine, and I argue briefly that this finding is also applicable to nursing. If there cannot be a theory of nursing, this entails that nursing ethics cannot be justifiably based on such a theory. In the final section, I then analyse the success of nursing ethics in resisting certain of the vices of Anglo-American analytic ethics, in particular the reductionism and individualism that characterizes much of healthcare ethics. I conclude that other healthcare ethics could usefully learn from this aspect of nursing ethics.

Ethical Analysis↗
PubMed1991

Ethics consultation as moral engagement.

I will begin by presenting some doubts about what might be called the "received view" of the role of the moral expert as a health care consultant. Then I will review the literature on moral experts and moral expertise and proceed to apply the results of that review to the notion that there are some who are expert in ethical decision making in health care. I will try to show that certain conclusions that can be drawn from this rather circumscribed topic have implications for the very conception of the relationship between moral theory and clinical ethics.

Bioethical Issues↗
PubMed1993

Teaching bioethics as a new paradigm for health professionals.

In The Clouds by Aristophanes, Strepsiades brings his son before Socrates so that he could learn Philosophy for he has heard that this science teaches how to overcome the most difficult causes with reasons. And Strepsiades wants his son to learn the art of failing to pay debts. Regarding medical education in our time, Edmund Pellegrino has noted that the educational philosophy of medical schools determines what a "good" physician is. Thus, teaching bioethics to future health professionals makes us face old problems now: What teaching method to choose among all the possible various ones? What should teaching aim at? Which will be our educational philosophy? Therefore I shall introduce here the epistemological basis of our Bioethics teaching program in Argentina and its implementing strategies in the undergraduate curriculum and the post-graduate level.

Argentina↗
PubMed1993

Teaching bioethics to future health professionals: a case-based clinical model.

In summary, I believe that ethics teaching based on actual cases, presented in a small-group format led by a clinician and an ethicist, offers the best prospect for achieving these goals. The physician serves as a role model and ensures that information and options are medically accurate. The ethicist helps to identify morally relevant features, can articulate ethical principles, and direct students to the appropriate literature. This method does not guarantee that the behavior of future health professionals will always be humane or ethically sound. But it is likely to get future health professionals to think about what they are doing when they encounter cases that resemble those discussed in teaching conferences devoted to clinical ethics.

Bioethical Issues↗
PubMed1995

The Ethics and Politics of Human Experimentation, by Paul M. McNeill.

...McNeill's book raises some very important questions about the ways in which a society comes to terms with the fact that the practice of medicine is more closely linked with experimentation than ever before. That often puts the doctor-patient relation into a new setting. We have registered our objection to McNeill's tendency to see that relationship, where experimentation is involved, in an adversarial form: there are, we must repeat, more than two sides to this argument, and the medical scientist's commitment is not only to truth at any cost any more than the medical practitioner's is to treatment in all circumstances. Objections do not mean that we cannot learn from this book: on the contrary they may help us to sharpen our perceptions of what should happen. Fair-mindedness would suggest that failure to fulfill expectations is nothing like as widespread or for that matter incurable as McNeill's polemical tone might lead us to believe. When McNeill ceases to be the prosecuting counsel the true worth of his comments will become more apparent.

Australia↗
PubMed1996

Experimenting with embryos: can philosophy help?

Beyond the well-known ethical issues involved in medical experimentation on human subjects, experimenting with embryos raises unique and particularly hard problems. Besides the psychological obstacles connected with the fear of "playing God" and the awe with which we hold the process of the creation of human beings, there are three philosophical problems which are the main subject of the article: 1. The logical problem of circularity: the morality of experimenting on embryos is dependent on the status of the embryo, which in turn is partly decided by experimentation; 2. The metaphysical problem: experiments are justified by the benefits they bring to human subjects; but it is doubtful whether an early embryo is a "subject" and whether coming into being is a "benefit"; 3. The moral problem: the standard constraint on medical experiments is that they benefit either the individual subject or at least members of a relevantly defined group of patients suffering from the same syndrome. But embryo experimentation is often associated with potential cure to people of a completely different category (like geriatric patients). Finally, the article discusses the limits of the force of philosophical arguments in the formation of actual policies for regulating such practices as experimenting with embryos. The widely-shared fourteen-day limit is shown to be a sound practical compromise despite the difficulties in justifying it philosophically.

Attitude↗
PubMed2004

Critical bioethics: beyond the social science critique of applied ethics.

This article attempts to show a way in which social science research can contribute in a meaningful and equitable way to philosophical bioethics. It builds on the social science critique of bioethics present in the work of authors such as Renee Fox, Barry Hoffmaster and Charles Bosk, proposing the characteristics of a critical bioethics that would take social science seriously. The social science critique claims that traditional philosophical bioethics gives a dominant role to idealised, rational thought, and tends to exclude social and cultural factors, relegating them to the status of irrelevancies. Another problem is they way in which bioethics assumes social reality divides down the same lines/categories as philosophical theories. Critical bioethics requires bioethicists to root their enquiries in empirical research, to challenge theories using evidence, to be reflexive and to be sceptical about the claims of other bioethicists, scientists and clinicians. The aim is to produce a rigorous normative analysis of lived moral experience.

Bioethics↗