A measuring instrument for ethical sensitivity in the therapeutic sciences

An emerging literature in behavioural ethics conceptualized ethical sensitivity as a critical part of the decision making process. Ethical sensitivity together with an understanding of the client, their needs, emotions and circumstances is fundamental to an effective therapeutic relationship and competent practice. This study appears to be the first to empirically measure this concept in decision making related to the therapeutic sciences, including audiology, occupational therapy, physiotherapy and speech-language therapy. A multidisciplinary measure of ethical sensitivity is developed and consists of 12 vignettes that represent clinically relevant ethical issues related to these four professions. The study followed a two-phase, sequential mixed-methods research approach. Phase 1, the qualitative stage, focused on developing a measuring instrument by means of a systematic review of the following: ethical codes of conduct; focus group discussions; individual in-depth interviews; an expert panel review; and public complaints websites. Phase 2, the quantitative stage, focused on implementing and evaluating the measuring instrument. One hundred participants representing the four professions completed the instrument. Participants’ overall scores on the Measuring Instrument for Ethical Sensitivity in the Therapeutic sciences (MIEST) were comparable for all four professions, confirming the multidisciplinary usability of the instrument. Participants were inclined to make grounded Beneficence centred decisions. Participants were particularly sensitive about the impact of the therapist’s actions on the individual client, and sometimes overlooked their duty to the community. The MIEST can be used to assess the ethical sensitivity of student therapists (and possibly qualified therapists) and describe the stage of their ethical sensitivity development throughout the course of their professional development. The constructed vignettes make the MIEST appropriate for use in problem-based learning programmes.The National Research Foundation (NRF)http://www.sciencepublishinggroup.com/j/hssam2017Centre for Augmentative and Alternative Communication (CAAC

Contralateral suppression of transient evoked otoacoustic emissions in adults

BACKGROUND : Whilst otoacoustic emission (OAE) testing has proved to be valuable in revealing information about cochlear outer hair cell integrity, it does not provide insight into the afferent and efferent pathways once the stimulus has reached neural receptors. This information can be obtained objectively through contralateral acoustic stimulation (CAS) suppression. However, obtaining normative data is essential in the implementation of such tests. OBJECTIVES : The primary aim was to undertake a small pilot study to collect the CAS suppression across a predefined frequency range in order to provide a preliminary normative data set to be used with the newly developed transient evoked otoacoustic emission (TEOAE)- CAS module (PATH MEDICAL, Germering, Germany). Secondary aims included the analysis of the relationships between left and right CAS suppression, between male and female CAS suppression and between TEOAE signal-to-noise ratio (SNR) and CAS suppression. METHODS : The purpose of this study was to determine preliminary normative data for contralateral TEOAE suppression from 40 normal ears of 20 healthy young adults (10 males and 10 females). Subjects were recruited using purposive sampling. The CAS suppression responses were obtained automatically by means of the data-collection protocol on the device used. From the data obtained, correlations between TEOAE SNR and CAS suppression were made using Pearson’s correlation coefficient. RESULTS : The data were statistically processed to form a normative database which possesses the potential of serving as a basis for further research aimed at determining the utility of CAS suppression testing when evaluating ear pathology. A mean CAS suppression of 0.8 decibels (dB) (0.61 SD) was obtained. There was no statistically significant relationship between TEOAE SNR and CAS suppression. There was no significant suppression difference in terms of laterality of ears or gender. CONCLUSION : Normative values for CAS suppression of TEOAEs in a group of normal-hearing individuals were obtained using the newly developed TEOAE-CAS module (PATH MEDICAL, Germering, Germany). The availability of normative data for contralateral TEOAE suppression using the studied module allows for it to become commercially available, which will enable researchers and audiologists to perform this measurement in different populations in the evaluation of ear pathology.http://www.sajcd.org.zaam2023Centre for Augmentative and Alternative Communication (CAAC

A systematic review of ethics knowledge in audiology (1980 – 2010)

PURPOSE : The purpose of this research was to apply multiple perspectives as part of a systematic review to analyse the literature regarding ethics in audiology. Audiologists are particularly vulnerable to the changing requirements of the discipline that compel them to straddle both professional obligations and business principles, creating a ‘hybrid’ professional. METHOD : A two-phase mixed method approach was used to analyse publications. Publications were sorted into categories, namely approach to ethics, author, decade, role of the audiologist, component of morality, and common themes. The sample consisted of peer-reviewed papers cited in MEDLINE, CINAHL, ERIC, MasterFILE Premier, E-Journals, Africa-Wide Information and Academic Search Premier electronic database indexes, as well as non-peer-reviewed papers in the Seminars in Hearing professional journal.RESULTS : The publications were predominantly philosophical, focused on the rehabilitative role of the audiologist, and addressed the moral judgement component of moral behaviour.CONCLUSIONS : Despite the fact that knowledge of ethics grew between 1980 and 2010, this retrospective analysis identified gaps in current knowledge. Research is needed to address the unique ethical problems commonly encountered in all 8 roles of the audiologist; patient perspectives on ethics; ethical approaches; factors affecting moral judgment, sensitivity, motivation, and courage; and cultural dimensions of ethical practice in audiology.http://aja.pubs.asha.org/issue.aspxhb201

Ethical sensitivity of practising audiologists

THEORETICAL FRAMEWORK : An understanding of the client, his/her needs, emotions and circumstances is fundamental to an effective therapeutic relationship. This holistic focus on the therapeutic relationship and service excellence constitutes, together with ethical sensitivity, the building blocks for effective and competent practice. The Measuring Instrument for Ethical Sensitivity in the Therapeutic Sciences (MIEST) is the first multidisciplinary measuring instrument to describe the ethical sensitivity of audiologists and other therapists. In an era where therapists are daily confronted with ethical decision making, it is important to determine the different levels of skill related to ethical sensitivity. The data obtained by means of the MIEST can provide guidance through workshops and professional development programmes. Ethical sensitivity is the first step in the framework of ethical behaviour and for that reason forms the foundation of this research. AIM : To investigate the ethical sensitivity of practising audiologists in terms of defined principles and skills. METHODOLOGY : A quantitative research design using an existing measuring instrument was applied. Fifty participants completed the MIEST measuring instrument. Data collection was managed electronically and the data was quantitatively analysed using parametric and inferential statistics. RESULTS : The mean score for the practising audiologists was 65%, which places this group of participants in the developing phase of ethical sensitivity. The highest level of ethical sensitivity related to the principle of justice and the skill emotional expression. The study identified a need to further develop the ethical sensitivity of audiologists, especially with regard to nonmaleficence, controlling social bias and the interpretation of situations.TEORETIESE RAAMWERK : ʼn Begrip van die kliënt, sy/haar behoeftes, emosies en omstandighede vorm die basis van ʼn doeltreffende terapeutiese verhouding. Diensuitnemendheid en etiese sensitiwiteit vorm saam met hierdie holistiese kliënt-terapeut-benadering die boustene vir doeltreffende dienslewering. Die Meetinstrument vir Etiese Sensitiwiteit in die Terapeutiese Wetenskappe (MIEST) is die eerste multidissiplinêre meetinstrument beskikbaar om etiese sensitiwiteit van oudioloë en ander terapeute te evalueer. In ʼn eeu waar terapeute daagliks gekonfronteer word met etiese besluitneming is dit belangrik om die vlak van ontwikkeling van terapeute in verskillende fases van etiese besluitneming te bepaal. Die MIEST kan in die toekoms as rigtingwyser vir werkswinkels en professionele ontwikkelingsprogramme gebruik word. Etiese sensitiwiteit is die eerste stap in die raamwerk van etiese optrede en word daarom as die vertrekpunt vir hierdie navorsing beskou. DOEL : Om die etiese sensitiwiteit van praktiserende oudioloë te ondersoek met verwysing na spesifieke beginsels en vaardighede. METODIEK : ʼn Kwantitatiewe navorsingsontwerp is gevolg met die gebruik van ʼn reeds ontwikkelde meetinstrument, naamlik die MIEST. Vyftig deelnemers het die meetinstrument voltooi. Data-insameling het elektronies plaasgevind. Die data is kwantitatief ontleed deur middel van beskrywende sowel as parametriese en inferensiële statistiek. BEVINDINGS : Die gemiddelde prestasie van praktiserende oudioloë was 65%, wat hul in die “ontwikkelende” fase van etiese sensitiwiteit plaas. Die hoogste vlak van etiese sensitiwiteit was in ooreenstemming met die beginsel van geregtigheid asook die vaardigheid, naamlik emosionele uitdrukking. ʼn Behoefte is geïdentifiseer om oudioloë se etiese sensitiwiteit spesifiek ten opsigte van nie-kwaadwilligheid, beheer oor sosiale vooroordeel en die vertolking van situasies te verhoog.http://www.journals.co.za/content/journal/akgeeshttp://www.scielo.org.za/scielo.php?script=sci_serial&pid=0041-4751&lng=enam2017Centre for Augmentative and Alternative Communication (CAAC

Older adults’ perspectives on fall risk: linking results to the ICF

The aim of this study is to establish the perceptions of older adults in the South African context regarding falls and to link these perceptions to the International Classification of Functioning, Disability and Health (ICF). Data were analyzed by a summative, conventional, and deductive approach. The analysis indicated that the Body Function and Structure codes were most frequently used during the discussions, but the contextual analysis of the most frequently used categories indicated that Activities and Participation were the participants’ main focus. The main focus of fall assessment in older adults should therefore be on Activities and Participation, as this can assist them in decreasing their fall risk, irrespective of whether they had a previous fall. Contrary to the majority of current literature on falls, this study included both participants who had fallen and those who hadn’t, resulting in richer data and themes gathered from the focus groups.The National Institute for the Humanities and Social Sciences, in collaboration with the South African Humanities Deans Association (SAHUDA).https://journals.sagepub.com/home/jaghj2020Centre for Augmentative and Alternative Communication (CAAC

The perspectives of healthcare practitioners on fall risk factors in older adults

BACKGROUND : Accidental falls could have severe and far-reaching consequences for older adults, their families and society at large. Healthcare practitioners’ (HCPs) perspectives on fall risk factors in older adults could assist in reducing and even preventing falls. Currently, no universal tool exists for this purpose. The World Health Organization’s globally accepted International Classification of Functioning, Disability and Health (ICF) was used. AIM : This study aimed to (1) describe the perspectives of HCPs on fall risk factors in older adults in South Africa and (2) link these factors to the ICF. SETTING : Eighteen HCPs participated in two focus groups. METHODS : Using a qualitative research design, an inductive thematic analysis allowed for the identification of important themes, which were linked to the ICF. RESULTS : The factors mentioned by participants were categorised into 38 themes, which were linked to 142 ICF codes, of which 43% (n = 61) were linked to the Body Function category, 23% (n = 32) to the Environmental Factors category, 18% (n = 26) to the Body Structure category and 16% (n = 23) to the Activities and Participation category. HCPs revealed two relevant factors that were not captured in existing fall risk assessment tools (FRATs), namely ‘muscle-power functions’ and ‘mobility-of-joint functions’, which directly relate to the ability to execute mobility activities. Combining HCPs’ perspectives with other stakeholders and with literature provides a holistic picture of fall risk factors in older adults.The National Institute for the Humanities and Social Sciences (NIHSS), in collaboration with the South African Humanities Deans Association (SAHUDA).http://www.hsag.org.zahj2020Centre for Augmentative and Alternative Communication (CAAC

Professional guidelines and reported practice of audiologists performing fall risk assessment with older adults : a systematic review

DATA AVAILABILITY STATEMENT : The authors confirm that the data supporting the findings of this study are available within the article.PURPOSE : This systematic review aimed to explore the recommended fall risk assessment practices in audiology, identify audiologists' reported practices in fall risk assessment, and recognize the barriers and facilitators affecting fall risk assessment in clinical practice. METHOD : This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS : CINAHL, PubMed, and gray literature yielded 262 articles. A total of 27 full-text articles were included in this review article. An additional 16 scope of practice and guideline documents were also reviewed. Pertinent data and findings from the review were tabulated and analyzed using a qualitative, inductive approach. CONCLUSIONS : Results revealed that despite fall risk assessment measures and protocols being mentioned, discussed, and reportedly implemented clinically in audiology literature, many audiologists are not conducting fall risk assessments clinically. The main challenges presented appear to be due to limited guidance within audiology documentation and inadequate training and knowledge of audiologists on fall risk factors and measures. This review article highlighted that all audiologists have an important role to play in reducing the global crisis of falls in older adults. However, without further research to aid in the development of standardization of documentation and training programs, we may continue to see a lack of awareness and education on fall risk and on the audiologist's role in the screening and early detection hereof.https://pubs.asha.org/journal/ajahj2023Centre for Augmentative and Alternative Communication (CAAC

Statistical evaluation and prediction of word recognition test scores of the Foneties Verteenwoordigende Eenlettergrepige Woordlyste in Afrikaans (FVEWA)

Theoretical framework: In audiology, speech audiometry is generally accepted as clinically more sensitive than pure tone audiometry to detect reduced auditory analytical skill in terms of complex acoustic structure, as it includes higher-level linguistic function in the evaluation. Although speech audiometry is considered to be an integral part of the audiometric test battery, there is currently no phonetically balanced Afrikaans speech material available to measure speech recognition. In order to obtain an accurate picture of an individual’s speech recognition abilities of monosyllabic words, it is important to perform speech recognition tests in a person’s first language. Aim: The purpose of this study was to determine the reliability of the Foneties Verteenwoordigende Eenlettergrepige Woordlyste in Afrikaans (FVEWA) to measure speech recognition abilities in members of an Afrikaans-speaking population. Methodology:The research is based on a quantitative retrospective study of audiological records of participants assessed at a private audiology practice. The FVEWA is evaluated in terms of interlist equivalence as well as performance-intensity or psychometric function for use in clinical practice. Results: The six FVEWA wordlists were found to be statistically equivalent in terms of difficulty level. The average intensity at which participants obtained 50% word recognition was 14.2 dBGP. The slope, at 50% (%/dB), of the wordlists used in the FVEWA was 3.1%/dB.Teoretiese raamwerk: In die oudiologiese toetsbattery word spraakoudiometrie klinies meer sensitief as suiwertoon-oudiometrie geag om verlaagde ouditiewe analitiese vaardigheid in terme van komplekse akoestiese strukture in individue te identifiseer, omdat dit ook hoër vlak linguistiese funksie in die evaluering insluit. Hoewel spraakoudiometrie dus as ʼn belangrike komponent geag word, is daar tot op hede geen foneties gebalanseerde Afrikaanse spraakmateriaal beskikbaar om woordherkenning mee te meet nie. Woordherkenning moet in individue se eerste taal bepaal word ten einde ’n meer verteenwoordigende beeld van hul daaglikse kommunikasie funksionering te verkry. Doel: Die hoofdoel van hierdie navorsing was om die geldigheid van die Foneties Verteenwoordigende Eenlettergrepige Woordlyste in Afrikaans (FVEWA) statisties te bepaal om woordherkenning in ’n bepaalde Afrikaanse populasie te meet. Metodiek: Die navorsing is gebaseer op ʼn kwantitatiewe retrospektiewe studie van die oudiologierekords van deelnemers wat by ʼn privaat oudiologiepraktyk geassesseer is. Die FVEWA is geëvalueer in terme van interlys-ekwivalensie en prestasie-intensiteit funksie vir gebruik in kliniese praktyk. Bevindings: Daar is bevind dat die ses FVEWA-woordlyste statisties ekwivalent is wat moeilikheidsgraad betref. Die gemiddeld waar deelnemers 50% korrekte woordherkenning bereik het, was 14.2 dBGP. Die helling van die woordlyste wat in die FVEWA gebruik is, was 3.1%/dB by 50% (%/dB).http://www.journals.co.za/content/journal/akgeeshttp://www.scielo.org.za/scielo.php?script=sci_serial&pid=0041-4751&lng=enam2018Centre for Augmentative and Alternative Communication (CAAC

The impact of pass/refer criteria in the use of otoacoustic emission technology for newborn hearing screening

PURPOSE : The current study aimed to compare the specificity of transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) in isolation and in combination, with varying pass/refer criteria for DPOAE technology. METHOD : A longitudinal, repeated-measures design was employed. The current study sample comprised 91 of the initial 325 participants who returned for the repeat screening and diagnostic audiological assessment within a risk-based newborn hearing screening program. RESULTS : TEOAE screening had the highest specificity in comparison to DPOAE screening at the initial and repeat screening, irrespective of differences in DPOAE pass/refer criteria. DPOAE screening had a slightly higher specificity, with a three out of six rather than the four out of six frequency pass criteria. CONCLUSIONS : Pass/refer criteria alone do not influence referral rates and specificity. Instead, consideration of other factors in combination with these criteria is important. More research is required in terms of the sensitivity and specificity of OAE screening technology using repeated-measures and diagnostic audiological evaluation as the gold standard.http://aja.pubs.asha.orghj2021Centre for Augmentative and Alternative Communication (CAAC

Infection prevention and control measures currently applied in South African audiology

Background: To counter the global increase in infection-related deaths, infection control has recently developed into an active area of research. Many diseases can be prevented by infection control. In the confines of the audiology clinic, cross-contamination by micro-organisms associated with opportunistic infections remains a real concern. Objective: The primary aim of the study was to ascertain the methods that audiologists in South Africa use to prevent and control the spread of infections during and after consultation with clients. Method: A survey study was conducted, using a self-administered questionnaire. Fifty currently practising audiologists participated in the study. Results: The majority (84%; n = 42) of respondents acknowledged the importance of hand hygiene for the purpose of infection control, with 76% (n = 38) making use of no-rinse hand sanitisers. Approximately a third of audiologists wear gloves during procedures such as otoscopy and immittance, and while handling hearing aids. Disinfecting audiological equipment seem to be the preferred choice of infection control, with only 60% (n = 30) of respondents sterilising audiological equipment after each individual patient consultation. Less than half of the respondents disinfected touch surfaces and toys in the reception area. Conclusions: Based on the results, further education and training should focus on measures implemented in infection control, awareness of possible risk factors at work settings, and vaccination as an effective means of infection control