Vulnerability, Preventability, and Responsibility: Exploring some Normative Implications of the Human Condition

Presented March 17, 2015. Papers presented for the Center for the Study of Ethics in Society Western Michigan University

We Need to Talk....About Institutional Integrity

It seems a reasonable hypothesis that institutional health depends upon institutional integrity and institutional integrity depends upon individual integrity. If that’s right, “disease” may be manifest at two levels—at the level of institutional or individual integrity. I begin with the first part of the hypothesis above, that institutional integrity is a condition of institutional health. The legal theorist Lon Fuller articulated this idea in a less generalized form when he spoke of a morality internal to law that makes law possible. I will explain and illustrate this idea and indicate how it applies to institutions of various sorts, including professions such as engineering, architecture, or medicine. Then I will turn to the second part of the hypothesis, that there is a dependency relation between institutional integrity and individual integrity. However, instead of exploring the consequences of lapses of integrity by individuals within an organization, I will approach this part of the hypothesis in terms of its suggestion that institutional integrity nourishes or promotes individual integrity. This suggestion presupposes a formative relation between institutions and persons; that in some measure our practices dictate both what we should do and what we should be. Todd May makes a powerful case for this thesis in his book Our Practices, Ourselves, and a recent book on privacy by Anita Allen has a similar thrust. I draw on their work to cash out what is little more than a suggestion in Fuller’s legal philosophy. I do this with an eye to achieving some clarity about what’s at stake if, as was suggested earlier, “disease” can manifest itself at the level of institutional integrity as well as individual integrity. And that, in turn, adds to the strength of the case for saying, with Fuller, that the principles internal to an enterprise constitute a morality and the responsibilities of the persons within an institution are moral responsibilities

How to Collaborate and Not Just Coexist: An Explanatory Sequential Mixed Methods Study on the Impact of a Physician and Nurse Interprofessional Education Program on the Development of Early Career Pediatrician Communication Skills and Collaborative Behaviors Once in Practice

Healthcare organizations are challenged to build and develop interprofessional (IP) teams capable of delivering effective patient care (Tang et al., 2018). Historically, these multiple professional roles are not formally educated together but are all expected to work in unison once they enter practice (El-Hanafy, 2018). This lack of relational foundation has led to age-old conflict between the physician and nurse roles on the care team (Stein et al., 1990). This conflict has been attributed to a lack of role definition or an overemphasis on hierarchical structures, poor communication, and the inability of physicians to collaboratively work with their nurse counterparts (Crawford et al., 2012). These barriers can lead to ineffective patient care planning and management, decreased work satisfaction, and workplace tension between essential roles (Wang et al., 2018). The problem is that no standard curriculum currently exists in the literature that is being actively used in U.S. based graduate medical education programs that uniformly places importance on IP collaboration between nurses and physicians, yet there is an identified need in the clinical care setting (Allenbaugh et al., 2019; Looman et al., 2020, Wang et al., 2018). This explanatory sequential mixed methods study aimed to determine the impact that participation in an interprofessional education (IPE) program had on graduates’ perceptions of collaborative behaviors and effective communication skills once in practice by answering the following research questions: Is there a difference in the participants’ perceived abilities across the six domains as they recall them on the Interprofessional Collaborative Competency Attainment Survey (revised; ICCASr) pre and post-assessment? Is there a difference between factor outcomes on the ICCASr pre/posttest between nurses’ and physicians’ professional roles? Is there a correlation between posttest factors for each participant group (nurses and physicians)? How do nurses and physicians describe their communication and collaboration with each other after participation in the program? The quantitative questions were answered using the ICCASr and the qualitative question was answered using open-ended survey questions and interviews. This mixed methods explanatory sequential design was divided into two distinct phases. Phase 1 involved the collection and analyses of quantitative data via the ICCASr and Phase 2 used qualitative methods derived from open-ended questions and a semi-structured interview. In Phase 1, quantitative data were gained by distributing the ICCASr to 53 graduates from an IPE program, representing the first three cohorts with a return of 22 responses. The ICCASr underwent paired t-tests, independent t-tests, and correlational statistics that were calculated to determine if there was a difference in the participants’ perceived abilities across the six designated domains: communication, roles and responsibilities, conflict management/resolution, team functioning, collaboration, and collaborative patient-family centered approach pre and postintervention. In Phase 2, qualitative data were collected using responses from the open-ended questions on the ICCASr to reveal how the program impacted the participants’ perceived abilities to communicate and collaborate postintervention to offer better patient care. These initial data led to the development of 12 semi-structured interview questions. Virtual interviews were conducted with eight survey participants who volunteered to share their experiences. The qualitative data utilized multilevel descriptive, holistic, and In Vivo coding for analysis to locate significant themes from the position of the participants’ own experiences in relation to the overall study aim. The ICCASr survey results showed a statistically significant difference in participants’ perceptions on all areas of the IP domains from pre to postintervention. There was no significant correlation between patient-family centered approach associated with conflict management/resolution or communication or team functioning associated with communication for the nurse role. The results of the descriptive statistics and comparative and correlation analyses supported the focused interview questions. The qualitative data generated four essential thematic interpretations as to the intervention’s impact: foundational deficits, construction of perspectives, development of relationship and organizational influence. Each essential theme was influenced through the discovery of categorizing data obtained from the participants’ narratives. The quantitative results were supported by qualitative insights, allowing for a more robust picture from the perspective of the learner as to how the intervention impacted their learning and why this type of programming is important. Using a mixed methods study design and sequential process aimed to determine perceptional behavior change and gain a deeper understanding of how participation in one institution’s early intervention program impacted communication skills and nurse–physician collaborative relationships. At the conclusion of the study, it was determined that the ICCASr was an effective assessment tool in identifying perceived changes in behavior as it relates to IP programming even years after an intervention. The statistical improvement identified between pre and post-learning surveys supports the effectiveness of this specific program to provide IPE knowledge long term. The themes that emerged from the interviews provided an in-depth look at how this specific program impacted the participants and revealed areas needing attention when developing future IPE programs, such as moving away from modules and simulation. There was a comprehensive belief that the deficit in IPE training in formal healthcare education created the most significant barrier to providing team care. IPE interventions should fill these gaps by providing the necessary job-related soft skills to ensure the positive collaboration between roles in the clinical care setting. Intervention activities should provide a pathway for participants to reflect on their own paradigms as they learn to see the “other” as a human instead of a role, which has not previously been role modeled but will change practice approaches immensely. Having a well-developed early career intervention will improve IP relationships immediately but also provide transferable skills to teach others as providers advance their careers. Finally, to truly support IPE education in the clinical care setting, there must be organizational support to maintain positive relationships and build trust among employees. Mixed methods designs are a novel approach to healthcare education research and provide a deeper dive into the lived experience and shared meaning of learners. The results of this study are meaningful for healthcare education as no other study has assessed the impact of a longitudinal IPE intervention between physicians-in-training and nurses. This study supports the importance of developing a standard IPE curriculum using interactive, relationship-driven activities as a meaningful and necessary part of training to preventatively reduce conflict and proactively develop effective IP communication and collaboration skills to meet healthcare organization and patient needs once in practice

The customer isn\u27t always right: Limitations of \u27customer service\u27 approaches to education or why Higher Ed is not Burger King

The increasingly popular trend of conceptualising education in terms of \u27customer service\u27 is, in some ways, attractive. It encourages educators to think in terms of meeting students\u27 needs and to develop innovative ways to deliver their product. In other ways, however, it fails to convey the essential collaborative, participatory, reciprocal relationship that is central to effective teaching and learning. With respect to academic integrity, the customer service model also obscures students\u27 roles and responsibilities. In this paper, we identify some of the ways this model provides an inappropriate metaphor for understanding the project of teaching and learning (i.e., education) and argue that, when embraced uncritically, the model has the potential both to undermine education and at the same time derail efforts to develop and sustain a culture of integrity. After identifying this model\u27s shortcomings, we suggest ways to develop and promote a more robust model in which faculty and students work together toward a shared purpose while recognising and embracing their interlocking responsibilities