Adapting a community of practice model to design an innovative ethics curriculum in healthcare

The focus of healthcare ethics within the framework of ethical principles and philosophical foundations has always, in recent times, been the community, namely, the healthcare provider, the patient or, in research, the study participant. An initiative is thus described whereby a community of practice (CoP) model was developed around health ethics in health research, education and clinical care. The ethics curriculum was redesigned to include several components that are integrated and all embracing, namely, health research ethics, healthcare ethics, health personnel education in ethics and global and public health ethics. A CoP is a group who share a common interest and a desire to learn from and contribute to the community with their variety of experiences. The CoP is dynamic and organic, generating knowledge that can be translated into effective healthcare delivery and ethical research. It requires the collaboration and social presence of active participants such as community members, healthcare professionals and educators, ethicists and policy makers to benefit the community by developing approaches that adapt to and resonate with the community and its health - care needs. Philosophical principles constitute the foundation or underpinning of this innovative curriculum. Recommendations are presented that will continue to guide the consolidation and sustainability of the CoP.IS

Re-examining ethical obligations in the intensive care unit: HIV disclosure to surrogates

Physicians treating newly incapacitated patients often must help navigate surrogate decision-makers through a difficult course of treatment decisions, while safeguarding the patient's autonomy. We offer guidance for intensive care physicians who must frequently address the difficult questions concerning disclosure of confidential information to surrogates. Three clinical vignettes will highlight the ethical challenges to physician disclosure of a critically ill patient's HIV status. Two key distinctions are offered that influence the propriety of disclosure: first, whether HIV infection represents a 'primary cause' for the patient's critical illness; and second, whether the surrogate may be harmed by failure to disclose HIV status. This balanced consideration of the direct duties of physicians to patients, and their indirect duties to surrogates and third-party contacts, may be used as a framework for considering other ethical obligations in the intensive care unit. We also provide a tabulation of individual US state laws relevant to disclosure of HIV status

Feasibility of implementing rapid oral fluid HIV testing in an urban University Dental Clinic: a qualitative study

<p>Abstract</p> <p>Background</p> <p>More than 1 million individuals in the U.S. are infected with HIV; approximately 20% of whom do not know they are infected. Early diagnosis of HIV infection results in earlier access to treatment and reductions in HIV transmission. In 2006, the CDC recommended that health care providers offer routine HIV screening to all adolescent and adult patients, regardless of community seroprevalence or patient lifestyle. Dental providers are uniquely positioned to implement these recommendations using rapid oral fluid HIV screening technology. However, thus far, uptake into dental practice has been very limited.</p> <p>Methods</p> <p>The study utilized a qualitative descriptive approach with convenience samples of dental faculty and students. Six in-depth one-on-one interviews were conducted with dental faculty and three focus groups were conducted with fifteen dental students.</p> <p>Results</p> <p>Results were fairly consistent and indicated relatively high levels of acceptability. Barriers and facilitators of oral fluid HIV screening were identified in four primary areas: scope of practice/practice enhancement, skills/knowledge/training, patient service/patient reactions and logistical issues.</p> <p>Conclusions</p> <p>Oral fluid HIV screening was described as having benefits for patients, dental practitioners and the public good. Many of the barriers to implementation that were identified in the study could be addressed through training and interdisciplinary collaborations.</p