Amy Haddad

Ethical considerations in home care of the oncology patient

OBJECTIVESnTo examine the context of home care and the values of providers and patients that lead to potential ethical conflicts. To discuss a normative model of ethical decision making, and to suggest resources for resolving ethical issues.nnnDATA SOURCESnPublished articles pertaining to ethical issues and home health care.nnnCONCLUSIONSnHome care is a viable and beneficial alternative to hospital care for a variety of patients, yet home care can result in unique value conflicts between patients and their families, and patients and home care providers. Loss of privacy and determining who is in charge are several unique areas to home care that can lead to ethical problems. Policies, guidelines, value statements, and ethics committees are excellent resources to assist in ethical decision-making.nnnIMPLICATIONS FOR NURSING PRACTICEnA workable method or model to resolve ethical problems, and resources to assist in ethical decision-making can provide home care providers with guidelines to analyze an ethical problem and the support to choose and act on the best option.

Scholarship of Teaching and Learning in Physical Therapist Education

In this special issue of the Journal of Physical Therapy Education we discuss, expand, and explore the scholarship of teaching and learning (SoTL) in physical therapist education. For the majority of papers, we have linked physical therapist educators with faculty members from other disciplines engaged in SoTL, and who have participated in the Carnegie Fellow program of the Carnegie Academy for the Scholarship of Teaching and Learning (CASTL). This allows us to focus on the emergence and development of SoTL in general, and in physical therapist education in particular. The first assumption of this special issue is that different disciplines will approach SoTL in different ways, ask different questions, and differ in their views of what counts as argument and evidence. The distinction between general observations about SoTL and the specific focus on physical therapy is an important one. We want to focus on the discipline of physical therapy and the way it organizes thinking about teaching and learning and how physical therapist educators approach critical inquiry into pedagogy. The discipline of physical therapy has its own history, agreements, and disputes about subject matter and methods that influence what is taught, to whom, when, where, how, and why.1 Contributors from the discipline of physical therapy will report on what has been going on in SoTL and answer the following broad questions: How do physical therapists talk about teaching and learning issues in their field? Is physical therapy concerned about advancing the practice and profession of teaching? Does physical therapy recognize SoTL as having the same intrinsic value as other forms of scholarship? The second major assumption we make is that, even though SoTL may be domainspecific, there is great richness in working across disciplines and finding common language or new ways to approach problems and reach resolutions. This special issue will be a sort of trading zone as described by Shulman,2 where scholars of teaching and learning seek advice, collaborate, discuss references and methods, and fill in the gaps in the discipline of physical therapy. We established partnerships between physical therapists and members of the Carnegie Academy for the Scholarship of Teaching and Learning (CASTL), who hail from a variety of disciplines such as mathematics, American literature, psychology, womens studies, psychiatry, and education, in the hope that it will broaden our inquiry, provide perspective, and, in the long run, contribute to enhanced student understanding. The partners were not randomly assigned, as we looked for areas of mutual interest in teaching and learning as a starting point for discussion and inquiry. The first 3 articles herein provide a background and overview of the basic components in SoTL applied to physical therapist education and practice. Ellen Spake, PT, PhD, and Anita Salem, MS, provide both an overview of the general characteristics of scholarly inquiry into teaching and learning, along with evidence of how this work is viewed by physical therapist educators. In their paper, Setting the Stage: Scholarship of Teaching and Learning. Martha Hinman, PT, PhD, and Alix Darden, PhD, examine the role of SoTL in physical therapist education more specifically in Beyond Scholarly Teaching: Opportunities for Engaging in the Scholarship of Teaching and Learning in Physical Therapist Education. They provide examples of how faculty scholarship in teaching and learning fits with faculty expectations in the accreditation criteria from the Commission on Accreditation in Physical Therapy Education (CAPTE). In addition, they describe opportunities for implementing SoTL in education programs. In the third paper, Cathy Peterson, PT, EdD, and Judith Haymore Sandholtz, PhD, focus on strategies for supporting and promoting SoTL with new faculty. The authors make a strong case by including examples of how to blur the boundaries between teaching and research. …

Teaching for enduring understandings in ethics

Background and Purpose. Teachers strive for understanding that survives beyond the end of a course, semester, or professional program. The purpose of this paper is to explore teaching for enduring understandings in ethics using the 4 filters proposed by Wiggins and McTighe to determine what is worth understanding, regardless of the discipline or content. Performance or learning by doing is described in the context of a required ethics course. Professionals not only possess knowledge and how to appropriately use it in novel contexts, they also have the ability to reflect on their actions and the relevance of knowledge to practice. Therefore, self‐reflection brings together understanding and doing through the personal development of the student. Position and Rationale. The specific design of learning experiences in a required ethics course to promote critical self‐reflection is described. In‐depth interviews were conducted with 9 students immediately following the ethics course and with 5 of the original 9 students 1 year later. Evidence of findings of students reflective discourse regarding enduring understanding is presented. Discussion and Conclusion. Overall, students explanations of what they retained from the ethics course and how they have used the skills learned in class changed from the first interview to the second becoming more elaborate, complex, and critical. Personal growth and development as a health professional emerged as a key factor in the second interview.

Trustworthiness and Professional Ethics

Earlier this year, Kansas City, Mo., pharmacist Robert Courtney admitted to charges that he had adulterated, tampered with, and mislabeled the chemotherapy drugs Taxol (paclitaxel—Bristol-Myers Squibb) and Gemzar (gemcitabine—Lilly) prescribed for 34 patients with cancer. Courtney pleaded guilty to 20 federal counts in an agreement with the government that avoided a

Learning from those working most intimately with the residents in long-term care

Certifi ed Nursing Assistants (CNAs) are responsible for nearly all of the direct patient care in nursing homes or long-term care facilities in the United States and account for nearly two-thirds of the total staff. Most nursing homes are for-profi t enterprises with an average of 107 beds (Centers for Disease Control and Prevention, 2000). The typical resident is female, widowed, and white with the majority over 85 years of age. CNAs are overwhelmingly female and black or Hispanic, or members of immigrant populations that refl ect the ethnic composition of a community. To put it bluntly, the least educated, worst paid members of the long-term health care team provide the majority of care to the most complex patients a health professional could encounter. The work is literally back-breaking as most of the residents in a nursing home need help with the basic physical activities of daily living such as walking, transferring, eating, dressing, and toileting. Many residents also suffer from at least one type of mental disorder such as depression or dementia. Thus, interacting with this frail dependent population places heavy emotional demands on CNAs. The potential for exasperation and abuse is high under such circumstances and CNAs can react with harsh words or neglect. However, abuse isn’t one-sided. Residents can become frustrated and angry when care isn’t delivered in the time frame or manner they want which can lead to verbal or even physical abuse directed at CNAs. CNAs comprise a vulnerable group of employees in health care with the highest rate of absenteeism and turnover among all health professionals (Fitzpatrick, 2002; Parsons, et al., 2003). The oversight of CNAs is minimal in most facilities. Their orientation to the facility and the residents is often scant. Their work occurs in relative isolation, generally hidden from public scrutiny. Few researchers have studied the experiences and perceptions of CNAs and attempted to understand their attitudes toward their work and interactions with residents, families, and supervisors. The little research that is available, often the result of observational studies, portrays CNAs’ behavior as one of extremes—compassionate care givers or abusers (Foner, 1994). Clearly, there are examples of great kindness demonstrated by CNAs who sometimes serve as surrogate family for residents who are literally alone in the world. As with many roles that cross age, race, and socioeconomic lines, the intimate relationship between CNAs and nursing home residents is far more nuanced than these polar opposite types indicate. In an attempt to tease out some the subtleties in this relationship, the call for stories for this narrative symposium included this request and these questions: