Research ethics review practices: experiences of the Armauer Hansen Research Institute/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center Ethics Review Committee, Ethiopia.

The need for ethics review committees (ERCs) is imperative in the conduct of research to ensure the protection of the rights, safety and well-being of research participants. However, the capacities of most ERCs in Africa are limited in terms of trained experts, competence, resources as well as standard operating procedures. The aim of this report is to share experiences of one of the local institutional ERCs, the Armauer Hansen Research Institute (AHRI)/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center (ALERT) Ethics Review Committee (AAERC), to other ERCs found in academic and research institutions in the Country. In this report, we used an empirical approach to review archived documents of the AAERC Secretariat to assess the Committee's strengths and weaknesses. The experiences of the AAERC in terms of its composition, routine work activities, learning practices and pitfalls that require general attention are summarized. In spite of this summary, the Committee strongly acknowledges the functions and roles of other ERCs in the Country. In addition, an independent assessment of the Committee's activity in general is warranted to evaluate its performance and further assess the level of awareness or oversights among researchers about the roles of ERCs.

A patient-centered care ethics analysis model for rehabilitation.

There exists a paucity of ethics resources tailored to rehabilitation. To help fill this ethics resource gap, the authors developed an ethics analysis model specifically for use in rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a process model to guide careful moral reasoning for particularly complex or challenging matters in rehabilitation. The Patient-Centered Care Ethics Analysis Model for Rehabilitation was developed over several iterations, with feedback at different stages from rehabilitation professionals and bioethics experts. Development of the model was explicitly informed by the theoretical grounding of patient-centered care and the context of rehabilitation, including the International Classification of Functioning, Disability and Health. Being patient centered, the model encourages (1) shared control of consultations, decisions about interventions, and management of the health problems with the patient and (2) understanding the patient as a whole person who has individual preferences situated within social contexts. Although the major process headings of the Patient-Centered Care Ethics Analysis Model for Rehabilitation resemble typical ethical decision-making and problem-solving models, the probes under those headings direct attention to considerations relevant to rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a suitable tool for rehabilitation professionals to use (in real time, for retrospective review, and for training purposes) to help arrive at ethical outcomes.

Nuestra especialidad en tiempos de crisis / Our specialty in times of crisis

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Rehabilitación intervencionista / No disponible

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Navigating ethical discharge planning: A case study in older adult rehabilitation.

BACKGROUND: Ethical issues are becoming more complex as individuals live longer with increased disability and medical needs. This article elucidates common ethical issues encountered in discharge planning with older adults. METHODS: We conducted normative ethical analysis of a clinical case using methods of philosophical inquiry, including thick description, reflexivity, conceptual clarification and examination of competing arguments for internal consistency. RESULTS: The analysis demonstrates how health-care teams struggle to balance protection from harm while honouring informed choices. We argue that ethical discharge planning requires judicious identification of client values, even if these conflict with team determinations of best interests. CONCLUSION: Dialogue is needed to identify risks, help clients determine their personal level of acceptable risk and determine provisions to minimise risks.

Mapa de conflictos éticos intrahospitalarios en rehabilitación / Map of ethical conflicts at health care hospital in the medical rehabilitation

Objetivo: Analizar los principales problemas que la ciencia, la tecnología y los cambios organizativos han causado en la actividad profesional, social, asistencial, organizativa y legal de los profesionales de rehabilitación. Material y método: El estudio comprendió a 83 profesionales sanitarios que atienden a pacientes que precisan tratamiento de rehabilitación: 35 médicos de rehabilitación (24 médicos especialistas con régimen estatutario y 11 MIR [médicos internos residentes] de rehabilitación), 48 diplomadas en enfermería (DUE): 16 de la Unidad de Lesionados Medulares, 16 de la Unidad de Cuidados Intensivos y 16 de las plantas de hospitalización general, no de urgencias. Se diseñaron 2 cuestionarios de valoración, uno basado en los 10 dilemas o conflictos éticos acreditados como más habituales en el desarrollo de la actividad asistencial y otro segundo basado en los conflictos expresados en diferentes áreas: profesional, social, asistencial, organizativa y legal. Resultados: No existen diferencias significativas entre los 2 grupos (DUE versus médicos) en relación con las variables de las áreas profesional, social y legal, pero sí en la asistencial y organizativa donde se mostraron diferencias significativas entre los 2 grupos (p<0,05): los médicos presentaron más conflictos que las DUE. No existen diferencias significativas entre los 2 grupos estudiados, médicos y DUE, para la puntuación global de los 10 dilemas. Conclusiones: Antes, la solución de los problemas éticos era competencia sólo del médico, hoy lo es también del resto de los profesionales de la salud, porque todos interaccionan con el paciente, por eso la ética es una construcción social y cultural que debe revisarse constantemente en las organizaciones asistenciales, para que sus procesos conlleven a mejorar la calidad de vida de la persona con discapacidad y promover su independencia, que ha sido el objeto del presente estudio (AU)

Objective: To analyze the ethical problems in the health care of the medical and nursing rehabilitation. Materials and methods: The sample were 83 health workers, 35 doctors and 48 nurse specialists. Materials and methods: Using two assessment scales, one of the 10 ethical dilemmas and conflicts the most important during health care and a second questionnaire where was studied professionals problems, social, medical care, organizational and legal. Results: There are not significant differences between the two groups (Physician and nurse) in the variables of the areas professional, social and legal, but there were differences in the care and organizational (p<0.05), presenting doctors more conflicts than nurses. There are not significant differences between the two groups for the 10 ethical dilemmas. Conclusion: The resolution of ethical problems was only the responsibility of the physician before, but now it is also other health professional, because all of us interact with the patient. For this reason the ethics is social and cultural construction which has to constantly revise with organizations aid. For their processes improve the quality of life of people with disabilities and promote their independence, which has been the goal of this study (AU)

Moral distress in rehabilitation professionals: results from a hospital ethics survey.

OBJECTIVE: Moral distress in the rehabilitation setting was examined in a follow-up survey. The survey had 3 goals: (1) to systematically and anonymously gather data about the ethical issues that employees struggle with in their daily work; (2) to raise the visibility of the hospital-based ethics program and resources available to employees; and (3) to prioritize and focus the direction of the program's educational seminars, quality improvement projects, and ethics consultation. DESIGN: Online survey of employees. SETTING: Urban rehabilitation system of care. PARTICIPANTS: The survey was open to all employees; 207 completed the survey. INTERVENTIONS: N/A MAIN OUTCOME MEASUREMENTS: N/A CONCLUSIONS: Three broad categories of moral distress were identified: institutional ethics, professional practice, and clinical decision-making. Institutional ethics issues related to the health care environment, such as health care reimbursement pressures and corporate culture. Professional practice issues involved codes of behavior and concepts of professionalism, including patient confidentiality/privacy. Clinical decision-making included such practical dilemmas as conflicts around goal-setting, discharge planning, and assessment of decision-making capacity. An anonymous survey of staff members allowed the hospital ethics program to identify sources of moral distress and prioritize strategies to address them.

Medical necessity: is current documentation practice and payment denial limiting access to inpatient rehabilitation?

Medical necessity is a legal, not medical, term. Depending on the stakeholder's point of view, it may seem less about human need and dispensing medical care and more about a web of rules, rulings, regulations, and manuals, especially for Medicare patients, who use the lion's share of rehabilitation services. In other words, the term medical necessity seems, to some stakeholders, to refer more to what determines payment by Medicare instead of what should be done to determine optimal patient health. Such a perspective on medical necessity has major implications, considering that Medicare pays for most of the rehabilitation treatment in some 1200 inpatient rehabilitation facilities and that its policies determine which patients qualify for admission to an inpatient rehabilitation facility. Medicare's medical necessity policies are often described by inpatient rehabilitation facility administrators and physiatrists as complicated and unfair, as well as being demeaning to the standing of physicians. Ask some physiatrists about their patients meeting Medicare guidelines for medical necessity, and they might bark, "Medical necessity?! That's what I was taught to know!"