Treatise on the influence of theism, transhumanism, and posthumanism on nursing and rehabilitation healthcare practice.

Reservations concerning the ontologies of theism, transhumanism and posthumanism compel an explicatory discourse on their influences on Nursing and rehabilitation healthcare. Key journals in Nursing and health sciences have recently devoted themed issues on intelligent machine technologies such as humanoid healthcare robots and other highly technological healthcare devices and practice initiatives. While the technological advance witnessed has been a cause for celebration, questions still remain that are focused on the epistemological concerns. The purpose of this article is to discuss theistic ontologies such as the Judeo-Christian, Shinto-Buddhist and Islamic religious belief systems on transhumanism and posthumanism in the assimilation of symbiotic technological beings in Nursing and rehabilitation healthcare practice. In view of the approaching technological singularity dominating arguments regarding the future of human beings, a treatise on Nursing and rehabilitation health care is positioned well within the realms of human care. Theism, transhumanism and posthumanism are directing discussions regarding human beings and healthcare processes. It is imperative that the beneficial effects of these discussions be acknowledged within the highly technological world of Nursing and rehabilitative healthcare.

Teaching ethics and professionalism in rehabilitation: an empirical research on active learning with university rehabilitation students.

BACKGROUND: Teaching ethics in university courses may benefit from different didactic approaches; nonetheless, it still seems unclear whether ethics teaching can be best offered in stand-alone courses or integrated into other courses, or perhaps both. OBJECTIVE: We describe the experience derived from a structured teaching activity in the field of medical ethics, conducted during a lesson for the students of a rehabilitation university second-cycle degree course. METHODS: The participating students were healthcare professionals with different graduate training in rehabilitation. The aim of the lesson was to discuss the essentials of the relationship between patients and rehabilitation healthcare providers, from an inter-professional viewpoint, focused on the principles of trust, mutual respect, power and personal closeness, which are essential components of the therapeutic relationship between patients and physical therapists. RESULT: Shared moral norms guiding the professional conduct of healthcare professionals are a fundamental characteristic of these professions, promoting the public trust in these professions, tearing down barriers to inter-professional collaboration and communication. CONCLUSION: The results are remarkable, and there has been very positive feedback from the students concerning the production of the oath and its contents, as well as about the proposed teaching method, resulting in great interest in clinical ethics.

Autonomy and the Patient with Right Hemisphere Cognitive-Communication Deficits: Ethical Considerations in Rehabilitation Practice.

Clinicians must often contend with ethical issues that arise during rehabilitation. When a patient has right hemisphere damage (RHD), these concerns may be exacerbated because of the presence of cognitive deficits. In this article, we focus on the ethical principle of respect for autonomy, which raises issues relevant to patients with RHD who have impaired executive control functions. Respect for autonomy involves respecting others in terms of their decision-making and subsequent actions. Disagreements may occur between members of the rehabilitation team, the patient, and family about the decisions that the patient makes. Clinicians may have concerns about the patient's capacity to make informed decisions. Indeed, in some cases, because the patient is "talking," the verbal skills may mask the impairments in underlying cognitive processes. We provide two case examples of patients with RHD with sufficient language skills to express their choices, but cognitive deficits that affect their decision-making abilities. We use a clinical decision-making model adapted from Jonsen et al to discuss the cases. In both cases, the rehabilitation team strives to balance what they deem to be in the best interest of the patient while continuing to respect the patient's autonomy.

Resilience From a Stakeholder Perspective: The Role of Next of Kin in Cancer Care.

OBJECTIVE: The aim of this article was to provide new knowledge on how next of kin are co-creators of resilient performance, as seen from the viewpoint of the healthcare personnel and managers. The following research question guided the study: How are next of kin involved in shaping resilience within cancer care in hospitals? METHODS: The design of the study is a case study of cancer departments in two Norwegian hospitals. Data collection included a total of 32 qualitative semistructured interviews at two organizational levels (managers and staff). The data were analyzed by ways of a directed content analysis according to Hollnagel's Resilience in Health Care framework of resilience potentials (anticipate, monitor, respond, learn). RESULTS: Next of kin are involved in creating and maintaining resilience in cancer care by different kind of activities and in-depth insight into the patient's condition, which strengthen all resilience potentials of responding, anticipation, monitoring, and learning. We have identified nine areas in which next of kin are co-creators in shaping resilience. Next of kin are important stakeholders, both as safety experts and as safety resources, helping healthcare professionals provide quality and safety in the patient care process under difficult conditions. Next of kin's knowledge of the patient's history, their observation of the patient over time within the hospital, at home, and across care transitions are key elements of their contribution. CONCLUSIONS: Next of kin complement healthcare professionals in all four potentials for resilient performance. The study suggests that the Resilience in Health Care framework takes into account the role of next of kin, as a stakeholder potential, because this has not previously been sufficiently considered.

Ethical Considerations in Chronic Brain Injury.

A growing number of individuals are living with chronic traumatic brain injury. As these individuals and their families attempt to reintegrate into their communities, several ethical questions arise for clinicians and researchers. These include issues around alignment of perspectives and priorities, as well as responsibilities for ongoing treatment, education, community outreach, and research. An action plan for addressing these questions is outlined.

[The medical ethical aspects of organization of medical rehabilitation].

The article considers such aspects of organization of medical rehabilitation care of population as accessibility, quality, social efficiency from perspective of medical ethics. The quality of diagnostic, prevention and treatment of diseases is affected by qualification of medical personnel that is applied both to areas of clinical medicine and health care management. The specialists are to apply common principles and standards of health care. Among them are support of valuable quality of medical care under optimal application of available resources and observance of medical ethics standards. The Republic of Dagestan is anagrarian region where 55% of population resides in rural area and most of health care resources are cumulated in urban area. The indices of health of population residing in rural area are in many parameters worse than in urban population and provision of medical institutions with medical personnel is low. The specialized medical care support including medical rehabilitation, of rural population, is provided without additional managerial decisions and is much more difficult as compared with patients residing in urban area. Hence in conditions of necessity of optimization of resource support of health care system functioning no extensive development of possibilities of medical rehabilitation is possible in rural residents of Dagestan.

Health professionals' perspectives of next of kin in the context of reablement.

Aim: To describe health professionals' perspectives of next of kin in the context of reablement. Methods: A total of 49 health professionals from different organizational levels participated. Their ages, genders, experiences, and professions varied. A total of 10 focus group discussions were held in two municipalities. The data analysis was conducted using a constructivist grounded theory approach. Results: The core category was identified as negotiating between themselves. Two categories captured the different dimensions of the core category: facing a dilemma with next of kin in reablement and ambiguous motives for collaborating with next of kin. Conclusion: In collaboration with next of kin, it is important for health professionals to be aware of and manage the possible differences in expectations and opinions concerning reablement. Health professionals need to acknowledge that next of kin can be a source of support for older adults. They also need to take into consideration that next of kin may need support, information, and education associated with their roles as next of kin to older adults. Implications for rehabilitation Health professionals need to be aware of how they collaborate with next of kin and what they expect of them. There is a need for health professionals to find a routine in how next of kin can become partners in reablement without compromising the older adult's autonomy. This study contributes to further awareness of the different roles of health professionals and next of kin regarding expectations of reablement. Health professionals may benefit from providing a more family-centred approach by taking into account that next of kin can be a resource in reablement. In addition, they need to take into consideration that next of kin also have their own needs and must be respected.

On-line ethics education for occupational therapy clinician-educators: a single-group pre-/post-test study.

Purpose: Ethics education is a critical component of training rehabilitation practitioners. There is a need for capacity-building among ethics educators regarding facilitating ethical decision-making among students. The purpose of this study was to evaluate the utility of an on-line ethics education module for occupational therapy clinician-educators (problem-based learning tutors/clinical placement preceptors/evidence-based practice facilitators).Method: The Knowledge-to-Action Process informed development and evaluation of the module. Clinician-educators (n = 33) viewed the module and reported on its impact on knowledge and facilitation practices via pre, post, and follow-up questionnaires.Results: Pre- and post-test data indicated improvement in self-reported ethics knowledge (t = 8.275, p < 0.01). Follow-up data indicated knowledge did not decrease over time (t = -1.483, p = 0.075). There was improvement in self-reported intent to change practice (t = 4.93, p < 0.01); however, actual practice change was not indicated (t = -1.499, p = 0.072).Conclusion: This study provides preliminary data regarding an on-line ethics education module for clinician-educators. Future recommendations include broader consideration of context, adding supplemental knowledge translation components, and further research exploring outcomes with larger samples, longer follow-up and randomized trial methodology.Implications for RehabilitationThe on-line ethics module has potential to improve rehabilitation practice by addressing the noted gap in knowledge among clinician-educators.Viewing an on-line module regarding approaches to ethics education may not be sufficient to change clinician-educators' teaching practices.More time and opportunities to discuss ethics with student occupational therapists may be required to effect practice change among clinician-educators.Developing ethics education tools for clinician-educators requires ongoing and iterative input from knowledge users to optimize translation of ideas to practice.

Ethical, Palliative, and Policy Considerations in Disorders of Consciousness.

This essay complements the scientific and practice scope of the American Academy of Neurology Guideline on Disorders of Consciousness by providing a discussion of the ethical, palliative, and policy aspects of the management of this group of patients. We endorse the renaming of "permanent" vegetative state to "chronic" vegetative state given the increased frequency of reports of late improvements but suggest that further refinement of this class of patients is necessary to distinguish late recoveries from patients who were misdiagnosed or in cognitive-motor dissociation. Additional nosologic clarity and prognostic refinement is necessary to preclude overestimation of low probability events. We argue that the new descriptor "unaware wakefulness syndrome" is no clearer than "vegetative state" in expressing the mismatch between apparent behavioral unawareness when patients have covert consciousness or cognitive motor dissociation. We advocate routine universal pain precautions as an important element of neuropalliative care for these patients given the risk of covert consciousness. In medical decision-making, we endorse the use of advance directives and the importance of clear and understandable communication with surrogates. We show the value of incorporating a learning health care system so as to promote therapeutic innovation. We support the Guideline's high standard for rehabilitation for these patients but note that those systems of care are neither widely available nor affordable. Finally, we applaud the Guideline authors for this outstanding exemplar of engaged scholarship in the service of a frequently neglected group of brain-injured patients.

Proactive Ethical Design for Neuroengineering, Assistive and Rehabilitation Technologies: the Cybathlon Lesson.

BACKGROUND: Rapid advancements in rehabilitation science and the widespread application of engineering techniques are opening the prospect of a new phase of clinical and commercial maturity for Neuroengineering, Assistive and Rehabilitation Technologies (NARTs). As the field enters this new phase, there is an urgent need to address and anticipate the ethical implications associated with novel technological opportunities, clinical solutions, and social applications. MAIN IDEA: In this paper we review possible approaches to the ethics of NART, and propose a framework for ethical design and development, which we call the Proactive Ethical Design (PED) framework. CONCLUSION: A viable ethical framework for neuroengineering, assistive and rehabilitation technology should be characterized by the convergence of user-centered and value-sensitive approaches to product design through a proactive mode of ethical evaluation. We propose four basic normative requirements for the realization of this framework: minimization of power imbalances, compliance with biomedical ethics, translationality and social awareness. The aims and values of the CYBATHLON competition provide an operative model of this ethical framework and could drive an ethical shift in neuroengineering and rehabilitation.

Contribuição da Prótese Bucomaxilofacial na internacionalização da Odontologia / Contribution of Maxillofacial Prosthetics for the dentistry internationalization

Objetivos: Este artigo visa exemplificar uma parceria internacional técnico cientifica por meio da utilização de técnica idealizada e patenteada por pesquisadores brasileiros. Materiais e Métodos: Um grupo de pesquisadores brasileiros idealizou, pesquisou e patenteou uma técnica de obtenção e utilização de íris digitalizada na reabilitação protética ocular. A internacionalização do método foi decorrente do intercâmbio estabelecido entre professores do Brasil e do México.A permanência do pesquisador mexicano, por um período em que especializou e concluiu o curso de mestrado, junto aos colegas brasileiros, pôde oferecer conhecimento e treinamento na aplicação da técnica proposta. Resultados: São apresentados casos clínicos em que a reabilitação protética ocular foi realizada usando a técnica brasileira de íris digitalizada. Conclusão:Pesquisas brasileiras, principalmente na área da saúde, vêm tendo destaque internacional. A preocupação com a melhora da qualidade de vida torna relevantes nossos estudos e técnica sem âmbito mundial.

Objectives: This article aims to illustrate a scientific technical international relation ship through the use of technique created and patented by Brazilian researchers. Materials and Methods: A group of Brazilian researchers devised, researched and patented a technique of obtaining and using scanned iris in ocular prosthetic rehabilitation. The internationalization of the technique was due to technical and scientific partner ship between Brazilian and Mexican researchers. A Mexican researcher remained for a period in which he specialized and completed his master’s course with the Brazilian team that was able to transfer knowledge and offer atraining in the application of the technique. Results: Three cases are shown, two Brazilian an done Mexican. Ocular Prosthetic rehabilitation of these cases was performed using the Brazilian technique of scanned iris. Conclusion: Brazilian research, especially in health, comes with international relevance. The concern with improving life quality makes our technical studies relevant world wide.

Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators.

PURPOSE: Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: (1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programmes and (2) explore useful and innovative teaching and evaluation methods. METHOD: Data for this qualitative descriptive study were collected during a 1-d knowledge exchange workshop focused on ethics teaching in rehabilitation. RESULTS: Twenty-three educators from 11 OT and 11 PT Canadian programmes participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important. CONCLUSION: The CREW Day provided ethics educators the opportunity to share knowledge and begin creating a community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge. Implications for Rehabilitation According to the study participants, rehabilitation ethics education should include learning about foundational knowledge related to ethical theory; be grounded in examples and cases drawn from clinical rehabilitation practice; and contribute to building professional competencies such as self-knowledge and critical thinking in students. Regardless of the methods used by occupational therapy (OT) and physical therapy (PT) educators for teaching and evaluation, the value of creating spaces that support open discussion for students (e.g. protected discussion time in class, peer-discussions with the help of a facilitator, use of a web discussion forum) was consistently identified as an important facet. Educators from OT and PT programmes should work with various professionals involved in OT and PT student training across the curricula (e.g. clinical preceptors, other educators) to extend discussions of how ethics can be better integrated into the curriculum outside of sessions specifically focused on ethics. The CREW Day workshop was the first opportunity for Canadian rehabilitation ethics educators to meet and discuss their approaches to teaching and evaluating ethics for OT and PT students. Including international rehabilitation ethics educators in this dialogue could positively expand on this initial dialogue by facilitating the sharing of tacit and experiential knowledge amongst a larger and more diverse group of ethics educators.