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2.
J Law Med ; 26(4): 849-865, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682363

RESUMO

Despite the increasing use of "vulnerability" in policy and legal documents, and the emerging scholarly literature about vulnerability and the law, there is little research focused on vulnerability from clients' perspectives. To address this gap, we analysed the New South Wales Civil and Administrative Tribunal (NCAT) and appellate court cases involving vulnerable clients and disciplined lawyers in NSW from 1 January 2011 to 30 January 2019. Our analysis of the cases draws from the "vulnerability theory" literature. We identified the following characteristics of clients for analysis: older age, gender, health impairment, and immigrant status. Twenty-eight tribunal cases and two appellate court cases involved vulnerable clients. Overall, the cases revealed that the relationship between public protection and vulnerability is not expressly discussed by NCAT. To optimise the legislative intent to safeguard the public, the NSW legislation should explicitly include vulnerability as a relevant feature of the disciplinary regime.


Assuntos
Advogados , Disciplina no Trabalho , Humanos , New South Wales
3.
Br J Nurs ; 28(14): 955, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31348710

RESUMO

Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on the responsibility employers have to ensure that disciplinary procedures and processes are fit for purpose.


Assuntos
Disciplina no Trabalho/normas , Enfermeiras e Enfermeiros/legislação & jurisprudência , Medicina Estatal/organização & administração , Competência Clínica/legislação & jurisprudência , Humanos , Má Conduta Profissional/legislação & jurisprudência , Sociedades de Enfermagem , Reino Unido
4.
Int Nurs Rev ; 66(3): 320-328, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31287164

RESUMO

AIM: This study explores Australian clinical nurses' and midwives' familiarity with a new code of conduct and understanding in what ways the code is important for nurses as they carry out clinical practice. BACKGROUND: Codes specify the expectations of nurses' responsibilities, legal requirements, behaviour and conduct. Being familiar with the code is central to being a professional nurse or midwife. As nursing continues to advance, updating the code is crucial to maintain professional and safe practice. DESIGN: This project utilized a cross-sectional descriptive design. METHODS: A survey was developed incorporating Likert-type scale assessments of the 7 value statements from the 2018 Australian Nurses' Code of Conduct for familiarity and importance. The survey included open-ended questions to elicit clinical nurses' experiences of conduct breaches, opinions regarding usefulness and relevance of the code for current practice. Data were collected at an acute care hospital in Sydney during January 2018. RESULTS: Significant differences relating to cultural and patient-centred approaches were revealed in the study. The new value involving the role of research was least understood and ranked least important by nurses and midwives. Professional 'integrity' resonated with participants when considering the behaviour of nurses, and short, unambiguous values were the most popular. Additionally, a substantial number of participants had no knowledge of the code or were not aware of the recently revised version. CONCLUSION AND IMPLICATIONS FOR NURSING: A code of conduct provides structure and guidance for workplace values and principles. A respected code is important to the nursing profession to help prevent inappropriate and incompetent behaviour and as a guide for nursing performance. Nurses in this study claimed the code was highly relevant to their work as a nurse and was incorporated into their daily practice.


Assuntos
Códigos de Ética , Tocologia/normas , Cuidados de Enfermagem/normas , Austrália , Estudos Transversais , Disciplina no Trabalho/ética , Feminino , Humanos , Masculino
5.
J Grad Med Educ ; 11(3): 307-312, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31210862

RESUMO

Background: State medical licensing boards ask program directors (PDs) to complete verification of training (VOT) forms for licensure. While residency programs use Accreditation Council for Graduate Medical Education core competencies, there is no uniform process or set of metrics that licensing boards use to ascertain if academic competency was achieved. Objective: We determined the performance metrics PDs are required to disclose on state licensing VOT forms. Methods: VOT forms for allopathic medical licensing boards for all 50 states, Washington, DC, and 5 US territories were obtained via online search and reviewed. Questions were categorized by disciplinary action (investigated, disciplined, placed on probation, expelled, terminated); documents placed on file; resident actions (leave of absence, request for transfer, unexcused absences); and non-disciplinary actions (remediation, partial or no credit, non-renewal, non-promotion, extra training required). Three individuals reviewed all forms independently, compared results, and jointly resolved discrepancies. A fourth independent reviewer confirmed all results. Results: Most states and territories (45 of 56) accept the Federation Credentials Verification Service (FCVS), but 33 states have their own VOT forms. Ten states require FCVS use. Most states ask questions regarding probation (43), disciplinary action (41), and investigation (37). Thirty-four states and territories ask about documents placed on file, 36 ask about resident actions, and 7 ask about non-disciplinary actions. Eight states' VOT forms ask no questions regarding resident performance. Conclusions: Among the states and territories, there is great variability in VOT forms required for allopathic physicians. These forms focus on disciplinary actions and do not ask questions PDs use to assess resident performance.


Assuntos
Revelação , Internato e Residência/normas , Licenciamento em Medicina/legislação & jurisprudência , Disciplina no Trabalho , Humanos , Competência Profissional , Má Conduta Profissional , Estados Unidos
6.
J Leg Med ; 39(1): 15-34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141457

RESUMO

Medical regulators have a responsibility to protect, promote, and maintain the health and safety of patients. Here, we compare and contrast the processes for addressing concerns about doctors in four countries with legal systems based on English common law: the UK, Australia, the United States, and Canada. The legal provisions underpinning each jurisdiction's disciplinary processes depict distinctive outlooks from the different authorities as each works toward the same goal. The initial stages of the investigation process are broadly similar in all of the jurisdictions examined. Each process, however, has subtle differences with regard to its comparators. Factors include how matters of discipline are framed, the constitution of disciplinary panels, and how the perceived independence of these panels all philosophically affect the public safety remit of each regulator. This work constitutes the first comparison of international regulatory frameworks for the profession of medicine.


Assuntos
Disciplina no Trabalho/legislação & jurisprudência , Médicos/legislação & jurisprudência , Médicos/normas , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/normas , Austrália , Canadá , Humanos , Internacionalidade , Jurisprudência , New York , Segurança do Paciente , Inabilitação do Médico/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Responsabilidade Social , Reino Unido
9.
Acad Med ; 94(6): 847-852, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30768464

RESUMO

PURPOSE: Lack of specialty board certification has been reported as a significant physician-level predictor of receiving a disciplinary action from a state medical board. This study investigated the association between family physicians receiving a disciplinary action from a state medical board and certification by the American Board of Family Medicine (ABFM). METHOD: Three datasets were merged and a series of logistic regressions were conducted examining the relationship between certification status and disciplinary actions when adjusting for covariates. Data were available from 1976 to 2017. Predictor variables were gender, age, medical training degree type, medical school location, and the severity of the action. RESULTS: Of the family physicians in this sample, 95% (114,454/120,443) had never received any disciplinary action. Having ever been certified was associated with a reduced likelihood of ever receiving an action (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.30, 0.40; P < .001), and having held a prior but not current certification at the time of the action was associated with an increase in receiving the most severe type of action (OR = 3.71; 95% CI = 2.24, 6.13; P < .001). CONCLUSIONS: Disciplinary actions are uncommon events. Family physicians who had ever been ABFM certified were less likely to receive an action. The most severe actions were associated with decreased odds of being board certified at the time of the action. Receiving the most severe action type increased the likelihood of physicians holding a prior but not current certification.


Assuntos
Disciplina no Trabalho/estatística & dados numéricos , Médicos de Família/educação , Conselhos de Especialidade Profissional/organização & administração , Adulto , Certificação , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Faculdades de Medicina , Estados Unidos
12.
Am J Bioeth ; 19(1): 16-34, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30676904

RESUMO

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.


Assuntos
Análise Ética , Ética Médica , Prescrição Inadequada/estatística & dados numéricos , Licenciamento em Medicina/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Médicos/legislação & jurisprudência , Má Conduta Profissional/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Disciplina no Trabalho , Humanos , Prescrição Inadequada/ética , Prescrição Inadequada/legislação & jurisprudência , Licenciamento em Medicina/ética , Licenciamento em Medicina/estatística & dados numéricos , Imperícia/legislação & jurisprudência , Médicos/ética , Má Conduta Profissional/ética , Má Conduta Profissional/legislação & jurisprudência , Delitos Sexuais/ética , Delitos Sexuais/legislação & jurisprudência , Estados Unidos
13.
20 Century Br Hist ; 30(3): 321-346, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30544173

RESUMO

This article considers the breakdown in discipline in the British Army which occurred in Britain and on the Western Front during the process of demobilization at the end of the First World War. Many soldiers, retained in the army immediately after the Armistice, went on strike, and some formed elected committees, demanding their swifter return to civilian life. Their perception was that the existing demobilization system was unjust, and men were soon organized by those more politically conscious members of the armed forces who had enlisted for the duration of the war. At one stage in January 1919, over 50,000 soldiers were out on strike, a fact that was of great concern to the British civilian and military authorities who miscalculated the risk posed by soldiers. Spurred on by many elements of the press, especially the Daily Mail and Daily Herald, who both fanned and dampened the flames of discontent, soldiers' discipline broke down, demonstrating that the patriotism which had for so long kept them in line could only extend so far. Though senior members of the government, principally Winston Churchill, and the military, especially Douglas Haig and Henry Wilson, were genuinely concerned that Bolshevism had 'infected' the army, or, at the very least, the army had been unionized, their fears were not realized. The article examines the government's strategy regarding demobilization, its efforts to assess the risk of politicization and manage the press, and its responses to these waves of strikes, arguing that, essentially, these soldiers were civilians first and simply wanted to return home, though, in the post-war political climate, government fears were very real.


Assuntos
Militares/história , Greve/história , Disciplina no Trabalho/história , História do Século XX , Reino Unido , I Guerra Mundial
14.
Curr Pharm Teach Learn ; 10(11): 1512-1517, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30514543

RESUMO

BACKGROUND AND PURPOSE: The purpose of this project was to impact pharmacy students' personal and professional development through simulation of a board of pharmacy disciplinary hearing regarding addiction. EDUCATIONAL ACTIVITY AND SETTING: The mock board hearing was conducted as part of the required curriculum. Faculty obtained materials from a prior board hearing. The actual respondent, lawyer, former executive director, and a board agent participated. Students served as board members and president, asked questions of the witnesses, and deliberated per board procedure. After the event, student learning and perceptions were assessed through knowledge-based, opinion-based questions, and open-ended questions. FINDINGS: Of the 141 students who attended the event, 97% completed the assessment. The average score on the knowledge-based questions was 95%. Ratings of perceptions and reflections of the experience were used in tandem to understand the experience. In general, students indicated the experience was positive and impactful towards their education. Students indicated they felt that the experience allowed them to better understand addiction and empathize with someone called before the board. In fact, there were fundamental differences in perceptions regarding the "addicted person," going from a penalizing and stigmatized perspective to one of caring and compassion. SUMMARY: Students were knowledgeable about the board and its regulatory process after the event. More than knowledge, students indicated fundamental changes in their views of addiction. Other institutions may consider implementing similar exercises to engender empathy and professionalism regarding drug addiction and regulatory compliance.


Assuntos
Empatia , Disciplina no Trabalho/métodos , Legislação de Medicamentos/tendências , Profissionalismo/educação , Estudantes de Farmácia/psicologia , Atitude do Pessoal de Saúde , Currículo/tendências , Educação em Farmácia/métodos , Avaliação Educacional/métodos , Humanos , Organização e Administração , Estudantes de Farmácia/estatística & dados numéricos
17.
J Med Ethics ; 44(11): 739-742, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30121629

RESUMO

Recent years have seen the rise of 'Just Culture' as an ideal in the patient safety movement, with numerous hospitals and professional organisations adopting a Just Culture response to incidents ranging from non-culpable human error to intentional misconduct. This paper argues that there is a deep problem with the Just Culture model, resulting from its impoverished understanding of the value of punitive, fundamentally backward-looking, practices of holding people accountable. I show that the kind of 'accountability' and 'punishment' contemporary Just Culture advocates endorse disrespects both patients and providers. I claim, first, that punishment is good because it respects participants in the healthcare system by restoring an equilibrium of social and moral status that wrongdoing disturbs, and, second, that it only does so when it communicates a backward-looking message of resentful blame.


Assuntos
Cultura , Punição , Responsabilidade Social , Disciplina no Trabalho/ética , Ética Médica , Humanos , Segurança do Paciente , Respeito
18.
Anesthesiology ; 129(4): 812-820, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29965814

RESUMO

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: In 2000, the American Board of Anesthesiology (Raleigh, North Carolina) began issuing time-limited certificates requiring renewal every 10 yr through a maintenance of certification program. This study investigated the association between performance in this program and disciplinary actions against medical licenses. METHODS: The incidence of postcertification prejudicial license actions was compared (1) between anesthesiologists certified between 1994 and 1999 (non-time-limited certificates not requiring maintenance of certification) and those certified between 2000 and 2005 (time-limited certificates requiring maintenance of certification); (2) within the non-time-limited cohort, between those who did and did not voluntarily participate in maintenance of certification; and (3) within the time-limited cohort, between those who did and did not complete maintenance of certification requirements within 10 yr. RESULTS: The cumulative incidence of license actions was 3.8% (587 of 15,486). The incidence did not significantly differ after time-limited certificates were introduced (hazard ratio = 1.15; 95% CI, 0.95 to 1.39; for non-time-limited cohort compared with time-limited cohort). In the non-time-limited cohort, 10% (n = 953) voluntarily participated in maintenance of certification. Maintenance of certification participation was associated with a lower incidence of license actions (hazard ratio = 0.60; 95% CI, 0.38 to 0.94). In the time-limited cohort, 90% (n = 5,329) completed maintenance of certification requirements within 10 yr of certificate issuance. Not completing maintenance of certification requirements (n = 588) was associated with a higher incidence of license actions (hazard ratio = 4.61; 95% CI, 3.27 to 6.51). CONCLUSIONS: These findings suggest that meeting maintenance of certification requirements is associated with a lower likelihood of being disciplined by a state licensing agency. The introduction of time-limited certificates in 2000 was not associated with a significant change in the rate of license actions.


Assuntos
Anestesiologistas/normas , Certificação/normas , Competência Clínica/normas , Disciplina no Trabalho/normas , Licenciamento em Medicina/normas , Conselhos de Especialidade Profissional/normas , Adulto , Certificação/métodos , Estudos de Coortes , Disciplina no Trabalho/métodos , Feminino , Seguimentos , Humanos , Masculino , Estados Unidos
19.
Psychol Assess ; 30(8): 1039-1048, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29708371

RESUMO

Screening for public safety positions (e.g., police officers, fire fighters, military service members) is a difficult and challenging task. Notably, the military has been widely criticized because of the general lack of an empirically based system or program for mental health screening. The purpose of the present study is to describe the use of statistical prediction rules for this task. Prediction rules were derived and validated using U.S. Air Force (USAF) recruits in basic military training (N = 50,322). Items from the Lackland Behavioral Questionnaire were used as predictors. General attrition (discharge for any reason before completing term of service) and disciplinary offenses (including criminal charges) were used as outcomes. For trainees in the top 2% or 1% of the general attrition prediction rule, 63% and 68% were discharged before they completed their first 4 years. The base rate was 25%. Similarly, for trainees in the top 2% or 1% of the disciplinary offenses prediction rule, 35% and 39% had a significant disciplinary offense over the following 4 years. The base rate was 15.5%. The results suggest that we may be able to use biographical data inventories and statistical prediction rules to identify a small percentage of trainees in public safety fields with significant mental health or behavioral histories who are at elevated risk for general attrition and disciplinary offenses. (PsycINFO Database Record


Assuntos
Transtornos Mentais/diagnóstico , Saúde Mental , Militares/psicologia , Adolescente , Disciplina no Trabalho/estatística & dados numéricos , Feminino , Bombeiros/psicologia , Humanos , Masculino , Programas de Rastreamento , Polícia/psicologia , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
20.
Biomed Res Int ; 2018: 6482507, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29707574

RESUMO

This paper aims to promote a national and international occupational health and safety (OHS) intervention for small and medium enterprises (SMEs) within internal and external resources. Based on the characteristics of small SME management, the work environment and occupational health may be positively affected by the dual-effects of employees and government. Evolutionary game theory is utilized to identify relevant interactions among the government, small enterprises, and employees. Furthermore, dynamic simulations of the evolutionary game model are used to explore stability strategies and to identify modes of equilibrium.


Assuntos
Disciplina no Trabalho , Teoria do Jogo , Modelos Teóricos , Saúde do Trabalhador , Setor Privado , Segurança , Comportamento Social , Humanos
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