Interprofessional Education and Ethics: introduction Ethics SIG 11 November 2006

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Interprofessional Education and Ethics
introductionEthics SIG 11 November 2006

• Dr Marion Helme
• UK Higher Education Academy

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European Interprofessional Education Network
Learning together to work together


Uczyc sie razem i od siebie aby razem racowac
Az együttes tanulástól a közös munkáig

Lära tillsammans för att arbeta tillsammans
Opimme yhdessä työskentelemään yhdessä
?a?a????µe µa?? ??a ?a d???????µe µa??
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IPE and ethics discussion points

• Definition of interprofessional education
• IPE - what works
• IPE - problems
• IPE and ethics
• Differences between professions (theorising)
• Ethics as a focus of interprofessional learning
• IPE as opportunity to debate professional
  ethics
• Example (1) A code of ethics for students from
  different professions learning together
• Example (2) A code of ethics in interprofessional
  practice for praction
• Example (3) Topics for learning together
• Challenges for ethics in IPE

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Definition of interprofessional education

• Interprofessional Education occurs when two or
  more professions learn with, from and about each
  other to improve collaboration and the quality of
  care
  
  
• CAIPE 2002 (Reflection on this definition just
  published on www.caipe.org)
• (improve and quality imply value judgements)

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Doing it (IPE) what works (from research)

• Parity of esteem between learners sustained and
  maintained by ground rules and facilitation
• The right time (for the particular learning
  opportunity)
• Good questions (not showing up differences in
  academic proficiency or leading to competition or
  implicitly stereotyping eg. which of you knows
  most about the other profession)
• Connecting IPE and the rest of the curriculum
  (integration)
• Respecting students choice of profession
• Facilitators as fire-stokers (enthusiastic)
• Related to practice learning and involving
  patients or simulated patients. IPE needs an
  idea that matters to people.
• Skilled facilitators/teachers in HEIs and
  practice

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Doing it problems (what doesnt work from
research)

• Lack of detailed attention to field specific
  content
• Limited opportunity for interactive learning
• Curriculum creep (adding to rather than
  integrating in the curriculum) and duplication
  (especially in terms of student assessment)
• Insufficient integration between classroom and
  practice learning experiences (contextualisation)
• (Not recognising) Limitations in transferability
  of learning and need for reinforcement,
  development, stages etc.
• Assessment (no assessment, an option)
• Lack of attention to language (different
  terminology, same terms different meaning,
  omissions (health and social care) )

Aveyard, H., S. Edwards, et al. (2005). "Core
topics of health care ethics. The identification
of core topics for interprofessional education."
Journal of Interprofessional Care 19(1).
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Sometimes neglected in IPE conceptualisations
and explanations of differences between
professions

• In terms of traditions, epistemologies,
  languages, cultures
• Values constrain, and sometimes control, much
  of what the people in any culture do and do not
  do. Moreover the values vary enormously from one
  culture to another. (Kline, S. J. (1995).
  Conceptual Foundations for Multidisciplinary
  Thinking. Stanford, CA, Stanford University
  Press)
• In terms of each other (decision-making
  hierarchies, spheres of responsibility, power
  over , legitimate actions)
• In terms of purpose and task (the
  needs/circumstances of the patient/service
  user/carer (patient-centred care, power to )
  and community)

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Differences in professional orientiations with
regard to ethical practice and values (a
characterisation)

• Social work social justice, anti-discriminatory
  practice, inclusion
• Nursing the ethics of care and virtue ethics
• Medicine the Hippocratic Oath and the World
  Medical Declaration of Helsinki (It is the
  mission of the physician to safeguard the health
  of the people)

Eg. Armstrong, Alan E (2006) Towards a strong
virtue ethics for nursing practice Nursing
Philosophy Volume 7 Issue 3 Page 110 
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Codes of practice and IPE as opportunity to
debate professional ethics

• A personal starting point (used in teaching
  social workers)
• Social Workers should stop using social work
  values as a set of rules and start using them as
  markers of problematic areas on the map of social
  work ... Social work values emerge from
  disputation about practice - not from the deep
  soul of social work, however they have become
  rules used to present an image of social work to
  the world. Instead they should provide a duality
  - a statement of conflict rather than a guide on
  where to go. In areas such as
  anti-discrimination there is not one simple rule
  - judgements still have to be made ...
• Malcom Payne, Professor of Social Work,
  Manchester Metropolitan University, quoted in
  Professional Social Work May 1995.

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A Code that takes into account the position of
studentsKings College London Code of Ethics
and Professional Conduct for Healthcare
Professional Students (2006) (written by Dr
Elaine Gill), applied by health profession
students in first term first year
interprofessional module

• As a healthcare professional student you must
• Acknowledge/recognise your learning needs for
  knowledge, skills and attitudes and participate
  in learning opportunities to develop
  understanding, insight and competencies
  throughout training.
• When in contact with patients and members of the
  public you are to dress smartly and appropriately
  (in or out of uniform) and have your personal
  identification with you.
• Do not discriminate against student or
  professional colleagues or patients.
• Respect others beliefs and values and avoid
  forcing your own beliefs on others.
• Work with colleagues in ways that promote
  effective teamwork and acknowledge individual
  disciplines contribution to best serve patients
  interests and care.
• Respect the rights of patients and others to
  information, confidentiality and contribution to
  decision making.
• Demonstrate effective communication skills with
  patients, carers and colleagues.
• Respect the rights of patients and others to
  dignity in the learning environment and clinical
  practice.
• Recognise the level of your own capabilities and
  ensure the safety of patients at all times
  seeking help and advice when needed.
• Seek advice if you are concerned about issues of
  professional misconduct in the clinical setting.
  Do not remain silent.
• Be aware of the professional boundaries in
  relationships with patients and clients.
• Be responsible for your own behaviour and develop
  appropriate professional integrity.
• Be familiar with your own disciplines
  professional code of ethics, conduct and duties.

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Draft statement of interprofessional values
underpinning work with children and young
peopleThis statement is being developed by the
General Teaching Council in final draft for
publication early 2007. It includes statements
concerningValuing contributions made by
colleaguesTransparency and reliability Being
supportive of each others well being It states
thatSharing responsibility does not mean acting
beyond competence or responsibilitiesKnowledge,un
derstanding and skills may be different for
interprofessional work than own specialism
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Core topics for interprofessional ethics teaching
in health and social care (Aveyard, H., S.
Edwards, et al. (2005)).

• Ethical theory
• The professional duty of care, codes of practice
  and accountability
• Informed consent and patient refusal
• Confidentiality
• The vulnerable patient
• Research ethics
• Rationing

Other topics identified in discussion included
end of life, truth telling
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Challenges for ethics in interprofessional
education

• Fitting interprofessional with
  uniprofessional values and the perspectives of
  service users and carers (problematising the
  professional)
• Developing appreciation of the gap between the
  same code and different practice (enactment)
• Working with differences in terms and meanings
  (languaging)
• Including different orientations Hippocratic
  Oath/Helsinki, ethics of care/social justice