A computer simulation for teaching critical thinking skills

Telephone-based health services is a fast growing subspecialty of nursing practice. It is used in demand management and managed care organizations in a highly unregulated environment. The article presents background information and identifies the need for systematic studies of ethical implications inherent in telephone-based practice. Conclusions suggest that nurses need to become actively involved in ethical decision making related to this area of practice.     

Ethical issues in health education

Moral dilemmas abound during health education practice and ethical decisions have to be made. This article examines the contribution of the four guiding ethical principles (respect for autonomy, beneficence, non-maleficence and justice) to nurse decision making. Multidisciplinary ethical guidelines to assist health educators to serve the best interests of patients and clients are suggested.     

The ethical practice of psychology in a managed-care framework.

With the rise of managed healthcare, psychologists face new challenges to their professional ethics. This article examines the dilemmas posed by managed care in 3 areas: client care, the handling of patient data, and issues surrounding membership in a managed-healthcare organization. Case examples of ethical dilemmas and strategies for dealing with these challenges are presented. In an attempt to summarize the strategies used to cope with the ethical dilemmas presented in the case examples, global solutions for the ethical practice of psychology in a managed-care framework are also reviewed. These strategies include understanding managed-care policies, clear communication with the client, additional training, increased advocacy by clinicians, and ultimately, psychologists' involvement in the formation of these organizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building healthier communities in a managed care environment: opportunities for advanced practice nurses

Two paradigm shifts are occurring in health care: managed care and community partnerships. The distinct principles and trends of each paradigm are certain to determine the future practice of advanced practice nurses (APNs). The impact of managed care and community partnerships will affect the resource management, clinical decision making, and time management of APNs. Concomitantly, APNs will have opportunities to influence practice guidelines, individual and community decision making, cultural competence, and the cost-effectiveness of care in communities. Capitalizing on these opportunities will enhance the value of APNs to their managed care plan employer and their community.     

Protecting patient welfare in managed care: six safeguards

The public is very suspicious and fearful that managed care threatens their health because of its interest in reducing costs. Because physicians' decisions control 75 percent of all health care spending, managed care organizations are focusing their cost-cutting strategies on influencing physician decision making through financial incentives and guidelines. These two techniques have had some important contributions, especially in enhancing efficiency and standardizing care to a high level. Nevertheless, they pose a threat--and are perceived by the public to pose a threat--to patients' health and well-being. How can we mitigate the threats to patient welfare posed by financial incentives and guidelines? We propose and analyze six safeguards. These safeguards are not an attempt to revive the fee-for-service system, but an effort to make managed care ethical and to focus it on improving patient welfare. They are designed to work together to ensure that patient welfare remains the primary focus of managed care organizations; they try to create institutional structures that emphasize quality over mere cost reductions.     

Psychological practice and managed care: Results of the CAPP practitioner survey.

Practicing members of the American Psychological Association (APA) were surveyed regarding their work settings, activities, and greatest professional concerns in the managed care era. Results from 15,918 licensed psychologists indicated that half were full-time independent practitioners engaged principally in psychotherapy and assessment and another third were in part-time private practice. Four out of five reported a negative impact of managed care on their practices. Concerns about changes to practice and ethical dilemmas as a result of managed care policies were common to all settings. Relatively few differences were apparent between earlier and more recent generations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Did Hamlet need a Canadian Code of Ethics for Psychologists?.

Attempts to demonstrate the creativity inherent in the principles and ethical decision-making process in a Canadian Code of Ethics for Psychologists (CCEP). Shakespeare's Hamlet from The Tragedy of Hamlet, Prince of Denmark is presented to illustrate how the new CCEP guidelines for ethical decision making can help resolve moral dilemmas more constructively. The resolution of dilemmas faced by professional women and psychologists are also addressed. The CCEP facilitates creative problem solving by (1) explicitly stating 4 ethical principles around which all other values and standards are organized; (2) recognizing that when there is conflict, reaching the most ethical decision may be difficult; and (3) outlining the basic steps that typify approaches to ethical decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In case of ethical dilemma, break glass: Commentary on ethical decision making in practice.

Psychologists are regularly confronted by a wide range of ethical challenges for which no clear solution is apparent. Although the "Ethical Principles of Psychologists and Code of Conduct" (American Psychological Association, 2002) is of some help when one faces such dilemmas, it cannot provide definitive guidance or all needed answers. The process of ethical decision making is reviewed, and the use of different models for ethical decision making is explored. Case examples highlight representative challenges faced by psychologist practitioners. Three invited experts provide commentaries in response to the points made and questions raised. They discuss ethical decision making from their perspectives and make recommendations to practitioners for how they can conceptualize and address the dilemmas they will face in their practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychology of making ethical decisions: What affects the decision?

Individuals engage in an ethical decision-making process to solve ethical dilemmas. This empirical study of Navy chaplains explored the process of ethical decision making and the extent to which the characteristics of the moral situation influence the decision-making process. The results of the study are visually displayed in a model that pictures the steps in ethical decision making, which could be used as a teaching and training tool for professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Taking on managed care: One reviewer at a time.

The ethical standing of the managed care reviewer who would make determinations of medical necessity in mental health practice is called into question. The ethical standards governing each of the major mental health professions are reviewed in reference to this activity. Each profession has provisions in its standards suggesting that such utilization review of psychotherapy is, at least, of questionable ethical standing. The author describes his personal effort to hold each reviewer to account for these alleged breaches of professional ethics. A recommendation is made for the ethics officers of the respective mental health professions, in concert, to make explicit their respective professions' stance against such ethical misconduct when their members engage in such review. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rural nurse practitioners: perceptions of ethical dilemmas

The purposes of this study were to identify ethical dilemmas encountered by rural nurse practitioners in primary practice and to identify constraints or enhancers that influenced ethical decision making. Nine nurse practitioners from Wyoming and Colorado responded to in-depth interviews. Six categories of ethical dilemmas and a list of constraints and enhancers were identified. One central concept, conflict between personal values and professional responsibility, emerged. Beneficence, nonmaleficence, justice, and patient autonomy, as core ethical principles, were related to this central conflict.     

Mixed agency in military psychology: Applying the American Psychological Association ethics code.

Military psychology can diverge significantly from traditional psychological practice. Mixed-agency conflicts--those arising when a military psychologist's obligations to individual patients compete with obligations to the Department of Defense or federal regulations--can generate challenging ethical dilemmas. This article explores the notion of mixed agency within the military setting and addresses the most pertinent aspects of the American Psychological Association's (2002) Ethical Principles of Psychologists and Code of Conduct related to this ethical challenge. Case vignettes are presented as a means of illustrating key mixed-agency dilemmas and the effective navigation of these conflicts. The article concludes with several recommendations for military psychologists as they work to anticipate and effectively manage ethical dilemmas bearing on their dual identities as officer and health care provider. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introducing ethics to beginning psychologists: A problem-solving approach.

Beginning and practicing psychologists both need more exposure to ethical training experiences. A new Canadian code of ethics provides an opportunity for universities to review their approach to this experience for students in clinical and counseling psychology. In the Canadian code, four basic ethical principles, followed by value statements and standards of behavior, are proposed. This structure provides a useful framework for ethics education. In addition, the problem-solving approach to ethical and moral dilemmas provides a better decision-making process for new psychologists than does simple exposure to professional behavior guidelines. The approach used at the University of Alberta is presented with the recommendation that ethical instruction focus on personal values and the process of informed decision making as well as learning "correct" responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The foundation and application of ethical principles in rehabilitation psychology.

Reviews the basic principles from which ethical thought and decision making in health care evolved in terms of autonomy, justice, beneficence and nonmalfeasance, and care. The interface between American Psychological Association (APA) ethics code and general bioethics principles is presented. A discussion of the applications of these principles to rehabilitation and the unique roles of psychologists in ethical decision making is provided. Training issues and the development of values for which ethics training provides a foundation are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The new CPA Code of Ethics for Canadian psychologists: An education and training perspective.

Examines the value of the Canadian Psychological Association's (CPA [1986]) Code of Ethics as a tool for instruction in ethics and in ethical decision making. It is suggested that the code's principles of respect for the dignity of persons, responsible caring, integrity in relationships, and responsibility to society provide guidelines for evaluating ethical dilemmas. The code also provides an opportunity to examine hypothetical situations in terms of these principles, allowing psychologists to consider their ethical decision-making processes. The author's (1987) previous experiences in discussing ethical dilemmas developed by the CPA's Ethics Committee in a classroom setting are summarized. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An alternative to managed care: a "guild" model for the independent practice of psychotherapy

As health care is reconfigured by HMOs and managed care organizations, family therapists often have to decide whether or not to cooperate with the new power structures and their ways of doing things. The chief concern of many therapists is the ethical bind created when the managed care organization demands breaches of confidentiality or makes decisions about the course of treatment that may not, in the therapist's opinion, be in the best interest of the family. Associations of independent, nonmanaged care psychotherapists are springing up in response to these dilemmas. This paper describes the philosophical evolution and organizational development of one such association.     

Managed care: Strongly conflicting views.

Presents opposing viewpoints on the issue of managed care. R. R. Blanck considers managed care, if well regulated, to be rationed care with ethics. The example of the military's managed health care system (TRICARE) is presented as a model for the civilian community, and an initiative managed care program, BEHAVIORALCARE, is discussed. K. Shore contributes an argument in opposition of managed care, calling it immoral because it makes people powerless. It deprives patients of 3 basic rights: choice, privacy, and decision making. Because it cannot be adequately regulated, it should be replaced with a more pro-patient and democratic system. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contrast-sensitivity testing with scanning-laser ophthalmoscope stimulation in normal, ocular hypertensive, and glaucomatous patients

This article reviews the history, growth, and evolution of managed care in mental health and substance abuse treatment. Specific issues described are stigma, the important social dimensions and chronicity of some types of mental illness and chemical dependency, and reliance on the public sector for care. Opportunities and challenges for occupational therapists in the rapidly changing mental health system are discussed, including the use of interdisciplinary teams, the importance of measuring functional outcomes of interventions, the need to develop clinical guidelines, the importance of the community setting and a continuum of services, ethical dilemmas, and the importance of assertive occupational therapy advocacy and involvement in health care reform.     

Competency and consent in dementia

Health care for demented older persons presents a range of ethical dilemmas. The disease process affects cognitive abilities, making competency a central issue. The syndrome of dementia carries a complex social overlay that colors perceptions of these patients and of their capacity for making decisions. An argument is made for a coherent, ethically based decision-making process that can be applied across the whole spectrum of dementia severity. The major ethical principles implicated in assessing a patient's ability to consent to treatment are reviewed. A sliding scale model of capacity is presented, in which the patient's ability to decide is weighed against the risk associated with the treatment decision in question. This model preserves the autonomy of the demented patient while minimizing the potential for harm. In situations where the patient is deemed incapable, two approaches that can be applied to making treatment decisions are contrasted. The 'prior competent choice' standard stresses the values that the patient held while competent. The 'best interests' standard moves the focus to the patient's subjective experience at the time the treatment is considered. The relative merits of these two concepts are evaluated in the context of dementia. Surveys of actual decision-making practice are contrasted with ethical and legal principles. The challenges inherent to applying the best interests standard are discussed. Despite the pitfalls, this standard offers an opportunity to restore the demented patient's sense of self.