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LeagueTLC Innovation Express
Exploring Issues, Innovations, and New Developments
with Information Technology Professionals


Institute for Ethics
in Health Care

Miami-Dade Community College

Medical Center Campus
 


A secretary, unable to read a doctor’s prescription, asks another doctor to interpret the handwriting. In doing so, does she breach patient confidentiality?

What is the ethical responsibility of the health care provider to further investigate a client’s claim that he is HIV positive?

And, given what little we know about coma patients, how conscious, after all, is conscious?

These are the kinds of questions raised and discussed on Miami-Dade Community College’s (M-DCC) Institute for Ethics in Health Care website. Launched in 2001 by faculty on the college’s Medical Center Campus, the site includes information about the institute’s activities, provides links to other health care-related home pages, and serves as a resource to apprise the community of upcoming ethics-oriented conferences.

The website is an outgrowth of M-DCC’s commitment to the incorporation of ethics throughout the curriculum. The Medical Center Campus offers 16 associate-degree and 12 short-term certificate programs in nursing and allied health. The Institute for Ethics in Health Care was developed to help support college values and to help faculty teach health care-related ethical concepts to the student population. These values include the respect for individuals from a variety of cultural backgrounds, the provision of role models, the offering of interdisciplinary educational programs, and the teaching of students about the cultural, economic, political, and social environments in which they live. Funding from the Department of Education Fund for the Improvement of Post-Secondary Education (FIPSE) and the Hugoton Foundation supports the institute’s activities.

The Medical Center Campus is one of six campuses of Miami-Dade Community College, one of the largest multicampus community colleges in the United States. In the academic year 2002-2003, 1,167 students were graduated from the Medical Center Campus. Committed to their health care professions and to their community, 95 percent of the graduates stayed and are employed in the South Florida area.

The Medical Center Campus student population is cultural diversity of the region. More than 52 percent of the student body is Hispanic, and more than 30 percent is African American. Students come from virtually every South and Central American country and the Caribbean Islands. Over half of the students speak Spanish or French as a primary language, and many speak their primary language at home. These students bring with them a variety of cultural and ethical experiences and values, and sometimes those values clash with the professional ideals of health care providers practicing in the United States.

Institute activities are designed to help students identify and understand professional ethical practice and standards and to provide them with the knowledge and skills necessary to practice ethically in their work environments. Faculty provide within their curriculum and classwork the knowledge and skills necessary to practice professional ethics within the health care arena.

Through the institute, faculty and students address contemporary ethical challenges in health care. In its second year, approximately 40,500 visitors viewed the site. M-DCC’s Medical Center Campus is also collaborating with Plattsburgh State University/SUNY and Utah State College in the development of case studies and analyses for eventual dissemination to faculty who can use them in the classroom. A serial format with layers was designed so that faculty could use the case briefly or extensively, depending on the course objectives and educational level of the student.

One case study is titled “Confidentiality vs. the Duty to Warn.” It is an exercise in applied bioethics, and the case evolves as students ask questions and learn about the situation. As the case progresses, the ethical questions that arise become increasingly complex. The same situation may have different meanings and promote different levels of discussion for students in community colleges and universities.

The institute and its partners have also developed an evaluation framework for assessing student responses to cases, as well as an evaluative matrix for making judgments about the student responses

The concept of the institute grew out of the work of Frances Aronovitz, director of the School of Nursing; Susan Kass, professor and program coordinator in Dental Hygiene; and Carol Petrozella, professor in the School of Nursing and Medical Center Campus training and development coordinator. An advisory committee sets the direction for institute activities through strategic planning and evaluates the programs it provides. The committee is composed of members of the community and college faculty from across disciplines and campuses. Philosophy faculty from other campuses teach a required Associate in Science degree core course called Critical Thinking/Ethics.

These faculty have strong backgrounds in ethics and stimulate the discussions at advisory committee meetings. The committee includes faculty from other universities in the area. Community members include an attorney who specializes in guardianship activities, an organ procurement coordinator from the University of Miami School of Medicine, and a physician who is well known for his philanthropic activities in the community. Several members also belong to other community health care ethics committees. One of the nurses, an advanced registered nurse practitioner in private practice, worked on the ethics component of the Human Genome Project. The director of the University of Miami’s bioethics program is also a member of the committee. Through collaborative relationships, the two organizations compliment and support one another rather than compete.

The Mission of the Institute for Ethics in Health Care is to

  • Create awareness in the community of ethical issues in health care;
  • Impart to faculty and students the skills and background needed to apply critical thinking and ethics in their disciplines;
  • Promote a forum through which skills and decision making related to ethical issues in health care can be addressed; and
  • Promote collaboration among disciplines.

Institute Director Petrozella has been granted partial release time for her work on the website. The webmaster is also a college employee who is paid separately for her work with the institute. A consultant with expertise in bioethics assists in answering some of the questions posed by students either on the website or in classes, and several faculty have been given partial release time to develop special projects.

Petrozella is available to students, faculty, and the community for support. She presents seminars for the college and the community on an ongoing basis, and she makes presentations to classes across disciplines regarding ethical decision making and increasing the awareness of faculty and students on the current ethical issues in health care. The goal of these presentations is to increase faculty and student knowledge and awareness of current biomedical ethical issues by facilitating classroom and clinical discussions.

The director is responsible for maintaining and monitoring the interactive website. It is a resource for the community, faculty, and students, and it includes current links to other professional sites, examples of course syllabi teaching strategies, the forum for questions and discussion, and research papers that comprise abstracts of theses and dissertations from colleagues in the community. Visitors to the website can use an electronic comment card that can be used for open discussion or sent directly to the director for analysis. As director, Petrozella consults with advisory committee members to develop responses to questions received on the site. And the site has a counter for visitors, as well as e-mail access to the webmaster for comments and questions.

The website also serves as a resource for faculty to integrate technology into the classroom. One of the current projects is the Ethics Primer, a faculty-initiated project. This extensive PowerPoint presentation is available on the website as a benefit to the community. The aim of the primer is to give faculty a resource to teach health care ethics across medical disciplines.

Brochures describing the website were distributed throughout the local health care community and other institutions, and the institute has collaborated with several professional organizations in disseminating information about the site. Included in these affiliations are the Florida Nurses Association, the Florida Bioethics Network, and the South Florida Bioethics and Health Law Working Group.

In 2002, the website launched a newsletter, The Ethical Times. It features information about institute activities and conferences. A nurse ethicist contributed an article titled “Ethics is in the Eye of the Beholder,” and the article is linked to the M-DCC home page, the campus home page, and the School of Nursing and School of Allied Health home pages, respectively. The site also provides an address book for those interested in obtaining copies of the newsletter.

In April of 2003, the Ethics Primer and website were presented at the University of Miami’s Nova Ethics Law Working Group, and the presentation was met with enthusiasm and accolades. In 2002, a poster presentation was made at the FIPSE Project Directors’ meeting in San Diego. In the fall of 2003, the primer will be presented during the Ethics Forum at the Florida Nurses Association Convention.

Summary and Lessons Learned

The site continues to gain in number of hits, although Director Petrozella has no way of identifying these visitors. The webmaster reported a large group from Texas visiting the website in 2003, and institute facilitators drew the assumption that a professor somewhere in that state had assigned the website as a resource or curricular tool.

The site’s address book is offered so that visitors can sign in and stay connected. Project teams are also exploring new avenues for generating interest in the newsletter, The Ethical Times, whose content and appearance on the site has won high praise.

M-DCC’s Institute for Ethics in Health Care and its website represent an ongoing commitment to promote ethics across curricula at M-DCC. The website’s founders and facilitators continue to look for ways to make it even more interactive. It is emerging as an outstanding example of collaboration, imagination, and dedication to ethics in the health care community at Miami-Dade.

For comments, suggestions, or more information, contact:

Carol Petrozella
Director
Institute for Ethics in Health Care
Miami-Dade Community College


 
 

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