From decisions on fetal surgery to dental education for pediatric cardiologists to moral distress among nurses and doctors, nine studies sponsored by The University of Texas Health Science Center at Houston (UTHealth) have received grants to explore the ethical intricacies shared by different health care professions.
Awarded by the Program in Interprofessional Ethics at UTHealth Medical School’s McGovern Center for Humanities and Ethics, the grants aim to spur “creative, out-of-the-box thinking” from researchers who forge interdisciplinary collaborations in examining ethics issues and their impact on health care, said Jeffrey Spike, Ph.D., professor and Samuel E. Karff chair in the McGovern Center and director of Campus-Wide Ethics Program at UTHealth.
Spike and Susan Benedict, Ph.D., R.N., co-director of the Program in Interprofessional Ethics, are part of a committee that selected the grant recipients. The studies chosen include four that received funding in 2012 and five in 2013, with each grant ranging from $3,700 to $10,000.
“Compared to research grants of some organizations that sometimes can amount to the millions, these are really minigrants for a pilot program to test a hypothesis, which might yield a larger study down the road,” Spike said. “Albeit the amount, the grants are stimulating to the researchers. With the grants, they are contributing some empirical data to fields that were originally mostly philosophical or reflective in nature.”
The studies were awarded for the originality and significance of the research topics, their educational value, practicality, potential and measured impact, as well as the depth of discussion on ethics.
Breaking out of silos
Cross-discipline collaboration was another criterion for funding. In these research projects, UTHealth investigators have teamed up with researchers from other UTHealth schools and programs or other universities and health care institutions for studies of common ethical problems facing various professions.
Medical education and research have been largely occurring in silos across the nation, in which work is confined to only one particular discipline without collaboration with others, Spike noted. The interprofessional ethics research grant program is part of UTHealth’s efforts to tear down such walls to help effect medically comprehensive and culturally and ethically appropriate patient care.
“We need to break out of these silos and try to find ways to engage in interprofessional ethics education and research,” he said. “If different ethics are taught and practiced in different disciplines and medical professions, it’s going to lead to conflict. You don’t want dentists and dental hygienists to have different ethical standards, for instance.
“Although ethics today still remains mostly library scholarship, there is growing interest among health care educators and providers in its empirical research. Our minigrants program is a step in that direction.”
Grant recipients hope their studies will yield data that help medical professionals in different disciplines understand each other’s work, identify common issues and concerns, resolve interprofessional conflicts and find solutions to improve patient care.
Finding common solutions
“My project has to be an interprofessional study by nature,” said Yang Gong, M.D., Ph.D., associate professor of health informatics at UTHealth School of Biomedical Informatics. His research involving Houston physicians and nurses seeks to unravel barriers to medical error reporting and find technical solutions to encourage voluntary, confidential and accurate reporting.
“Across the nation, medical errors are severely underreported, about half of them are not documented as shown by a study,” he said. “I hope my study will fill a gap in the study of those barriers and help remove them.”
Medical professionals are often in an ethical dilemma whether to report medical errors. Doctors are faced with reporting their own or their colleagues’ errors while nurses, under the pressure of the hospital hierarchy, have to decide if they report doctors’ mistakes.
Gong said his study aims to spur interprofessional understanding of the obstacles to reporting and foster awareness that patient safety trumps all concerns. He plans to expand his study to include people from more medical professions, such as lab managers, nutritionists, and radiology and physical therapists.
In their project, Gary Badger, D.D.S., M.S., chair of the Department of Pediatric Dentistry at UTHealth School of Dentistry, and collaborator Keila Lopez, M.D., M.P.H., assistant professor of pediatric cardiology at Baylor College of Medicine and Texas Children’s Hospital, are exploring how pediatric cardiologists and dentists can work together to improve oral health of children with congenital heart disease in light of a link between poor dental health and increased infectious endocarditis, an infection of the inner layer of the heart.
“The objective is to educate cardiologists, pediatric cardiologist fellows and pediatrics residents in the dental caries risk assessment for children and adolescents with congenital heart disease,” Badger said. “The cardiologists in turn will provide guidance and education to pediatric dentistry residents on issues of importance when treating such patients.”
A key goal is to develop a protocol for referral for needed dental care to eradicate tooth decay for young patients before a heart surgery, Badger added.
Spike said Badger’s study tackles a poignant ethical issue.
“So many poor children can’t find dentists. It’s rarely insured,” Spike said. “So we’re trying to find a way to address this health disparity, focusing on the population whose lives could be at risk from lack of dental care.”
Spike described all nine grant-funded studies as pioneering endeavors to find solutions to common problems that affect different professions.
“We hope more researchers will apply for this grant to further UTHealth’s interprofessional ethics work efforts,” he said.
A synopsis of the grant-awarded studies
Interprofessional ethics in medical errors reporting: Led by Yang Gong, M.D., Ph.D., associate professor of health informatics at UTHealth School of Biomedical Informatics, the project investigates the ethical dilemma between physicians and nurses with regard to the reporting of medical errors. Co-investigators include Nnaemeka Okafor, M.D., M.S., assistant professor of emergency medicine at UTHealth Medical School; and Maureen Beck, M.S.N., R.N., co-medical director of UTHealth Center for Healthy Aging.
Innovative health care models to reduce pediatric oral health disparities, enhance ethical awareness of health disparities and improve interdisciplinary training for medical and dental professionals: The project aims to develop and pilot an application of the Chronic Care Model to understand barriers to oral health care, increase oral health knowledge, increase dental screenings, referrals and access, and create a unique training model for pediatric and dental trainees through a subspecialty venue. Investigators are Gary Badger, D.D.S., program director and chairman of pediatric dentistry at UTHealth School of Dentistry; and Keila Lopez, M.D., M.P.H., assistant professor of pediatric cardiology at Texas Children’s Hospital and Baylor College of Medicine.
Nursing and dental ethics: Led by Joan Engebretson, Dr.P.H., R.N., Judy Fred professor of nursing at the School of Nursing, the project seeks to expand understanding and awareness of ethical issues facing nurses, dentists and dental hygienists.
Interprofessional humanities and dental ethics: Conducted by Catherine Flaitz, D.D.S., M.S., professor of diagnostic and biometrical sciences at UTHealth School of Dentistry; Nathan Carlin, Ph.D., director of UTHealth Medical School’s Medical Humanities and Ethics Certificate program; and David Taylor, Ed.D., associate professor of health informatics at UTHealth School of Biomedical Informatics, the project aims to develop an interprofessional and sequential curriculum for dental and dental hygiene students leading to a certificate in clinical humanities and ethics.
Ethical decision-making: Tools for health care professionals: Undertaken by Janelle Rios, Ph.D., director of continuing education at the Southwest Center for Occupational and Environmental Health at the UTHealth School of Public Health, the study seeks to develop a fully-credentialed online continuing education course in ethical decision-making for UTHealth nurses and physicians.
Personal and professional impact of moral distress in interprofessional health care providers: The project identifies and compares the types of moral distress in Houston dentists, nurses, dental hygienists and physicians, as well as its personal and professional impact. Investigators include Deborah Jones, Ph.D., R.N., assistant dean of undergraduate programs and assistant professor at UTHealth School of Nursing; Donna Warren-Morris, R.D.H., M.Ed., professor and member of Dean’s Academy of Distinguished Teaching Scholars at UTHealth School of Dentistry; June Sadowsky, D.D.S., M.P.H., associate professor and dentist geriatrician at UTHealth School of Dentistry; Bela Patel, M.D., assistant dean of Healthcare Quality, division director for Critical Care Medicine at UTHealth Medical School, and assistant chief medical officer and executive medical director of Critical Care for Memorial Hermann Hospital-Texas Medical Center; and Yang Gong, M.D., Ph.D., associate professor at UTHealth School of Biomedical Informatics.
Parental decision-making for an unborn child with spina bifida: The study looks into various aspects of decision-making faced by parents of an unborn child with spina bifida, including the frequency of pursuing or not pursuing surgery and factors involved in making decisions. Investigators are Lynnette Mazur, M.D., M.P.H., professor of pediatrics at UTHealth Medical School and pediatric consultant for the Texas Fetal Center ; and Anthony Johnson, D.O., Ken Moise, M.D., and Kuojen Tsao, M.D., co-directors of the Texas Fetal Center; and Sangbum Choi, Ph.D., statistician at UTHealth School of Public Health.
Ethical dilemma in surgical interventions for fragility hip fractures in older dementia patients: The research examines how clinical teams decide for or against surgical intervention for hip fractures in patients with dementia at least age 65. Investigators include three researchers from UTHealth Medical School: Nahid Rianon, M.B.B.S., Dr.P.H., assistant professor of geriatric and palliative medicine; Catherine Ambrose, Ph.D., associate professor of orthopedic surgery; Paula Knudson, special advisor to the Center for Clinical Research and Evidence-Based Medicine; and Sheryl McCurdy, Ph.D., assistant professor of health promotion and behavioral sciences at UTHealth School of Public Health.
Enhancing ethical decision-making in an interprofessional team dealing with end of life care in a vulnerable patient population: The project evaluates team members’ prioritization of ethical core values both overall and in relation to specific end-of-life ethical scenarios, conducted by researchers at UTHealth Medical School, including Rebecca Wiatrek, M.D., assistant professor of surgery; Cheryl Person, M.D., assistant professor of psychiatry and behavioral sciences; Andrea Taylor, Ph.D., assistant professor of psychiatry; and Jeanette Ferrer, D.O., assistant professor of geriatric and palliative medicine, in addition to Kathleen Sexton, L.C.S.W., clinical case management program coordinator at Harris Health System-Lyndon B. Johnson General Hospital.
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