Although the management of Motor Neuron Disease (MND) remains devoid of a cure, persons affected by this devastating condition are nonetheless entitled to the best quality care that is available. A paucity of information exists documenting the perceptions of healthcare consumers regarding the management that is provided. In addition optimal healthcare comprises an intricate interaction of patient-centred care, patient-centred communication, and bioethical practice, and when these three dimensions are implemented according to acceptable standards, high-quality healthcare is perceived by the healthcare consumer. Given however the socio-political challenges that face healthcare systems, the management of MND needs to be considered against current trends in service delivery and the need for evidence-based medicine. An exploratory study was therefore conducted to investigate the perceptions of persons with MND and their family members regarding current medical and rehabilitative management. The sample comprised six persons with MND who presented with a communication impairment, as well as six family members. Participants’ perceptions were elicited through the use of a semi-structured interview schedule, and questions focused on healthcare professionals’ behaviours during healthcare encounters. In addition emphasis was placed on the potential of the communication impairment to influence management. A standardised dysarthria assessment was conducted to characterise the nature of the speech impairment in each person with MND. Qualitative responses obtained from the interviews were analysed in accordance with a matrix-based approach, while quantitative data from the dysarthria assessment were analysed using descriptive statistics. Despite individual variability, perceptions of both persons with MND and their family members revealed general dissatisfaction with regard to medical and rehabilitative management. The majority of persons with MND were not referred for intervention following diagnosis, and the recommended team approach for the management of MND was absent. In addition the bioethical practice of many healthcare professionals was deemed questionable, and the communication impairment was perceived to impose a significant burden on the healthcare encounter. Furthermore all participants perceived a lack of available support systems for persons with MND, and it was thus not uncommon for individuals to pursue complementary and alternative medicine. South Africa’s current healthcare climate also appeared to further limit healthcare for this clinical population. In an attempt to improve the management of MND, implications are provided in terms of health communication, intervention, bioethical practice, and support systems. A proposed new framework of ideal service delivery for healthcare consumers of MND management is also presented. Further implications are outlined with regard to the need for innovative models of service delivery in South Africa’s healthcare context, as well as the role of speech-language pathologists, other healthcare professionals, policy makers, and educators in the improvement of the medical and rehabilitative management of MND. Finally theoretical implications and implications for future research are also documented.

The number of international students in the U.S. is increasing, and a similar trend exists in the counselor education field. International students are defined as neither permanent residents nor U.S. citizens. It is therefore important for counselor educators to understand this population better in order to provide culturally appropriate career development training for them, as well as gain knowledge about their career decision-making process. While several studies have investigated international students’ experiences with language barriers or cultural adjustment concerns, little research explores their lived experiences regarding the choice to stay or return to their home countries after completing their doctoral training. Given the limitations of previous studies on international students’ career development, this study focused on the career decision-making experiences of a particular subgroup of international students, namely, South Korean women in counselor education programs. The overarching research question guiding this study is: How do Korean female doctoral students and counselor educators who trained in CACREP-accredited programs experience/experienced their career decision-making processes upon graduation? The sub-questions of this study are: 1) How do they decide to pursue a particular job, either in their home country or in the U.S.? 2) What values impacted their career decisions? The purpose of this qualitative study is to investigate the lived experiences of Korean female counselor educators who have decided on the location of their career upon graduation and explore how they made their decisions. Utilizing the phenomenological research method, this study aims to identify themes and patterns, as well as unique lived experiences in the career stories of Korean women counselor educators. Findings from this study illustrated the unique career-decision-making experiences of Korean female counselor educators. By exploring their experiences, the researcher found common values influenced their career decisions were: family, academic freedom, belongingness, desire to make a scholarly contribution, and self-awareness. Participants also struggled from challenges like fear, hesitation, and exhaustion; limited resources; visa issues; language barrier and cultural differences; lack of publications; and competitive job market. Lastly, Korean female counselor educators utilized support systems such as Korean community, family, and their doctoral programs. The findings provide insight into Korean female doctoral students’ career decision-making processes and contribute to U.S. university faculty and administrators' cultural awareness and understanding of the international student population in counselor education programs.

The importance of ethics in helping professions and ethics education in counselor preparation programs have been stressed and discussed greatly. In order to foster helping professionals' ethical behaviors to ensure clients' rights and welfare, professional organizations have developed codes of ethics to serve as guidelines for helping professionals in ethical decision making; accreditation bodies for counselor education programs also have included standards of including ethics into curriculum. Studies regarding ethics-related issues and ethics education have been broadly explored and discussed within the counseling profession. Research regarding ethics education has emphasized the goals of ethics education, teaching in an ethical manner, using ethical instructional materials, and other general elements in ethics education, and was mainly focused on the perspectives of counselor educators. However, there has been a lack of studies to examine the outcome and influence ethics education has had on students' ability and practice. The purposes of the present study are to: (a) discover the current status of ethics education in master's rehabilitation counseling programs across the United States; (b) identify the general profiles of ethical orientations among a sample of master's students in rehabilitation counseling programs; (c) determine whether ethics education would impact future counselors' ethical reasoning and decision-making skills in terms of ethical orientation; and (d) explore rehabilitation counseling master's students' satisfaction towards ethics education and training received in the programs and their self-perceived confidence and competence level in making ethical decisions. The study surveyed a total of 47 master's students in rehabilitation counseling programs. The results showed that a majority of programs offered ethics education in a combination method of a separate course and infused ethics-related topics throughout the curriculum, and 48 and 60 credit hours were the commonly adopted graduation requirements. ACA Codes of Ethics and Code of Professional Ethics for Rehabilitation Counselors by Commissions on Rehabilitation Counselor Certification (CRCC) were the commonly used materials in ethics education. Dual relationships on non-sexual nature, confidentiality, informed consent, duty to warn, and scope of practice were the five topics that were indicated to be important concepts to be covered in ethics education. In addition, lecture and whole class discussion were the common adopted methods in teaching ethics, while students' preparation was usually evaluated by examinations, assigned case studies, and term papers. Examination was not perceived as the most helpful evaluation method by master's students. On the other hand, practicum supervision and case studies were perceived to be more helpful in evaluating students' competence to practice ethically. The ethical reasoning level of all participants as a whole exhibited a primary emphasis on individuals' needs, while societal regulations, norms, and laws are recognized but are considered as secondary concerns in ethical decision making. The results of data analyses also showed that students who received varied formats of ethics education and in different demographic information groups did not demonstrate significant differences on the degree of their moral development and sophistication of ethical reasoning. Moreover, on a 6-point Likert scale, participants reported to have a mean of 4.48 on their satisfaction about their current ethics education and have an overall mean of 4.39 on the confidence level and an overall mean of 4.53 on self-reported competence level in approaching and handling an ethical situation.

Vocational guidance and career counseling is the primary service provided to all applicants applying for vocational rehabilitation services. Vocational rehabilitation (VR) counselors specialize in helping people with a disability acquire employment. Yet, when the person has a disability and a criminal record this adds an additional element for consideration. The object of this research is Louisiana vocational rehabilitation counselors in the Baton Rouge Regional Office (BRRO) and their vocational guidance and career counseling skills of people with a disability and a criminal record. For vocational rehabilitation counselors are required to apply theoretically-based career counseling practices in the provision of vocational guidance and career counseling. The expected outcome is the agreement of an employment goal between both the person with a disability and a criminal record and the VR counselor. The purpose of this qualitative research study is to explore the perceptions and actual experiences of vocational rehabilitation counselors in their usage of career theories when providing vocational guidance and career counseling to with people with a disability and a criminal record. Given the scarce amount of research on career counseling of people with a disability and a criminal record, anecdotal information from BRRO vocational rehabilitation counselors, and the researcher's experience working as a VR counselor, the researcher used the heuristic qualitative design to explore these perceptions and actual experiences. The nature of heuristics incorporates the researcher's work experience as a vocational rehabilitation counselor. Therefore, through review of literature and face to face interviews, the efficacy of the career theories is explored along with successes and challenges faced by Louisiana rehabilitation counselors in helping clients select an appropriate employment goal. From the individual case studies, the themes of expectations, autonomy, counselor development, and fidelity to theories emerged from the data analysis. Eventually, the core category of incongruence in theory and practice emerged from the themes. The final chapter provides a discussion of the findings through the heuristic lens of the researcher. Additionally, implications for VR counselors, educators, and supervisors, future recommendations for research, and closing summary are provided.

The goal of the acute inpatient rehabilitation facility (IRF) is to rehabilitate patients and discharge them back into the community at their optimal level of functioning. The IRF patient is more acutely ill today than in the past, and due to a change in condition may be discharged back into the acute care hospital before achieving maximal level of function. An IRF was identified as discharging 14% of patients back into acute care, which indicated the IRF was not meeting its treatment goals. A chart review revealed a possible link between the nurse's role in patient care and the patient's discharge disposition. The purpose of this project was to design a nurse staffing care model that would support the registered nurse in providing care and treatment for the IRF patient. The missed nursing care model and Lewin's change theory were used to support the design of the new staffing model. Sources of evidence included a literature review of nurse staffing models and the nurse's role in patient outcomes. A project team of expert stakeholders participated in the development of the new model. The Appraisal of Guidelines for Research and Evaluation was used in formative and summative evaluations of the new model to systematically assess the quality of the new staffing model. Formative feedback was given by 3 project team members. Nine expert end users provided summative evaluations of the new model after revisions by the project team. All end users recommended implementation without modification. Positive social change with implementation of this model may lead to reduced acute care transfers, improved quality measures, and enhanced patient outcomes in the IRF.

The purpose of this study was to discover attitudes and knowledge of four healthcare student groups toward occupational therapy in Iceland. A fact-sheet identifying philosophy, theoretical background, skills roles and occupational therapy working areas was developed. Pre-test and post-test questionnaires were used to measure any attitude and knowledge changes which might have occurred after reading the fact-sheet. The results demonstrated that the four student groups had obtained knowledge about occupational therapy during their university experiences; either from in class information or from field trips to occupational therapy departments. The questionnaire results indicated that students' attitudes toward cooperation with occupational therapists was positive. The overall outcome indicated that as a result of information gained from the fact-sheet, significant attitude and knowledge changes were demonstrated among the four student groups about occupational therapy in Iceland.

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Aims This study aimed to demonstrate reliability and validity of the Stroke Rehabilitation Motivation Scale, a novel instrument designed to assess internal and external contributions to motivation. Many studies recognise motivation, in the everyday sense, as a factor affecting stroke rehabilitation, but there is no standard measure. There is also no agreement as to whether motivation in the post-stroke period is the same as the absence of depression, anxiety or stress; hence the need for an independent measure of motivation. Method The Stroke Rehabilitation Motivation Scale was adapted from the 28-item Sports Motivation Scale, which in turn was developed according to the intrinsic and extrinsic contributions to motivation identified by Self-Determination Theory. The resulting Stroke Rehabilitation Motivation Scale was tested in two stages. In the 28-item reliability stage, in a sample of 18 stroke patients from the stroke ward of Bankstown-Lidcombe Hospital, the scale was tested for Inter-rater reliability, scale reliability, and validity via comparison of high vs. low motivation groups according to a novel ???motivation score???. The scale was shortened from 28-items (four per subscale) to 7 items (one per subscale) by selecting the most reliable items. The three intrinsic and extrinsic subscales were summed and averaged, and the amotivation score was subtracted from this to produce a ???motivation score???, such that a person with a positive score had more motivation, either extrinsic or intrinsic, than they had amotivation. e.g. [ ( E + I )/2 ??? A ] In the 7-item reliability stage, a further 13 patients were recruited from Bankstown-Lidcombe and Liverpool Hospitals. The 7-item scale was tested for scale reliability, and for validity by comparison of high vs. low motivation groups as well as correlations between motivation score, anxiety, depression and stress, and rehabilitation outcomes. Results In both the 28-item and 7-item stages the scale demonstrated adequate to very good reliability. There was a lack of significant mean differences or correlations to demonstrate validity in either stage; this study does not represent a convincing demonstration of validity of the SRMS. However, it would appear that motivation is conceptually distinct from depression, anxiety and stress, and the scale definitely warrants further testing in a larger sample.