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Introduction: Ethical decision-making is an important component of occupational therapy practice in Canada. Research is needed to understand ethical decision-making and how to build occupational therapists’ competency to make ethical decisions. Purpose: The aim of this thesis was to study ethical decision-making in occupational therapy practice in order to contribute to epistemological development regarding ethics in occupational therapy and to support continuing competency in ethical decision-making. Method: Three studies comprise this thesis. A constructivist grounded theory study was conducted involving in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings to explore the process of ethical decision-making. An interpretive description study using secondary analysis of grounded theory data was conducted to explore gaps related to continuing competency in ethical decision-making from the participants’ perspective and to generate recommendations for future directions to support continuing competency. Finally, a non-randomized, single-group, pre- and post-test study (n=33) was conducted to evaluate an on-line education module developed to support competency for clinician-educators. Findings: The grounded theory study led to development of an ethical decision-making prism capturing three processes: Considering the Fundamental Checklist, Consulting Others, and Doing What’s Right. The interpretive description study highlighted two gaps related to continuing competency in ethical decision-making: lack of knowledge and lack of supports. Education, tool development, and ethics mentorship were identified directions for development. The third evaluation study found that an on-line education module led to improvements in ethics knowledge and intent to change practice but not to actual practice change. Implications: This thesis advances a theoretical understanding of ethical decision-making in occupational therapy practice and an applied understanding of occupational therapists’ needs related to competent ethical decision-making. Findings also provide preliminary data regarding on-line ethics education to advance knowledge and skills of clinician-educators who are involved in cultivating ethical decision-making among student occupational therapists. / Thesis / Doctor of Philosophy (PhD) / “Doing what’s right”, or ethical decision-making, is an important part of being an occupational therapist in Canada. To help occupational therapists build knowledge and skills it is important to understand how they make ethical decisions in day-to-day practice. This PhD describes three studies that look at three different aspects of ethical decision-making. The first study presents a theoretical explanation of how occupational therapists decide what’s right to do. The second study uses the same data to look at supports that occupational therapists feel they need to build knowledge and skills about ethical decision-making. The third study measures the value of an on-line education course in helping occupational therapy educators teach students about ethical decision-making. Results of these studies can be used to support occupational therapists in doing what’s right. Results also highlight areas for additional study to further support ethical occupational therapy practice in Canada.

Perceptions of benefits of speech therapy, success of therapy across clinical settings, reasons for returning to therapy, client-clinician relationships, and clinicians' competency were assessed in 57 participants (47 men, 10 women; M age = 34 yr.) trying a new therapy. A majority of respondents had cumulatively five or more years in therapy and at least two stuttering therapies. Respondents rated university or hospital settings as more successful than services in public schools. 70% of the respondents noted difficulty communicating basic needs; they blamed themselves for inability to maintain posttherapeutic gains while perceiving their clinicians to be competent and attentive ? although 47% of the respondents had minimal to no contact with their therapist after therapy.

Nurse-Physician Communication Tools to Enhance use of Nursing Evidence-Based Protocols by Tochi Onyenwe Ubani MSN, Walden University, 2011 BSN, Chamberlain College of Nursing, 2009 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2015 In the current health care environment, consumers are demanding collaboration among clinicians even when traditional attitudes minimize nurses' input on the direction of clinical care. Compounding this problem is that nursing practices have not always been derived from randomized clinical trials, but instead from personal experiences. The purpose of this study was to explore the perceptions of nurses, physicians, and administrators on clinical protocols, including the use of nurse evidence-based practice (EBP) in practice settings. The study aimed at fostering clinical decisions anchored on shared knowledge, collegiate interactions, and emotions. A survey designed using nurse-physician communication tools was disseminated among a convenience sample of 50 nurses, 12 physicians, and 3 administrators. Content analysis was applied to survey responses. The findings revealed that effective communication between nurses, physicians, and administrators enhanced the use of nursing EBPs; these findings were used to generate the Nurse-Physician Communication Tools (NPCT) as a mechanism to enhance the translation of nursing EBP in clinical setting. The use of NPCT provided a mechanism for practice changes needed to improve clinical collaboration and enhance use of nursing EBPs in patient care.

Nurses as professionals and front-liners in patient care should possess good knowledge about health research, as this is critical in improving patient outcomes. The purpose of this study was to determine the level of knowledge and attitudes that public health clinic nurses possess regarding health research in Botswana in order to make recommendations to enhance a research culture among nurses. A quantitative study with a cross-sectional study design was used. Twenty-six clinics in Gaborone were sampled and 168 nurses participated in the survey. Data was analysed using Stata version 15.1. Only 51% of the nurses demonstrated satisfactory knowledge of health research. Despite this limited knowledge, nurses had a good attitude towards health research (66%). Degree nurses were more likely to have satisfactory knowledge, as were those who reported research training and experience. Additionally, research training and experience were associated with a good attitude. Recommendations include provision of research training and practicums as part of the nursing education curriculum, as well as in-service training, in order to improve the levels of knowledge of health research among nurses. / Health Studies / M. P. H.

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Prehospital akutsjukvård är till för patienter i alla åldrar, symtom, tillstånd och sjukdom. Ambulanspersonalen behöver ha kompetens och förmåga att bedöma och behandla alla patienter. Enligt Travelbee främjas den mellanmänskliga relationen genom kommunikation, förståelse och handling vilket skapar förutsättningar för omvårdnaden. Alla patienter har rätt till god och jämlik vård oavsett prehospitala förutsättningar. Syftet var att belysa ambulanspersonalens upplevelser av att vårda barn. Metoden som användes var en litteraturöversikt med en systematisk ansats för att sammanställa befintlig forskning inom området. Både kvalitativa och kvantitativa artiklar har inkluderats från databaserna Pub Med och Cinahl Complete. Sammanlagt har 15 artiklar inkluderats till resultatet. Resultaten visar att ambulanspersonal upplever otillräcklig utbildning i omhändertagande av barn, att det tillkommer utmaningar kring denna patientgrupp samt olika känslor som uppkommer i vårdmötet med barn. Slutsatsen av litteraturstudien beskriver att vård och omvårdnad av barn prehospitalt leder till känslor som stress, osäkerhet och otrygghet. Det beskrivs bero på begränsad kunskap och erfarenhet av akut sjuka och skadade barn samt mötet med patienternas föräldrar. Ambulanspersonal önskar mer teoretisk och praktisk utbildning av det akut sjuka barnet samt debriefing i samband med särskilt påfrestande händelser. / Prehospital emergency care is for patients of all ages, symptoms, conditions and illness. Ambulance clinicians (AC) need to have the competence to assess and treat all patients. According to Travelbee, the interpersonal relationship is promoted through communication, understanding and action, which creates conditions for nursing. All patients have the same right to good and equal care regardless of different circumstances and/or factors that challenge the AC´s in assessing and treating children in prehospital emergency settings. The aim was to describe ambulance clinicians’ experiences of caring for children in prehospital emergency care. A literature review with a systematic approach was used as a method to compile existing research in the field. Both qualitative and quantitative articles have been included from the databases PubMed and Cinahl Complete. A total of 15 articles have been included in the results. The results show that AC´s experience insufficient training regarding the care of children, that there are challenges to this patient group and different emotions that arise in the care when meeting with children in the prehospital emergency settings. The literature study concludes that the care of children in prehospital emergency settings leads to feelings of stress, uncertainty and insecurity, which is described to be caused due to limited knowledge and experience of acutely ill and injured children as well as the meeting with the patient's parents. AC´s want more theoretical and practical training of the acutely ill child as well as debriefing in connection with particularly stressful events.

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A gold standard measurement does not exist to assess fatigue symptoms across patient populations. Current tools only consist of self-report measures that may not assess fatigue objectively. The National Institutes of Health-Brief Fatigue Inventory (NIH-BFI) is a clinician-administered instrument developed as a more objective assessment of fatigue symptoms. This study assessed the NIH-BFI's validity in diverse clinical populations, which included patients diagnosed with a mood disorder, Parkinson's disease, cancer, and healthy controls. Results suggest good criterion-related and convergent validity for the NIH-BFI. Results also indicate significant differences in fatigue severity between cohorts. Moreover, the data also suggest significant differences among groups in depression, anxiety, pain catastrophizing, sleep quality, global mental and physical health, and cognitive functioning. This study proposes that the NIH-BFI is a valid clinician-administered measure of fatigue that can be administered in multiple clinical populations.

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