Development Of Institutional Policies Research Articles

Ethics Corner: Cases from the Hebrew Rehabilitation Center for Aged

This article begins a new six-part series in the Journal of the American Medical Directors Association devoted to medical ethics. Each issue, a case will be presented from the Ethics committee at the Hebrew Rehabilitation Center for Aged (HRCA) in Boston, Massachusetts. Following a description of the case and a discussion of the ethical issues that the case raises, Dr. Steven Levenson will discuss the implications for medical directors. Founded in 1905 as the Jewish Ladies Home for Aged, HRCA is now a 725-bed long-term care facility in Boston, Massachusetts. There is a 20-bed skilled nursing unit, with permanent residents occupying the remaining beds. The main campus also houses an outpatient clinic and adult day health program. The mean age of the inpatient population is 89 years old and the average length of stay for a permanent resident is 4 years. Medical care is provided by a closed medical staff. The HRCA is a major teaching site for the Harvard Geriatrics Fellowship Program and is home to the Research and Training Institute, whose members conduct clinical and social science research. The 12-member ethics committee is composed of representatives from psychiatry, geriatric medicine, social services, nursing, hospital administration, dietary, and the therapies (eg, physical therapy, occupational therapy, recreation, creative arts). There is also a community representative. Training and experience of ethics committee members varies from member to member, and members are encouraged to read the medical ethics literature and attend relevant educational programs. Consult requests are referred to the ethics committee chairperson, who assigns the consult to two committee members. Any staff member at HRCA may request an ethics consult to address an ethical dilemma in the care of a resident. The ethics committee consultants’ findings are discussed with the requesting party, and a report is placed in the resident’s medical record. The ethics committee meets monthly, at which time the month’s consults are discussed. A journal article is distributed at each meeting for discussion the following month. Other activities of the ethics committee have included participation in staff education programs, quality assurance initiatives in areas such as documentation of advance directives, and development of institutional policies relating to areas such as the withdrawal and withholding of treatment.

Higher Education Communication and Information Systems Policy

AbstractEffective use of new technologies calls for the development of institutional policies in equally new areas of concern.

Preventing and Resolving Ethical Conflicts: More help for policy makers

Institutional policy makers have a useful resource in the “Joint Statement on Preventing and Resolving Ethical Conflicts Involving Healthcare Providers and Persons Receiving Care”. Yet, some aspects of the joint statement pose challenges for institutional policy development and merit further reflection. With the aim of clarifying and augmenting the recommendations in the joint statement, this paper gives additional guidance on the issues of benefit, power imbalance, and legitimate decisional authority.

French academics: Between the professions and the civil service

In France, where most higher education institutions are in the public sector, permanent academic staff at universities and other higher education institutions are tenured and enjoy a broad individual autonomy. The number of staff on short-term contracts is limited. Most part-time staff are drawn from professionals, business executives, and administrators – in both the public and private sectors. In recent decades, the number of teaching-only faculty expanded rapidly as tenured secondary school teachers were transferred to higher education institutions. As universities have acquired some autonomy, especially in academic matters, recruitment and promotion of staff combine elements of centralisation at the national level with local processes. Some degree of pay differentiation has been introduced through a growing use of supplementary compensation. As the system evolves toward increased self-governance of institutions, the autonomy enjoyed by the faculty is seen by administrators as an obstacle to the development of institutional policies.

An Alternative Definition of Quality of Undergraduate College Education: Toward Usable Knowledge for Improvement

The 1980s saw a spate of reports focused on the improvement of the of undergraduate college education. Major reports included those issued by the study group on the Conditions of Excellence in American Higher Education [31], the American Association of Colleges' Integrity in the College Curriculum [3], and the National Endowment for the Humanities' To Reclaim a Legacy [5]. Although the flow of reports has abated in the 1990s, the issue of improving the of undergraduate college education remains. What also remains is a growing interest among the public in discerning the comparative of undergraduate institutions. The rankings of colleges in various categories each year in US News and World Report is a response to this growing public interest. Another response is the growth of unconventional college guides that provide inside perspectives on institutions that go beyond the more descriptive summaries in the traditional college guides such as Barron's Profiles of American Colleges and Lovejoy's College Guide. The growing interest in comparative college among the public is premised upon two desires. The first is the desire to obtain a good bargain for the money spent on higher education, which has become more important as the costs of higher education have accelerated. The second is the desire of many students to obtain a degree from the most prestigious institution of higher education possible, because the prestige of one's undergraduate institution is seen as facilitating success later in life. High prestige institutions are seen as worth the high costs of attendance. Whereas the public may often frame the issue of quality in terms of which school is best, the various reports on the of undergraduate college education have as their goal an improved system of higher education to serve society's needs. If the of undergraduate education is to be improved, then must be defined in some way that provides useful information for the development of institutional policy to institute such improvement [13]. Traditional Approaches to Defining Academic Quality Three customary approaches to addressing the question of in undergraduate higher education are the reputational approach, the resources approach, and the value-added approach. The reputational approach defines in terms of a college's or university's rank in the pecking order of institutions [2]. The US News and World Report annual rating of undergraduate institutions is a good example of the reputational method of appraising or excellence: the higher an institution's perceived place in the institutional pecking order, the higher the of the institution. A major problem with the reputational approach is that it is not clear whether the various persons who rank institutions are using the same criteria of evaluation, and even if the criteria are specified, the question arises whether the persons doing the ranking have access to reliable evidence on how well individual institutions meet these criteria. The resources approach, in fact, is an attempt to specify and assess the criteria that are the bases for institutional reputations. Thus, the resource approach delineates by applying criteria such as SAT or ACT scores of entering first-year students, the number of books in the institution's library, or the scholarly productivity of its faculty [2]. Under this approach, the higher the average test scores of entering first-year students or the larger the library collection, the higher the of the institution. Jacobi, Astin, and Ayala [17] point out that both the reputational and the resources approach are highly interdependent. An increase in reputation can bring additional resources to an institution, and an increase in resources can also yield a greater reputation. At first glance it seems that information useful to institutional policy can be obtained from these two approaches. …

Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists

Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists

Role of infection control practitioners in human immunodeficiency virus testing

Background: As a result of the HIV epidemic, the role of the ICP has changed; acute care settings have developed a variety of policies regarding patient and health care worker (HCW) HIV testing and issues related to the HIV-infected HCW. APIC conducted a survey to determine the extent to which ICPs were involved in HCW and patient HIV testing and counseling, the prevalence of routine HIV testing for patients, institutional policies on HIV testing of patients and HCWs, and the management of HIV infected HCWs. Methods: In 1990, a questionnaire was sent to ICPs in a simple random sample of 1300 acute care hospitals (approximately 20%) in the United States. Results: Response rate was 52.8%. Of the 686 respondents, 54.8% provided counseling to the HCW after an exposure incident. ICPs were involved not only in HIV testing and counseling for patients and HCWs but also in institutional policy development for HIV-related issues. Most facilities (73.8%) obtained written consent for testing from the patient after an employee exposure. When a direct care giver was known to be HIV positive, 61.5% of the respondents evaluated each case individually. Conclusions: The ICP has a significant role in the development and implementation of institutional policies on HIV testing and counseling and on the management of HIV-infected workers. These findings affirm the need for APIC to provide educational opportunities on the issues related to HIV testing and counseling.

Enteral and parenteral nutrition support of terminally ill patients: practical and ethical perspectives.

The ethics of dealing with the provision of nutrition has been greatly complicated by technological advances. Seventy percent of all deaths in the United States include a decision to forgo some life-sustaining treatment including nutrition support. This article reviews ethical issues in nutrition support, appropriate and inappropriate nutrition support, practical information regarding provision of nutrition, and the development of institutional policies regarding artificial nutrition and hydration. Communication is emphasized in the process of establishing an ethically defensible consensus between patient and caregiver regarding withholding or withdrawing nutrition support. Within this context, withholding and withdrawing this support are considered to have the same ethical significance. Artificial nutrition and hydration is considered medical therapy and can be refused by competent patients and surrogates of incompetent patients under certain circumstances. Patient autonomy is emphasized as a guiding ethical principle.

The Development of Institutional Policies for Farm Management and Farmland System

The Development of Institutional Policies for Farm Management and Farmland System

Termination of life support: guidelines for the development of institutional policy. Bay Area Network of Ethics Committees.

Termination of life support: guidelines for the development of institutional policy. Bay Area Network of Ethics Committees.

The interface between undergraduate and graduate medical education

The principal current problem related to the interface between undergraduate and graduate medical education is the lack of preparation of graduating medical students to assume many of the patient-care responsibilities required in certain graduate programs. There are two sides to the interface, and both require attention if the problem is to be resolved. The educational quality of the generally permissive fourth year of medical school should be examined in terms of the need for medical schools to prepare students for graduate educational programs. An effective broad first year of graduate medical education requires the development of institutional policy by all clinical departmental directors jointly and the delegation of operational responsibility to a small group of professionals. ( JAMA 241:1148-1150, 1979)

The Interface Between Undergraduate and Graduate Medical Education

The principal current problem related to the interface between undergraduate and graduate medical education is the lack of preparation of graduating medical students to assume many of the patient-care responsibilities required in certain graduate programs. There are two sides to the interface, and both require attention if the problem is to be resolved. The educational quality of the generally permissive fourth year of medical school should be examined in terms of the need for medical schools to prepare students for graduate educational programs. An effective broad first year of graduate medical education requires the development of institutional policy by all clinical departmental directors jointly and the delegation of operational responsibility to a small group of professionals.

Norway's regional colleges

The regional college movement in Norway is in direct response to societal pressure felt worldwide to democratize and decentralize higher education. Created in 1969 as a three-college system coordinated by the Regional College section of the Ministry of Education, the current six institutions represent Norway's attempt to extend equal opportunity and employment-oriented education to rural and remote areas. Although initially established on a five-year experimental basis, the institutions appear to be in a solid position, having university endorsement as well as strong support of the local community constituencies. Another prominent factor giving support to the regional college movement is the egalitarian nature of Norwegian society. The “folkekogskole” (folk high school or people's college) which had become the accepted preparation for teacher training institutions throughout Scandinavia, helped to strengthen the case for short-term career-oriented education. The regional colleges operate with a high degree of administrative autonomy to allow each institution maximum freedom to develop regional identities. From the beginning, innovation and experimentation have been officially encouraged. Faculty and students participate broadly in institutional policy development, and at several colleges, in the actual day-to-day decision making process. The Ministry and institutional leaders appear firmly committed to goals expressed in the planning reports and in the enabling legislation: to prepare students for immediate employment in specific occupations and for further education in universities and professional schools, and to offer educational opportunities, including general education, for adults. Consideration in long-range planning should be given to: