Skip to main content
Top
Gepubliceerd in:

01-12-2014

Ethical behaviour in clinical practice: a multidimensional Rasch analysis from a survey of primary health care professionals of Barcelona (Catalonia, Spain)

Auteurs: Luis González-de Paz, Belchin Kostov, Jose A. López-Pina, Adelaida Zabalegui-Yárnoz, M. Dolores Navarro-Rubio, Antoni Sisó-Almirall

Gepubliceerd in: Quality of Life Research | Uitgave 10/2014

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

Purpose

Normative ethics includes ethical behaviour health care professionals should uphold in daily practice. This study assessed the degree to which primary health care (PHC) professionals endorse a set of ethical standards from these norms.

Methods

Health care professionals from an urban area participated in a cross-sectional study. Data were collected using an anonymous, self-administered questionnaire. We examined the level of ethical endorsement of the items and the ethical performance of health care professionals using a Rasch multidimensional model. We analysed differences in ethical performance between groups according to sex, profession and knowledge of ethical norms.

Results

A total of 452 Professionals from 56 PHC centres participated. The level of ethical performance was lower in items related to patient autonomy and respecting patient choices. The item estimate across all dimensions showed that professionals found it most difficult to endorse avoiding interruptions when seeing patients. We found significant differences in two groups: nurses had greater ethical performance than family physicians (p < 0.05), and professionals who reported having effective knowledge of ethical norms had a higher level of ethical performance (p < 0.01).

Conclusions

Paternalistic behaviour persists in PHC. Lesser endorsement of items suggests that patient-centred care and patient autonomy are not fully considered by professionals. Ethical sensitivity could improve if patients are cared for by multidisciplinary teams.
Bijlagen
Alleen toegankelijk voor geautoriseerde gebruikers
Literatuur
1.
go back to reference Pellegrino, E. D. (2000). Bioethics at century’s turn: Can normative ethics be retrieved? Journal of Medicine and Philosophy, 25(6), 655–675.PubMedCrossRef Pellegrino, E. D. (2000). Bioethics at century’s turn: Can normative ethics be retrieved? Journal of Medicine and Philosophy, 25(6), 655–675.PubMedCrossRef
2.
go back to reference Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics. New York: Oxford University Press. Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics. New York: Oxford University Press.
3.
go back to reference Gracia, D. (2007). Fundamentos de bioética. Madrid: Triacastela. Gracia, D. (2007). Fundamentos de bioética. Madrid: Triacastela.
4.
go back to reference Weaver, K., Morse, J., & Mitcham, C. (2008). Ethical sensitivity in professional practice: Concept analysis. Journal of Advanced Nursing, 62(5), 607–618.PubMedCrossRef Weaver, K., Morse, J., & Mitcham, C. (2008). Ethical sensitivity in professional practice: Concept analysis. Journal of Advanced Nursing, 62(5), 607–618.PubMedCrossRef
6.
go back to reference Papanikitas, A., & Toon, P. (2011). Primary care ethics: A body of literature and a community of scholars? Journal of the Royal Society of Medicine, 104(3), 94–96.PubMedCentralPubMedCrossRef Papanikitas, A., & Toon, P. (2011). Primary care ethics: A body of literature and a community of scholars? Journal of the Royal Society of Medicine, 104(3), 94–96.PubMedCentralPubMedCrossRef
7.
go back to reference Martin, R. (2004). Rethinking primary health care ethics: Ethics in contemporary primary health care in the United Kingdom. Primary Health Care Research & Development, 5(04), 317.CrossRef Martin, R. (2004). Rethinking primary health care ethics: Ethics in contemporary primary health care in the United Kingdom. Primary Health Care Research & Development, 5(04), 317.CrossRef
8.
go back to reference Gonzalez-de Paz, L. (2013). Clinical bioethics for primary health care. Semergen, 39(8), 445–449.PubMedCrossRef Gonzalez-de Paz, L. (2013). Clinical bioethics for primary health care. Semergen, 39(8), 445–449.PubMedCrossRef
9.
go back to reference Schuetz, B., Mann, E., & Everett, W. (2010). Educating health professionals collaboratively for team-based primary care. Health Affairs, 29(8), 1476–1480.PubMedCrossRef Schuetz, B., Mann, E., & Everett, W. (2010). Educating health professionals collaboratively for team-based primary care. Health Affairs, 29(8), 1476–1480.PubMedCrossRef
11.
go back to reference Furler, J., & Palmer, V. (2010). The ethics of everyday practice in primary medical care: Responding to social health inequities. Philosophy, Ethics, and Humanities in Medicine, 5, 6. Furler, J., & Palmer, V. (2010). The ethics of everyday practice in primary medical care: Responding to social health inequities. Philosophy, Ethics, and Humanities in Medicine, 5, 6.
12.
go back to reference Antiel, R. M., Curlin, F. A., Hook, C. C., & Tilburt, J. C. (2011). The impact of medical school oaths and other professional codes of ethics: Results of a national physician survey. Archives of Internal Medicine, 171(5), 469–471.PubMedCentralPubMedCrossRef Antiel, R. M., Curlin, F. A., Hook, C. C., & Tilburt, J. C. (2011). The impact of medical school oaths and other professional codes of ethics: Results of a national physician survey. Archives of Internal Medicine, 171(5), 469–471.PubMedCentralPubMedCrossRef
13.
go back to reference Numminen, O., van der Arend, A., & Leino-Kilpi, H. (2009). Nurses’ codes of ethics in practice and education: A review of the literature. Scandinavian Journal of Caring Sciences, 23(2), 380–394.PubMedCrossRef Numminen, O., van der Arend, A., & Leino-Kilpi, H. (2009). Nurses’ codes of ethics in practice and education: A review of the literature. Scandinavian Journal of Caring Sciences, 23(2), 380–394.PubMedCrossRef
14.
go back to reference Ramsay, J., Campbell, J. L., Schroter, S., Green, J., & Roland, M. (2000). The General Practice Assessment Survey (GPAS): Tests of data quality and measurement properties. Family Practice, 17(5), 372–379.PubMedCrossRef Ramsay, J., Campbell, J. L., Schroter, S., Green, J., & Roland, M. (2000). The General Practice Assessment Survey (GPAS): Tests of data quality and measurement properties. Family Practice, 17(5), 372–379.PubMedCrossRef
15.
go back to reference Bjertnaes, O. A., Lyngstad, I., Malterud, K., & Garratt, A. (2011). The Norwegian EUROPEP questionnaire for patient evaluation of general practice: Data quality, reliability and construct validity. Family Practice, 28(3), 342–349.PubMedCrossRef Bjertnaes, O. A., Lyngstad, I., Malterud, K., & Garratt, A. (2011). The Norwegian EUROPEP questionnaire for patient evaluation of general practice: Data quality, reliability and construct validity. Family Practice, 28(3), 342–349.PubMedCrossRef
16.
go back to reference Safran, D., Kosinski, M., Tarlov, A., Rogers, W., Taira, D., Lieberman, N., et al. (1998). The Primary Care Assessment Survey: Tests of data quality and measurement performance. Medical Care, 36(5), 728–739.PubMedCrossRef Safran, D., Kosinski, M., Tarlov, A., Rogers, W., Taira, D., Lieberman, N., et al. (1998). The Primary Care Assessment Survey: Tests of data quality and measurement performance. Medical Care, 36(5), 728–739.PubMedCrossRef
17.
go back to reference Merbitz, C., Morris, J., & Grip, J. C. (1989). Ordinal scales and foundations of misinference. Archives of Physical Medicine and Rehabilitation, 70(4), 308–312.PubMed Merbitz, C., Morris, J., & Grip, J. C. (1989). Ordinal scales and foundations of misinference. Archives of Physical Medicine and Rehabilitation, 70(4), 308–312.PubMed
18.
go back to reference Wright, B. D., & Linacre, J. M. (1989). Observations are always ordinal; measurements, however, must be interval. Archives of Physical Medicine and Rehabilitation, 70(12), 857–860.PubMed Wright, B. D., & Linacre, J. M. (1989). Observations are always ordinal; measurements, however, must be interval. Archives of Physical Medicine and Rehabilitation, 70(12), 857–860.PubMed
19.
go back to reference Gonzalez-de Paz, L., Devant-Altimir, M., Kostov, B., Mitjavila-Lopez, J., Navarro-Rubio, M. D., & Siso-Almirall, A. (2013). A new questionnaire to assess endorsement of normative ethics in primary health care: Development, reliability and validity study. Family Practice, 30(6), 724–733.PubMedCrossRef Gonzalez-de Paz, L., Devant-Altimir, M., Kostov, B., Mitjavila-Lopez, J., Navarro-Rubio, M. D., & Siso-Almirall, A. (2013). A new questionnaire to assess endorsement of normative ethics in primary health care: Development, reliability and validity study. Family Practice, 30(6), 724–733.PubMedCrossRef
20.
go back to reference Wright, B. D., & Masters, G. N. (1982). Rating scale analysis. Chicago: Mesa Press. Wright, B. D., & Masters, G. N. (1982). Rating scale analysis. Chicago: Mesa Press.
23.
go back to reference Adams, R. J., Wu, M. L., & Wilson, M. R. (2012). ConQuest. ACER, 3.0. Adams, R. J., Wu, M. L., & Wilson, M. R. (2012). ConQuest. ACER, 3.0.
24.
go back to reference R Core Team. (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing, 3, 1. R Core Team. (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing, 3, 1.
25.
go back to reference Adams, R., Wilson, M., & Wang, W. (1997). The multidimensional random coefficients multinomial logit model. Applied Psychological Measurement, 21(1), 1–23.CrossRef Adams, R., Wilson, M., & Wang, W. (1997). The multidimensional random coefficients multinomial logit model. Applied Psychological Measurement, 21(1), 1–23.CrossRef
26.
go back to reference Wang, W. (1995). Implementation and application of the multidimensional random coefficients multinomial logit model. Dissertation abstracts international. The Sciences and Engineering, 55(9-B), 4166. Wang, W. (1995). Implementation and application of the multidimensional random coefficients multinomial logit model. Dissertation abstracts international. The Sciences and Engineering, 55(9-B), 4166.
27.
go back to reference Briggs, D., & Wilson, M. (2003). An introduction to multidimensional measurement using Rasch models. Journal of Applied Measurement, 4(1), 87–100.PubMed Briggs, D., & Wilson, M. (2003). An introduction to multidimensional measurement using Rasch models. Journal of Applied Measurement, 4(1), 87–100.PubMed
28.
go back to reference Andrich, D. (1988). Rasch models for measurement. Newbury Park: Sage Publications. Andrich, D. (1988). Rasch models for measurement. Newbury Park: Sage Publications.
29.
go back to reference Vrieze, S. (2012). Model selection and psychological theory: A discussion of the differences between the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). Psychological Methods, 17(2), 228–243.PubMedCentralPubMedCrossRef Vrieze, S. (2012). Model selection and psychological theory: A discussion of the differences between the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). Psychological Methods, 17(2), 228–243.PubMedCentralPubMedCrossRef
30.
go back to reference Andrich, D. (1996). Category ordering and their utility. Rasch Measurement Transactions, 9, 465–466. Andrich, D. (1996). Category ordering and their utility. Rasch Measurement Transactions, 9, 465–466.
31.
go back to reference Wright, B., Linacre, J., Gustafson, J., & Martin-Lof, P. (1994). Reasonable mean-square fit values. Rasch Measurement Transactions, 8, 370. Wright, B., Linacre, J., Gustafson, J., & Martin-Lof, P. (1994). Reasonable mean-square fit values. Rasch Measurement Transactions, 8, 370.
32.
go back to reference Bezruczko, N. (2005). Rasch measurement in health sciences. Maple Grove: JAM Press. Bezruczko, N. (2005). Rasch measurement in health sciences. Maple Grove: JAM Press.
33.
go back to reference Wang, W. (2008). Assessment of differential item functioning. Journal of Applied Measurement, 9(4), 387.PubMed Wang, W. (2008). Assessment of differential item functioning. Journal of Applied Measurement, 9(4), 387.PubMed
34.
go back to reference Mislevy, R., Beaton, A., Kaplan, B., & Sheehan, K. (1992). Estimating population characteristics from sparse matrix samples of item responses. Journal of Educational Measurement, 29(2), 133–161.CrossRef Mislevy, R., Beaton, A., Kaplan, B., & Sheehan, K. (1992). Estimating population characteristics from sparse matrix samples of item responses. Journal of Educational Measurement, 29(2), 133–161.CrossRef
35.
go back to reference Beaton, A. E. (1987). Implementing the new design: The NAEP 1983–84 technical report. Report No. 15-TR-20. Beaton, A. E. (1987). Implementing the new design: The NAEP 1983–84 technical report. Report No. 15-TR-20.
36.
go back to reference Wolfe, E. W., & Smith, E. V, Jr. (2007). Instrument development tools and activities for measure validation using Rasch models: Part II-validation activities. Journal of Applied Measurement, 8(2), 204–234.PubMed Wolfe, E. W., & Smith, E. V, Jr. (2007). Instrument development tools and activities for measure validation using Rasch models: Part II-validation activities. Journal of Applied Measurement, 8(2), 204–234.PubMed
37.
go back to reference Rosenbloom, A. H., & Jotkowitz, A. (2010). The ethics of the hospitalist model. Journal of Hospital Medicine, 5(3), 183–188.PubMedCrossRef Rosenbloom, A. H., & Jotkowitz, A. (2010). The ethics of the hospitalist model. Journal of Hospital Medicine, 5(3), 183–188.PubMedCrossRef
38.
go back to reference Pantilat, S. Z., Alpers, A., & Wachter, R. M. (1999). A new doctor in the house: Ethical issues in hospitalist systems. Journal of the American Medical Association, 282(2), 171.PubMedCrossRef Pantilat, S. Z., Alpers, A., & Wachter, R. M. (1999). A new doctor in the house: Ethical issues in hospitalist systems. Journal of the American Medical Association, 282(2), 171.PubMedCrossRef
40.
go back to reference Ciccone, M. M. (2010). Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo). Vascular Health and Risk Management, 6(1), 297–305.PubMedCentralPubMedCrossRef Ciccone, M. M. (2010). Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo). Vascular Health and Risk Management, 6(1), 297–305.PubMedCentralPubMedCrossRef
41.
go back to reference Stewart, M. J. (2001). Fostering partnerships between peers and professionals. The Canadian Journal of Nursing Research, 33(1), 97–116.PubMed Stewart, M. J. (2001). Fostering partnerships between peers and professionals. The Canadian Journal of Nursing Research, 33(1), 97–116.PubMed
42.
go back to reference Thille, P. H. (2010). Giving patients responsibility or fostering mutual response-ability: Family physicians’ constructions of effective chronic illness management. Qualitative Health Research, 20(10), 1343–1352.PubMedCrossRef Thille, P. H. (2010). Giving patients responsibility or fostering mutual response-ability: Family physicians’ constructions of effective chronic illness management. Qualitative Health Research, 20(10), 1343–1352.PubMedCrossRef
43.
go back to reference Rivera Rodriguez, A. J., & Karsh, B. (2010). Interruptions and distractions in healthcare: Review and reappraisal. Quality Safety in Health Care, 19(4), 304.PubMedCrossRef Rivera Rodriguez, A. J., & Karsh, B. (2010). Interruptions and distractions in healthcare: Review and reappraisal. Quality Safety in Health Care, 19(4), 304.PubMedCrossRef
44.
go back to reference Connolly, M., Perryman, J., McKenna, Y., Orford, J., Thomson, L., Shuttleworth, J., et al. (2010). SAGE THYME (TM): A model for training health and social care professionals in patient-focussed support. Patient Education and Counseling, 79(1), 87–93.PubMedCrossRef Connolly, M., Perryman, J., McKenna, Y., Orford, J., Thomson, L., Shuttleworth, J., et al. (2010). SAGE THYME (TM): A model for training health and social care professionals in patient-focussed support. Patient Education and Counseling, 79(1), 87–93.PubMedCrossRef
45.
go back to reference Lin, Y., Lee, W., Kuo, L., Cheng, Y., Lin, C., Lin, H., et al. (2013). Building an ethical environment improves patient privacy and satisfaction in the crowded emergency department: A quasi-experimental study. BMC Medical Ethics, 14(1), 8.PubMedCentralPubMedCrossRef Lin, Y., Lee, W., Kuo, L., Cheng, Y., Lin, C., Lin, H., et al. (2013). Building an ethical environment improves patient privacy and satisfaction in the crowded emergency department: A quasi-experimental study. BMC Medical Ethics, 14(1), 8.PubMedCentralPubMedCrossRef
46.
go back to reference González-de Paz, L., Kostov, B., Sisó-Almirall, A., & Zabalegui-Yárnoz, A. (2012). A Rasch analysis of nurses’ ethical sensitivity to the norms of the code of conduct. Journal of Clinical Nursing, 21(19–20), 2747–2760.PubMedCrossRef González-de Paz, L., Kostov, B., Sisó-Almirall, A., & Zabalegui-Yárnoz, A. (2012). A Rasch analysis of nurses’ ethical sensitivity to the norms of the code of conduct. Journal of Clinical Nursing, 21(19–20), 2747–2760.PubMedCrossRef
47.
go back to reference Jha, V., Bekker, H. L., Duffy, S. R., & Roberts, T. E. (2007). A systematic review of studies assessing and facilitating attitudes towards professionalism in medicine. Medical Education, 41(8), 822–829.PubMedCrossRef Jha, V., Bekker, H. L., Duffy, S. R., & Roberts, T. E. (2007). A systematic review of studies assessing and facilitating attitudes towards professionalism in medicine. Medical Education, 41(8), 822–829.PubMedCrossRef
48.
go back to reference Pellegrino, E. D. (2006). Toward a reconstruction of medical morality. The American Journal of Bioethics: American Journal of Bioethics, 6(2), 65–71.PubMedCrossRef Pellegrino, E. D. (2006). Toward a reconstruction of medical morality. The American Journal of Bioethics: American Journal of Bioethics, 6(2), 65–71.PubMedCrossRef
49.
go back to reference Hansson, A., Arvemo, T., Marklund, B., Gedda, B., & Mattsson, B. (2010). Working together—Primary care doctors’ and nurses’ attitudes to collaboration. Scandinavian Journal of Public Health, 38(1), 78–85.PubMedCrossRef Hansson, A., Arvemo, T., Marklund, B., Gedda, B., & Mattsson, B. (2010). Working together—Primary care doctors’ and nurses’ attitudes to collaboration. Scandinavian Journal of Public Health, 38(1), 78–85.PubMedCrossRef
50.
go back to reference Soklaridis, S., Oandasan, I., & Kimpton, S. (2007). Family health teams: Can health professionals learn to work together? Canadian Family Physician, 53(7), 1198–1199.PubMedCentralPubMed Soklaridis, S., Oandasan, I., & Kimpton, S. (2007). Family health teams: Can health professionals learn to work together? Canadian Family Physician, 53(7), 1198–1199.PubMedCentralPubMed
51.
go back to reference Chadi, N. (2011). Breaking the scope-of-practice Taboo: Where multidisciplinary rhymes with cost-efficiency. McGill Journal of Medicine, 13(2), 44.PubMedCentralPubMed Chadi, N. (2011). Breaking the scope-of-practice Taboo: Where multidisciplinary rhymes with cost-efficiency. McGill Journal of Medicine, 13(2), 44.PubMedCentralPubMed
52.
go back to reference Marsteller, J. A., Hsu, Y. J., Reider, L., Frey, K., Wolff, J., Boyd, C., et al. (2010). Physician satisfaction with chronic care processes: A cluster-randomized trial of guided care. Annals of Family Medicine, 8(4), 308–315.PubMedCentralPubMedCrossRef Marsteller, J. A., Hsu, Y. J., Reider, L., Frey, K., Wolff, J., Boyd, C., et al. (2010). Physician satisfaction with chronic care processes: A cluster-randomized trial of guided care. Annals of Family Medicine, 8(4), 308–315.PubMedCentralPubMedCrossRef
Metagegevens
Titel
Ethical behaviour in clinical practice: a multidimensional Rasch analysis from a survey of primary health care professionals of Barcelona (Catalonia, Spain)
Auteurs
Luis González-de Paz
Belchin Kostov
Jose A. López-Pina
Adelaida Zabalegui-Yárnoz
M. Dolores Navarro-Rubio
Antoni Sisó-Almirall
Publicatiedatum
01-12-2014
Uitgeverij
Springer International Publishing
Gepubliceerd in
Quality of Life Research / Uitgave 10/2014
Print ISSN: 0962-9343
Elektronisch ISSN: 1573-2649
DOI
https://doi.org/10.1007/s11136-014-0720-x

Andere artikelen Uitgave 10/2014

Quality of Life Research 10/2014 Naar de uitgave