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Most countries that provide for compulsory treatment for mental illness have a system by which this treatment is subject to independent legal oversight. Many countries use a special type of legal body for this purpose, called a mental health tribunal. Mental health tribunals have been subject to criticism from the points of view of both legal professionals and mental healthcare practitioners. Similar themes have manifested in these criticisms and have been consistent across several decades; legal professionals tend to focus on the tribunals being biased toward the medical opinion, and acting as a 'rubber stamp', whereas healthcare practitioners tend to focus on the adversarial nature of the trial, and the adverse effect that this can have on clients. However, empirical studies of the tribunals have not separated and directly compared these perspectives. This study aimed to explore this dynamic between lawyers' views and healthcare practitioners' views of mental health tribunals. We used thematic analysis to re-analyse data from two previous research studies, one which looked at lawyers' views of the tribunals, and one which looked at healthcare practitioners' views. Our results are divided into three themes: views of the problems with tribunals, professional roles in relationship to the tribunals and professional values demonstrated through these views and roles. We then consider if the 'clash of values' represented by these findings, and found in the literature, may pose an impediment to tribunal reform. Identifying and exploring this barrier is an important step to moving beyond critique to reform. [ABSTRACT FROM AUTHOR]

The majority of research on the coach–athlete relationship has been explored from the perspective of able-bodied athletes. The purpose of this study was to explore wheelchair basketball athletes' perceptions of the coach–athlete relationship. Timelining and semistructured interviews were conducted with six wheelchair basketball athletes, and data were analyzed using a reflexive thematic analysis. Athletes highlighted the important role that parasport coaches played in fostering an enjoyable wheelchair basketball environment and valued coaches who displayed expertise regarding their athletes' equipment and had personal parasport athletic experiences. Additionally, athletes identified personal preferences, including coaches who addressed sex differences and maintained professional relationships at the national level as contributing factors to the coach–athlete relationship. The current results benefit both parasport coaches and athletes by providing a portrayal of coaching behaviors, characteristics, and expertise that not only influence the parasport coach–athlete dyad but also affect the well-being and athletic development of parasport athletes. [ABSTRACT FROM AUTHOR]

Background: Charting is an essential component of professional nursing practice and is arguably a key element of patient safety in surgery: without proper, objective, and timely documentation, both benign and tragical errors can occur. From surgery on wrong patients to wrong limbs, to the omission of antibiotics administration, many harms can happen in the operating room. Documentation has thus served as a safeguard for patient safety, professional responsibility, and professional accountability. In this context, we were puzzled by the practices we observed with respect to charting compliance with the surgical safety checklist (SSC) during a study of surgical teams in a large, urban teaching hospital in Canada (pseudonym 'C&C'). Methods: This article leverages institutional ethnography and a subset of data from a larger study to describe and explain the social organisation of the system that monitored surgical safety compliance at C&C from the standpoint of operating room nurses. This data included fieldnotes from observations of 51 surgical cases, on-the-spot interviews with nurses, formal interviews with individuals who were involved in the design and implementation of the SSC, and open-ended questions from two rounds of survey of OR teams. Findings: We found that the compliance form and not the SSC itself formed the basis for reporting. To meet hospital accuracy in charting goals and legislated compliance documentation reporting requirements nurses 'pre-charted' compliance with the surgical checklist. The adoption of this workaround technically violated nursing charting principles and put them in ethically untenable positions. Conclusions: Documenting compliance of the SSC constituted a moral hazard, constrained nurses' autonomy and moral agency, and obscured poor checklist adherence. The findings highlight how local and extra local texts, technologies and relations create ethical issues, raise questions about the effectiveness of resulting data for decision-making and contribute to ongoing conversations about nursing workarounds. [ABSTRACT FROM AUTHOR]

This study aimed to better understand the factors influencing the provision of sexuality-related post-stroke rehabilitation services by clinicians on different sites and to explore strategies to improve post-stroke rehabilitation services with stakeholders. A qualitative study with co-design methods was conducted with 20 clinicians from five post-stroke rehabilitation centers in Canada, 1 manager and 1 patient-partner. Participants either took part in a focus group or in sessions of an adapted version of the LEGO Serious Play method to explore influencing factors and strategies of improvement in relation to post-stroke sexual rehabilitation services. Thematic analysis was conducted semi-deductively using the Theoretical Domains Framework (TDF), the Capability, Opportunity, Motivation and Behaviour (COM-B) system and the Behaviour Change Wheel (BCW). A total of twenty factors pertaining either to the categories of Capability (n = 8; e.g., Sexual rehabilitation procedural knowledge), Motivation (n = 4; e.g., Professional boundaries) or Opportunity (n = 8; e.g., Workload) were perceived as influencing provision of sexual rehabilitation services by participants. A theoretical model was conceptualized. Strategies (n = 10) were categorized in concordance with the BCW as Training (n = 1), Enablement (n = 5) or Environmental restructuring (n = 4). This study showed that factors influencing provision of post-stroke rehabilitation services were numerous and interrelated, and that various strategies aiming either clinicians or the rehabilitation environment would be relevant to improve services. This study will help guide the design and implementation of future interventions studies aiming at improving post-stroke sexual rehabilitation services. [ABSTRACT FROM AUTHOR]

Introduction: People with disabilities are underrepresented in health professions education and practice. Barriers for inclusion include stigma, disabling discourses, discriminatory programme design and oppressive interactions. Current understandings of this topic remain descriptive and fragmented. Existing research often includes only one profession, excludes particular types of disability and focuses on one aspect of the career journey. To expand understanding, we examined the recurrent forms of social relations that underlie the participation of disabled individuals in learning and practice contexts across five health professions. Method: We analysed 124 interviews with 56 disabled health practitioners and students. Participants were interviewed up to three times over 1.5 years. Using constructivist grounded theory, authors used a staged analytic approach that resulted in higher level conceptual categories that advance interpretations of social processes. Finally, the authors compared and integrated findings among students and practitioners. Results: Participants experience challenges to their sense of legitimacy and belonging as health providers. They describe tensions within the health education and practice between the commitment to inclusion and the day‐to‐day realities experienced by disabled participants. We identified six distinct, but related, conditions underlying these tensions: (i) validity and transparency of competencies' evaluation; (ii) the social and physical contexts; (iii) integration of inclusive practices; (iv) boundaries between personal and professional identities; (v) vulnerability to authority figures; and (vi) dynamic person‐level factors. Discussion: If we are to commit to health practitioners and students with disabilities experiencing an overall sense of legitimacy and belonging, priority needs to be given to system‐level practices and policies to support inclusion. Attention to the day‐to‐day marginalisation of students and practitioners with disabilities in the health professions is also needed. Additionally, inclusive and transparent delineation of competency requirements is needed. Finally, educational actions are needed to increase understanding of disability in the health professions, with particular attention to promoting social relations that foster collective responsibility for supporting inclusion. The authors demonstrate how priority needs given to system‐level practices and policies that support inclusion if practitioners and students with disabilities are to experience a sense of legitimacy and belonging. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe policies developed by English-speaking Canadian health authorities to guide multi-disciplinary healthcare practice in the context of MAID. Seventeen policies from 9 provinces and 3 territories were identified and analyzed thematically. Themes developed from these documents related to ensuring a team approach to care, supporting informed patient choice, creating region-specific guidance on eligibility criteria and safeguards, accommodating conscientious objection, and making explicit organizational responsibilities. Ethical language concerned vulnerability, non-judgmental care, dignity, non-abandonment, confidentiality, moral conscience, and diverse cultural values. Overall, these policies addressed important risk mitigation strategies, acknowledged important social contracts, and supported ethical practice. Collectively, these policies outline important considerations in the evolving Canadian context for other jurisdictions seeking to create policy around assisted death. [ABSTRACT FROM AUTHOR]

This paper will identify existing models of professional regulatory reform that could ensure a single licensing process that results in multi-jurisdictional licensure. The paper will also distinguish models or ad hoc arrangements that fail to achieve such a result. This is a timely topic in Canada because its professional regulatory framework is being examined for modernization. The Canadian professional regulatory framework for health care providers is a legacy of the Constitution of 1867. It can be characterized as a Federation of 13 different jurisdictional systems with each province or territory having exclusive jurisdiction over regulation of its health professionals. This results in differing entry to practice requirements, standards of practice, classes or categories of registration and transfer criteria for eligibility from other provinces. The United States nursing state board regulators, the Australian Commonwealth, and their state governments have moved from their original regulatory frameworks to modern ones. Their models are more supportive of mobility, cross-border virtual care, education, and health provider professional development and well-being. Aside from recent discussions in the 4 Canadian Atlantic provinces, there has been little will, effort, or advancement to modernize the regulatory framework in Canada to support multi-jurisdictional licensure. This paper aims to briefly describe 6 existing models that support multijurisdictional licensure. In the fall of 2022, the 4 Atlantic Premiers (akin to state Governors in the US) asked each of their medical regulatory authority (akin to State Medical Boards) to develop a licensing system such that physicians could practice in all 4 Atlantic provinces without the need to acquire multiple licenses. Two models will be discussed that meet this recently stated objective of the Atlantic Premiers while the others do not. [ABSTRACT FROM AUTHOR]

Through the regulation of both femininity and fatness, dominant norms in queer communities construct fatness and femininity as excessive, desexualised/hypersexualised, and undeserving of sexual desire, pleasure, and care. Care, as a feminine ethical stance emphasising relationality and interdependency, is not typically associated with fucking, yet is critical in sex therapeutic work and interventions. In this article, we contend that fat scholarship, femme theory, and care ethics offer productive intersections in terms of crafting an ethic of care in sex therapy practice and activism for fat bodies of all genders. Using the example of the Fat Fuckers workshop developed in Ontario, Canada, offered internationally and online, this article describes how sex therapeutic work that combines fat activism, care, community building and relationality works at the intersections of femme theory, fat studies, and care ethics. This article combines theory with praxis by describing the Fat Fuckers workshop as a form of fat activism that simultaneously promotes fat identification and care for fat bodies in sex therapy while illustrating a nuanced form of feminine relationality for fat subjects and sexualities. Through this, practical tips are described for practitioners (e.g. sex therapists, activists and sex workers) with theoretical implications for sexuality scholars. [ABSTRACT FROM AUTHOR]

Significant ethical challenges arise when mental health practitioners care for patients who seek to accelerate their own dying for rational medically valid reasons. Current and proposed laws provide for medical assistance in dying (MAiD) in several U.S. jurisdictions, all of Canada, and several other nations. Differing provisions of these laws complicate their utility for some patients who seek aid in dying. Some extant laws include roles that mental health professionals might play in assessing patients' competence or capacity to consent, mental illness, or other cognitive and behavioral factors. Practitioners who choose to accept roles in the MAiD process must consider and resolve a number of ethical challenges including potential conflicts between and among laws, ethical standards, third-party requests, personal values, and patients' wishes. These include becoming aware of patients who may wish to act independently to end their lives when MAiD laws might otherwise exclude them. Examples from actual cases and the resultant discussion will form a basis for exploration of the ethical and legal complexities confronted when psychologists become engaged in the process either intentionally or incidentally. The lead article (Koocher) is not intended to comprehensively address MAiD in all of its complexity but rather to trigger a thoughtful discussion among the accompanying commentaries. Public Significance Statement: Current and proposed laws provide for medical assistance in dying (MAiD), sometimes described as physician-assisted suicide, in several U.S. jurisdictions, all of Canada, and in several other nations. Some such laws require psychological input, usually from either a psychologist or a psychiatrist. The limited scope of existing laws may result in some patients suffering with debilitating, painful, chronic, and fatal illnesses to consider suicide without medical assistance. With or without MAiD legislation, mental health professionals will come in contact with such patients and must consider the potentially complex ethical ramifications of caring for such patients. [ABSTRACT FROM AUTHOR]

Older adults living in social housing are disproportionally impacted by poverty, social isolation, and chronic health conditions that negatively impact their housing stability. In response, service coordination models of care that provide proactive case management have seen widespread adoption across lowincome seniors housing communities. We examined the design and implementation of a new "seniors services coordinator" (SSC) role that was introduced by a social housing provider in Toronto, Canada. We conducted qualitative focus groups with tenants (n = 16), housing and policy staff (n = 16), and government- funded care coordinators (n = 16) to understand how the new SSC position formed relationships with tenants, assessed tenant needs and coordinated services, and built partnerships with government-funded system navigators. Since staff were assigned to specific buildings and had smaller caseloads, stakeholders felt that the SSC would be well positioned to build relationships of trust with tenants. Histories of mistrust, boundaries and time management, role conflicts, and system-level barriers, however, made it difficult for SSCs to fully carry out their role. Our findings highlight several design and implementation considerations that may impact the success of tenantfacing support staff such as SSCs, which can serve as a roadmap for other housing providers looking to implement similar initiatives. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has had deleterious effects on individuals experiencing homelessness; yet, less is known about how this global health crisis is impacting service providers that support the homeless population. This qualitative study examined the perceived impacts of the COVID‐19 pandemic on the lives and work experiences of service providers in the homeless service, supportive housing, and harm reduction sectors in Canada. Further analyses were conducted to identify the occupational values that were represented in the work‐related changes experienced by providers. A stratified purposive sample of 40 participants (30 direct service providers and 10 providers in leadership roles) were drawn from a pan‐Canadian study of the mental health of service providers working with individuals experiencing homelessness. Reflexive thematic analysis was used to identify five themes of the work‐related changes experienced by service providers during the pandemic: [1] "Everything was changing every day": Work role and responsibility instability; [2] "How on Earth do we do our job?": Challenges to working relationships with service users; [3] "It used to be a social environment": Transitions to impersonal and isolating workspaces; [4] "It all comes down the chute": Lack of organisational support and hierarchical conflict; and [5] "We've been supported as well as we could have": Positive organisational support and communication. The findings underscored how many of the occupational changes during the pandemic did not align with service providers' occupational values for collaboration, control, effective and safe service provision, and the importance of human relationships, among other values. As pre‐existing sectoral problems were exacerbated by the pandemic, recovery efforts need to address these long‐standing issues in ways that are aligned with service providers' values. Future research is warranted on how organisational approaches can promote supportive workplaces for service providers and improve outcomes for individuals experiencing homelessness. [ABSTRACT FROM AUTHOR]

The 1999 IFLA Statement on Libraries and Intellectual Freedom makes no explicit distinction between personal and professional ethics, though there are implicit indications that there may be divergence between professional and personal considerations. Across three national contexts (the USA, Canada, and the UK), we explore the gaps between professional and personal ethics, as well as how these gaps have been potentially exploited, addressed, or resolved. There have been waves of debate about intellectual freedom and social responsibility across these three national contexts. In the contemporary age, we see clashes around conceptions of neoliberalism, neutrality, expressive freedom, justice, diversity, equity, inclusion, and anti-racism. The divergence of opinion comes from both the left and the right. The gap between library rhetoric and how it is practiced on the ground in different contexts is visibly shifting and under increased scrutiny, certainly in the USA, Canada, and the UK. [ABSTRACT FROM AUTHOR]

Background: Examining the emerging body of evidence investigating what drives physiotherapist's clinical decisions in the management of low back pain can guide future research into identifying barriers and facilitators of their adherence to evidence recommended interventions. Objective: To establish the body of evidence regarding factors that improve or hinder physiotherapists' adherence to high‐value interventions on the management of non‐specific low back pain. Design: Scoping review. Methods: We conducted a Scoping review by searching MEDLINE, CINAHL, and SPORTDiscus databases on 13 February 2021. Two reviewers independently screened the retrieved literature and selected articles for inclusion. We included quantitative research that investigated an association between physiotherapists' personal characteristics or setting related characteristics with their clinical management of patients with non‐specific low back pain. Results: Twelve studies reported in 13 publications were included. The majority of the studies were conducted in high‐income countries including, the United States, Canada and UK. Twenty‐six factors were investigated as potentially influencing physiotherapists' adherence to high value interventions in low back pain management. The most commonly examined physiotherapists' attributes were educational qualification that is postgraduate or certification course (58%, N = 7 studies), years of experience (41%, N = 5 studies), and beliefs and attitude about low back pain (41%, N = 5 studies). Work setting (N = 4) and workload (N = 3) were frequently investigated setting related factors. Conclusion: Currently, there is limited evidence available to understand determinants controlling practice behaviours of physiotherapists' management of nonspecific low back pain. Future researches conceptualized within contemporary theories of clinician behaviour change and models of knowledge translation are needed. [ABSTRACT FROM AUTHOR]

Language – the words we use – can play a key role in enabling or limiting transformation of inequalities in the field of global health. At the same time, given the interdisciplinary, intersectoral, and international nature of much global health work, intended meanings, commitments, and underlying values for words used cannot be taken for granted. This commentary sets out to clarify, and in this manner render available for further discussion and debate, the phrase 'critical and ethical global engagement' (CEGE). It derives from discussions between scholars and partners in research, education, and healthcare practice based at one Canadian and two Rwanda institutions. Initially, our aim was to conceptualise the term 'critical and ethical global engagement' in order to guide our own practices. As the complexity of the values, commitments, and considerations underlying our use of this phrase emerged, however, we realised these discussions merited being captured and shared, to facilitate further exploration and exchange on this phrase. [ABSTRACT FROM AUTHOR]

Background: The scope of practice of nurse practitioners (NPs) is expanding, and an increasing number of registered nurses (RNs) are advancing their careers to become NPs. Nurse practitioners are prepared to improve access to high-quality care and enhance care standards. The barriers and facilitators in the transition of RNs to NPs have been seldom studied in the Canadian context. Objective: To conduct a scoping review to identify systemic barriers and facilitators affecting Canadian RN experience in transitioning to independent practice as NPs. Data Sources: Four electronic databases were searched for primary studies, and several search engines were used to retrieve gray literature. Keywords included NP, transition, novice, Canada, barriers, obstacles, facilitators, and their variations. Eligible studies are those published from the inception of each respective database to 2021. Conclusions: Four research studies and one report in the gray literature were located. Three themes were identified from the literature review, including inconsistencies in education and the need for mentors, need for legislation supportive of NP practice, and inconsistent remuneration structures for NPs. Implications for Practice: Addressing systemic barriers and employing systemic facilitators are likely to facilitate the transition of RNs to NPs. The lack of primary evidence to explore the factors that affect the transition process from an RN to an NP in Canada indicates that further research must be done. Findings from the future research are likely to furnish a better understanding of the transition process so that the integration of new NPs into the health care system can be achieved efficiently. [ABSTRACT FROM AUTHOR]

Information and Communication Technologies (ICTs) permeated social work practice before coronavirus disease 2019 (COVID-19). In addition to ICT-based formal services (e.g. e-counselling), social workers used ICTs informally as an adjunct to face-to-face practice. Building on our previous research, our cross-sectional online survey examined social workers' informal use of ICTs in four countries: Canada, the USA, Israel and the UK. The survey was administered through Qualtrics software among social workers across Canada (n  = 2,609), the USA (n  = 1,225), Israel (n  = 386) and the UK (n  = 134), and analysed using IBM SPSS Statistics version 26. The findings substantiate the ubiquitous use of informal ICTs in social work practice, as an adjunct to face-to-face treatment, across the four countries. Given the current, unprecedented context of COVID-19, we discuss the meaning of our findings related to access, ethical considerations (e.g. professional boundaries) and supervision in the context of restricted face-to-face practice. We discuss the implications for social work practice, education and research, and conclude that in the COVID-19 context, there is an even greater need for research, clinical discussion, supervision and policy on informal ICT use in social work practice. [ABSTRACT FROM AUTHOR]

In social work, integration of theory and practice primarily occurs within the practicum. For practitioners, enacting the role of field instructor is associated with both personal and professional benefits. The COVID-19 pandemic led to dramatic challenges in this role, given that many student placements transitioned from inperson to remote engagement. This study explores the experience of field instructors in supervising social work students who were engaged in remote learning plans. Their experiences followed a continuum from crisis to developing a "new normal," with opportunities that augmented and, occasionally, had benefits over traditional approaches to field education. [ABSTRACT FROM AUTHOR]

Objective: Hypoglycemia can cause psychological distress in people with diabetes; however, less is understood about the emotional impact of hypoglycemia on their health care providers (HCPs). This article focuses on the experiences and emotions of HCPs caring for patients with diabetes. Methods: This was a descriptive qualitative study from the InHypo-DM research program. Purposive sampling was used to recruit 20 HCPs from a variety of professions for 30- to 45-minute semi-structured interviews. An iterative analysis was conducted to identify the overarching themes. Results: Three overarching themes encompassed the responses of participants when their patients experienced hypoglycemia. The first was a sense of professional responsibility, as participants felt they must have failed or inadequately fulfilled their professional duties. The second was a more personal range of emotions such as sadness and guilt. The final theme was how these emotions created a "call to action," prompting participants to identify potential strategies to prevent future hypoglycemic events. Conclusion: This qualitative study highlights the emotional impact of patients' hypoglycemia on HCPs. Although it may have been expected that HCPs have a strong sense of professional responsibility, it was unexpected that these responses often became personal emotions. To ameliorate the negative impact of these responses on patient care, HCPs should engage in activities that enable them to anticipate and manage their own emotional responses. In addition, strategies to optimize hypoglycemia detection and prevention should be promoted. [ABSTRACT FROM AUTHOR]

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Background: Therapeutic lying is an intervention used by health care professionals (HCPs) when a person with dementia is disoriented and distressed and when all other interventions have not succeeded in deescalating the symptoms of dementia. Method: The goal of this study was to evaluate a workshop on therapeutic lying and dementia care for HCPs specializing in the care of persons living with dementia with symptoms of dementia. Seventeen HPCs, including nurses and personal support workers (PSWs), participated in the workshop and evaluation survey. Results: The workshop did not affect the attitudes of HCPs toward therapeutic lying and dementia, their sense of competence in providing care to patients with dementia, or their rate of admitting to using therapeutic lying in dementia care settings. All of the PSWs and 50.0% of the nurses admitted to using therapeutic lying as an intervention. Conclusion: Current nursing ethics standards and training practices may cause reluctance among nurses to include therapeutic lying in care plans as a last resort and as a person- and family-centered intervention to deescalate the symptoms of dementia. [J Contin Educ Nurs. 2021;52(9):438–444.] [ABSTRACT FROM AUTHOR]

Objective: The implementation of medical aid-in-dying (MAID) poses new challenges for clinical communication and counseling. Among these, health care providers must consider whether to initiate a discussion of MAID with eligible patients who do not directly ask about it. Norms and policies concerning this issue vary tremendously across jurisdictions where MAID is legally authorized, reflecting divergent assumptions about patients' rights to information about end-of-life options and the purpose and potential harms of clinical disclosure.Method: This discussion forum essay draws on informed consent doctrine to analyze two policies concerning clinical communication about MAID: the legal prohibition against provider-initiated discussions of MAID in Victoria, Australia, and the Canadian Association of MAID Assessors and Providers (CAMAP) position that providers have an ethical and professional responsibility to inform eligible patients about MAID.Conclusions: Informed consent requires that clinicians strike a balance between minimizing potential harms to patients caused by initiating discussions of MAID and the imperative to inform and counsel patients about all of their legally available medical options.Practice Implications: Clinicians should be aware of both the importance of communication as a tool to inform patients and the potential for clinical language to cause harm to or to unduly influence patients. [ABSTRACT FROM AUTHOR]

Despite broad debates surrounding how the human resource management occupation can increase its legitimacy, researchers have yet to examine the collective steps HR practitioners are taking in this regard and the extent to which they have been successful. We conduct a case study of the HR professionalization project in Canada via multisource qualitative and quantitative data, which we analyze using a unique integration of the trait and control models from the sociology of professions, as well as isomorphism from institutional theory. Viewed through the lens of these frameworks, we find that HR practitioners are attempting to emulate traits that define traditional notions of professions, and are aspiring to transcendent values associated with balancing the sometimes conflicting interests of employers and employees. Objective data from external stakeholders and institutions show that these collective strategies have been somewhat successful in garnering greater legitimacy thus far, particularly when comparisons are made with the HR professional project in the United States. We highlight numerous implications for future research and practice surrounding the legitimacy of the HR profession. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This article presents data from a mixed-method study on evangelical faith-based organizations in Southern Ontario, Canada. The authors sought to explore the nature and extent of faith-sharing in these organizations by using the Convergent Triangulation Design, which permitted the use of semi-structured interviews, focus groups, surveys, and document review. First, The Great Commission acts as a de facto institutional policy in the evangelical faith-based organizations sampled; The Great Commission is a Biblical injunction, strongly observed by evangelicals, which states that evangelicals are commissioned by Jesus to share and ultimately convert others to their faith. The second theme is that in seeking to realize The Great Commission these organizations tried not to be coercive in sharing their faith. In the discussion, the paper explores briefly some of the potential ethical issues that emerge from faith-sharing in social service settings. [ABSTRACT FROM AUTHOR]

We administered a questionnaire to 78 counselling psychologists who were members of the Section for Counselling Psychology of the Canadian Psychological Association (CPA), achieving a 35.4% response rate. There was high satisfaction with the profession and no evidence of gender differences in satisfaction. The sampled counselling psychologists tended to see counselling psychology as moderately different from allied professions with academics and older counselling psychologists reporting the strongest distinctiveness. Respondents were concerned about other professions' increasingly overlapping scope of practice, and thought that the most important next step was advocacy for the profession and its core values. The results of this study can be used to better address training and professional identity issues adversely impacting the field (e.g. counselling psychologists with graduate degrees in subjects other than counselling psychology, trained counselling psychologists who license as other types of professionals), promote the profession, and prepare for future challenges to the field. The results also are relevant for those seeking to increase their knowledge of the profession in other countries to learn ways to better expand and promote the profession in their own country and for those looking to create country-specific surveys to better elucidate the profession in their own country. [ABSTRACT FROM AUTHOR]

Human rights are foundational to the health and well-being of all individuals and have remained a central tenet of nursing's ethical framework throughout history. The purpose of this study is to explore continuity and changes to human rights in nursing codes of ethics in the Canadian context. This study examines nursing codes of ethics between the years 1953 and 2017, which spans the very first code in Canada to the most recently adopted. The historical method is used to compare and contrast human rights language, positioning and descriptions between different code editions. The findings suggest there has been very little change in how human rights have been included within the Canadian nursing codes of ethics. Furthermore, we consider how changes within the nursing profession have influenced the authority of codes of ethics and their ability to support nurses in carrying out ethical obligations specific to human rights. Finally, the impacts and implications of these changes are discussed concerning the protection of human rights in today's healthcare landscape in Canada. [ABSTRACT FROM AUTHOR]

The residency years comprise the last period of a physician’s formal training. It is at this stage that trainees consolidate the clinical skills required for independent practice and achieve a level of ethical development essential to their work as physicians, a process known as professional identity formation (PIF). Ethics education is thought to contribute to ethical development and to that end the Royal College of Physicians and Surgeons of Canada (RCPSC) requires that formal ethics education be integrated within all postgraduate specialty training programs. However, a formal ethics curriculum can operate in parallel with informal and hidden ethics curricula, the latter being more subtle, pervasive, and influential in shaping learner attitudes and behavior. This paper reports on a study of the formal, informal, and hidden ethics curricula at two postgraduate psychiatry programs in Canada. Based on the analysis of data sources, we relate the divergences between the formal, informal, and hidden ethics curricula to two aspects of professional identity formation (PIF) during psychiatry residency training. The first is the idea of group membership. Adherence to the hidden curriculum in certain circumstances determines whether residents become part of an ingroup or demonstrate a sense of belonging to that group. The second aspect of PIF we explore is the ambiguous role of the resident as a student and a practitioner. In ethically challenging situations, adherence to the messages of the hidden curriculum is influenced by and influences whether residents act as students, practitioners, or both. This paper describes the hidden curriculum in action and in interaction with PIF. Our analysis offers a complementary, empirical perspective to the theoretical literature concerning PIF in medical education. This literature tends to position sound ethical decisionmaking as the end result of PIF. Our analysis points out that the mechanism works in both directions: how residents respond to hidden curriculum in ethics can be a driver of professional identity formation. [ABSTRACT FROM AUTHOR]

This study looked into client access to their case records routinely maintained by social workers in the course of professional practice. An online survey and semi-structured interviews were undertaken with Canadian social workers. The study found that while the majority of the participants indicated that they granted clients access to their case records, clients were not effectively granted such access in practice. Client access to their case records is a core issue in social work, and social workers need to proactively grant such access if they are to live by the core values of social work. [ABSTRACT FROM AUTHOR]

Background: Moral philosophical positions and professional values have been shown to influence nurses' practice behaviours. Understanding nursing students' professional values and ethical ideologies, therefore, is important as they may help inform evidence-informed curriculum decisions and education strategies to develop students' professional reflective competencies. However, there is a dearth in current empirical data on Canadian nursing students' perceptions of professional values and ethical positions. Objectives: This study's purpose was to examine undergraduate nursing student's perceptions of professional values and ethical ideology and explore relationships in data and selected participant demographic variables. Research design, participants and context: A descriptive cross-sectional research design was conducted with a convenience sample of undergraduate nursing students recruited from a university in Canada. An online encrypted survey consisting of two validated instruments was administered to participants who met study eligibility criteria. Descriptive and inferential statistics were employed to analyse the data and classify nursing students' ethical ideologies into four categories based on mean scores for idealism and relativism. Ethical considerations: This study received ethical approval from the institutional Behavioural Research Ethics Board and was executed in-line with ethical principles for research involving humans. Findings: Nursing students scored high on professional values and ethical idealism and differed significantly on a measure of ethical relativism in terms of age and year of study. Professional values were significantly associated with ethical idealism. Based on mean scores for idealism and relativism, most nursing students in the study were classified as situationists. Discussion and conclusion: Findings suggest that faculty pay attention to influences of moral philosophical positions in facilitating nursing students' professional values development. Implications for future research and curriculum are highlighted to strengthen nursing students' professional values. [ABSTRACT FROM AUTHOR]

The obesity epidemic in the United States and Canada has been accompanied by an increased demand on behavioral health specialists to provide comprehensive behavior therapy for weight loss (BTWL) to individuals with obesity. Clinical health psychologists are optimally positioned to deliver BTWL because of their advanced competencies in multimodal assessment, training in evidence-based methods of behavior change, and proficiencies in interdisciplinary collaboration. Although published guidelines provide recommendations for optimal design and delivery of BTWL (e.g., behavior modification, cognitive restructuring, and mindfulness practice; group-based vs. individual therapy), guidelines on ethical issues that may arise during assessment and treatment remain conspicuously absent. This article reviews clinical practice guidelines, ethical codes (i.e., the Canadian Code of Ethics for Psychologists and the American Psychological Association Ethical Principles of Psychologists), and the extant literature to highlight obesity-specific ethical considerations for psychologists who provide assessment and BTWL in health care settings. Five key themes emerge from the literature: (a) informed consent (instilling realistic treatment expectations; reasonable alternatives to BTWL; privacy and confidentiality); (b) assessment (using a biopsychosocial approach; selecting psychological tests); (c) competence and scope of practice (self-assessment; collaborative care); (d) recognition of personal bias and discrimination (self-examination, diversity); and (e) maximizing treatment benefit while minimizing harm. Practical recommendations grounded in the American Psychological Association's competency training model for clinical health psychologists are discussed to assist practitioners in addressing and mitigating ethical issues in practice. Public Significance Statement: This article consolidates professional guidance from ethical standards, practice guidelines, and published literature to outline key ethical issues relevant to clinical health psychologists providing behavior therapy for weight loss to adults with obesity. Obesity-specific ethical considerations are discussed in terms of obtaining informed consent, assessment, competence/scope-of-practice, self-examination, and balancing treatment harms and benefits. [ABSTRACT FROM AUTHOR]

In this article, we argue that evidence-based advocacy for climate change action should be a core competency of professional planners. However, data from our case study in Metro Vancouver, Canada, suggests that municipal-level climate change practitioners have conflicting views regarding their professional responsibility to advocate for action on climate change. We contend these tensions stem from twentieth-century planning debates, which oscillate between rational-comprehensive planning versus calls to advocate, in one form or another, for various public interests. Overall, we find that transforming barriers into enablers of action on climate change must include critical engagement with planning theory and education. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to (a) investigate the relationship between dentists' perceived professional role (PPR), defined as the belief that they are health care professionals versus business people, and treatment intensity, determined by the aggressiveness of clinical approaches, such as in number or scope, and (b) identify the demographic and practice characteristics that have a relationship to PPR.Methods: A 46-item survey with questions on dentists' demographic and professional characteristics was mailed to a random sample of 3,201 general dentists in Ontario, Canada. PPR was measured by visual analog scale and by Likert-type scale questions, which have been validated in the literature in terms of their ability to measure PPR. Treatment intensity was measured by a set of case scenarios. Univariate, bivariate, and multivariable analyses were performed.Results: One-thousand and seventy-five dentists returned usable surveys (33.6% response rate). When using the two methods to measure PPR, visual analog scale and Likert-type scale questions, dentists who identified as business people tended to have a higher treatment intensity compared to those who identified as health care professionals (p < 0.1 and p < 0.05, respectively). In multivariable logistic regression, years of practice, number of technologies used in a practice, and perceiving other dentists as competitors rather than colleagues were significant predictors of identifying as a business person.Conclusions: Dentists' PPRs had a significant relationship to the aggressiveness of treatment decisions. Demographic and practice characteristics also had significant relationships to PPR. These findings may have implications for public trust and dentistry's status as a health care profession. [ABSTRACT FROM AUTHOR]

In the last few decades, the number of women graduating from North American (NA) dental schools has increased significantly. Thus, we aimed to determine women's representation in leadership positions in NA dental and specialty associations/organizations, dental education, and dental journals, as well as the proportion of men/women researcher members of the American Association for Dental Research (AADR). We contacted NA dental associations to provide us with the total number and the men/women distribution of their members. Men/women distributions in leadership positions were accessible from the internet, as were data on the sex of deans of NA dental schools. Data on the editors in chief of NA dental journals were gathered from their websites, and the AADR provided the number and sex of its researcher members. Collected data underwent descriptive statistics and binomial tests (α = 0.05). Our findings suggest that women are underrepresented in leadership positions within the major NA dental professional associations. While the median ratio of women leaders to women members in professional associations is 0.91 in Canada, it is only 0.67 in the United States. The same underrepresentation of women is evident in the leadership of the Canadian Dental Association and the American Dental Association. We found that women are underrepresented as deans and editors in chief for NA oral health journals. Only 16 of 77 NA dental school deans are women, while 3 of 38 dental journals have women editors in chief. The probability of finding these ratios by chance is low. However, the number of women dental researcher AADR members underwent an overall increase in the past decade, while the number of men declined. These results suggest that, despite the increase in women dentists, it will take time and effort to ensure that they move through the pipeline to senior leadership positions in the same manner as their male colleagues. [ABSTRACT FROM AUTHOR]

The article reports on research findings of social responsibility methods within corporations in Canada and the U.S. Corporate social responsibility is being mainstreamed globally as businesses acknowledge the need for social and environmental virtues. The research investigates how the process is assimilated on a day-to-day basis within corporations. The bottom line in business has historically referred to finances, however a triple bottom line has developed which includes social and environmental issues.

The literature on professional socialization focuses on how students adopt and internalize professional identities and values, and assumes that boundary work is essential to learning how best to practice their profession. However, a focus on boundary work in the context of midwifery training - which is embedded in the gendered and hierarchical landscape of maternity care - is lacking. Thus, this article examines how Canadian student-midwives learn to navigate and negotiate interprofessional boundaries. Grounded in a symbolic interactionist approach, it draws on 31 semi-structured qualitative interviews from a mixed-methods national study on midwifery retention, explores how midwifery students make sense of the tensions among midwives, physicians, and nurses, and describes what strategies they utilize when navigating boundaries. Our analysis, based in constructivist grounded theory, revealed that participants learned about interprofessional tensions in clinical placement encounters via direct or indirect interactions with other healthcare professionals, and that strategies to navigate these tensions included educating others about midwifery training and adopting a learner identity. This article proposes that the process of professional socialization enables to reshape professional boundaries and that students are not only learners but also agents of change. These findings may yield practical applications in health education by highlighting opportunities for improving interprofessional collaborations. • Boundary work is part of professional socialization process. • Professional boundaries are ambiguous in midwifery but they are understudied. • This paper examines boundary work among 31 Canadian midwifery students. • The boundaries were clear with physicians but blurred in communication with nurses. • Learning about boundaries, students recreated them but also became agents of change. [ABSTRACT FROM AUTHOR]

Summary: Social workers practicing in small rural towns regularly encounter overlapping or dual relationships with clients. This can lead to boundary crossing and conflicts of interest that require an ethical decision. Previous research on how rural social workers approach ethical decision-making in these situations has suggested that while they might draw on ethical codes, many rely on intuitive or personal viewpoints rather than systematic decision-making processes. Although social workers are often trained to engage in self-reflection when faced with the complexities of practice and the possibilities of personal biases, the role of systematic self-reflection in personal decision-making about dual relationships has not been sufficiently documented in the literature. Using qualitative inquiry, this study explored the lived experiences with dual relationships reported by 44 practitioners working in small towns in rural Canada. Findings: The findings confirm that practitioners were frequently guided in their decisions by an intuitive or emotional understanding of dual relationships rather than by external codes, and while self-reflection was seen to play a role, a formal or systematic approach to personal self-reflection was not reported. Applications: The findings suggest that educational or professional development on more intentional use of self-reflection in practice would aid in safeguarding the client and the worker when dealing with dual relationships, while providing an ethical process congruent with a rural and remote community identity. Explicit decision-making would also make the process more defensible and justifiable, not only to themselves, but also to colleagues, supervisors, and to their professional association. [ABSTRACT FROM AUTHOR]

Background.: Competency in ethical decision making is a criterion for ethical practice, and it is expected to advance with ongoing professional development. However, research exploring continuing competency needs of occupational therapists regarding ethical decision making is limited. Purpose.: The purpose of this study was to explore potential gaps and directions for development related to continuing competency in ethical decision making from the perspective of practicing occupational therapists. Method.: Interpretive description informed secondary data analysis of professional narratives from a grounded theory study regarding ethical decision making. In-depth interviews were conducted with a purposive sample of 18 occupational therapists. Data analyses focused on identifying gaps and future directions regarding continuing competency. Findings.: Two main themes regarding gaps were identified: "I didn't have the knowledge" and "I don't have anybody." Education, tool development, and ethics mentorship were identified directions for development. Implications.: Findings advance understanding of continuing competency needs of occupational therapists regarding ethical decision making. [ABSTRACT FROM AUTHOR]

Health care services provided by workers' compensation systems aim to facilitate recovery for injured workers. However, some features of these systems pose barriers to high quality care and challenge health care professionals in their everyday work. We used interpretive description methodology to explore ethical tensions experienced by physical therapists caring for patients with musculoskeletal injuries compensated by Workers' Compensation Boards. We conducted in-depth interviews with 40 physical therapists and leaders in the physical therapy and workers' compensation fields from three Canadian provinces and analyzed transcripts using concurrent and constant comparative techniques. Through our analysis, we developed inductive themes reflecting significant challenges experienced by participants in upholding three core professional values: equity, competence, and autonomy. These challenges illustrate multiple facets of physical therapists' struggles to uphold moral commitments and preserve their sense of professional integrity while providing care to injured workers within a complex health service system. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Early mobilization is safe, feasible, and associated with better outcomes in patients with critical illness. However, barriers to mobilization in clinical practice still exist. The objective of this study was to assess the knowledge and practice patterns of intensive care unit (ICU) clinicians, as well as the barriers and facilitators to early mobilization. Design: Cross-sectional survey. Setting: Intensive care units of 3 university-affiliated hospitals in Montreal, Canada. Participants: One hundred and thirty-eight ICU clinicians, including nurses, physicians, respiratory therapists, and physiotherapists. Interventions: None. Measurements: Perceived barriers, facilitators, knowledge, and practice patterns of early mobilization were assessed using a previously validated mobility survey tool. Main Results: The overall response rate was 50.0% (138 of 274). Early mobilization was not perceived as a top priority in 49% of respondents. Results showed that clinicians were not fully aware of the benefits of early mobilization as per the current literature. About 58% of clinicians did not feel well trained and informed to mobilize mechanically ventilated patients. Perceptions on patient-level barriers varied with clinicians' professional training, but there was a high degree of interprofessional and intraprofessional disagreement on the permissible maximal level activity in different scenarios of critically ill patients. Conclusions: Our survey shows limited awareness, among our respondents, of the clinical benefits of early mobilization and high level of disagreement on the permissible maximal level of activity in the critically ill patients. Future studies should evaluate the role of knowledge translation in modifying these barriers and improving early mobilization. [ABSTRACT FROM AUTHOR]

The diagnostic process for patients presenting with cognitive decline and suspected dementia is complex. Physicians face challenges distinguishing between normal aging, mild cognitive impairment, Alzheimer's disease, and other dementias. Although there is some evidence for improving attitudes towards the importance of prompt diagnosis, there is limited information describing how physicians approach this diagnostic challenge in practice. This was explored in the present study. Across-sectional survey of primary care and specialist physicians, in 5 European countries, Canada, and the United States, was conducted. Participants were asked about their use of cognitive screening tools and diagnostic technologies, as well as the rationales and barriers for use. In total, 1365 physicians participated in the survey, 63% of whom were specialists. Most physicians stated they use objective cognitive tools to aid the early detection of suspected mild cognitive impairment or Alzheimer's disease in patients. The Mini-Mental State Examination was the most common tool used for initial screening; respondents cited speed and ease of use but noted its lack of specificity. Cerebrospinal fluid biomarker and amyloid positron emission tomography tests, respectively, had been used by only 26% and 32% of physicians in the preceding 6 months, although patterns of use varied across countries. The most commonly cited reasons for not ordering such tests were invasiveness (for cerebrospinal fluid biomarker testing) and cost (for amyloid positron emission tomography imaging). Data reported by physicians reveal differences in the approaches to the diagnostics process in Alzheimer's. A higher proportion of primary care physicians in the United States are routinely incorporating cognitive assessment tools into annual visits, but this is due to country differences in clinical practice. The value of screening tools and regular use could be discussed further with physicians; however, lack of specificity associated with cognitive tools and the investment required from patients and the healthcare system are limiting factors. [ABSTRACT FROM AUTHOR]

Abstract The potential medical risks to egg donors, in addition to the concern over the commodification of life, has led to debates surrounding the ethics of paying donors. In Canada, payment for eggs is prohibited by law; however, what is considered payment is contentious and has yet to be defined. The lack of legislative clarity coupled with increased ethical concerns over paying a donor has shifted egg donation from a medically-controlled procedure to a legal and social endeavor involving multiple professionals. Through semi-structured interviews with 52 medical and non-medical fertility practitioners, I show how medical practitioners use boundary-work to remove their practice from the ethical and legal debates surrounding egg donation, the "dirty work". I examine how the medical profession relies on discourses of "practicing science" to present their work as favorable and removed from current debates and potential legal ramifications. In showing how medical practitioners rely on boundary-work to distinguish their work from non-scientific and non-medical activities, I expand Gieryn's original conceptualization of boundary-work to demonstrate how medical practitioners can selectively draw on their practice of science to remove their work from ethically and legally contentious issues, the dirty work. Highlights • The Canadian Assisted Human Reproduction Act criminalized paid egg donation. • The act placed legal threats on medical practitioners and restricted their practices. • Medical practitioners used boundary-work to remove their work from legal threats. • Medical practitioners allocated contentious tasks to counselors and lawyers. • Boundary-work allowed medical practitioners to maintain their professional status. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Oncology Nursing Journal is the property of Pappin Communications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article explores the ways in which age and gender intersect to shape the workplace experiences of first-year Canadian social workers. The researcher conducted in-depth interviews with nine early-career (0.6–3.7 years post-bachelor of social work [BSW]), young adult (aged 23.9–32.9) social workers in Alberta, Canada, to understand their experiences in the first year of practice after completing the BSW; this article addresses the themes relating to age and gender. The methodology used in the study was hermeneutic phenomenology. Findings include negative conceptualizations of young social workers, meanings related to age and gender, use of evocative language to communicate positionality and practice values (“little girls” and “bitching up”), and feminized constructions of social work. Implications for social work education, practice, and research are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Education / Revue Canadienne de l'Éducation is the property of Canadian Society for the Study of Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Upon beginning their school-based teaching practica, teacher candidates enter a realm of practice that is at once uncertain, vulnerable, and particular, and where good educational practice centers on teacher's ability to see and to judge and to act ethically with others in concrete situations and ways. An important question for teacher education is: how do teacher candidates begin to acquire this capacity? This article draws on Martha Nussbaum's Aristotelian-inspired concept of “discernment” to explore how people begin to grasp phronesis or practical wisdom in teaching by becoming more responsive to the ethical character of classroom particulars while on practicum in ITE. The discussion is grounded in a teacher candidate's comments while on practicum at a Canadian elementary school to illustrate how becoming an ethical teacher is bound up in becoming perceptive, in opening oneself to the value and special wonder of the particular, in feeling the appropriate emotions about what one chooses, and by engaging in a play of thought about classroom particulars and educational universals. [ABSTRACT FROM AUTHOR]

Judges often have access to information that is outside the public record, such as the deliberations of their colleagues and excluded evidence. Despite this, Canadian judges have no express obligation under current ethics frameworks, including the Canadian Judicial Council's Ethical Principles for Judges and provincial codes of judicial conduct, to keep such information confidential or to avoid using it outside their judicial capacity. This gap means that it is possible for judges and former judges to take advantage of such information in ways that may undermine public confidence in the judiciary and the integrity of judicial deliberations. Surveying existing Canadian judicial ethics frameworks, the doctrine of deliberative secrecy, and the ethics frameworks of other jurisdictions including the UK and the USA, the authors argue that Canadian judicial ethics frameworks are inconsistent with international norms that recognize a duty of judicial confidentiality. The authors argue that imposing this duty would bring greater consistency to the legal profession by mirroring other duties of confidentiality and would safeguard public confidence in reasons for decisions and the intellectual freedom of judges' deliberative processes. The authors recommend that Ethical Principles for Judges should be revised and that the Canadian Judges Act should be amended to create a duty of judicial confidentiality that can be enforced against current and former judges using more flexible sanctions than currently exist. [ABSTRACT FROM AUTHOR]

Abstract: Background: Conventional wisdom links supervisor self‐confidence with experience in supervisory practice. Aims: This study explored the nature of confidence from an emic perspective. Method: Twelve experienced Canadian supervisors were interviewed, and data was analysed using Structured Thematic Analysis. Results: Aspects of the role and process produce tensions that create ambiguity that may diminish self‐confidence. Five main themes were distilled: (a) building supervisee confidence when experiencing self‐doubt as supervisor or clinician;(b) parallel process‐what disturbs therapy disturbs supervision; (c) expert vs. co‐explorer; (d) engaging in supervision while maintaining boundaries; and (e) catch 22 – inviting disclosures of difficulties and evaluation. Conclusion: The study adds nuance to the scholarly work that informs supervisor self‐confidence. [ABSTRACT FROM AUTHOR]