Relational responsibilities in responsive evaluation

Seeking connections, creating movement: the power of altruistic action

Participation of older people in designing and improving the care and services provided in residential care settings is limited. Traditional forms of democratic representation, such as client councils, and consumer models are management-driven. An alternative way of involving older people in the decisions over their lives, grounded in notions of care ethics and deliberative democracy, was explored by action research. In line with this tradition older people engage in collective action to enhance the control over their lives and those of others. In this article the theoretical background of altruistic action is presented and illustrated by a case example of a group of older women who changed the food policies within their residential home. Altruistic action is the joint and coordinated action by a group of clients based on their agenda. Such action is given in by a shared dissatisfaction and search for connections. Altruistic action may enhance the sense of self, belonging and ownership, and create a transformative movement enhancing the wellbeing and community life in residential settings.

Managers' views on and experiences with moral case deliberation in nursing teams

AIMS

Providing management insights regarding moral case deliberation (MCD) from the experiential perspective of nursing managers.

BACKGROUND

MCD concerns systematic group-wise reflection on ethical issues. Attention to implementing MCD in health care is increasing, and managers' experiences regarding facilitating MCD's implementation have not yet been studied.

METHOD

As part of an empirical qualitative study on implementing MCD in mental health care, a responsive evaluation design was used. Using former research findings (iterative procedures), a managers' focus group was organised.

RESULTS

Managers appreciated MCD, fostering nurses' empowerment and critical reflection - according to managers, professional core competences. Managers found MCD a challenging intervention, resulting in dilemmas due to MCD's confidential and egalitarian nature. Managers value MCD's process-related outcomes, yet these are difficult to control/regulate.

CONCLUSIONS

MCD urges managers to reflect on their role and (hierarchical) position both within MCD and in the nursing team.

IMPLICATIONS FOR NURSING MANAGEMENT

MCD is in line with transformative and participatory management, fostering dialogical interaction between management and nursing team.