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Primc N, Schwabe S, Poeck J, Günther A, Hasseler M, Rubeis G. A typology of nurses' interaction with relatives in emergency situations. Nurs Ethics 2023; 30:232-244. [PMID: 36314501 PMCID: PMC10014892 DOI: 10.1177/09697330221128902] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In nursing homes, residents' relatives represent important sources of support for nurses. However, in the heightened stress of emergency situations, interaction between nurses and relatives can raise ethical challenges. RESEARCH OBJECTIVES The present analysis aimed at elaborating a typology of nurses' experience of ethical support and challenges in their interaction with relatives in emergency situations. RESEARCH DESIGN Thirty-three semi-structured interviews and six focus groups were conducted with nurses from different nursing homes in Germany. Data were analysed according to Mayring's method of qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT Participants were licensed nurses working in nursing homes. ETHICAL CONSIDERATIONS Ethical approval was granted by Ostfalia University of Applied Sciences (02.07.2020) and the Ethics Committee of Hannover Medical School (Nr. 8866_BO_K_2020; 27.01.2020). Interviewees were anonymised and focus group were pseudonymised during transcription. All participants provided written consent. FINDINGS/RESULTS In emergency situations, relatives can represent important sources of support for nurses. However, they may also give rise to different challenges, relating to four ethical conflicts: (1) the challenge of meeting the information needs of relatives while providing appropriate care to all residents; (2) the challenge of managing relatives' demands for hospitalisation when hospitalisation is not deemed necessary by nurses; (3) the challenge of managing relatives' demands for lifesaving treatment when such treatment contradicts the will of the resident; and (4) the challenge of attempting to initiate hospitalisation when relatives oppose this course of action. Several external factors make these conflicts especially challenging for nurses: fear of legal consequences, a low staffing ratio, and a lack of qualified nursing staff. CONCLUSIONS Conflict between nurses and relatives typically revolves around hospitalisation and the initiation of lifesaving treatment. Whether nurses perceive interaction with relatives as supportive or conflictual essentially depends on the quality of the relationship, which may be negatively influenced by a number of external factors.
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Affiliation(s)
- Nadia Primc
- Institute of History and Ethics of Medicine, 9144University of Heidelberg, Heidelberg, Germany
| | - Sven Schwabe
- Institute for General Practice and Palliative Care, 9177Hannover Medical School, Hanover, Germany
| | - Juliane Poeck
- Institute of General Practice, 39065University Hospital Jena, Jena, Germany
| | - Andreas Günther
- Fire Department, 524823City of Braunschweig, Braunschweig Germany
| | - Martina Hasseler
- Faculty of Health Sciences, 120199Ostfalia University of Applied Sciences, Wolfenbüttel Germany
| | - Giovanni Rubeis
- Division Biomedical and Public Health Ethics, 467773Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
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Momeni P, Årestedt K, Alvariza A, Winnberg E, Goliath I, Kneck Å, Leksell J, Ewertzon M. A survey study of family members' encounters with healthcare services within the care of older people, psychiatric care, palliative care and diabetes care. Scand J Caring Sci 2022; 36:1228-1240. [PMID: 35808909 PMCID: PMC9796367 DOI: 10.1111/scs.13096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/23/2022] [Accepted: 05/22/2022] [Indexed: 01/01/2023]
Abstract
The aim of this study was to describe and compare family members' experiences of approach in encounters with healthcare professionals and possible feelings of alienation in the professional care within four care contexts: the care of older people, psychiatric care, palliative care and diabetes care. The design was an explorative cross-sectional survey study. Data were collected in Sweden using the Family Involvement and Alienation Questionnaire-Revised (FIAQ-R). It measures family members' experiences of the healthcare professionals' approach and the family members' feeling of alienation from the provision of professional care. A total of 1047 questionnaires were distributed to family members using convenient sampling method, of which 294 were included. Data were analysed using rank-based, non-parametric statistical methods. The results indicated that most respondents experienced a positive actual approach from the healthcare professionals. Many participants rated the importance of approach at a higher level than their actual experience. Participants in the context of diabetes care reported a more negative actual approach from the healthcare professionals than did participants in the other contexts and considered the healthcare professionals' approach towards them as being less important. The results for the entire group indicated that the participants felt a low level of alienation from the professional care. Participants in the context of the care of older people reported significantly lower level of feeling of being alienated than did participants in the contexts of psychiatric care and diabetes care. The differences between participants in diabetes care and other care contexts can possibly be explained by a more fully implemented self-care approach among the patients in diabetes care than in the other care contexts. Even though the results are quite positive, it is still important that nurses consider a family-centred approach to better adapt to the needs of both the family members and the patients.
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Affiliation(s)
- Pardis Momeni
- Department of Health Care SciencesErsta Sköndal Bräcke University CollegeStockholmSweden
| | - Kristofer Årestedt
- Faculty of Health and Life SciencesLinnaeus UniversityKalmarSweden,Department of ResearchRegion Kalmar CountyKalmarSweden
| | - Anette Alvariza
- Department of Health Care SciencesErsta Sköndal Bräcke University CollegeStockholmSweden,Capio Palliative CareDalen HospitalStockholmSweden
| | - Elisabeth Winnberg
- Department of Health Care SciencesErsta Sköndal Bräcke University CollegeStockholmSweden
| | - Ida Goliath
- Stockholm Gerontology Research CenterStockholmSweden
| | - Åsa Kneck
- Department of Health Care SciencesErsta Sköndal Bräcke University CollegeStockholmSweden
| | - Janeth Leksell
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - Mats Ewertzon
- Department of Health Care SciencesErsta Sköndal Bräcke University CollegeStockholmSweden,Swedish Family Care Competence CenterKalmarSweden
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Glomsås HS, Knutsen IR, Fossum M, Christiansen K, Halvorsen K. Family caregivers' involvement in caring for frail older family members using welfare technology: a qualitative study of home care in transition. BMC Geriatr 2022; 22:223. [PMID: 35303816 PMCID: PMC8932075 DOI: 10.1186/s12877-022-02890-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/02/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Demographic, economic and organisational changes challenge home care services. Increased use of welfare technology and involvement of family members as co-producers of care are political initiatives to meet these challenges. However, these initiatives also involve ethical aspects. METHOD The aim of this qualitative study was to explore family caregivers' experience of involvement and possible ethical aspects of caring for frail older family members receiving home care services supported by welfare technology. This study used a qualitative explorative and descriptive design within a phenomenological-hermeneutical approach. Sixteen interviews with eighteen family caregivers were conducted. The participants were sons, daughters, siblings and spouses of frail older people receiving home care services with the support of welfare technology. Data were analysed using reflexive thematic analysis. The COREQ checklist was used. RESULTS The analysis led to five main themes. First, the family caregivers' experienced caring as meaningful but increasingly demanding concerning the changes in home care services. Second, they experienced a change in relationships, roles, tasks, and responsibilities related to more family involvement and the use of welfare technology. This also challenged their sense of autonomy. However, welfare technology helped them deal with responsibilities, especially safety. The family caregivers requested early involvement, dialogue for care decisions, more cooperation and support from health professionals. Third, the participants experienced that health professionals decided the conditions for co-production without discussion. Their need for information and knowledge about welfare technology were not met. Fourth, the family caregivers felt that the health professionals did not adequately recognise their unique knowledge of the care receiver and did not use this knowledge for customising the welfare technology to the care receiver and their families. Fifth, the family caregivers expressed concern about service and welfare technology inequality in home care services. CONCLUSIONS Co-production in the involvement of family caregivers in care is still not an integral part of home care service. Welfare technology was appreciated, but the family caregivers called for early involvement to ensure successful and safe implementation and use. More attention needs to be given to ethical concerns about the change in relations, transfer of tasks and responsibility, and risk of inequality.
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Affiliation(s)
- Heidi Snoen Glomsås
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130 Oslo, Norway
| | - Ingrid Ruud Knutsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130 Oslo, Norway
| | - Mariann Fossum
- Faculty of Health and Sport Sciences, Institute of Health and Nursing Science, University of Agder, Postboks 422, N-4604 Kristiansand, Norway
| | - Karin Christiansen
- Faculty of Health Sciences, Research Centre for Health and Welfare Technology, VIA University College, Hedeager 2, DK-8200 Aarhus, Denmark
| | - Kristin Halvorsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130 Oslo, Norway
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Rykkje L, Holm AL, Hem MH. Norwegian Nurses' Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis. SAGE Open Nurs 2021; 7:23779608211057938. [PMID: 34869863 PMCID: PMC8640321 DOI: 10.1177/23779608211057938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Internationally, aging populations have increased needs for health care services, and often specialized care is required. However, services for older people tend to be underfunded, resulting in lack of qualified staff and poor quality care. Resource shortages lead to ethical challenges and insufficient nursing care. Therefore, quality in daily care for older people also depends upon the nurses’ ability to make complex, ethical decisions in their practice. Objectives To explore ethical challenges experienced by nurses caring for older people in clinical practice, and to provide examples of management for the challenges. Methods The data collected were written reflection notes by Norwegian continuous education students in advanced gerontology. Forty two of 83 notes were included and a thematic analysis in six steps was utilized. Findings There are three main themes: (1) meeting vulnerability, discomfort, and suffering, (2) collaboration with relatives, and (3) struggling to perform professional care. Conclusion Nurses strive to “do what is in the patients’ best interest”, and this is fostered through collaboration, professionalism, care, and presence. Nurses’ ethical competencies may develop when reflecting upon their own care performance. Building ethical competencies should be a priority in both nursing education and clinical practice. However, to improve care quality, nurses also need professional knowledge about older people care and ethical awareness should be supported by the workplace.
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Affiliation(s)
- Linda Rykkje
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
| | - Anne Lise Holm
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Marit Helene Hem
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Claesson M, Jonasson LL, Josefsson K. Next of kin's experiences of registered nurses' leadership close to older adults in municipal home care in Sweden: an interview study. BMC Nurs 2021; 20:213. [PMID: 34715871 PMCID: PMC8554742 DOI: 10.1186/s12912-021-00745-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Next of kin to older adults over 65 years in municipal home care are concerned whether their older adults’ needs are being met. In municipal home care, the registered nurses’ leadership is important and complex, entailing multi-artist skills involving the older adults and their next of kin. Yet, little is known about next of kin’s experiences of registered nurses’ leadership. Thus, the aim of this study was to explore next of kin’s experiences of registered nurses’ leadership close to older adults in municipal home care. Methods Individual telephone interviews were conducted with next of kin (n = 11) of older adults from April to September 2020 in two municipalities in western Sweden. Data were analysed using qualitative content analysis. Results The results are presented with the theme, registered nurses do what they can, including two categories, interaction and competence, and the subcategories, relationship, communication, availability, responsibility, team leadership and cooperation. Registered nurses’ leadership was experienced as a balancing act between their commitments and what they were able to achieve. Conclusions Next of kin’s experiences of registered nurses’ leadership can contribute knowledge that will strengthen and prepare registered nurses for their leadership roles. This knowledge can support the development of policies for organisational preconditions that ensure quality and safe care to older adults in municipal home care.
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Affiliation(s)
- Maria Claesson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.
| | - Lise-Lotte Jonasson
- Department of Nursing School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Karin Josefsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.,Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden
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Schofield G, Dittborn M, Selman LE, Huxtable R. Defining ethical challenge(s) in healthcare research: a rapid review. BMC Med Ethics 2021; 22:135. [PMID: 34587950 PMCID: PMC8479723 DOI: 10.1186/s12910-021-00700-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/03/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Despite its ubiquity in academic research, the phrase 'ethical challenge(s)' appears to lack an agreed definition. A lack of a definition risks introducing confusion or avoidable bias. Conceptual clarity is a key component of research, both theoretical and empirical. Using a rapid review methodology, we sought to review definitions of 'ethical challenge(s)' and closely related terms as used in current healthcare research literature. METHODS Rapid review to identify peer-reviewed reports examining 'ethical challenge(s)' in any context, extracting data on definitions of 'ethical challenge(s)' in use, and synonymous use of closely related terms in the general manuscript text. Data were analysed using content analysis. Four databases (MEDLINE, Philosopher's Index, EMBASE, CINAHL) were searched from April 2016 to April 2021. RESULTS 393 records were screened, with 72 studies eligible and included: 53 empirical studies, 17 structured reviews and 2 review protocols. 12/72 (17%) contained an explicit definition of 'ethical challenge(s), two of which were shared, resulting in 11 unique definitions. Within these 11 definitions, four approaches were identified: definition through concepts; reference to moral conflict, moral uncertainty or difficult choices; definition by participants; and challenges linked to emotional or moral distress. Each definition contained one or more of these approaches, but none contained all four. 68/72 (94%) included studies used terms closely related to synonymously refer to 'ethical challenge(s)' within their manuscript text, with 32 different terms identified and between one and eight different terms mentioned per study. CONCLUSIONS Only 12/72 studies contained an explicit definition of 'ethical challenge(s)', with significant variety in scope and complexity. This variation risks confusion and biasing data analysis and results, reducing confidence in research findings. Further work on establishing acceptable definitional content is needed to inform future bioethics research.
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Affiliation(s)
- Guy Schofield
- Centre for Ethics in Medicine, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
| | - Mariana Dittborn
- Paediatric Bioethics Centre, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Lucy Ellen Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Richard Huxtable
- Centre for Ethics in Medicine, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
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de Snoo-Trimp JC, Molewijk B, Ursin G, Brinchmann BS, Widdershoven GA, de Vet HC, Svantesson M. Field-testing the Euro-MCD Instrument: Experienced outcomes of moral case deliberation. Nurs Ethics 2019; 27:390-406. [PMID: 31177947 DOI: 10.1177/0969733019849454] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. AIM To describe experienced outcomes after participating in a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. METHODS In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. ETHICAL CONSIDERATIONS The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. RESULTS The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. CONCLUSION Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare.
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Affiliation(s)
| | - Bert Molewijk
- Amsterdam UMC, location VU Medical Center, The Netherlands; University of Oslo, Norway
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Rasoal D, Kihlgren A, Skovdahl K. Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach. BMC Geriatr 2018; 18:312. [PMID: 30547755 PMCID: PMC6293571 DOI: 10.1186/s12877-018-0996-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background The general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services. Method This study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations (n = 122), memos and informal interviews with registered nurses (n = 8), and nurse assistants (n = 4). The transcribed texts were analyzed with interpretive content analysis. Results The inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues. Conclusions This study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.
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Affiliation(s)
- Dara Rasoal
- School of Health, Care and Social Welfare, Mälardalen University, Högskoleplan 1, 721 23, Västerås, Sweden.
| | - Annica Kihlgren
- Institution of Health and Medical Sciences, Örebro University, Faultetsgatan 1, 701 82, Örebro, Sweden
| | - Kirsti Skovdahl
- Faculty for Health and Social Sciences, University in South-Eastern Norway, Post box 235, 3603, Kongsberg, Norway
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Pergert P, Bartholdson C, Wenemark M, Lützén K, Af Sandeberg M. Translating and culturally adapting the shortened version of the Hospital Ethical Climate Survey (HECS-S) - retaining or modifying validated instruments. BMC Med Ethics 2018; 19:35. [PMID: 29747639 PMCID: PMC5946534 DOI: 10.1186/s12910-018-0274-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 04/25/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The Hospital Ethical Climate Survey (HECS) was developed in the USA and later shortened (HECS-S). HECS has previously been translated into Swedish and the aim of this study was to describe a process of translating and culturally adapting HECS-S and to develop a Swedish multi-professional version, relevant for paediatrics. Another aim was to describe decisions about retaining versus modifying the questionnaire in order to keep the Swedish version as close as possible to the original while achieving a good functional level and trustworthiness. METHODS In HECS-S, the respondents are asked to indicate the veracity of statements. In HECS and HECS-S the labels of the scale range from 'almost never true' to 'almost always true'; while the Swedish HECS labels range from 'never' to 'always'. The procedure of translating and culturally adapting the Swedish version followed the scientific structure of guidelines. Three focus group interviews and three cognitive interviews were conducted with healthcare professionals. Furthermore, descriptive data were used from a previous study with healthcare professionals (n = 89), employing a modified Swedish HECS. Decisions on retaining or modifying items were made in a review group. RESULTS The Swedish HECS-S consists of 21 items including all 14 items from HECS-S and items added to develop a multi-professional version, relevant for paediatrics. The descriptive data showed that few respondents selected 'never' and 'always'. To obtain a more even distribution of responses and keep Swedish HECS-S close to HECS-S, the original labels were retained. Linguistic adjustments were made to retain the intended meaning of the original items. The word 'respect' was used in HECS-S with two different meanings and was replaced in one of these because participants were concerned that respecting patients' wishes implied always complying with them. CONCLUSIONS The process of developing a Swedish HECS-S included decisions on whether to retain or modify. Only minor adjustments were needed to achieve a good functional level and trustworthiness although some items needed to be added. Adjustments made could be used to also improve the English HECS-S. The results shed further light on the need to continuously evaluate even validated instruments and adapt them before use.
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Affiliation(s)
- Pernilla Pergert
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Children's and Women's Healthcare, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
| | - Cecilia Bartholdson
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Children's and Women's Healthcare, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Marika Wenemark
- Division of Community Medicine, Department of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.,Centre for Healthcare Development, Region Östergötland, SE-581 85, Linköping, Sweden
| | - Kim Lützén
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Margareta Af Sandeberg
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Children's and Women's Healthcare, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
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Tønnessen S, Ursin G, Brinchmann BS. Care-managers' professional choices: ethical dilemmas and conflicting expectations. BMC Health Serv Res 2017; 17:630. [PMID: 28882150 PMCID: PMC5590170 DOI: 10.1186/s12913-017-2578-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/29/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Care-managers are responsible for the public administration of individual healthcare decisions and decide on the volume and content of community healthcare services given to a population. The purpose of this study was to investigate the conflicting expectations and ethical dilemmas these professionals encounter in their daily work with patients and to discuss the clinical implications of this. METHODS The study had a qualitative design. The data consisted of verbatim transcripts from 12 ethical reflection group meetings held in 2012 at a purchaser unit in a Norwegian city. The participants consist of healthcare professionals such as nurses, occupational therapists, physiotherapists and social workers. The analyses and interpretation were conducted according to a hermeneutic methodology. This study is part of a larger research project. RESULTS Two main themes emerged through the analyses: 1. Professional autonomy and loyalty, and related subthemes: loyalty to whom/what, overruling of decisions, trust and obligation to report. 2. Boundaries of involvement and subthemes: private or professional, care-manager or provider and accessibility. CONCLUSIONS Underlying values and a model illustrating the dimensions of professional responsibility in the care-manager role are suggested. The study implies that when allocating services, healthcare professionals need to find a balance between responsibility and accountability in their role as care-managers.
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Affiliation(s)
- Siri Tønnessen
- University College of Southeast Norway, Campus Vestfold, 3603 Kongsberg, Norway
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