The usability, feasibility and fidelity of the Ethics Quarter e-learning intervention for nurse managers

Strategies to mitigate moral distress as reported by eldercare professionals

Eldercare workers experience higher levels of moral distress than other health and social care service workers. Moral distress is a psychological response to a morally challenging event. Very little is known about moral distress in the context of eldercare and about the mechanisms of preventing or mitigating moral distress. This qualitative study was conducted as part of the "Ensuring the availability of staff and the attractiveness of the sector in eldercareservices" project in Finland in 2021. The data were from 39 semi-structured interviews. This qualitative interview data were examined using two-stage content analysis. The key finding of this study, as reported by eldercare professionals, is that strategies to mitigate moral distress can be found at all organizational levels : organizational, workplace and individual. The tools that emerged from the interviews fell into four main categories:) organizational support and education 2) peer support 3) improving self-care and competence and 4) defending patients. The main identified categories confirmed the earlier findings but the qualitative, rich research interview data provided new insights into a little-studied topic: mitigating moral distress in eldercare. The main conclusion is that, in order to mitigate moral distress, ethical competence needs to be strengthened at all organizational levels.

Interventions for the promotion of the ethical environment among health professionals: Scoping review

BACKGROUND

Education is a tool for the promotion of ethical skills that ensure the principles of conduct and the quality of care provided. The literature is still incipient in this theme; however, some studies point to education and ethical consultations as strategies to promote an ethical environment.

OBJECTIVE

To map the interventions that aim to prospect the ethical environment in health services.

METHOD

Scoping review to answer the question "What interventions are being used by health professionals to prospect an ethical environment in health services?" It occurred in the Medline (PubMed), CINAHL with Full Text (EBSCO), Scopus, Embase (Elsevier), and Web of Science databases in January 2023 by two reviewers, via the Rayyan platform. Articles with health professionals addressing interventions to prospect the ethical environment in any health service were included, without time frame. A form was used for data extraction and analysis occurred via Bardin content analysis. The review protocol was registered in the Open Science Framework.

RESULTS

2429 records were found; however, only 12 articles were included for analysis, these being randomized, cross-sectional, descriptive, and qualitative studies. Among the interventions, it was noticed that 58.3% (n = 7) is about ethical education, 16.7% (n = 2) about ethical guidelines and codes, 16.7% (n = 2) about ethical reflection and leadership, and 8.3% (n = 1) of ethical consultations. A theoretical map was elaborated, and four types of interventions were identified, based on ethical consultation, ethical education, guidelines and codes of ethics, reflection, and ethical leadership.

CONCLUSIONS

The interventions were considered effective to prospect the ethical environment in health services, and their effectiveness was evaluated by validated instruments, as well as through interviews and focus groups.

Digital ethical reflection in long-term care: Leaders' expectations

BACKGROUND

Healthcare leader support and facilitation for ethics work are of great importance for healthcare professionals' handling of ethical issues, moral distress, and quality care provision. A digital tool for ethical reflection in long-term care was developed in response to the demand for appropriate tools.

RESEARCH AIM

This study aimed to explore healthcare leaders' expectations of using a digital tool for ethical reflection among their home nursing care staff.

RESEARCH DESIGN

A qualitative research design with vignettes and focus group interviews was used. The data were analyzed using reflexive thematic analysis.

PARTICIPANTS AND RESEARCH CONTEXT

The sample comprised ten healthcare leaders from municipal long-term care in Norway.

ETHICAL CONSIDERATIONS

Participation was voluntary and based on informed consent. The Norwegian Agency for Shared Services in Education and Research approved this study.

FINDINGS

The analysis resulted in the development of three themes representing leaders' expectations of the tool: (i) giving staff a voice, (ii) revealing ethics in practice, and (iii) keeping the pot boiling.

DISCUSSION

Leaders must be informed about the ethical issues experienced to engage in supportive measures for their staff. Digital channels can increase the democratization, safety, and efficiency of communication between employees and leaders and increase awareness of ethical aspects in daily care work. The leaders had positive expectations of employees' activities and benefits from using the tool for ethical reflection. However, they admitted that realizing the tool's potential to ensure continuity in ethics work requires considerable organizational and leader involvement.

CONCLUSIONS

This study shows that healthcare leaders are open to digital solutions for managing ethics work in home nursing care. Both opportunities and important prerequisites for successfully implementing the digital tool were identified.