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Jakobsen LM, Molewijk B, de Snoo-Trimp J, Svantesson M, Ursin G. What is a High-Quality Moral Case Deliberation?-Facilitators' Perspectives in the Euro-MCD Project. HEC Forum 2024:10.1007/s10730-023-09519-w. [PMID: 38315250 DOI: 10.1007/s10730-023-09519-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 02/07/2024]
Abstract
The evaluation of the European Moral Case Deliberation Outcomes project (Euro-MCD) has resulted in a revised evaluation instrument, knowledge about the content of MCD (moral case deliberation), and the perspectives of those involved. In this paper, we report on a perspective that has been overlooked, the facilitators'. We aim to describe facilitators' perceptions of high-quality moral case deliberation and their Euro-MCD sessions. The research took place in Norway, Sweden, and the Netherlands using a survey combined with interviews with 41 facilitators. Facilitators' perceived that attaining a high-quality MCD implies fostering a safe and respectful atmosphere, creating a wondering mode, being an attentive authority, developing moral reflective skills, reaching a common understanding, and ensuring organisational prerequisites for the MCD sessions. Our central conclusion is that efforts at three levels are required to attain a high-quality MCD: trained and virtuous facilitator; committed, respectful participants; and organizational space. Furthermore, managers have a responsibility to prepare MCD participants for what it means to take part in MCD.
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Affiliation(s)
- Lena M Jakobsen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Harstad, Norway.
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway.
| | - Bert Molewijk
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, Amsterdam, The Netherlands
- Center of Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Janine de Snoo-Trimp
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Mia Svantesson
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Gøril Ursin
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
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Jakobsen L, Olsen RM, Brinchmann BS, Devik SA. Developing and Testing Digital Ethical Reflection in Long-Term Care: Nurses' Experiences. SAGE Open Nurs 2023; 9:23779608221150725. [PMID: 36654853 PMCID: PMC9841835 DOI: 10.1177/23779608221150725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/17/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Nurses working in municipal long-term care face ethical challenges that can lead to moral distress and discomfort for the nurse and affect the quality of patient care. Tools and methods that contribute to increased ethical awareness and support for nurses dealing with moral issues are lacking. Technological innovations may be suitable for ethics work, but little research has been conducted on how such solutions could be designed or their potential benefit. Therefore, this study contributes knowledge about the development and testing of a digital tool for ethics support among nurses. Objective To investigate how digital ethical reflection can support ethics work among nurses working in long-term care. Methods A digital ethical reflection tool was designed and tested in nursing homes and home nursing care in collaboration with two Norwegian municipalities. The study used sequential explanatory mixed-methods design. Over a 6-week period, at the end of each shift, nurses digitally reported the ethical challenges they had experienced. Their responses and experiences were described using descriptive statistics. Additionally, focus group interviews were conducted and analyzed using reflexive thematic analysis (TA). Results During the study period, 17 nurses reported a total of 223 registrations, with 24.8% stating that they had been in an ethically difficult situation. The digital reporting was perceived as practically applicable and helped to increase nurses' awareness of morally charged situations. The value of the registrations was found to depend on manager participation and the application of the obtained information. The participating nurses become aware that they lacked an arena for meaningful dialogue with and recognition from their manager. Conclusions Information obtained through digital reflection can form the basis for ethical reflections at the departmental level. Digital reflection has the potential to become a tool for managers in their support for employees facing ethical challenges when providing long-term care.
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Affiliation(s)
- Lena Jakobsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway,Lena Jakobsen, Faculty of Nursing and Health Sciences, Nord University, PO Box 1490, 8049 Bodø, Norway.
| | - Rose Mari Olsen
- Centre for Care Research Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
| | - Berit Støre Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, Norway and Nordland Regional University, Bodø, Norway
| | - Siri Andreassen Devik
- Centre for Care Research Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
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Nurses’ experiences of the ethical values of home care nursing: A qualitative study. Int J Nurs Sci 2022; 9:364-372. [PMID: 35891901 PMCID: PMC9305015 DOI: 10.1016/j.ijnss.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/25/2022] [Accepted: 06/11/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Considering the importance of out-of-hospital services, the emergence of home care nursing, and the need for an ethical framework in nursing practice, the present study aimed to explore the nurses’ experience of ethical values of home care nursing. Methods The data of the study was collected using face-to-face individual interviews. Through purposive sampling, 20 nurses who worked in the home care centers in four cities of Iran in 2020 were interviewed. They shared their experiences of the ethical values of home care nursing. Then, the interviews were analyzed based on the content analysis approach and using Graneheim and Lundman method. Results In the present study, 416 codes were extracted. Merging these codes based on the similarity, seven main themes, and 16 sub-themes were extracted. The themes included perception of the professional identity, respect for the client’s autonomy, respecting privacy, establishing human interaction, maintaining mutual safety, observance of justice, and cultural-religious competence. The sub-themes included responsibility, development of professional and inter-professional interactions, maintaining the professional status at home, providing the holistic artistic care, patient’s privacy, nurse’s privacy, and maintaining the confidentiality of information, respect for the client’s choice, honestly informing, empathetic interaction, adjusting the power positions, client's safety, nurse’s safety, establishing justice, respect for the religious beliefs at home and cultural sensitivity. Conclusion The participants stated that due to entering the patient’s privacy in the home care cases, the ethical values such as perception of the professional identity, privacy, family interactions’ management, mutual security, and cultural-religious competence became doubly important compared to the hospital caring.
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Magelssen M, Karlsen H. Clinical ethics committees in nursing homes: what good can they do? Analysis of a single case consultation. Nurs Ethics 2021; 29:94-103. [PMID: 34254541 PMCID: PMC8866748 DOI: 10.1177/09697330211003269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Ought nursing homes to establish clinical ethics committees (CECs)? An answer
to this question must begin with an understanding of how a clinical ethics
committee might be beneficial in a nursing home context – to patients, next
of kin, professionals, managers, and the institution. With the present
article, we aim to contribute to such an understanding. Aim: We ask, in which ways can clinical ethics committees be helpful to
stakeholders in a nursing home context? We describe in depth a clinical
ethics committee case consultation deemed successful by stakeholders, then
reflect on how it was helpful. Research design: Case study using the clinical ethics committee’s written case report and
self-evaluation form, and two research interviews, as data. Participants and research context: The nursing home’s ward manager and the patient’s son participated in
research interviews. Ethical considerations: Data were collected as part of an implementation study. Clinical ethics
committee members and interviewed stakeholders consented to study
participation, and also gave specific approval for the publication of the
present article. Findings/results: Six different roles played by the clinical ethics committee in the case
consultation are described: analyst, advisor, support, moderator, builder of
consensus and trust, and disseminator. Discussion: The case study indicates that clinical ethics committees might sometimes be
of help to stakeholders in moral challenges in nursing homes. Conclusions: Demanding moral challenges arise in the nursing home setting. More research
is needed to examine whether clinical ethics committees might be suitable as
ethics support structures in nursing homes and community care.
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Affiliation(s)
| | - Heidi Karlsen
- Centre for Medical Ethics, University of Oslo, Norway
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Laukkanen L, Suhonen R, Poikkeus T, Löyttyniemi E, Leino-Kilpi H. The effectiveness of the Ethics Quarter intervention on the ethical activity profile of nurse managers: A randomized controlled trial. J Nurs Manag 2021; 30:2126-2137. [PMID: 34231275 DOI: 10.1111/jonm.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
AIM To test the effectiveness of a new ethics educational e-learning intervention, Ethics Quarter, in supporting nurse managers' ethical activity profile. BACKGROUND Health care organisations need evidence-based ethics interventions to support nurse managers' ethical activity profile. METHODS A parallel-group, individually randomized controlled trial was conducted in 2020. Finnish nurse managers nationwide [members of the Union of Health and Social Care Professionals in Finland (Tehy) trade union] were randomly allocated to intervention (n = 169) or control group (n = 172). The intervention group participated in the Ethics Quarter comprising twelve 15-min evidence-based educational 'quarters' spread over 6 weeks. The control group had standard organisational ethics structures. The primary and secondary outcomes were ethical activity profile and ethics knowledge, respectively. The Consolidated Standards of Reporting Trials (CONSORT) statement for study design and reporting was adopted. RESULTS Ethical activity profile showed statistically significant differences in mean changes between the groups from baseline to 10 weeks: all five dimensions were statistically significantly higher in the intervention group compared with the control group (p = <.0001). CONCLUSION The Ethics Quarter was effective in increasing nurse managers' ethical activity profile. IMPLICATIONS FOR NURSING MANAGEMENT Applying this ethics educational e-learning intervention would benefit nursing management education and health care organisations. TRIAL REGISTRATION clinicaltrials.gov: NCT04234503.
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Affiliation(s)
- Laura Laukkanen
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,City of Turku, Welfare Division, Turku, Finland
| | - Tarja Poikkeus
- Emergency Medical Services, Emergency Department and Wards, Hospital District of Northern Savo, Kuopio University Hospital, Kuopio, Finland
| | | | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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Conceptualizing and Fostering the Quality of CES Through a Dutch National Network on CES (NEON). HEC Forum 2021; 34:169-186. [PMID: 33449233 PMCID: PMC9142414 DOI: 10.1007/s10730-020-09432-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 12/03/2022]
Abstract
The prevalence of Clinical ethics support (CES) services is increasing. Yet, questions about what quality of CES entails and how to foster the quality of CES remain. This paper describes the development of a national network (NEON), which aimed to conceptualize and foster the quality of CES in the Netherlands simultaneously. Our methodology was inspired by a responsive evaluation approach which shares some of our key theoretical presuppositions of CES. A responsive evaluation methodology engages stakeholders in developing quality standards of a certain practice, instead of evaluating a practice by predefined standards. In this paper, we describe the relationship between our theoretical viewpoint on CES and a responsive evaluation methodology. Then we describe the development of the network (NEON) and focus on three activities that exemplify our approach. In the discussion, we reflect on the similarities and differences between our approach and other international initiatives focusing on the quality of CES.
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Svantesson M, Griffiths F, White C, Bassford C, Slowther A. Ethical conflicts during the process of deciding about ICU admission: an empirically driven ethical analysis. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106672. [PMID: 33402429 PMCID: PMC8639921 DOI: 10.1136/medethics-2020-106672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Besides balancing burdens and benefits of intensive care, ethical conflicts in the process of decision-making should also be recognised. This calls for an ethical analysis relevant to clinicians. The aim was to analyse ethically difficult situations in the process of deciding whether a patient is admitted to intensive care unit (ICU). METHODS Analysis using the 'Dilemma method' and 'wide reflective equilibrium', on ethnographic data of 45 patient cases and 96 stakeholder interviews in six UK hospitals. ETHICAL ANALYSIS Four moral questions and associated value conflicts were identified. (1) Who should have the right to decide whether a patient needs to be reviewed? Conflicting perspectives on safety/security. (2) Does the benefit to the patient of getting the decision right justify the cost to the patient of a delay in making the decision? Preventing longer-term suffering and understanding patient's values conflicted with preventing short-term suffering and provision of security. (3) To what extent should the intensivist gain others' input? Professional independence versus a holistic approach to decision-making. (4) Should the intensivist have an ongoing duty of care to patients not admitted to ICU? Short-term versus longer-term duty to protect patient safety. Safety and security (experienced in a holistic sense of physical and emotional security for patients) were key values at stake in the ethical conflicts identified. The life-threatening nature of the situation meant that the principle of autonomy was overshadowed by the duty to protect patients from harm. The need to fairly balance obligations to the referred patient and to other patients was also recognised. CONCLUSION Proactive decision-making including advance care planning and escalation of treatment decisions may support the inclusion of patient autonomy. However, our analysis invites binary choices, which may not sufficiently reflect reality. This calls for a complementary relational ethics analysis.
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Affiliation(s)
- Mia Svantesson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Frances Griffiths
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Catherine White
- Patient and Public Representative, Trustee, ICUsteps - the Intensive Care Patient Support Charity, Coventry, UK
| | - Chris Bassford
- Department of Anaesthesia, Critical Care and Pain, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK
| | - AnneMarie Slowther
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
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Magelssen M, Karlsen H, Pedersen R, Thoresen L. Implementing clinical ethics committees as a complex intervention: presentation of a feasibility study in community care. BMC Med Ethics 2020; 21:82. [PMID: 32873310 PMCID: PMC7466831 DOI: 10.1186/s12910-020-00522-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background How should clinical ethics support services such as clinical ethics committees (CECs) be implemented and evaluated? We argue that both the CEC itself and the implementation of the CEC should be considered as ‘complex interventions’. Main text We present a research project involving the implementation of CECs in community care in four Norwegian municipalities. We show that when both the CEC and its implementation are considered as complex interventions, important consequences follow – both for implementation and the study thereof. Emphasizing four such sets of consequences, we argue, first, that the complexity of the intervention necessitates small-scale testing before larger-scale implementation and testing is attempted; second, that it is necessary to theorize the intervention in sufficient depth; third, that the identification of casual connections charted in so-called logic models allows the identification of factors that are vital for the intervention to succeed and which must therefore be studied; fourth, that an important part of a feasibility study must be to identify and chart as many as possible of the causally important contextual factors. Conclusion The conceptualization of the implementation of a CEC as a complex intervention shapes the intervention and the way evaluation research should be performed, in several significant ways. We recommend that researchers consider whether a complex intervention approach is called for when studying CESS implementation and impact.
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Affiliation(s)
- Morten Magelssen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130 Blindern, N-0318, Oslo, Norway.
| | - Heidi Karlsen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130 Blindern, N-0318, Oslo, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130 Blindern, N-0318, Oslo, Norway
| | - Lisbeth Thoresen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
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Devik SA, Munkeby H, Finnanger M, Moe A. Nurse managers' perspectives on working with everyday ethics in long-term care. Nurs Ethics 2020; 27:969733020935958. [PMID: 32666876 PMCID: PMC7564296 DOI: 10.1177/0969733020935958] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nurse managers are expected to continuously ensure that ethical standards are met and to support healthcare workers' ethical competence. Several studies have concluded that nurses across various healthcare settings lack the support needed to provide safe, compassionate and competent ethical care. OBJECTIVE The aim of this study was to explore and understand how nurse managers perceive their role in supporting their staff in conducting ethically sound care in nursing homes and home nursing care. DESIGN AND PARTICIPANTS Qualitative individual interviews were performed with 10 nurse managers with human resources responsibilities for healthcare workers in four nursing home wards and six home nursing care districts. Content analysis was used to analyse the data. ETHICAL CONSIDERATIONS The Norwegian Centre for Research Data granted permission for this study. FINDINGS The analysis resulted in seven subcategories that were grouped into three main categories: managers' perception of the importance of the role, managers' experiences of exercising the role and managers' opportunities to fulfil the role. Challenges with conceptualizing ethics were highlighted, as well as lack of applicable tools or time and varying motivation among employees. DISCUSSION The leaders tended to perceive ethics as a 'personal matter' and that the need for and benefit of ethical support (e.g., ethics reflection) depended on individuals' vulnerability, attitudes, commitment and previous experiences. The managers did not seem to distinguish between their own responsibility to support ethical competence and the responsibility of the individual employee to provide ethical care. CONCLUSIONS Our findings suggest that nurse managers need support themselves, both to understand and to carry out their responsibilities to foster their staffs' ethical conduct. Supporting staff in conducting ethically sound care requires more than organizing meeting places for ethical reflection; it also requires greater awareness and understanding of what ethical leadership means.
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Affiliation(s)
| | | | | | - Aud Moe
- Centre of Care Research, Norway; Nord University, Norway
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Porr C, Gaudine A, Woo K, Smith-Young J, Green C. How Community Nurses Manage Ethical Conflicts: A Grounded Theory Study. Glob Qual Nurs Res 2019; 6:2333393619894958. [PMID: 31909092 PMCID: PMC6937525 DOI: 10.1177/2333393619894958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 11/24/2022] Open
Abstract
Research is limited on how nurses in community settings manage ethical conflicts. To address this gap, we conducted a study to uncover the process of behaviors enacted by community nurses when experiencing ethical conflicts. Guided by Glaserian grounded theory, we developed a theoretical model (Moral Compassing) that enables us to explain the process how 24 community nurses managed challenging ethical situations. We discovered that the main concern with which nurses wrestle is moral uncertainty ("Should I be addressing what I think is a moral problem?"). Moral Compassing comprises processes that resolve this main concern by providing community nurses with the means to attain the moral agency necessary to decide to act or to decide not to act. The processes are undergoing a visceral reaction, self-talk, seeking validation, and mobilizing support for action or inaction. We also discovered that community nurses may experience continuing distress that we labeled moral residue.
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Affiliation(s)
- Caroline Porr
- Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Alice Gaudine
- Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Kevin Woo
- Queen’s University, Kingston, Ontario, Canada
| | - Joanne Smith-Young
- Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Candace Green
- Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
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Antonsen Y, Normann AK, Nilsen HR, Magelssen M. Systematisk etikkarbeid krever lederforankring. TIDSSKRIFT FOR OMSORGSFORSKNING 2018. [DOI: 10.18261/issn.2387-5984-2018-01-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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