Ethics reflection groups in community health services: an evaluation study

Abstract

BackgroundSystematic ethics support in community health services in Norway is in the initial phase. There are few evaluation studies about the significance of ethics reflection on care. The aim of this study was to evaluate systematic ethics reflection in groups in community health (including nursing homes and residency), - from the perspectives of employees participating in the groups, the group facilitators and the service managers. The reflection groups were implemented as part of a research and development project.MethodsA mixed-methods design with qualitative focus group interviews, observations and written reports were used to evaluate. The study was conducted at two nursing homes, two home care districts and a residence for people with learning disabilities. Participants were employees, facilitators and service managers. The study was guided by ethical standard principles and was approved by the Norwegian Social Science Data Services.ResultsWe found support for ethics reflection as a valuable measure to strengthen clinical practice. New and improved solutions, more cooperation between employees, and improved collaboration with patients and their families are some of the results. No negative experiences were found. Instead, the ethics reflection based on experiences and challenges in the workplace, was described as a win-win situation. The evaluation also revealed what is needed to succeed and useful tips for further development of ethics support in community health services.ConclusionsEthics reflection groups focusing on ethical challenges from the participants’ daily work were found to be significant for improved practice, collegial support and cooperation, personal and professional development among staff, facilitators and managers. Resources needed to succeed were managerial support, and anchoring ethics sessions in the routine of daily work.

Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits

“…There is a need to explore how the culture of the organisation can affect the communication in home care encounters. Supervision and educational training are suggested as an important means to develop person‐centred care in practice (Edvardsson, Fetherstonhaugh, McAuliffe, Nay, & Chenco, ; Lillemoen & Pedersen, ; Sundler, Höglander, et al., ).…”

“…In recent years, more focus has been given to the care environment and its prerequisites (McCormack, Dewing, et al., ) and how these affect the delivery of person‐centred care. Community health care is often characterised by time constraints and the inability to meet all the patients’ needs, with little time for reflection on clinical practice (Lillemoen & Pedersen, ). A pertinent question therefore is how to perform person‐centred communication in home care.…”

The Norwegian national project for ethics support in community health and care services

“…In some municipalities, the ethics activities have ceased. In most municipalities, ethics activities consist of discussing actual dilemmas experienced in the professionals’ practice, [22] yet only a minority use structured methods for ethical deliberation [19]. The present study is the first to survey the Norwegian ethics project on a national scale, where we ask what the municipal ethics activities have consisted of, and what consequences they have had for the services and the professionals.…”

Er kliniske etikk-komiteer i den kommunale helse- og omsorgstjenesten bærekraftige?

“…Dette er ikke overraskende resultater, også annen forskning viser at tilrettelegging av arenaer for systematisk refleksjon og drøfting av etiske problemer har en positiv betydning både når det gjelder oppmerksomheten på etikk og på håndteringen av etisk utfordrende situasjoner (Söderhamn et al 2015;Lillemoen & Pedersen 2015). Arenaer for systematisk drøfting av etiske problemer, som for eksempel etikkrefleksjonsgrupper og kliniske etikkomiteer, er to viktige måter å gjøre etikken allmenn og systematisk, samt å møte helse-og omsorgstjenestens behov for etisk refleksjon og drøfting.…”

“…Dette er et tiltak som i stor grad vurderes å ha en positiv betydning for helsepersonell og for tjenesten de utøver (Gjerberg et al 2014;Söderhamn et al 2015;Lillemoen & Pedersen 2015). Dette synes å vaere et godt tiltak som både hjelper helsepersonellet til ny forståelse, handlingsalternativer og styrker deres evne til samarbeid (Lillemoen & Pedersen 2015).…”