Moral competence, moral teamwork and moral action - the European Moral Case Deliberation Outcomes (Euro-MCD) Instrument 2.0 and its revision process

Abstract

Background: Clinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process. Methods: The revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes. Results: The Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. 'now') instead of an assumed improvement over time (e.g. 'better') and we omitted the question about perceived importance.

Moral and exhausting distress working in the frontline of COVID-19: a Swedish survey during the first wave in four healthcare settings

“… 44 Goals, among others, are enhancing moral sensibility and responsiveness to the needs of patients and families. 45 However, the deliberation needs to be adapted to first depart from participants’ experiences of their own stress to be able to focus on the suffering of the patient and family. 46 …”

“…Moral case deliberation is a facilitator-led collective moral inquiry by staff into a concrete moral issue connected to a real patient situation in their practice 44. Goals, among others, are enhancing moral sensibility and responsiveness to the needs of patients and families 45. However, the deliberation needs to be adapted to first depart from participants’ experiences of their own stress to be able to focus on the suffering of the patient and family 46…”

“…44 Goals, among others, are enhancing moral sensibility and responsiveness to the needs of patients and families. 45 However, the deliberation needs to be adapted to first depart from participants' experiences of their own stress to be able to focus on the suffering of the patient and family. 46 Strengths and limitations of this study One limitation is the low overall response rate, but considering that data-collection took place in the midst of the pandemic crisis along with rich open responses, we consider the response rate for nurses as high and the findings generalisable and transferable to nurses working during the first wave of COVID-19 in high-income countries.…”

Two Years of Ethics Reflection Groups About the Use of Coercion. Changes Over Time in Employees’ Normative Attitudes Regarding the Use of Coercion, User Involvement, Team Cooperation and the Handling of Disagreement

“…Evaluation of clinical ethics support CES evaluation (review) studies are increasingly focusing on quite different things; such as structure, process, content, outcomes and e ciency of CES [18][19][20][21][22][23][24][25][26][27][28][29] [2]. CES evaluation studies are of crucial importance since they may contribute to the further development of the relatively young professional domain of CES.…”

“…Indeed, high quality prospective CES evaluation studies which include baseline and follow-up measurements are rare [23,25,[40][41][42]. A recent Cochrane review, studying the available evidence of controlled studies of the effectiveness of ethical case interventions for adult patients, included 6 articles from 4 randomised trials, concluded that it was not possible to determine the effectiveness of CES due to low quality of the evidence presented in those studies [43].…”