Reflecting Before, During, and After the Heat of the Moment: A Review of Four Approaches for Supporting Health Staff to Manage Stressful Events

Delany, Clare; Jones, Sarah; Sokol, Jenni; Gillam, Lynn; Prentice, Trisha M

doi:10.1007/s11673-021-10140-0

Cited by 15 publications

(21 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As noted previously, clinical ethics review or ethics rounds is not an inevitably benign intervention ( 15 , 18 ). While relief may stem from clarifying the source of emotions that accompany ECS, including frustration, anger, shame and guilt ( 44 ), recalling events that gave rise to these emotions may intensify moral distress.…”

Section: Discussionmentioning

confidence: 96%

“…For the above reasons, “bottom-up” approaches, including MCD, ethics rounds, clinical ethics review, ethics discussion groups, and ethics reflection groups ( 15 , 27 ), may be more helpful in veterinary settings. Rather than relying on the deliberation of experts, bottom-up approaches utilize facilitator-led, structured discussions of one or more ethical challenges specific to a particular setting ( 42 ), aiming to support participants in managing ECS ( 43 ).…”

Section: Introductionmentioning

confidence: 99%

“…Typically, the topic is chosen by participants ( 15 , 27 ). Bottom-up approaches enable participants to formulate ethical questions, review facts, norms, values, decision points leading to a particular outcome, opportunities and constraints for decision makers, and alternatives at each decision point, establish common ground between different stakeholders, and gain new insights into an ECS or type of ECS ( 15 , 27 , 45 ). They may help team members to clarify their ethical values, identify and navigate ECS, and may also help mitigate negative impacts of ECS, including moral distress and burnout ( 27 , 43 , 44 , 46 , 47 ).…”

Section: Introductionmentioning

confidence: 99%

“…Participation in these discussions may play a restorative role in helping participants process their thoughts and feelings about ECS they have encountered ( 27 , 42 ). Through this process, participants may shift from a feeling of moral distress or unresolved moral conflict, toward increased clarity about what might have or should have been done in the circumstances ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

“…Sessions typically run for 45–90 min, and involve groups of 5–12 participants ( 46 ). The facilitator utilizes specific techniques such as Socratic dialogue or the hermeneutic method to draw participants on their values, or provide language and conceptual tools like ethical frameworks to clarify the moral dimensions of healthcare or veterinary work ( 15 , 34 , 44 ). This approach has been trialed with veterinarians at the Division of Small Animal Internal Medicine at the University of Veterinary medicine in Vienna ( 40 ).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

“There Was a Sense That Our Load Had Been Lightened”: Evaluating Outcomes of Virtual Ethics Rounds for Veterinary Team Members

2022

View full text Add to dashboard Cite

Clinical ethics support services (CESS) are employed in healthcare to improve patient care and help team members develop skills to recognize and navigate ethically challenging situations (ECS). The objective of this study was to evaluate the impact of ethics rounds, one form of CESS, on veterinary team members. An anonymous, online mixed-methods survey incorporating a 15-item instrument designed to assess the outcomes of moral case deliberation originally developed for human healthcare workers (the Euro-MCD 2.0), was developed. The survey was administered to veterinary team members prior to and following participation in a 90-min virtual ethics rounds session. A total of 23 sessions of virtual ethics rounds were held. In total, 213 individuals participated, and 89 completed both surveys (response rate 41.8%). Most respondents were female (n = 70, 81%). Most were veterinarians (n = 51, 59%), followed by other veterinary team members (practice manager, animal attendant) (n = 18, 21%), veterinary nurses or animal health technicians (n = 10, 12%) and veterinary students (n = 8, 9%). Age ranged from 20 to 73 (median 41, IQR 32–52, n = 87). While there was no statistically significant difference between overall modified Euro-MCD 2.0 scores between T1 and T2, there were statistically significant changes in 7 out of 15 Euro-MCD 2.0 items in the domains of moral competence and moral teamwork. Reflexive thematic analysis of free-text responses identified themes including the types, impact and barriers to resolving ECS, the impacts of ethics rounds on veterinary team members and constraints preventing veterinary team members from speaking up in the face of ECS. While participants largely described the impact of ethics rounds as beneficial (for example, by facilitating clarification of thinking about ECS, allowing participants to see ECS from the perspective of others and providing a safe space for discussion), reflecting on ECS could be stressful for participants. Active participation in ethics rounds may be inhibited in the context of power imbalance, or in settings where bullying occurs. Overall, carefully facilitated ethics rounds has the potential to improve the ability of veterinary team members to identify and navigate ECS, and potentially mitigate moral distress.

show abstract

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

“There Was a Sense That Our Load Had Been Lightened”: Evaluating Outcomes of Virtual Ethics Rounds for Veterinary Team Members

2022

View full text Add to dashboard Cite

show abstract

Embracing clinical ethics support services in the UK veterinary profession

Gibson¹,

Quain²

2022

In Practice

View full text Add to dashboard Cite

Veterinary practitioners commonly encounter ethically challenging situations (ECSs). Not only do ECSs raise questions about how to best safeguard patient welfare, they can also be emotionally challenging for those involved. In recognition of the far‐reaching consequences of ECSs, human healthcare has embraced the use of clinical ethics support services (CESS). In this article, we discuss the use of CESS in human healthcare, why it matters for the veterinary profession and how CESS could be practically applied in a veterinary context.

show abstract

Ethical challenges faced by healthcare workers in pediatric oncology care during the COVID‐19 pandemic in Australia

Marks

O’Neill

Gillam

et al. 2022

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Objective: This qualitative study examined ethical challenges reported by healthcare professionals (HCPs) working in a large Australian pediatric oncology center during a period of strict COVID-19 restrictions. Methods:We conducted semi-structured interviews with 21 HCPs who provided pediatric cancer care during the pandemic in 2020, during strict lockdown periods.Interviews examined the difficulties they faced, as well as their own ethical evaluation of the impact of COVID-19 policies on oncology care. Data were analyzed using inductive content analysis and thematic analysis.Results: HCPs faced several challenges, primarily originating from hospital restrictions, which led to changes in usual clinical practices. These challenges included delivering care with personal protective equipment (PPE), the impact of a one-parent visitation policy, changes in psychosocial and allied health services, and COVID-19 swabbing policies. Overall, there was consensus from participants that hospital restrictions were justified and, while difficult, HCPs simply had to provide the best care possible given the circumstances. However, participants described decreased capacity to deliver holistic patient care and, in some instances, a tendency to avoid ethical reflection. Lastly, there was a consistent theme of shame and sense of responsibility underlying some participants' anxiety around inadvertently transmitting COVID-19 to immunocompromised patients. Conclusion:Our findings show that many staff felt unease at the disruptions in patient care due to COVID-19 restrictions. Some HCPs indicated a degree of moral distress, with a possibility of moral injury among some HCPs. A focus on ethical recovery could assist in preventing any ongoing difficulties among HCPs because of their experiences.

show abstract

Reflecting Before, During, and After the Heat of the Moment: A Review of Four Approaches for Supporting Health Staff to Manage Stressful Events

Cited by 15 publications

References 65 publications

“There Was a Sense That Our Load Had Been Lightened”: Evaluating Outcomes of Virtual Ethics Rounds for Veterinary Team Members

“There Was a Sense That Our Load Had Been Lightened”: Evaluating Outcomes of Virtual Ethics Rounds for Veterinary Team Members

Embracing clinical ethics support services in the UK veterinary profession

Ethical challenges faced by healthcare workers in pediatric oncology care during the COVID‐19 pandemic in Australia

Contact Info

Product

Resources

About