What healthcare teams find ethically difficult

Rasoal, Dara; Kihlgren, Annica; James, Inger; Svantesson, Mia

doi:10.1177/0969733015583928

Cited by 39 publications

(41 citation statements)

References 44 publications

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“…The emotions will reveal the proper conceptualisation of what is at stake [46]. According to Rasoal et al [47], discussing ethical questions in MCD can help them better understand the associated emotions.…”

Section: Discussionmentioning

confidence: 99%

Addressing harm in moral case deliberation: the views and experiences of facilitators

2020

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Background: In healthcare practice, care providers are confronted with decisions they have to make, directly affecting patients and inevitably harmful. These decisions are tragic by nature. This study investigates the role of Moral Case Deliberation (MCD) in dealing with tragic situations. In MCD, caregivers reflect on real-life dilemmas, involving a choice between two ethical claims, both resulting in moral damage and harm. One element of the reflection process is making explicit the harm involved in the choice. How harmful are our decisions? We investigated how facilitators of MCD experience the importance of addressing harm in MCD and what participants learn from reflecting on harm. Methods: The study was qualitative, focusing on the views and experiences of the facilitators of MCD. Semi-structured interviews (N = 12) were conducted with facilitators of MCD. The research focuses on the subjective experiences of facilitators. Grounded Theory was used for analysis. Results: The results show two main categories. The first concerns the awareness of tragedy. Within this category, five themes were discerned: making explicit that there is no solution, visualizing consequences, uncovering pain, focusing on emotion, and exploring perspectives on harm. The second category concerns the support for healthcare professionals in dealing with the tragedy of the choices they face. In this category, five themes came forward: acknowledging, offering comfort, managing harm, consideration through dialogue and repairing harm. Conclusion: Our study shows that addressing harm in MCD in tragic situations provides an important moral learning opportunity for participants. By formulating and becoming aware of harm, MCD aids healthcare professionals in the task they are faced with, namely making difficult and painful choices. MCD helps healthcare professionals to repair moral damage, making clear at the same time that harm cannot be undone.

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Section: Discussionmentioning

confidence: 99%

Addressing harm in moral case deliberation: the views and experiences of facilitators

2020

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“…Other challenges were the interests and expectations from the next-of-kin that were not in accordance with the wishes of the patient, nor recommendations from the personnel. Next-of-kin have been described in several previous studies as having power in the caregiving process as well as unrealistic expectations [34, 51] In addition, personnel can feel powerlessness when trying to manage difficult interactions with patients and next-of-kin [52].…”

Section: Discussionmentioning

confidence: 99%

“…The pressure from the group was however bigger than individual staff members could handle emotionally. Personnel with long work experience and more qualifications seemed to have a more dominant voice in the group [52]. A possible interpretation is that personnel did not dare to voice their disagreements in front of their colleagues in the office.…”

Section: Discussionmentioning

confidence: 99%

Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach

2018

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BackgroundThe general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services.MethodThis study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations (n = 122), memos and informal interviews with registered nurses (n = 8), and nurse assistants (n = 4). The transcribed texts were analyzed with interpretive content analysis.ResultsThe inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues.ConclusionsThis study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.

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“…In the Netherlands and other European countries [1–3], Moral Case Deliberation (MCD) is an established form of clinical ethics support (CES) [4]. MCD is a reflective and structured dialogue between healthcare professionals, sometimes also including other stakeholders (such as patients, family members, and volunteers) about their concrete moral questions regarding a real clinical case, and the underlying values and norms within a specific context [5–7].…”

Section: Introductionmentioning

confidence: 99%

Developing an ethics support tool for dealing with dilemmas around client autonomy based on moral case deliberations

et al. 2018

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BackgroundMoral Case Deliberations (MCDs) are reflective dialogues with a group of participants on their own moral dilemmas. Although MCD is successful as clinical ethics support (CES), it also has limitations. 1. Lessons learned from individual MCDs are not shared in order to be used in other contexts 2. Moral learning stays limited to the participants of the MCD; 3. MCD requires quite some organisational effort, 4. MCD deals with one individual concrete case. It does not address other, similar cases (it is case based). These limitations warrant research into complementary ways of providing CES to healthcare professionals. Our research objective was therefore to develop a low threshold CES tool based on a series of MCDs on autonomy in long-term care.MethodsWe used a qualitative research design in which we analyzed the process and content of a series of MCDs, combined with reflections on the theoretical background of MCD. In total 28 MCDs (10 transcripts and 18 summary reports) were analyzed by means of a thematic content analysis. In various rounds of development, the results of the analysis were combined with theoretical reflections on CES. Consequently, the tool was evaluated in three focus groups and adjusted.ResultsThe CES tool, called ‘moral compass’, guides the users through a series of six subsequent questions in order to methodically reflect on their concrete moral dilemma, in the form of a booklet of 23 pages. It combines a methodical element that encourages and structures a reflection process with a substantive element, including norms, values, options, strategies, and insights regarding dealing with client autonomy.ConclusionBy using data from a series of MCDs, combined with theoretical reflections on MCD, ethics support and moral learning, we developed a thematic, low-threshold CES tool that supports healthcare professionals in daily practice in dealing with moral questions regarding client autonomy. It integrates examples and insights from earlier MCDs on the same topic. The moral compass is not a replacement of, but can be used complementary to MCD. The feasibility and impact of the moral compass need to be investigated in an evaluative follow-up study. The methodology presented in this paper may be used to develop moral compasses on different topics in various healthcare organizations.

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What healthcare teams find ethically difficult

Abstract: MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.

Cited by 39 publications

References 44 publications

Addressing harm in moral case deliberation: the views and experiences of facilitators

Addressing harm in moral case deliberation: the views and experiences of facilitators

Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach

Developing an ethics support tool for dealing with dilemmas around client autonomy based on moral case deliberations

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