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Perspectives on clinical ethics support and ethically difficult situations: reflections and experiences
Örebro University, School of Health Sciences.ORCID iD: 0000-0002-0068-943X
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Healthcare personnel encounter ethically difficult situations in their everyday work and clinical ethics support might be important to support healthcare personnel to deal with these situations. The overall aim of this thesis was to describe perspectives on clinical ethics support, experiences of being in ethically difficult situations and experiences of facilitating ethics reflection. Methods. Study I had a descriptive design in which research articles were reviewed (n=54). In study II audio-recorded moral case deliberation (n=70) in 10 Swedish workplaces in hospitals and community care were analysed. In study III interviews were conducted with facilitators (n=11) of moral case deliberation. Study IV used non-participant observation during three weeks as well as informal conversations with healthcare personnel (n=12) in community home healthcare. Results and conclusion. In study I, two perspectives emerged on clinical ethics support, a “Top-down” perspective, where an individual or a group of “experts” in ethics could recommend the best course of action and a “Bottom-up” perspective that allows healthcare personnel to manage ethically difficult situations through ethical reflections led by a facilitator. Studies II and IV showed how ethically difficult situations on different levels are often connected with emotions and uncertainties. Study III showed the role of the facilitator to be fundamental in creating a space for self-reflection among healthcare personnel. Study IV showed that healthcare personnel face complex demands and expectations from the healthcare organization regarding the provision of care as well as having to meet the needs of patients and their next-of-kin. To conclude, healthcare personnel needed to find a balance among demands and expectations in order to satisfy those stakeholders involved and they had to seek compromise. There is a need for clinical ethics support that helps healthcare personnel reflect individually and collectively on ethically difficult situations they encounter in their everyday clinical practice. From this standpoint, a “Bottom-up” perspective may reduce the risk of moral distress among healthcare personnel and promote care based on person-centred values.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2017. , 94 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 72
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-57007ISBN: 978-91-7529-198-7 (print)OAI: oai:DiVA.org:oru-57007DiVA: diva2:1088059
Public defence
2017-06-01, Örebro universitet, Gymnastikhuset, Hörsalen, Fakultetsgatan 1, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-04-11 Created: 2017-04-11 Last updated: 2017-05-12Bibliographically approved
List of papers
1. Clinical ethics support for healthcare personnel: An integrative literature review
Open this publication in new window or tab >>Clinical ethics support for healthcare personnel: An integrative literature review
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-57636 (URN)
Available from: 2017-05-11 Created: 2017-05-11 Last updated: 2017-05-11Bibliographically approved
2. What healthcare teams find ethically difficult: Captured in 70 moral case deliberations
Open this publication in new window or tab >>What healthcare teams find ethically difficult: Captured in 70 moral case deliberations
2016 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 23, no 8, 825-837 p.Article in journal (Refereed) Published
Abstract [en]

Background: Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss.

Aim: To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation.

Research design: A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis.

Ethical considerations: An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation.

Findings: Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient's/next-of-kin's emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient's autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have.

Discussion: The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders.

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

Place, publisher, year, edition, pages
London, United Kingdom: Sage Publications, 2016
Keyword
Clinical ethics, ethically difficult situations, ethics consultation, healthcare professionals, moral case deliberation
National Category
Nursing
Research subject
Ethics
Identifiers
urn:nbn:se:oru:diva-44848 (URN)10.1177/0969733015583928 (DOI)000391461900002 ()25991657 (PubMedID)2-s2.0-85007109749 (Scopus ID)
Note

Funding Agency:

Stiftelsen Olle Engqvist Byggmästare 

Available from: 2015-06-05 Created: 2015-06-05 Last updated: 2017-05-11Bibliographically approved
3. ‘It’s like sailing’- experiences of the role as facilitator during moral case deliberation
Open this publication in new window or tab >>‘It’s like sailing’- experiences of the role as facilitator during moral case deliberation
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-57637 (URN)
Available from: 2017-05-11 Created: 2017-05-11 Last updated: 2017-05-11Bibliographically approved
4. Balancing different expectations in ethically difficult situations while providing community home health care services: A focused ethnographic approach
Open this publication in new window or tab >>Balancing different expectations in ethically difficult situations while providing community home health care services: A focused ethnographic approach
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-57639 (URN)
Available from: 2017-05-11 Created: 2017-05-11 Last updated: 2017-05-11Bibliographically approved

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