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Balancing different expectations in ethically difficult situations while providing community home health care services: A focused ethnographic approach
Örebro University, School of Health Sciences.
Örebro University, School of Health Sciences.ORCID iD: 0000-0002-2873-4247
Department of Nursing and Health Sciences, University College in Southeast Norway, Campus Drammen, Norway.
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-57639OAI: oai:DiVA.org:oru-57639DiVA: diva2:1094939
Available from: 2017-05-11 Created: 2017-05-11 Last updated: 2017-05-11Bibliographically approved
In thesis
1. Perspectives on clinical ethics support and ethically difficult situations: reflections and experiences
Open this publication in new window or tab >>Perspectives on clinical ethics support and ethically difficult situations: reflections and experiences
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:nbn:se:oru:diva-57007 (URN)978-91-7529-198-7 (ISBN)
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

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Citation style
  • apa
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