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Learning a way through ethical problems: Swedish nurses’ and doctors’ experiences from one model of ethics rounds
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0003-0679-5695
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2008 (English)In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 34, no 5, p. 399-406Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate one ethics rounds model by describing nurses' and doctors' experiences of the rounds.

METHODS: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis. Findings: The goal of the rounds was partly fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses' expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous.

CONCLUSION: When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented.

Place, publisher, year, edition, pages
2008. Vol. 34, no 5, p. 399-406
National Category
Humanities and the Arts Religious Studies Social Sciences Interdisciplinary Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-2976DOI: 10.1136/jme.2006.019810OAI: oai:DiVA.org:oru-2976DiVA, id: diva2:135874
Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2018-01-13Bibliographically approved
In thesis
1. Postpone death?: Nurse-physician perspectives on life-sustaining treatment and ethics rounds
Open this publication in new window or tab >>Postpone death?: Nurse-physician perspectives on life-sustaining treatment and ethics rounds
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The starting point of the present thesis is nurses’ reported experiences of disagreements with physicians for pushing life sustaining treatment too far. The overall aim was to describe and compare nurses’ and physicians’ perspectives on the boundaries for life-sustaining treatment and to evaluate whether ethics rounds could promote mutual understanding and stimulate ethical reflection. A mixed methods design with qualitative and quantitative data was used, including interviews and questionnaires. The health professionals’ experiences/perceptions were based on known patients foremost from general wards, but also intensive care units, at four Swedish hospitals. The first two studies treated the perspective on boundaries for life-sustaining treatment and the last two evaluated philosopher- ethicist led ethics rounds. Analysis of data was performed using a phenomenological approach and content analysis as well as comparative and descriptive non-parametric statistics.

In the first study, the essence of the physicians’ decision-making process to limit life-sustaining treatment for ICU patients, was a process of principally medical considerations in discussions with other physicians. In the second study, there were more similarities than differences between nurses’ and physicians’ opinions regarding the 714 patients studied. The physicians considered limited treatment as often as the nurses did. The ethics rounds studies generated mixed experiences/perceptions. It seemed that more progress was made toward the goal of promoting mutual understanding than toward the goal of stimulating ethical reflection. Above all, the rounds seemed to meet the need for a forum for crossing over professional boundaries. The most salient finding was the insight to enhance team collaboration, that the interprofessional dialogue was sure to continue. Predominating new insights after rounds were interpreted as corresponding to a hermeneutic approach. One of nurses’ negative experiences of the ethics rounds was associated with the lack of solutions. Based on the present findings, one suggestion for improvement of the model of ethics rounds is made with regard to achieving a balance between ethical analyses, conflict resolution and problem solving. In conclusion, the present thesis provides strong evidence that differences in opinions regarding boundaries for life-sustaining treatment are not associated with professional status. The findings support the notion of a collaborative team approach to end-of-life decision-making for patients with diminished decisionmaking capacity. There is an indication that stimulation of ethical reflection in relation to known patients may foremost yield psychosocial insights. This could imply that social conflicts may overshadow ethical analysis or that ethical conflicts and social conflicts are impossible to distinguish.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 16
Keyword
Clinical ethics, Life-sustaining treatment, End-of-life decisions, Attitudes, Nurses, Physicians, Inter-professional relations, Ethics consultation, Ethics rounds
National Category
Clinical Science
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-2093 (URN)978-91-7668-596-9 (ISBN)
Public defence
2008-05-16, Wilandersalen, M-huset, Universitetssjukhuset, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2017-10-18Bibliographically approved

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Svantesson, MiaThorsén, HåkanKallenberg, KjellAhlström, Gerd

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