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  • 1.
    Kjellin, Lars
    et al.
    Örebro University Hospital. Psykiatriskt forskningscentrum, Örebro University Hospital, Örebro, Sweden.
    Thorsen, Håkan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Backström, Jan
    Psykiatrisk akut- och heldygnsvård, Region Örebro län, Karlskoga, Sverige.
    Wadefjord, Anna
    Psykiatriskt forskningscentrum, Örebro University Hospital, Örebro, Sweden.
    Engström, Ingemar
    Örebro University Hospital. Psykiatriskt forskningscentrum, Örebro University Hospital, Örebro, Sweden.
    Etik och moralisk stress diskuteras sällan i psykiatrin2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 4, p. 150-3Article in journal (Refereed)
  • 2.
    Svantesson, Mia
    et al.
    Örebro University, School of Health and Medical Sciences.
    Anderzén-Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences.
    Thorsén, Håkan
    Örebro University, School of Health and Medical Sciences.
    Kallenberg, Kjell
    Ahlström, Gerd
    Hälsohögskolan i Jönköping.
    Interprofessional ethics rounds concerning dialysis patients: staff's ethical reflections before and after rounds2008In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 34, no 5, p. 407-413Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate whether ethics rounds stimulated ethical reflection. METHODS: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to stimulate ethical reflection and promote mutual understanding between professions but not to offer solutions. Questionnaires directly before and after rounds were answered by 194 respondents. The analyses were primarily content analysis with Boyd's framework but were also statistical in nature. FINDINGS: Seventy-six per cent of the respondents reported a moderate to high rating regarding new insights on ethical problem identification, but the ethics rounds did not seem to stimulate the ethical reflection that the respondents had expected (p < 0.001). Dominant new insights did not seem to fit into traditional normative ethics but were instead interpreted as hermeneutic ethics. This was illustrated in the extended perspective on the patient and increased awareness of relations to other professions. Regarding insights into how to solve ethical problems, the request for further interprofessional dialogue dominated both before and after rounds. CONCLUSION: The findings show the need for interprofessional reflective ethical practice but a balance between ethical reflection and problem solving is suggested if known patients are discussed. Further research is needed to explore the most effective leadership for reflective ethical practice.

  • 3.
    Svantesson, Mia
    et al.
    Örebro University, School of Health and Medical Sciences.
    Löfmark, Rurik
    Thorsén, Håkan
    Kallenberg, Kjell
    Ahlström, Gerd
    Learning a way through ethical problems: Swedish nurses’ and doctors’ experiences from one model of ethics rounds2008In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 34, no 5, p. 399-406Article in journal (Refereed)
    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.

  • 4.
    Svantesson, Mia
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Sjökvist, Peter
    Thorsén, Håkan
    Örebro University, Department of Nursing and Caring Sciences.
    End-of-life decisions in Swedish ICUs: how do physicians from the admitting department reason?2003In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 19, no 4, p. 241-251Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs).

    DESIGN:

    Qualitative interview that applies a phenomenological approach.

    SETTING:

    Two ICUs at one secondary and one tertiary referral hospital in Sweden.

    PARTICIPANTS:

    Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment.

    RESULTS:

    The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process.

    CONCLUSION:

    This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.

  • 5.
    Svantesson, Mia
    et al.
    Örebro University, Department of Clinical Medicine.
    Sjökvist, Peter
    Thorsén, Håkan
    Örebro University, Department of Health Sciences.
    Ahlström, Gerd
    Nurses’ and physicians’ opinions on aggressiveness of treatment for general ward patients2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, p. 147-162Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate agreement between nurses’ and physicians’ opinions regarding aggressiveness of treatment and to investigate and compare the rationales on which their opinions were based. Structured interviews regarding 714 patients were performed on seven general wards of a university hospital. The data gathered were then subjected to qualitative and quantitative analyses. There was 86% agreement between nurses’ and physicians’ opinions regarding full or limited treatment when the answers given as ‘uncertain’ were excluded. Agreement was less (77%) for patients with a life expectancy of less than one year. Disagreements were not associated with professional status because the physicians considered limiting life-sustaining treatment as often as the nurses. A broad spectrum of rationales was given but the results focus mostly on those for full treatment. The nurses and the physicians had similar bases for their opinions. For the majority of the patients, medical rationales were used, but age and quality of life were also expressed as important determinants. When considering full treatment, nurses used quality-of-life rationales for significantly more patients than the physicians. Respect for patients’ wishes had a minor influence.

  • 6.
    Thorsén, Håkan
    et al.
    Örebro University, Department of Health Sciences.
    Fredäng, Päivi
    Örebro University, Department of Education.
    Sundberg, Björn
    Personalens etiska reflektioner2006In: Tvingad till hjälp: Om tvång, etik, tillit i barn- och ungdomspsykiatrisk vård / [ed] Ingemar Engström, Lund:: Studentlitteratur AB, 2006, p. 117-150Chapter in book (Other academic)
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