Aims and harvest of moral case deliberation

Abstract

Deliberative ways of dealing with ethical issues in health care are expanding. Moral case deliberation is an example, providing group-wise, structured reflection on dilemmas from practice. Although moral case deliberation is well described in literature, aims and results of moral case deliberation sessions are unknown. This research shows (a) why managers introduce moral case deliberation and (b) what moral case deliberation participants experience as moral case deliberation results. A responsive evaluation was conducted, explicating moral case deliberation experiences by analysing aims (N = 78) and harvest (N = 255). A naturalistic data collection included interviews with managers and evaluation questionnaires of moral case deliberation participants (nurses). From the analysis, moral case deliberation appeals for cooperation, team bonding, critical attitude towards routines and nurses' empowerment. Differences are that managers aim to foster identity of the nursing profession, whereas nurses emphasize learning processes and understanding perspectives. We conclude that moral case deliberation influences team cooperation that cannot be controlled with traditional management tools, but requires time and dialogue. Exchanging aims and harvest between manager and team could result in co-creating (moral) practice in which improvements for daily cooperation result from bringing together perspectives of managers and team members.

Concept Clarification of Moral Case Deliberation

“…-Improved morale (confidence) [22]; others that they have a background in ethics [23]. Often, but not always, a specific conversation method is applied, such as the Dilemma method [14] in which a consensus is sought [19] or the Socratic Dialogue, which aims to help professionals develop moral skills and an appropriate, reflective attitude [20].…”

Refleksjonsgrupper i etikk: «Pusterom» eller læringsarena?

“…Studier viser at slike tiltak fører til bedret kommunikasjon, stimulerer til ferdigheter i kritisk tenkning og øker den enkeltes etiske kompetanse (Kalager et al 2011;Weidema et al 2013). I pleie-og omsorgstjenesten viser studier at refleksjon bidrar til en økt forståelse for andres perspektiv, fremmer uformell kommunikasjon om etiske spørsmål og hjelper deltagerne med å finne flere og bedre løsninger (Lillemoen & Børslett 2010;Söderhamn et al 2014;van der Dam et al 2013).…”

Deliberação ética em saúde: revisão integrativa da literatura

“…Six studies had, as research participants, professionals working in psychiatric hospitals 7,8,[10][11][12]28 ; four had professionals in geriatric institutions 9,13,15,16 ; one had professionals in basic health 30 .…”

“…In the moral case deliberation [7][8][9][10][11]15,16,19,31 a group of professionals meet to reflect systematically on a certain moral question om a concrete clinical case, coming from the practice 8,11,15,16,19 . Such strategy has the aim of allowing professional to reflect on the moral case; improve the quality of their service; discuss on the meaning of being a good professional and strengthen their moral competencies; reflect on institutional and organizational issues; improve the quality of their care 11,15,19 .…”

“…Benefits from the deliberation process reach the personal and professional spheres considering, in the latter, the whole multidisciplinary team (Table 1). Mutual Understanding and cooperation among professionals 7,10,12,28 Awareness of ethical questions 15,16 Strengthening of the dialogue among participants 7,15 Confidence to question and deal with ethical problems 11,30 Strengthening of the dialogue among participants 7,15 Recognition and discernment of ethical issues 10 Possibility of the educational process 21,28 Critical reflexion on ethical problems 7,11 Learning from other professionals 17,15 Relief from moral suffering 15,16 Establishing an ethical environment of reciprocity, solidarity and empathy 15 Decrease in frustration and anguish 15 A space to share experiences on a certain ethical problem 11 Aid in the recognition of solutions or answers to ethical problems 10 Useful and relevant for the daily practice 11 Development of moral competence 15 Motivation at work 10 Feeling of belonging to the team 8 The study with nurses in the psychiatric hospital showed that participants evaluated the practice as "positive" or "very positive" 10 . In the study with professionals of primary health care, participants felt safe to deal with situations of moral conflict and recognized that the ethical dimension is inherent to the clinical practice, encompassing the cases and values involved in the context.…”