Beyond Recommendation and Mediation: Moral Case Deliberation as Moral Learning in Dialogue

Metselaar, Suzanne; Molewijk, Bert; Widdershoven, Guy

doi:10.1080/15265161.2014.975381

Cited by 32 publications

(34 citation statements)

References 14 publications

(11 reference statements)

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“…In this discussion, we, as authors, take a middle position in that we assume that neither theoretical viewpoints nor empirical results alone can determine what ‘the’ right MCD outcomes are. This means that, although respondents found outcomes relating to moral competencies (ie, moral reflexivity and moral attitude) somewhat less important as compared with other Euro-MCD outcomes, they could still be considered as important, given the fact that ethicists and MCD facilitators argue that MCD aims at, among other aims, fostering moral competencies 32. Given the limited scope of this paper, we will elaborate on the integration of empirical findings from all Euro-MCD field studies and our normative reasoning about appropriate MCD outcomes in a future paper.…”

Section: Discussionmentioning

confidence: 99%

Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals’ priorities

et al. 2019

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BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings (practice) and normative reflection (theories) will contribute to the revision of the instrument.

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Section: Discussionmentioning

confidence: 99%

Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals’ priorities

et al. 2019

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“…6 In literature about MCD, various goals have been described, like improving collaboration among colleagues, learning to identify moral questions, and, by becoming aware of one's own viewpoint, acknowledging viewpoints of others. [6][7][8] Furthermore, several studies have been carried out to evaluate MCD through ways of dealing with moral dilemmas, 3,9 satisfaction among MCD participants 10,11 and assessment of MCD content. 7,[12][13][14] As such, these studies were qualitative in nature and focused on the experiences of participants during the MCD sessions.…”

Section: Introductionmentioning

confidence: 99%

Field-testing the Euro-MCD Instrument: Experienced outcomes of moral case deliberation

et al. 2019

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Background: Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. Aim: To describe experienced outcomes after participating in a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. Methods: In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. Ethical considerations: The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. Results: The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. Conclusion: Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare.

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“…The perceived outcomes questionnaire was based on the partially validated Euro-MCD instrument measuring the experienced outcomes of moral case deliberation (MCD) (Svantesson et al, 2014). We chose the Euro-MCD because of the similarities between MCD and CURA: both instruments are rooted in hermeneutic and dialogical ethics, regarding concrete experience as the source of moral The manual is supportive when using CURA a knowledge (Widdershoven et al, 2009) and are aimed at developing moral competences (Metselaar et al, 2015). The Euro-MCD consists of 26 possible outcomes of MCD (Svantesson et al, 2014).…”

Section: Perceived Outcomes Questionnairementioning

confidence: 99%

CURA—An Ethics Support Instrument for Nurses in Palliative Care. Feasibility and First Perceived Outcomes

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Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point Likert scales were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience.

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Beyond Recommendation and Mediation: Moral Case Deliberation as Moral Learning in Dialogue

Cited by 32 publications

References 14 publications

Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals’ priorities

Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals’ priorities

Field-testing the Euro-MCD Instrument: Experienced outcomes of moral case deliberation

CURA—An Ethics Support Instrument for Nurses in Palliative Care. Feasibility and First Perceived Outcomes

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