‘It’s like sailing’ – Experiences of the role as facilitator during moral case deliberation

Rasoal, Dara; Kihlgren, Annica; Svantesson, Mia

doi:10.1177/1477750917710882

Cited by 11 publications

(16 citation statements)

References 21 publications

(42 reference statements)

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“…Developing a measurement instrument for outcomes of a clinical ethics supportive intervention like MCD is a complex (but highly needed) process. 24 For the revision of the Euro-MCD instrument, various empirical findings from different field studies 12,19,20,[25][26][27][28] should be combined with conceptual and normative discussions on what outcomes should be included based on the (theoretically described) goals of MCD. The main relevance of the factor analysis as done in the current study is that it informs us about the correlations among items and about what possible clustering of items would be meaningful in the sense that items indeed refer to the same underlying construct.…”

Section: Various Empirical Data Sources and Normative Reasoning Determentioning

confidence: 99%

“…The findings on the experienced outcomes and the factor structure add to the data from other Euro-MCD field studies to further validate and revise the Euro-MCD Instrument. 12,19,20,[25][26][27][28] Other ongoing field studies include the perceived importance of the outcomes (by healthcare participants) after MCD participation, the facilitator's role, and the manager's views on impact. In the overall process of developing a new Euro-MCD instrument, which is currently taken place, the empirical evidence will be combined with normative reflections by the research team, ethics experts as well as healthcare professionals from the field.…”

Section: Future Perspectivesmentioning

confidence: 99%

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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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Section: Various Empirical Data Sources and Normative Reasoning Determentioning

confidence: 99%

Section: Future Perspectivesmentioning

confidence: 99%

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

et al. 2019

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“…So far, the Euro‐MCD project has generated potential outcomes of MCD regarding emotional support, collaboration, moral reflexivity, moral attitude, concrete results and improvement on organizational level (Svantesson et al, ). These outcomes are now under revision after results from field‐studies (, in press) and perspectives of those involved (Rasoal, Kihlgren, & Svantesson, ), where first‐line managers’ bird‐eye perspective is an important source.…”

Section: Literature Reviewmentioning

confidence: 99%

Impact of clinical ethics support on daily practice—First‐line managers’ experiences in the Euro‐MCD project

Silén

Svantesson

2019

J Nurs Manag

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Aim To explore first‐line managers’ experiences of what Moral Case Deliberation has meant for daily practice, to describe perceptions of context influence and responsibility to manage ethically difficult situations. Background In order to find measures to evaluate Moral Case Deliberation, the European Moral Case Deliberation Outcome instrument was developed and is now in the stage of revision. For this, there is a need of several perspectives, one of them being the managerial bird‐eye perspective. Method Eleven first‐line managers at workplaces, participating in the European Moral Case Deliberation Outcome instrument project, were interviewed and thematic analysis was applied. Results Managers’ experiences were interpreted as enhanced ethical climate: a closer‐knit and more emotionally mature team, morally strengthened individuals, as well as ethics leaving its marks on everyday work and morally grounded actions. Despite organizational barriers, they felt inspired to continue ethics work. Conclusion and Implications This study confirmed, but also added ethical climate aspects, such as morally grounded actions. Furthermore, adding ethical climate as a construct in the European Moral Case Deliberation Outcome instrument should be considered. First‐line managers need clear directives from their managers that ethics work needs to be prioritized for the good of both the staff and the patients.

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“…Guvå and Hylander (2012) state that by listening to the participant's expressions and asking challenging questions the facillitators may both confirm and guide to the participants to further reflections. Rasoal, Kihlgren, and Svantesson (2017) showed in a study that, if the facillitators challenged the participants to reflect on their own perspective on the situation, then new insights were opened up. The facillitators in this study acted as role models in their responsiveness, and let the participants communicate freely without intervening more than necessary.…”

Section: Discussionmentioning

confidence: 99%

Communicative and organizational aspects of clinical ethics support

Grönlund

Söderberg

Dahlqvist

et al. 2018

Journal of Interprofessional Care

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Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio-and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept-and datadriven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an interprofessional dialogue about ethically difficulties.

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‘It’s like sailing’ – Experiences of the role as facilitator during moral case deliberation

Cited by 11 publications

References 21 publications

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

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

Impact of clinical ethics support on daily practice—First‐line managers’ experiences in the Euro‐MCD project

Communicative and organizational aspects of clinical ethics support

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