Organizing moral case deliberation Experiences in two Dutch nursing homes

Dam, Sandra van der; Abma, Tineke; Molewijk, Bert; Kardol, Martinus Josephus Maria; Schols, J.M.G.A.; Widdershoven, Guy

doi:10.1177/0969733011400299

Cited by 51 publications

(57 citation statements)

References 22 publications

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“…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 .…”

Section: Identificationmentioning

confidence: 99%

“…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 .…”

Section: Strategies Of Deliberationmentioning

confidence: 99%

“…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 .…”

Section: Strategies Of Deliberationmentioning

confidence: 99%

“…Mediation of the deliberative process is done by the facilitator, who may be an ethics specialist or a professional trained for the task. Conversation is the basis of the method and, for this reason, the facilitator promotes constructive dialog among the participants, keeping focus on the moral dimension of the case and helping in the planning of actions, aiming at the improvement of the service provided 9,11,15,19 . It is similar, in the procedures, to the strategy proposed by Gracia.…”

Section: Strategies Of Deliberationmentioning

confidence: 99%

“…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.…”

Section: Contributions Of the Deliberation Processmentioning

confidence: 99%

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Deliberação ética em saúde: revisão integrativa da literatura

Nora

Zóboli

2015

Rev. Bioét.

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Working in the health field requires that professionals master means and tools for resolving the ethical dilemmas they face. We conducted an integrative review of the literature in health-related databases. We included original research articles, reports of experience, theoretical studies, case studies and editorials, in English, Spanish and Portuguese carried out with healthcare teams that included nurses. The review covered 28 studies, published between 1999 and 2013. The analysis yielded four categories: concept of deliberation; strategies of deliberation; contributions of deliberation, and facilitators of implemention of the deliberation process. We concluded that deliberation is a useful and relevant strategy for health teams in the analysis, assessment and indication of the best course of action in problem solving. It is also an instrument of continuing education for professionals through mutual exchange of experience and dialogue about values, beliefs and principles. Keywords: Deliberations. Ethics. Bioethics. Decision support techniques. Decision making. Review. ResumoDeliberação ética em saúde: revisão integrativa da literatura Trabalho em saúde requer que profissionais dominem meios e instrumentos para resolução de problemas éticos vivenciados. Este estudo analisa o uso da deliberação ética na solução dos problemas éticos vividos pela equipe de saúde. Realizou-se revisão integrativa da literatura em bases de dados da saúde. Incluíram-se artigos de pesquisa originais, relatos de experiências, estudos teóricos, estudos de caso, editoriais, em inglês, espanhol e português, enfocando equipes de saúde que contassem com enfermeiros. A revisão abrangeu 28 estudos, publicados entre 1999 e 2013. Da análise resultaram quatro categorias: conceito de deliberação; estratégias de deliberação; contribuições da deliberação; facilitadores da implementação do processo de deliberação. Conclui-se que a deliberação é estratégia útil e relevante para equipes de saúde na análise, avaliação e indicação do melhor curso de ação para solução dos problemas. Também é instrumento de educação permanente para profissionais, pela troca mútua de experiências e diálogos sobre valores, crenças e princípios. Palavras-chave: Deliberações. Ética. Bioética. Técnicas de apoio para a decisão. Tomada de decisões. Revisão. ResumenDeliberación ética en salud: revisión integrativa de la literatura El trabajo en salud requiere que los profesionales dominen medios y herramientas para resolver los problemas éticos de la práctica. Este estúdio analisa el uso de la deliberación ética em la solución de los problemas éticos vividos por el equipo de salud. Hemos llevado a cabo una revisión integradora de la literatura en las bases de datos de salud. La revisión incluyo artículos originales de investigación, informes de experiencias, estudios teóricos, estudios de casos, editoriales, publicados en los idiomas inglés, español y portugués, realizados efocándo se em los casos de salud que contasen con enfermeros. La revisión incluyó 28 estudios public...

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Section: Identificationmentioning

confidence: 99%

Section: Strategies Of Deliberationmentioning

confidence: 99%

Section: Strategies Of Deliberationmentioning

confidence: 99%

Section: Strategies Of Deliberationmentioning

confidence: 99%

Section: Contributions Of the Deliberation Processmentioning

confidence: 99%

See 3 more Smart Citations

Deliberação ética em saúde: revisão integrativa da literatura

Nora

Zóboli

2015

Rev. Bioét.

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“Here’s My Dilemma”. Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care

Dam

Abma

Kardol³

et al. 2011

Health Care Anal

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Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’.

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Client Participation in Moral Case Deliberation: A Precarious Relational Balance

Weidema

Abma²,

Widdershoven³

et al. 2011

HEC Forum

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Moral case deliberation (MCD) is a form of clinical ethics support in which the ethicist as facilitator aims at supporting professionals with a structured moral inquiry into their moral issues from practice. Cases often affect clients, however, their inclusion in MCD is not common. Client participation often raises questions concerning conditions for equal collaboration and good dialogue. Despite these questions, there is little empirical research regarding client participation in clinical ethics support in general and in MCD in particular. This article aims at describing the experiences and processes of two MCD groups with client participation in a mental healthcare institution. A responsive evaluation was conducted examining stakeholders’ issues concerning client participation. Findings demonstrate that participation initially creates uneasiness. As routine builds up and client participants meet certain criteria, both clients and professionals start thinking beyond ‘us-them’ distinctions, and become more equal partners in dialogue. Still, sentiments of distrust and feelings of not being safe may reoccur. Client participation in MCD thus requires continuous reflection and alertness on relational dynamics and the quality of and conditions for dialogue. Participation puts the essentials of MCD (i.e., dialogue) to the test. Yet, the methodology and features of MCD offer an appropriate platform to introduce client participation in healthcare institutions.

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Organizing moral case deliberation Experiences in two Dutch nursing homes

Cited by 51 publications

References 22 publications

Deliberação ética em saúde: revisão integrativa da literatura

Deliberação ética em saúde: revisão integrativa da literatura

“Here’s My Dilemma”. Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care

Client Participation in Moral Case Deliberation: A Precarious Relational Balance

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