The significance of ethics reflection groups in mental health care: a focus group study among health care professionals

Abstract

BackgroundProfessionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion.MethodsIn 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive.ResultsMost participants report positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing.ConclusionThis focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices.

Defining and categorizing outcomes of Moral Case Deliberation (MCD): concept mapping with experienced MCD participants

“…When exploratively reviewing literature, we found some (but not all) of these clusters as well. For instance, in the focus group study of Hem et al [ 15 ], participants of ethics reflection groups (which is similar to MCD) described that they experienced an increased awareness of ethical issues, ‘professional development’ and better collaboration among their colleagues, in which we see a clear link with two clusters in our study, namely Team development and Personal development as a Professional. A better team collaboration and the impact on personal development have also been suggested by other studies [ 11 , 13 , 14 ].…”

“…For instance, Lillemoen and Pedersen [ 11 ] have evaluated ethics reflection groups by using qualitative research methods in which they asked ‘What is the significance of ethics reflection groups on health care professionals’ practice?’. Recently, Hem et al [ 15 ] have also studied the significance of ethics reflection groups in mental healthcare. Weidema and colleagues [ 14 ] tried to measure the impact of MCD (described as ‘harvest’) by asking MCD participants to answer the question ‘What changes would you apply to your practice after this session?’.…”

“…Weidema and colleagues [ 14 ] tried to measure the impact of MCD (described as ‘harvest’) by asking MCD participants to answer the question ‘What changes would you apply to your practice after this session?’. In all studies, they found that the ethics reflection groups or MCDs positively influenced the cooperation among colleagues and made professionals better able to deal with ethical challenges in everyday practice [ 11 , 14 , 15 ]. Questions about the significance and harvest of MCD are relevant, but it remains unclear what these terms exactly entail.…”

“… 1 Also described as ‘ethics rounds’ [ 10 , 21 ]; ‘ethics reflection groups’ [ 11 , 15 ] and ‘ethics case reflection sessions’ [ 23 ]. …”

The Value of Group Reflection

“…With regard to ethics reflection groups, Hem, Molewijk, Gjerberg, Lillemoen, and Pederson (2018) showed that participants promote improved professional competence and confidence. Vråle, Borge, and Nedberg (2017) identified courage as an important dimension of ethics reflection groups.…”