| 1. |
- Bartholdson, C, et al.
(författare)
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Clarifying perspectives: Ethics case reflection sessions in childhood cancer care
- 2016
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Ingår i: Nursing ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 23:4, s. 421-431
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Tidskriftsartikel (refereegranskat)abstract
- Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child’s growing autonomy are known ethical concerns that involve the whole professional team around the child’s care. Objectives: The purpose of this study was to explore healthcare professionals’ experiences of participating in ethics case reflection sessions in childhood cancer care. Research design: Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology. Participants and research context: Healthcare professionals working at a publicly funded children’s hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on. Ethical considerations: The children’s and their parents’ integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board. Findings: Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants’ articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions. Discussion: The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care. Conclusion: Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child. A consolidated care approach would be valuable for both the child and the healthcare professionals because of the common care goals.
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| 2. |
- Bartholdson, C, et al.
(författare)
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Ethics case reflection sessions: Enablers and barriers
- 2018
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Ingår i: Nursing ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 25:2, s. 199-211
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Tidskriftsartikel (refereegranskat)abstract
- In previous research on ethics case reflection (ECR) sessions about specific cases, healthcare professionals in childhood cancer care were clarifying their perspectives on the ethical issue to resolve their main concern of consolidating care. When perspectives were clarified, consequences in the team included ‘increased understanding’, ‘group strengthening’ and ‘decision grounding’. Additional analysis of the data was needed on conditions that could contribute to the quality of ECR sessions. Objective: The aim of this study was to explore conditions for clarifying perspectives during ECR sessions. Research design: Data were collected from observations and interviews and the results emerged from an inductive analysis using grounded theory. Participants and research context: Six observations during ECR sessions and 10 interviews were performed with healthcare professionals working in childhood cancer care and advanced paediatric homecare. Ethical considerations: The study was approved by a regional ethical review board. Participants were informed about their voluntary involvement and that they could withdraw their participation without explaining why. Findings: Two categories emerged: organizational enablers and barriers and team-related enablers and barriers. Organizational enablers and barriers included the following sub-categories: the timing of the ECR session, the structure during the ECR session and the climate during the ECR session. Sub-categories to team-related enablers and barriers were identified as space for inter-professional perspectives, varying levels of ethical skills and space for the patient’s and the family’s perspectives. Discussion: Space for inter-professional perspectives included the dominance of a particular perspective that can result from hierarchical positions. The medical perspective is relevant for understanding the child’s situation but should not dominate the ethical reflection. Conclusion: Conditions for ECR sessions have been explored and the new knowledge can be used when training facilitators as well as for those who organize/implement ECR sessions. Awareness of space for different perspectives, including the possible medical advantage over the nursing perspective, could reduce the somewhat unilateral attention and contribute to an inter-professionally shared reflection.
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| 3. |
- Bartholdson, C, et al.
(författare)
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Healthcare professionals' perceptions of the ethical climate in paediatric cancer care
- 2016
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Ingår i: Nursing ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 23:8, s. 877-888
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Tidskriftsartikel (refereegranskat)abstract
- How well ethical concerns are handled in healthcare is influenced by the ethical climate of the workplace, which in this study is described as workplace factors that contribute to healthcare professionals’ ability to identify and deal with ethical issues in order to provide the patient with ethically good care. Objectives: The overall aim of the study was to describe perceptions of the paediatric hospital ethical climate among healthcare professionals who treat/care for children with cancer. Research design: Data were collected using the Hospital Ethical Climate Survey developed by Olsson as a separate section in a questionnaire. Descriptive statistics were used to analyse perceptions of the ethical climate. Participants and research context: Physicians, nurses and nurse-aides (n = 89) from three paediatric units participated in this study: haematology/oncology, chronic diseases and neurology. Ethical considerations: The study was approved by the regional ethical review board. Findings: Different perceptions of the ethical climate were rated as positive or negative/neutral. Nurses’ ratings were less positive than physicians on all items. One-third of the participants perceived that they were able to practice ethically good care as they believed it should be practised. Discussion: Differences in professional roles, involving more or less power and influence, might explain why physicians and nurses rated items differently. A positive perception of the possibility to practice ethically good care seems to be related to inter-professional trust and listening to guardians/parents. A negative/neutral perception of the possibility to practice ethically good care appears to be influenced by experiences of ethical conflicts as well as a lack of ethical support, for example, time for reflection and discussion. Conclusion: The two-thirds of participants who had a negative/neutral perception of the possibility to practice ethically good care are at risk of developing moral stress. Clinical ethics support needs to be implemented in care where important values are at stake.
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| 4. |
- Lutzen, K, et al.
(författare)
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Moral sensitivity in psychiatric practice
- 1997
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Ingår i: Nursing ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 4:6, s. 472-482
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Tidskriftsartikel (refereegranskat)abstract
- This study reports the results of a study of Swedish psychiatrists’ responses to moral statements related to decision making in the psychiatric context. Use was made of the Moral Sensitivity Questionnaire, a modified instrument previously constructed from a theory of moral sensitivity. This Likert-type scale contains 30 items constructed from the following categories: interpersonal orientation, structuring moral meaning, benevolence, modifying autonomy, experiencing moral conflict, and trust in medical knowledge and principles of care. The purpose was to identify possible differences in responses rather than to evaluate right or wrong responses. The analysis is based on 754 completed questionnaires. The results of the study showed some significant differences in the item and category levels; for example, male psychiatrists experienced more conflicts than female psychiatrists and agreed to a greater extent that medical knowledge was most important in deciding what was best for the patient. The results also showed that more female than male psychiatrists thought that the relationship with the patient was most important in psychiatric practice.
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| 5. |
- Lutzen, K, et al.
(författare)
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Moral sensitivity: some differences between nurses and physicians
- 2000
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Ingår i: Nursing ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 7:6, s. 520-530
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Tidskriftsartikel (refereegranskat)abstract
- We report the results of an investigation of nurses’ and physicians’ sensitivity to ethical dimensions of clinical practice. The sample consisted of 113 physicians working in general medical settings, 665 psychiatrists, 150 nurses working in general medical settings, and 145 nurses working in psychiatry. The instrument used was the Moral Sensitivity Questionnaire (MSQ), a self-reporting Likert-type questionnaire consisting of 30 assumptions related to moral sensitivity in health care practice. Each of these assumptions was categorized into a theoretical dimension of moral sensitivity: relational orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing moral conflict, and following the rules. Significant differences in responses were found between health care professionals from general medical settings and those working in psychiatry. The former agreed to a greater extent with the assumptions in the categories ‘meaning’ and ‘autonomy’ and to a lesser degree with the categories ‘benevolence’ and ‘conflict’. Moreover, those from the psychiatric sector agreed to a greater extent to the use of coercion if necessary. Significant differences were also found for some of the MSQ categories, between physicians and nurses, and between males and females.
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| 6. |
- Lutzen, K
(författare)
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Nursing ethics into the next millennium: a context-sensitive approach for nursing ethics
- 1997
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Ingår i: Nursing ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 4:3, s. 218-226
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this article is to argue for the need for a context-sensitive approach to the understanding of ethical issues in nursing practice as we face the next millennium. This approach means that the idea of universalism must be questioned because ethics is an interpersonal activity, set in a specific context. This view is based on issues that arise in international collaborative research as well as in research focused on ethical problems in nursing practice. Moral values are indigenous to a particular culture and influence beliefs about health and illness as well as what priorities are to be made in providing health care. Nursing practice must include thoughtful reflection on the meaning of moral concepts and principles in terms of culture. Theoretical developments in nursing ethics must be based on empirical research focusing on contextual aspects of health care.
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| 7. |
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| 8. |
- LUTZEN, K, et al.
(författare)
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The influence of gender, education and experience on moral sensitivity in psychiatric nursing: a pilot study
- 1995
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Ingår i: Nursing ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 2:1, s. 41-50
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to investigate some factors which may influence moral decision-making in psychiatric nursing practice. The Moral Sensitivity Questionnaire, a 30-item, seven-point Likert scale, measures six dimensions that are assumed to be related to moral sensitivity. In scoring, the test is divided into six categories: interpersonal orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing conflict, and reliance on medical authority. Seventy-nine nurses, employed in the same psychiatric district, were included in the sample. Significant differences were found for some items in five of the six categories regarding gender, post-basic nursing education, experience as a mental care worker and type of clinical setting. Le but de cette étude était d'investiguer quelques éléments qui pourraient influencer les décisions morales dans la pratique infirmière psychiatrique. Le Questionnaire de Sensibilité Morale de 30 questions, sept points échelle Likert, mesure six dimensions qu'on assume d'être lié à la sensibilité morale. En marquant les points, le test est divisé entre les six catégories: orientation interpersonnelle, structurant un sens moral, l'expression de bénévolence, la modification de l'autonomie, l'expérience de conflit et dépendance de l'autorité médicale. Soixante-dix neuf infirmiers/ères, employé(e)s dans le même rayon de psychiatrie, ont participé dans l'étude. On a trouvé des différences considérables pour quelques questions dans cinq des six catégories en ce qui concerne le genre, l'éducation avancée, l'expérience d'infirmier/ère psychiatrique et type de cadre clinique. Das Ziel dieser Studie war die Untersuchung einiger Faktoren, die Einfluss haben auf die moralische Entscheidungsfindung in der psychiatrischen Krankenpflege. Der Fragebogen zur 'Moralischen Einfühlsamkeit' ist eine sieben-Punk Likert Skala für 30 Sachaspekte und misst sechs Dimensionen, von denen man annimmt, daß sie zur moralischer Einfühlsamkeit gehören. Für die Auswertung ist der Test in sechs Kategorien eingeteilt: Orientierung zu andem Personen, das Strukturieren moralischer Bedeutungselemente, Wohlwollen ausdrücken, Modifizierung von Selbstbestimmung,
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| 9. |
- Lutzen, K, et al.
(författare)
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The role of virtue ethics in psychiatric nursing
- 1996
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Ingår i: Nursing ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 3:3, s. 202-211
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Tidskriftsartikel (refereegranskat)abstract
- The main purpose of this article is to discuss the place of the ethics of virtues and char acter in nursing and health care in general, and in psychiatric nursing in particular. To attain this goal, the relationship between the ethics of duty (i.e. rule based ethics) and the ethics of virtue and character will be clarified in order to defend our main hypothe sis that these two types of ethics should complement each other, since both are necessary but neither by itself is sufficient for nursing. This means that any applied ethics, as in nursing, should consider the importance of the agent's moral character. To support our arguments, we shall use cases from the empirical reality of psychiatric and mental health care.
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| 10. |
- Magnusson, A, et al.
(författare)
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Intrusion into patient privacy: a moral concern in the home care of persons with chronic mental illness
- 1999
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Ingår i: Nursing ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 6:5, s. 399-410
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to identify and analyse ethical decision making in the home care of persons with long-term mental illness. A focus was placed on how health care workers interpret and deal with the principle of autonomy in actual situations. Three focus groups involving mental health nurses who were experienced in the home care of persons with chronic mental illness were conducted in order to stimulate an interactive dialogue on this topic. A constant comparative analysis of the transcribed audiotaped sessions identified a central theme that concerned the moral symbolic meaning of ‘home’. This reflected the health care workers’ conflict between their professional role and their moral role, which they perceived as unclear.
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