| 1. |
- Fläckman, Birgitta, et al.
(author)
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Despite shattered expectations a willingness to care for elders remains with education and clinical supervision
- 2007
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 21:3, s. 379-389
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Journal article (peer-reviewed)abstract
- The aim was to describe nursing home (NH) caregivers' work experiences while receiving education and clinical supervision for 2 years. Working in elder care seems to be losing its attraction especially with organizational changes, cutbacks and changes in work place conditions. Clinical supervision has been reported to increase job satisfaction and creativity. Semi-structured interviews from caregivers working at an NH in Sweden were conducted, at the start and again at 12 and 24 months. At about 12 months the caregivers were informed of planned cutbacks. Content analysis was the method used to analyse the interviews from seven caregivers who participated throughout the entire period. Findings show that the value of a caring milieu was one category generated by the subcategories: experiences related to work activities and changes, and experiences related to relationships. The value of knowledge was the other category that was influenced by the experiences related to the different backgrounds and the experiences related to increased knowledge gained from the support through education and clinical supervision. The categories contained positive as well as negative influences on care. The initial focus on practical duties associated with the opening of the NH shifted towards caregiver activities with the elders they spoke warmly about. After 2 years the caregivers' willingness to care continued despite their disappointment in the worsened working conditions. The main theme that resulted was: Despite shattered expectations a willingness to care for elders remained. Continued education and clinical supervision seems to be one factor behind the retained willingness. These findings demonstrate that support and caregiver involvement in educational programmes are important during times of change and when disappointments arise in the workplace.
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| 2. |
- Kihlgren, Annica Larsson, 1957-, et al.
(author)
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Referrals from home care to emergency hospital care : basis for decisions.
- 2003
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 12:1, s. 28-36
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Journal article (peer-reviewed)abstract
- The Swedish government implemented a reform, the Adel reform, in the care of older citizens in 1992, so that the communities where older people live became responsible for their care and housing. Nurses were appointed to make sure that older people were given accurate care and to act as supervisors for nurses' aides. In this study, 10 Registered Nurses from community home care services and four consultant head physicians in primary care were interviewed in order to illuminate what they thought influenced nurses' decisions to refer patients for emergency treatment and what support they requested to facilitate the decision. Content analysis showed the necessity of feeling secure in one's role as a community nurse. The categories that developed were: own competence, knowledge about the patient and a supportive working environment. The main theme was To feel safe in one's role - a basis for decision-making. High demands were put on the nurses' competence and their burden of responsibility became too great. This influenced decision-making negatively, if nurses felt that they were lacking in their own personal competence. Training in documentation for the nurses was required, as well as the need for organizations to provide staff with sufficient time for accurate documentation. A greater input of nursing and medical care was required to make it possible for patients to be cared for at home if they so wished. Respondents described considerable deficiencies in their working environment and in co-workers' competence, and nurses' professional roles within the community were not made clear. If these problems were remedied, this would improve working conditions, increase understanding, and reduce feelings of uncertainty among decision-makers.
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| 3. |
- Kihlgren, Annica, et al.
(author)
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Managements' perception of community nurses' decision-making processes when referring older adults to an emergency department
- 2006
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In: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 14:6, s. 428-436
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Journal article (peer-reviewed)abstract
- In Sweden, older adults are living and being cared for under the responsibility of their respective community. Extensive reorganizations in the community led to management having different backgrounds, which may have caused uncertainty among community nurses, especially in decision-making processes. The aim was to understand how 10 nurses, 10 doctors and 10 home care assistants as leaders for the nurses conceptualized the decision-making processes of community nurses, when referring older persons to Emergency Departments, and whether perceptual differences and/or similarities exist. Narrative interviews and content analysis were performed. The managers had differing views, but all felt there was a need to feel secure in order to trust professional decisions as being correct, thus avoiding inappropriate referrals. Management could see nurses' exposed position, but had varying solutions. This might lead to different messages being given regarding what is important and might explain why the nurses reported that the managers did not understand them.
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| 4. |
- Rasoal, Dara, 1980-, et al.
(author)
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What healthcare teams find ethically difficult : Captured in 70 moral case deliberations
- 2016
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In: Nursing Ethics. - London, United Kingdom : Sage Publications. - 0969-7330 .- 1477-0989. ; 23:8, s. 825-837
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Journal article (peer-reviewed)abstract
- Background: Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss.Aim: To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation.Research design: A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis.Ethical considerations: An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation.Findings: Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient's/next-of-kin's emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient's autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have.Discussion: The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders.Conclusion: MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.
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| 5. |
- Rasoal, Dara, et al.
(author)
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Balancing different expectations in ethically difficult situations while providing community home health care services : A focused ethnographic approach
- 2018
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In: BMC Geriatrics. - : BioMed Central Ltd.. - 1471-2318. ; 18:1
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Journal article (peer-reviewed)abstract
- Background: The general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services. Method: This study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations (n = 122), memos and informal interviews with registered nurses (n = 8), and nurse assistants (n = 4). The transcribed texts were analyzed with interpretive content analysis. Results: The inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues. Conclusions: This study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.
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| 6. |
- Rasoal, Dara, 1980-, et al.
(author)
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Clinical Ethics Support for Healthcare Personnel : An Integrative Literature Review
- 2017
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In: HEC Forum. - Dordrecht, Netherlands : Springer. - 0956-2737 .- 1572-8498. ; 29:4, s. 313-346
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Research review (peer-reviewed)abstract
- This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different coun-tries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a ‘‘bot-tom-up’’ perspective might give healthcare personnel opportunities to think and reflect more than a ‘‘top-down’’ perspective. A ‘‘bottom-up’’ approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a ‘‘top-down’’ approach risks removing such moral responsibility.
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| 7. |
- Rasoal, Dara, 1980-, et al.
(author)
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‘It’s like sailing’ : experiences of the role as facilitator during moral case deliberation
- 2017
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In: Clinical Ethics. - United Kingdom : Royal Society of Medicine Press. - 1477-7509 .- 1758-101X. ; 12:3, s. 1-8
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Journal article (peer-reviewed)abstract
- Moral case deliberation is one form of clinical ethics support, and there seems to be different ways of facilitating thedialogue. This paper aimed to explore the personal experiences of Swedish facilitators of their role in moral casedeliberations. Being a facilitator was understood through the metaphor of sailing: against the wind or with it. Therole was likened to a sailor’s set of skills: to promote security and well-being of the crew, to help crew navigate theirmoral reflections, to sail a course into the wind against homogeneity, to accommodate the crew’s needs and just sail withthe wind, and to steer towards a harbour with authority and expertise. Balancing the disparate roles of being accom-modative and challenging may create a free space for emotions and ideas, including self-reflection and consideration ofmoral demands. This research opens the question of whether all these skills can be taught through systematic training orwhether facilitators need to possess the characteristics of being therapeutic, pedagogical, provocative, sensitive andauthoritarian.
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| 8. |
- Rasoal, Dara, 1980-
(author)
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Perspectives on clinical ethics support and ethically difficult situations : reflections and experiences
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Healthcare personnel encounter ethically difficult situations in their everyday work and clinical ethics support might be important to support healthcare personnel to deal with these situations. The overall aim of this thesis was to describe perspectives on clinical ethics support, experiences of being in ethically difficult situations and experiences of facilitating ethics reflection. Methods. Study I had a descriptive design in which research articles were reviewed (n=54). In study II audio-recorded moral case deliberation (n=70) in 10 Swedish workplaces in hospitals and community care were analysed. In study III interviews were conducted with facilitators (n=11) of moral case deliberation. Study IV used non-participant observation during three weeks as well as informal conversations with healthcare personnel (n=12) in community home healthcare. Results and conclusion. In study I, two perspectives emerged on clinical ethics support, a “Top-down” perspective, where an individual or a group of “experts” in ethics could recommend the best course of action and a “Bottom-up” perspective that allows healthcare personnel to manage ethically difficult situations through ethical reflections led by a facilitator. Studies II and IV showed how ethically difficult situations on different levels are often connected with emotions and uncertainties. Study III showed the role of the facilitator to be fundamental in creating a space for self-reflection among healthcare personnel. Study IV showed that healthcare personnel face complex demands and expectations from the healthcare organization regarding the provision of care as well as having to meet the needs of patients and their next-of-kin. To conclude, healthcare personnel needed to find a balance among demands and expectations in order to satisfy those stakeholders involved and they had to seek compromise. There is a need for clinical ethics support that helps healthcare personnel reflect individually and collectively on ethically difficult situations they encounter in their everyday clinical practice. From this standpoint, a “Bottom-up” perspective may reduce the risk of moral distress among healthcare personnel and promote care based on person-centred values.
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