Ethics rounds: affecting ethics quality at all organisational levels

2018 ◽  
Vol 44 (12) ◽  
pp. 805-809
Author(s):  
Dagmar Schmitz ◽  
Dominik Groß ◽  
Charlotte Frierson ◽  
Gerrit A Schubert ◽  
Henna Schulze-Steinen ◽  
...  
Keyword(s):  
Ethical Leadership ◽  
Clinical Ethics ◽  
Clinical Ethics Support ◽  
Comprehensive Account ◽  
Ethics Support ◽  
Support Strategies ◽  
Ethics Rounds

Clinical ethics support (CES) services are experiencing a phase of flourishing and of growing recognition. At the same time, however, the expectations regarding the acceptance and the integration of traditional CES services into clinical processes are not met. Ethics rounds as an additional instrument or as an alternative to traditional clinical ethics support strategies might have the potential to address both deficits. By implementing ethics rounds, we were able to better address the needs of the clinical sections and to develop a more comprehensive account of ethics quality in our hospital, which covers the level of decisions and actions, and also the level of systems and processes and aspects of ethical leadership.

Evaluating clinical ethics support in mental healthcare

2014 ◽  
Vol 22 (4) ◽  
pp. 452-466 ◽  
Author(s):  
Marit Helene Hem ◽  
Reidar Pedersen ◽  
Reidun Norvoll ◽  
Bert Molewijk
Keyword(s):  
Support Services ◽  
Clinical Ethics ◽  
Good Practice ◽  
Mental Healthcare ◽  
Grey Zone ◽  
Ethical Challenges ◽  
Clinical Ethics Support ◽  
Quantitative Research Methods ◽  
Ethics Support ◽  
Ethics Rounds

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented.

scholarly journals Managing ethical issues in patient care and the need for clinical ethics support

2015 ◽  
Vol 39 (1) ◽  
pp. 44 ◽  
Author(s):  
Evan Doran ◽  
Jennifer Fleming ◽  
Christopher Jordens ◽  
Cameron L Stewart ◽  
Julie Letts ◽  
...  
Keyword(s):  
Patient Care ◽  
Clinical Ethics ◽  
Ethical Issues ◽  
Public Hospitals ◽  
Cross Sectional Survey ◽  
Convenience Sample ◽  
Clinical Ethics Support ◽  
Ethical Environment ◽  
Ethics Support ◽  
A Priority

Objective To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia. Methods A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. Results Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful. Conclusion Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia. What is known about the topic? Clinicians working in hospitals in the US, Canada and UK have access to ethics expertise to help them manage ethical issues that arise in patient care. How Australian clinicians currently manage the ethical issues they face has not been investigated. What does this paper add? This paper describes the types of ethical issues faced by Australian clinicians, how they manage these issues and whether they think ethics support would be helpful. What are the implications for practitioners? Clinicians frequently encounter ethically and legally difficult decisions and want additional ethics support. Helping clinicians to provide ethically sound patient care should be a priority of public hospitals in NSW and elsewhere in Australia.

scholarly journals Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?

2017 ◽  
Vol 44 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Rosalind J McDougall ◽  
Lynn Gillam ◽  
Clare Delany ◽  
Yasmin Jayasinghe
Keyword(s):  
Fertility Preservation ◽  
Clinical Ethics ◽  
Reproductive Potential ◽  
Clinical Ethics Support ◽  
Prepubertal Children ◽  
Ethics Support ◽  
Future Fertility ◽  
Difference Of Opinion ◽  
Proven Efficacy ◽  
Pathway Of Care

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia.

scholarly journals A pragmatist approach to clinical ethics support: overcoming the perils of ethical pluralism

2019 ◽  
Vol 22 (3) ◽  
pp. 427-438 ◽  
Author(s):  
Giulia Inguaggiato ◽  
Suzanne Metselaar ◽  
Rouven Porz ◽  
Guy Widdershoven
Keyword(s):  
Clinical Ethics ◽  
Clinical Ethics Support ◽  
Ethical Pluralism ◽  
Ethics Support

scholarly journals Theory and practice of integrative clinical ethics support: a joint experience within gender affirmative care

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Laura Hartman ◽  
Giulia Inguaggiato ◽  
Guy Widdershoven ◽  
Annelijn Wensing-Kruger ◽  
Bert Molewijk
Keyword(s):  
Clinical Ethics ◽  
Theory And Practice ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Joint Experience

scholarly journals Lessons learned from implementing a responsive quality assessment of clinical ethics support

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Eva M. Van Baarle ◽  
Marieke C. Potma ◽  
Maria E. C. van Hoek ◽  
Laura A. Hartman ◽  
Bert A. C. Molewijk ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Assessment ◽  
Learning Process ◽  
Clinical Ethics ◽  
Health Care Organizations ◽  
Lessons Learned ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Dutch Health

Abstract Background Various forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project. Methods CES practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions. Results The main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices. Conclusions The evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA.

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