Evaluation and perceived results of moral case deliberation

2014 ◽  
Vol 22 (8) ◽  
pp. 870-880 ◽  
Author(s):  
Rien MJPA Janssens ◽  
Ezra van Zadelhoff ◽  
Ger van Loo ◽  
Guy AM Widdershoven ◽  
Bert AC Molewijk
Keyword(s):  
The Netherlands ◽  
Evaluation Studies ◽  
Aged Care ◽  
Ethical Review ◽  
Care Practice ◽  
Moral Case Deliberation ◽  
Team Leaders ◽  
Healthcare Organizations ◽  
Large Organization ◽  
Moral Case

Background: Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. Research questions: How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Research design: Quantitative analysis of a questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Participants and research context: Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Ethical considerations: Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Findings: Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. Conclusion: The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team’s cohesion as mutual understanding for one another’s views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents.

Chapitre 3. Moral case deliberation in an academic hospital in the Netherlands

2012 ◽  
Vol 23 (3) ◽  
pp. 53 ◽  
Author(s):  
Margreet Stolper ◽  
Suzanne Metselaar ◽  
Bert Molewijk ◽  
Guy Widdershoven
Keyword(s):  
The Netherlands ◽  
Moral Case Deliberation ◽  
Academic Hospital ◽  
Moral Case

scholarly journals What healthcare teams find ethically difficult

2016 ◽  
Vol 23 (8) ◽  
pp. 825-837 ◽  
Author(s):  
Dara Rasoal ◽  
Annica Kihlgren ◽  
Inger James ◽  
Mia Svantesson
Keyword(s):  
Ethical Issues ◽  
Ethical Review ◽  
Moral Case Deliberation ◽  
Next Of Kin ◽  
Life And Death ◽  
Healthcare Teams ◽  
Ethics Support ◽  
Moral Case ◽  
Interprofessional Healthcare ◽  
Difficult Situations

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.

It’s not all about moral reasoning: Understanding the content of Moral Case Deliberation

2017 ◽  
Vol 25 (2) ◽  
pp. 212-229 ◽  
Author(s):  
Mia Svantesson ◽  
Marit Silén ◽  
Inger James
Keyword(s):  
Moral Reasoning ◽  
Moral Distress ◽  
Evaluation Research ◽  
Human Interaction ◽  
Ethical Review ◽  
Moral Case Deliberation ◽  
Difficult Patient ◽  
Ethics Support ◽  
Moral Case ◽  
Outcome Criteria

Background: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain. Objective: To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces. Methods: A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority. Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation. Findings: Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%). Conclusion: The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

scholarly journals Field-testing the Euro-MCD Instrument: Experienced outcomes of moral case deliberation

2019 ◽  
Vol 27 (2) ◽  
pp. 390-406 ◽  
Author(s):  
Janine C de Snoo-Trimp ◽  
Bert Molewijk ◽  
Gøril Ursin ◽  
Berit Støre Brinchmann ◽  
Guy AM Widdershoven ◽  
...  
Keyword(s):  
The Netherlands ◽  
Factor Structure ◽  
Healthcare Professionals ◽  
Field Testing ◽  
Daily Practice ◽  
Delphi Panel ◽  
Moral Case Deliberation ◽  
Ethics Support ◽  
Exploratory Factor Analyses ◽  
Moral Case

Background: Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. Aim: To describe experienced outcomes after participating in a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. Methods: In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. Ethical considerations: The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. Results: The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. Conclusion: Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare.

Heeft de evaluatie van reïntegratiebeleid nog toekomst?

2005 ◽  
Vol 21 (1) ◽  
Author(s):  
Pierre Koning
Keyword(s):  
The Netherlands ◽  
Labour Market ◽  
Evaluation Studies ◽  
Future Research ◽  
Welfare To Work ◽  
Labour Market Policies ◽  
Active Labour Market Policies ◽  
Active Labour ◽  
Proper Account

Does the evaluation of active labour market policies have any future? Does the evaluation of active labour market policies have any future? The literature on the effectiveness of welfare-to-work services (i.e. schooling and job counseling) in the Netherlands provides a gloomy picture. First, only a few studies take proper account of selectivity and endogeneity biases. Second, the results of this (subset of) studies suggest that both schooling and counseling have only a modest, or no significant impact. In this article, I discuss various explanations for these findings. Furthermore, I describe various avenues for future research in this area, as well as the organization of more sound evaluation studies.

scholarly journals Evaluation of moral case deliberation at the Dutch Health Care Inspectorate: a pilot study

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Wike Seekles ◽  
Guy Widdershoven ◽  
Paul Robben ◽  
Gonny van Dalfsen ◽  
Bert Molewijk
Keyword(s):  
Health Care ◽  
Pilot Study ◽  
Moral Case Deliberation ◽  
Dutch Health ◽  
Dutch Health Care ◽  
Moral Case

Moral case deliberation

2017 ◽  
Vol 18 (3) ◽  
pp. 181-186 ◽  
Author(s):  
Daniel Y B Tan ◽  
Bastiaan C ter Meulen ◽  
Albert Molewijk ◽  
Guy Widdershoven
Keyword(s):  
Support Services ◽  
Healthcare Professionals ◽  
Ethical Dilemmas ◽  
Daily Practice ◽  
Moral Case Deliberation ◽  
Ethics Support ◽  
Moral Case ◽  
Moral Damage ◽  
Dilemma Method

Ethical dilemmas in general are characterised by a choice between two mutually excluding options neither of which is satisfactory, because there always will be a form of moral damage. Within the context of medicine several ethics support services have been developed to support healthcare professionals in dealing with ethical dilemmas, including moral case deliberation. In this article, we describe how moral case deliberation works in daily practice, illustrated with a case example from the neurology ward. The article is meant as an introduction to moral case deliberation according to the dilemma method. We show its relevance to the clinic and the context needed to put it into practice.

European Moral Case Deliberation Outcomes Instrument

2014 ◽  
Author(s):  
Mia Svantesson ◽  
Jan Karlsson ◽  
Pierre Boitte ◽  
Jan Schildman ◽  
Linda Dauwerse ◽  
...  
Keyword(s):  
Moral Case Deliberation ◽  
Moral Case

Learning Practical Wisdom from Moral Case Deliberation Through Morisprudence

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 106-106
Author(s):  
Jos Kole ◽  
◽  
Keyword(s):  
Medical School ◽  
Conceptual Analysis ◽  
Healthcare Professionals ◽  
Practical Wisdom ◽  
Teaching Method ◽  
Moral Case Deliberation ◽  
Organizational Contexts ◽  
Moral Case ◽  
Strong Relation ◽  
The Individual

"Moral case deliberation is regularly used as a teaching method at our medical school. Besides we facilitate moral case deliberation on the ward in our hospital. In both instances, our assumption is that practicing moral case deliberation will assist our (future) healthcare professionals to cultivate the virtue of practical wisdom. But, is this assumption, right? The answer to this question requires both empirical research and conceptual analysis. This paper focuses on the latter. The claim defended is that we can elucidate the relation between moral case deliberation and practical wisdom through an analysis of so called morisprudence. We start with discussing two divergent but related interpretations of morisprudence: one introduced by Toulmin and Jonsen, related to casuistry, and one related to a Dutch interpretation with a strong relation to moral case deliberation. The combination of the both interpretations shed new light on the conceptual connections between cultivating prudence (practical wisdom) and moral case deliberation, but it also provides new insights into the individual and collective dimensions of practical wisdom, of character formation within organizational contexts. Finally, it may have consequences for how moral case deliberation should actually be employed to teach practical wisdom. "

A transformative approach to systems theory in caregiving research

2017 ◽  
Vol 18 (4) ◽  
pp. 710-726 ◽  
Author(s):  
Belinda Cash ◽  
Suzanne Hodgkin ◽  
Jeni Warburton
Keyword(s):  
Social Work ◽  
Systems Theory ◽  
Research Design ◽  
Social Research ◽  
Systems Of Care ◽  
Aged Care ◽  
Care Practice ◽  
Complex Phenomenon ◽  
Critical Approach ◽  
Social Work Research

This paper illustrates how systems theory can be used in social work research design to understand the systemic issues associated with spousal care in rural Australia. Spousal caregiving is embedded within multiple formal and informal systems, including family, community, health and aged care practice, social policy, and social and cultural norms. It is therefore a complex phenomenon to explore in social research, with each of these systems interacting with and influencing other aspects of the care system. The purpose of this paper is to provide an illustration of a research design that explores this systemic complexity. The design is conceptually underpinned by the transformative paradigm; a critical approach that reflects social work principles of social justice. The methodology is based on an ecosystems approach to assessment, using multiple methods to explore interactions between systems of care at policy, practice and individual levels. This application of systems theory to research presents an innovative opportunity for social work research to reflect long-established practices of understanding complex phenomenon within its sociocultural context.

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