Moral Competence, Moral Teamwork, Moral Action – Outcomes of Moral Case Deliberation in the Euro-MCD 2.0 For Evaluating Clinical Ethics Support

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 67-67
Author(s):  
Janine de Snoo-Trimp ◽  
◽  
Keyword(s):  
Clinical Ethics ◽  
Healthcare Professionals ◽  
Moral Action ◽  
Moral Case Deliberation ◽  
Moral Competence ◽  
Revision Process ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Case ◽  
Difficult Situations

"Background: For Moral Case Deliberation (MCD), like any form of Clinical ethics support (CES), it is important to know whether it reaches its presumed goal of supporting healthcare professionals in their ethical challenges. Evaluation is needed to gain insight in the value of MCD. Therefore, the Euro-MCD instrument was developed to assess outcomes of MCD, and has now been revised. The aim of this presentation is to present the revised Instrument: the Euro-MCD 2.0. Methods: The revision process was an iterative dialogue in which field study findings were integrated with theoretical reflections and expert-input. Results: The Euro-MCD 2.0 has three domains: 1) Moral Competence, 2) Moral Teamwork and 3) Moral Action. Moral Competence includes items on moral sensitivity, analytical skills and a virtuous attitude, like ‘I speak up in ethically difficult situations’. Moral Teamwork refers to open dialogue and supportive relationships, for example ‘We feel secure to share emotions in ethically difficult situations’. Moral Action includes items about moral decision-making and responsible care, like ‘We are able to explain and justify our care towards patients and their families’. Discussion: The Euro-MCD 2.0 is shorter and more strongly substantiated by empirical data and theoretical reflections. At the conference, we will reflect on the revision process and the underlying foundations of the domains. The revised instrument helps to get insight in the MCD related outcomes for healthcare professionals in their daily practice. Our research can further improve implementation of MCD and contribute to the research field of evaluation of CES in general. "

scholarly journals Moral Competence, Moral Teamwork and Moral Action – The European Moral Case Deliberation Outcomes (Euro-MCD) Instrument 2.0 and its revision process

2020 ◽  
Author(s):  
Janine de Snoo-Trimp ◽  
Riekie de Vet ◽  
Guy Widdershoven ◽  
Bert Molewijk ◽  
Mia Svantesson
Keyword(s):  
Healthcare Professionals ◽  
Field Studies ◽  
Current Status ◽  
Future Research ◽  
Moral Action ◽  
Moral Case Deliberation ◽  
Sentence Structure ◽  
Moral Competence ◽  
Revision Process ◽  
Moral Case

Abstract Background Clinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process.Methods The revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.Results The Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.Conclusions : The Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD.

scholarly journals Moral Competence, Moral Teamwork and Moral Action – The European Moral Case Deliberation Outcomes (Euro-MCD) Instrument 2.0 and its revision process

2020 ◽  
Author(s):  
Janine de Snoo-Trimp ◽  
Riekie de Vet ◽  
Guy Widdershoven ◽  
Bert Molewijk ◽  
Mia Svantesson
Keyword(s):  
Healthcare Professionals ◽  
Field Studies ◽  
Current Status ◽  
Future Research ◽  
Moral Action ◽  
Moral Case Deliberation ◽  
Sentence Structure ◽  
Moral Competence ◽  
Revision Process ◽  
Moral Case

Abstract Background Clinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process. Methods The revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.Results The Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.Conclusions: The Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD.

scholarly journals Moral Competence, Moral Teamwork and Moral Action – The European Moral Case Deliberation Outcomes (Euro-MCD) Instrument 2.0 and its revision process

2020 ◽  
Author(s):  
Janine de Snoo-Trimp ◽  
Riekie de Vet ◽  
Guy Widdershoven ◽  
Bert Molewijk ◽  
Mia Svantesson
Keyword(s):  
Healthcare Professionals ◽  
Field Studies ◽  
Current Status ◽  
Future Research ◽  
Moral Action ◽  
Moral Case Deliberation ◽  
Sentence Structure ◽  
Moral Competence ◽  
Revision Process ◽  
Moral Case

Abstract Background Clinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process. Methods The revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.Results The Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.Conclusions: The Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD.

scholarly journals Outcomes of Moral Case Deliberation - the development of an evaluation instrument for clinical ethics support (the Euro-MCD)

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Mia Svantesson ◽  
Jan Karlsson ◽  
Pierre Boitte ◽  
Jan Schildman ◽  
Linda Dauwerse ◽  
...  
Keyword(s):  
Clinical Ethics ◽  
Moral Case Deliberation ◽  
Evaluation Instrument ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Case

scholarly journals Emotions and Clinical Ethics Support. A Moral Inquiry into Emotions in Moral Case Deliberation

HEC Forum ◽  
2011 ◽  
Vol 23 (4) ◽  
pp. 257-268 ◽  
Author(s):  
Bert Molewijk ◽  
Dick Kleinlugtenbelt ◽  
Scott M. Pugh ◽  
Guy Widdershoven
Keyword(s):  
Clinical Ethics ◽  
Moral Case Deliberation ◽  
Moral Inquiry ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Case

scholarly journals Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Charlotte Weiner ◽  
Pernilla Pergert ◽  
Bert Molewijk ◽  
Anders Castor ◽  
Cecilia Bartholdson
Keyword(s):  
Quality Of Care ◽  
Childhood Cancer ◽  
Clinical Ethics ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Well Being ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Case

Abstract Background In childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden. Methods This study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation. Results Data was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows: Interprofessional well-being in team interactions on a team level; Professional comfort when dealing with moral challenges on a personal level; and Improved quality of care for the child and the family on a care level. Conclusions Healthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support.

scholarly journals The Role of Worldview in Moral Case Deliberation: Visions and Experiences of Group Facilitators

2021 ◽  
Author(s):  
Benita Spronk ◽  
Guy Widdershoven ◽  
Hans Alma
Keyword(s):  
Clinical Ethics ◽  
Daily Practice ◽  
Moral Dilemmas ◽  
Moral Case Deliberation ◽  
Structured Interviews ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Case ◽  
Role Concerns

AbstractThis study investigates the role of worldview in moral case deliberation (MCD). MCD is a form of clinical ethics support which aims to assist caregivers in reflection on moral dilemmas, experienced in daily practice. Bioethicists acknowledge that existential and religious aspects must be taken into account in the analysis of ethical questions, but it remains unclear how these elements are addressed in clinical ethics support. We investigated how facilitators of MCD address worldview in MCD. MCD facilitation is often done by spiritual caregivers, but not in their role as spiritual caregiver. Discussing worldview is no standard part of the procedure in MCD. This study was qualitative, focusing on the views and experiences of the facilitators of MCD. Semi-structured interviews (N = 12) were conducted with facilitators of MCD. Grounded theory was used for analysis. The results show that worldview plays both an explicit and an implicit role in the MCD process. The explicit role concerns the religious beliefs of patients and professionals. This calls for avoiding stereotyping and devoting attention to different visions. The implicit role comes to the fore in addressing core values and spiritual fulfillment. In order to clarify the fundamental nature of values, more explicit attention for worldview might be useful during MCD. However, this should be done with caution as the term ‘worldview’ might be interpreted by participants in terms of religious and personal beliefs, rather than as an invitation to reflect on one’s view of the good life as a whole.

scholarly journals Moral competence, moral teamwork and moral action - the European Moral Case Deliberation Outcomes (Euro-MCD) Instrument 2.0 and its revision process

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
J. C. de Snoo-Trimp ◽  
H. C. W. de Vet ◽  
G. A. M. Widdershoven ◽  
A. C. Molewijk ◽  
M. Svantesson
Keyword(s):  
Moral Action ◽  
Moral Case Deliberation ◽  
Moral Competence ◽  
Revision Process ◽  
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.

Preventing moral conflicts in patient care: Insights from a mixed-methods study with clinical experts

2021 ◽  
pp. 147775092110572
Author(s):  
Jan Schürmann ◽  
Gabriele Vaitaityte ◽  
Stella Reiter-Theil
Keyword(s):  
Risk Factors ◽  
Patient Care ◽  
Clinical Ethics ◽  
Process Model ◽  
Healthcare Professionals ◽  
Preventive Measures ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Problems ◽  
Early Indicators

Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in Basel, Switzerland. A Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives.

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