Systematic Evaluation of Two Years of Ethics Reflection Groups. Changes Over Time Regarding Employees’ Attitudes, User Involvement, Team Cooperation and the Handling of Disagreement

"Background: Ethics reflection groups (ERG) or moral case deliberations (MCD) are increasingly used in health care as a form of clinical ethics support (CES). ERGs are often evaluated with a focus on evaluating ERG itself yet not on the impact of or change due to ERGs. Within a larger study implementation and impact of ERG was studied with use of various qualitative and qualitative research methodologies. In this presentation we present findings of the quantitative research. Research question: Are there changes over time after two years of ERG regarding employees’ normative attitudes with respect to the use of coercion, user involvement during the use of coercion, team cooperation and the handling of disagreement? Research methods: Repeated cross-sectional survey at seven wards within three different Norwegian mental health care institutions (T0-T1-T2). Results: In total, 817 surveys were included in the analyses. Of these, only 7.6 % (N= 62) have responded at all three points in time, while 76.8 % (N= 628) responded only once. Over time, adjusted for ward and profession, respondents agreed less that coercion is a form of care or security. Furthermore, respondents thought they involved patients and their family significantly more often in situations of coercion and they reported that the constructive of disagreement within the team significantly improved. More frequent ERG participation seemed associated with a more critical attitude towards the use of coercion and higher scores for user involvement, team cooperation and the constructive handling of disagreement, yet differences between ERG participation were generally small in absolute terms. Conclusion: Structural participation in ERG seems to contribute to changes in attitudes, user involvement and team cooperation. Studying changes over time and trying to find a relationship between CES interventions and outcome is difficult yet important and need to be further developed in future CES evaluation research. "

Analytical Feminist Ethics

Feminist ethics is that branch of ethics that is concerned first and foremost with understanding the oppression of women and developing a normative analysis of its wrongness. Analytical feminist ethics uses the tools and techniques of analytical philosophy, such as conceptual analysis, to further understand the injustices revealed by feminist approaches to ethics. The chapter surveys analytic themes, trends, and tendencies within feminist ethics taking a broad lens on what counts. The chapter offers an account of central issues and themes in analytic feminist philosophical engagements with ethics, reflection on examples of important contributions to this discussion, a discussion the extent to which feminist work has changed or entered the mainstream of the field, and current and future directions in analytic feminist ethics.

Two Years of Ethics Reflection Groups About the Use of Coercion. Changes Over Time in Employees’ Normative Attitudes Regarding the Use of Coercion, User Involvement, Team Cooperation and the Handling of Disagreement

Background: Research on the impact of ethics reflection groups (ERG) or moral case deliberations (MCD) is complex and scarce. Within a larger study, ERG has been used as an intervention for stimulating critical ethical reflection and improved team cooperation while observing changes over time.Research question: Are there – during and after two years of ERGs - changes over time regarding employees’ normative attitudes regarding the use of coercion and how employees perceive user involvement, team cooperation and the handling of disagreement in teams?Methods: Repeated cross-sectional survey to multidisciplinary employees at seven wards within three Norwegian mental health care institutions (T0-T1-T2). Changes in normative attitudes over time were estimated using linear mixed models.Results: In total, 817 surveys (from employees that did and did not participate in ERG) were included in the analyses. Of these, 7.6 % (N=62) responded at all three points in time, 15.5% (N=127) at two points, and 76.8 % (N= 628) once. On average, over time, respondents who participated in ERG agreed less that coercion can be seen a form of care or security. ERG participants more often reported that they involved users and that they handled disagreement within the team constructively. Furthermore, more frequent ERG participation was associated with a more critical attitude towards coercion and higher scores for user involvement, the coercion competence of the team and the constructive handling of disagreement within their teams.Conclusions: Structural ERGs or MCDs seem to contribute to employees reporting a more critical attitude towards coercion, more user involvement around coercion and a more constructive handling of disagreement. Differences were generally small in absolute terms possibly due to the low amount of longitudinal data and the relative low frequency of ERG’s during the two years. Studying changes over time in clinical practice and trying to find a relationship between CES interventions and CES outcomes is difficult yet important and needs to be further developed in future CES evaluation studies. This explorative quantitative study may be a first step from qualitative evidence towards more robust quantitative evidence of the contribution of CES to clinical practice and quality of care.

“I have a gun and I know how to use it”: A phenomenology of handgun ownership by evangelical Christians

American gun culture pervades American evangelicalism. Field research of this phenomenon utilizes phenomenological methods, involving online and onsite visits to Frontier Justice, a Kansas City-based gun store and boutique with evangelical Christian owners. Additional research entails concealed-carry gun training and interviews and email correspondence with Christian handgun owners, including the pastor of a church with armed security. Research culminates with the purchase of a used handgun for specified purposes. Theological ethics reflection controversially correlates the phenomenon of dutiful or fanatical evangelical gun ownership with fear, idolatry, and narcissism.

Ethics reflection groups for school nurses

Background: School nurses have great responsibilities as the connecting link between school, children/adolescents, parents, and other healthcare services. Being in this middle position, and handling complex situations and problems related to children in school, may be demanding and also lead to ethical challenges. Clinical ethics support, such as ethics reflection groups, may be of help when dealing with ethical challenges. However, there is little research on experiences with ethics reflection groups among school nurses. Aim: The aim of this research was to explore how nurses in school healthcare experience their role, and how they experience participation in ethics reflection groups, using a model for systematic ethics reflection, the Centre for Medical Ethics model. Research design: The project had a qualitative design, using focus group interviews and thematic analysis. Ethical considerations: The study was evaluated by the Data Protection Official at the Norwegian Centre for Research Data (project no. 57373). The participants were given oral and written information about the study and signed a written consent. Participants and context: Twelve participants from school healthcare were recruited to the interviews. Findings: School nurses described their role as extremely challenging. How the school nurses experienced their role also influenced how they experienced participating in ethics reflection groups. The Centre for Medical Ethics model was experienced as both challenging and comprehensive. However, they also experienced that the model helped them to clarify their role and could also help them to find better solutions. Conclusion: The role as school nurse is complex and demanding, with several ethical challenges. Ethics reflection groups may be of great help when dealing with these challenges. However, it is of great importance that the methods used are adjusted to the professionals’ needs and context.

Hospital ethics reflection groups: a learning and development resource for clinical practice

Background An ethics reflection group (ERG) is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark. Methods This is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the analysis of significance. Results A recurring ethical challenge for clinicians, in a total of 63 cases described and assessed in 3 ethical reflection groups, is to strike a balance between respect for patient autonomy, paternalistic responsibility, professional responsibilities and institutional values. Both in psychiatric and general hospital departments, the study participants report a positive impact of ERG, which can be divided into three categories: 1) Significance for patients, 2) Significance for clinicians, and 3) Significance for ward managers. In wards characterized by short-time patient admissions, the cases assessed were retrospective and the beneficiaries of improved dialogue mainly future patients rather than the patients discussed in the specific ethical challenge presented. In wards with longer admissions, the patients concerned also benefitted from the dialogue in the ERG. Conclusion This study indicates a positive significance and impact of ERGs; constituting an interdisciplinary learning resource for clinicians, creating significance for themselves, the ward managers and the organization. By introducing specific examples, this study indicates that ERGs have significance for the patients discussed in the specific ethical challenge, but mostly indirectly through learning among clinicians and development of clinical practice. More research is needed to further investigate the impact of ERGs seen from the perspectives of patients and relatives.

“Let no one delude you”: The apostle as moralist in the letter to Colossians

The letter to Colossian Christians depicts the apostle as moralist, a teacher of what is good and right, while warning against immorality as he understands it. Some in Colossae have become disoriented or even deluded by teachings contrary to those of the apostles, prompting a moralistic response from Paul. The letter prompts ethics reflection for a contemporary Christian context of potential moral disorientation and delusion on issues such as honesty in government, immigration, and ownership of handguns. Discernment of moral matters is enhanced by tools such as Rosell’s “FARM Box” and a typology of moral situations. Some matters raised by Paul give reason to question the apostle’s moral teachings, such as those pertaining to wives and slaves. Mostly, his letter to Colossians makes good moral sense, arguably with universal application of rules such as, “Above all . . . walk in love.”