Svantesson M, Anderzén-Carlsson A, Thorsén H, Kallenberg K, Ahlström G
Centre for Health Care Sciences, Orebro University Hospital, Box 1324, SE-701 13 Orebro, Sweden.
J Med Ethics. 2008 May;34(5):407-13. doi: 10.1136/jme.2007.023572.
To evaluate whether ethics rounds stimulated ethical reflection.
Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to stimulate ethical reflection and promote mutual understanding between professions but not to offer solutions. Questionnaires directly before and after rounds were answered by 194 respondents. The analyses were primarily content analysis with Boyd's framework but were also statistical in nature.
Seventy-six per cent of the respondents reported a moderate to high rating regarding new insights on ethical problem identification, but the ethics rounds did not seem to stimulate the ethical reflection that the respondents had expected (p < 0.001). Dominant new insights did not seem to fit into traditional normative ethics but were instead interpreted as hermeneutic ethics. This was illustrated in the extended perspective on the patient and increased awareness of relations to other professions. Regarding insights into how to solve ethical problems, the request for further interprofessional dialogue dominated both before and after rounds.
The findings show the need for interprofessional reflective ethical practice but a balance between ethical reflection and problem solving is suggested if known patients are discussed. Further research is needed to explore the most effective leadership for reflective ethical practice.
评估伦理查房是否能激发伦理思考。
在瑞典的三家医院开展了由哲学家-伦理学家主导的跨专业团队伦理查房，内容涉及透析患者护理问题。要求哲学家激发伦理思考并促进不同专业之间的相互理解，但不提供解决方案。194名受访者在查房前后分别填写了问卷。分析主要采用基于博伊德框架的内容分析法，但也包含统计分析。
76%的受访者对伦理问题识别方面的新见解给予了中等至高评价，但伦理查房似乎并未激发受访者预期的伦理思考（p < 0.001）。主要的新见解似乎并不符合传统规范伦理学，而是被解释为诠释学伦理学。这体现在对患者的扩展视角以及对与其他专业关系的认识增强上。关于如何解决伦理问题的见解方面，对进一步开展跨专业对话的需求在查房前后都占主导地位。
研究结果表明需要开展跨专业反思性伦理实践，但如果讨论的是已知患者，建议在伦理思考和问题解决之间取得平衡。需要进一步研究以探索反思性伦理实践的最有效领导方式。
