Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden.
VU University Medical Center Amsterdam, The Netherlands; University of Oslo, Norway.
Nurs Ethics. 2018 Mar;25(2):199-211. doi: 10.1177/0969733017693471. Epub 2017 Mar 21.
In previous research on ethics case reflection (ECR) sessions about specific cases, healthcare professionals in childhood cancer care were clarifying their perspectives on the ethical issue to resolve their main concern of consolidating care. When perspectives were clarified, consequences in the team included 'increased understanding', 'group strengthening' and 'decision grounding'. Additional analysis of the data was needed on conditions that could contribute to the quality of ECR sessions.
The aim of this study was to explore conditions for clarifying perspectives during ECR sessions.
Data were collected from observations and interviews and the results emerged from an inductive analysis using grounded theory. Participants and research context: Six observations during ECR sessions and 10 interviews were performed with healthcare professionals working in childhood cancer care and advanced paediatric homecare. Ethical considerations: The study was approved by a regional ethical review board. Participants were informed about their voluntary involvement and that they could withdraw their participation without explaining why.
Two categories emerged: organizational enablers and barriers and team-related enablers and barriers. Organizational enablers and barriers included the following sub-categories: the timing of the ECR session, the structure during the ECR session and the climate during the ECR session. Sub-categories to team-related enablers and barriers were identified as space for inter-professional perspectives, varying levels of ethical skills and space for the patient's and the family's perspectives.
Space for inter-professional perspectives included the dominance of a particular perspective that can result from hierarchical positions. The medical perspective is relevant for understanding the child's situation but should not dominate the ethical reflection.
Conditions for ECR sessions have been explored and the new knowledge can be used when training facilitators as well as for those who organize/implement ECR sessions. Awareness of space for different perspectives, including the possible medical advantage over the nursing perspective, could reduce the somewhat unilateral attention and contribute to an inter-professionally shared reflection.
在之前关于特定案例的伦理案例反思（ECR）会议的研究中，儿童癌症护理的医疗保健专业人员澄清了他们对伦理问题的看法，以解决巩固护理的主要关注点。当观点得到澄清时，团队中的后果包括“增加理解”、“团队强化”和“决策基础”。需要对有助于 ECR 会议质量的条件进行额外分析。
本研究旨在探讨在 ECR 会议中澄清观点的条件。
数据收集自观察和访谈，结果源自使用扎根理论的归纳分析。参与者和研究背景：在 ECR 会议期间进行了六次观察和十次访谈，参与者为从事儿童癌症护理和高级儿科家庭护理的医疗保健专业人员。
该研究获得了区域伦理审查委员会的批准。参与者被告知他们的自愿参与，并且可以在不解释原因的情况下退出参与。
出现了两个类别：组织促进因素和障碍以及团队相关的促进因素和障碍。组织促进因素和障碍包括以下子类别：ECR 会议的时间安排、ECR 会议期间的结构和 ECR 会议期间的氛围。团队相关促进因素和障碍的子类别被确定为专业观点的空间、不同程度的伦理技能以及患者和家庭观点的空间。
专业观点的空间包括特定观点的主导地位，这种主导地位可能源于等级地位。医学观点对于理解孩子的情况很重要，但不应主导伦理反思。
已经探讨了 ECR 会议的条件，这些新知识可用于培训促进者以及组织/实施 ECR 会议的人员。对不同观点的空间的认识，包括护理观点可能具有的医学优势，可能会减少有些片面的关注，并有助于专业间的共同反思。
