Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Odense C, Denmark.
Center for medical Ethics, Institute of Health and Society, University of Oslo, Kirkevejen 166, 0450, Oslo, Norway.
BMC Med Ethics. 2019 Jul 16;20(1):49. doi: 10.1186/s12910-019-0387-5.
An ethics reflection group (ERG) is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments.
The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers.
The implementation process was influenced by both structural factors and factors related to clinicians having different values, interests and experiences. Structural barriers and promotors in the process to implement ERG included the following sub-categories: Organizational factors, recruitment and training of ethics facilitators, the deliberation model, planning and recruitment of participants to the ERGs, the support of the ward managers and the project group. Barriers and promotors found among clinicians included the following sub-categories: Expectations and pre-understandings of ERGs, understandings of a physician's job, challenges experienced by ethics facilitators. At the end of the study, when it was decided that the ERGs should be continued, the implementation strategies were remodeled by the participants to meet new challenges.
The study of ERG implementation identified important structural and professional barriers and promotors that are likely to be relevant to anyone wanting to implement ethics support services across various types of healthcare services.
伦理反思小组（ERG）是一系列伦理支持服务之一，旨在更好地应对医疗保健中的伦理挑战。本文的目的是评估丹麦精神病学和综合医院科室中跨学科 ERG 的实施过程。据我们所知，这是第一项包括精神病学和综合医院科室的 ERG 实施研究。
实施和评估策略的灵感来自行动研究，采用定性方法和对 28 名临床医生、伦理促进者和病房经理的个人访谈和 4 个焦点小组的系统文本浓缩。
实施过程受到结构因素和临床医生具有不同价值观、利益和经验的因素的影响。实施 ERG 过程中的结构障碍和促进因素包括以下子类别：组织因素、伦理促进者的招聘和培训、审议模式、ERG 参与者的计划和招聘、病房经理和项目组的支持。临床医生中发现的障碍和促进因素包括以下子类别：对 ERG 的期望和预先理解、对医生工作的理解、伦理促进者所面临的挑战。在研究结束时，当决定继续开展 ERG 时，参与者对实施策略进行了重塑，以应对新的挑战。
对 ERG 实施的研究确定了重要的结构和专业障碍和促进因素，这些因素可能与任何希望在各种类型的医疗保健服务中实施伦理支持服务的人有关。
