Quain Anne, Mullan Siobhan, Ward Michael P
Faculty of Science, Sydney School of Veterinary Science, University of Sydney, Sydney, NSW, Australia.
University College Dublin, Dublin, Ireland.
Front Vet Sci. 2022 Jul 18;9:922049. doi: 10.3389/fvets.2022.922049. eCollection 2022.
Clinical ethics support services (CESS) are employed in healthcare to improve patient care and help team members develop skills to recognize and navigate ethically challenging situations (ECS). The objective of this study was to evaluate the impact of ethics rounds, one form of CESS, on veterinary team members. An anonymous, online mixed-methods survey incorporating a 15-item instrument designed to assess the outcomes of moral case deliberation originally developed for human healthcare workers (the Euro-MCD 2.0), was developed. The survey was administered to veterinary team members prior to and following participation in a 90-min virtual ethics rounds session. A total of 23 sessions of virtual ethics rounds were held. In total, 213 individuals participated, and 89 completed both surveys (response rate 41.8%). Most respondents were female ( = 70, 81%). Most were veterinarians ( = 51, 59%), followed by other veterinary team members (practice manager, animal attendant) ( = 18, 21%), veterinary nurses or animal health technicians ( = 10, 12%) and veterinary students ( = 8, 9%). Age ranged from 20 to 73 (median 41, IQR 32-52, = 87). While there was no statistically significant difference between overall modified Euro-MCD 2.0 scores between T1 and T2, there were statistically significant changes in 7 out of 15 Euro-MCD 2.0 items in the domains of moral competence and moral teamwork. Reflexive thematic analysis of free-text responses identified themes including the types, impact and barriers to resolving ECS, the impacts of ethics rounds on veterinary team members and constraints preventing veterinary team members from speaking up in the face of ECS. While participants largely described the impact of ethics rounds as beneficial (for example, by facilitating clarification of thinking about ECS, allowing participants to see ECS from the perspective of others and providing a safe space for discussion), reflecting on ECS could be stressful for participants. Active participation in ethics rounds may be inhibited in the context of power imbalance, or in settings where bullying occurs. Overall, carefully facilitated ethics rounds has the potential to improve the ability of veterinary team members to identify and navigate ECS, and potentially mitigate moral distress.
临床伦理支持服务（CESS）被应用于医疗保健领域，以改善患者护理，并帮助团队成员培养识别和应对伦理挑战性情况（ECS）的技能。本研究的目的是评估伦理查房（CESS的一种形式）对兽医团队成员的影响。我们开发了一项匿名的在线混合方法调查，其中包含一个15项的工具，旨在评估最初为人类医护人员开发的道德案例审议结果（欧洲道德案例审议2.0版）。该调查在兽医团队成员参加90分钟的虚拟伦理查房会议之前和之后进行。总共举行了23次虚拟伦理查房会议。共有213人参与，89人完成了两项调查（回复率41.8%）。大多数受访者为女性（n = 70，81%）。大多数是兽医（n = 51，59%），其次是其他兽医团队成员（诊所经理、动物护理员）（n = 18，21%）、兽医护士或动物健康技术员（n = 10，12%）以及兽医学生（n = 8，9%）。年龄范围为20至73岁（中位数41，四分位距32 - 52，n = 87）。虽然T1和T2之间总体修改后的欧洲道德案例审议2.0分数没有统计学上的显著差异，但在道德能力和道德团队合作领域的15项欧洲道德案例审议2.0项目中有7项有统计学上的显著变化。对自由文本回复的反思性主题分析确定了一些主题，包括解决ECS的类型、影响和障碍、伦理查房对兽医团队成员的影响以及阻碍兽医团队成员在面对ECS时发声的因素。虽然参与者大多将伦理查房的影响描述为有益的（例如，通过促进对ECS的思考澄清，让参与者从他人角度看待ECS，并提供一个安全的讨论空间），但反思ECS对参与者来说可能会有压力。在权力不平衡的情况下或存在欺凌行为的环境中，积极参与伦理查房可能会受到抑制。总体而言，精心组织的伦理查房有可能提高兽医团队成员识别和应对ECS的能力，并有可能减轻道德困扰。
