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‘It’s like sailing’: experiences of the role as facilitator during moral case deliberation
Örebro universitet, Institutionen för hälsovetenskaper.ORCID iD: 0000-0002-0068-943x
Örebro universitet, Institutionen för hälsovetenskaper.ORCID iD: 0000-0002-2873-4247
Örebro universitet, Institutionen för hälsovetenskaper.ORCID iD: 0000-0003-0679-5695
2017 (English)In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 12, no 3, p. 1-8Article in journal (Refereed) Published
Abstract [en]

Moral case deliberation is one form of clinical ethics support, and there seems to be different ways of facilitating thedialogue. This paper aimed to explore the personal experiences of Swedish facilitators of their role in moral casedeliberations. Being a facilitator was understood through the metaphor of sailing: against the wind or with it. Therole was likened to a sailor’s set of skills: to promote security and well-being of the crew, to help crew navigate theirmoral reflections, to sail a course into the wind against homogeneity, to accommodate the crew’s needs and just sail withthe wind, and to steer towards a harbour with authority and expertise. Balancing the disparate roles of being accom-modative and challenging may create a free space for emotions and ideas, including self-reflection and consideration ofmoral demands. This research opens the question of whether all these skills can be taught through systematic training orwhether facilitators need to possess the characteristics of being therapeutic, pedagogical, provocative, sensitive andauthoritarian.

Place, publisher, year, edition, pages
United Kingdom: Royal Society of Medicine Press , 2017. Vol. 12, no 3, p. 1-8
Keywords [en]
Ethics, clinical ethics, ethics consultation, moral case deliberation, healthcare professionals
National Category
Medical and Health Sciences Medical Ethics
Identifiers
URN: urn:nbn:se:du-32564DOI: DOI: 10.1177/1477750917710882Scopus ID: 2-s2.0-85029502486OAI: oai:DiVA.org:du-32564DiVA, id: diva2:1426919
Projects
NUPARCAvailable from: 2020-04-28 Created: 2020-04-28 Last updated: 2020-04-28
In thesis
1. Perspectives on clinical ethics support and ethically difficult situations: reflections and experiences
Open this publication in new window or tab >>Perspectives on clinical ethics support and ethically difficult situations: reflections and experiences
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Healthcare personnel encounter ethically difficult situations in their everyday work and clinical ethics support might be important to support healthcare personnel to deal with these situations. The overall aim of this thesis was to describe perspectives on clinical ethics support, experiences of being in ethically difficult situations and experiences of facilitating ethics reflection. Methods. Study I had a descriptive design in which research articles were reviewed (n=54). In study II audio-recorded moral case deliberation (n=70) in 10 Swedish workplaces in hospitals and community care were analysed. In study III interviews were conducted with facilitators (n=11) of moral case deliberation. Study IV used non-participant observation during three weeks as well as informal conversations with healthcare personnel (n=12) in community home healthcare. Results and conclusion. In study I, two perspectives emerged on clinical ethics support, a “Top-down” perspective, where an individual or a group of “experts” in ethics could recommend the best course of action and a “Bottom-up” perspective that allows healthcare personnel to manage ethically difficult situations through ethical reflections led by a facilitator. Studies II and IV showed how ethically difficult situations on different levels are often connected with emotions and uncertainties. Study III showed the role of the facilitator to be fundamental in creating a space for self-reflection among healthcare personnel. Study IV showed that healthcare personnel face complex demands and expectations from the healthcare organization regarding the provision of care as well as having to meet the needs of patients and their next-of-kin. To conclude, healthcare personnel needed to find a balance among demands and expectations in order to satisfy those stakeholders involved and they had to seek compromise. There is a need for clinical ethics support that helps healthcare personnel reflect individually and collectively on ethically difficult situations they encounter in their everyday clinical practice. From this standpoint, a “Bottom-up” perspective may reduce the risk of moral distress among healthcare personnel and promote care based on person-centred values.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. p. 94
National Category
Other Health Sciences
Identifiers
urn:nbn:se:du-32567 (URN)978-91-7529-198-7 (ISBN)
Public defence
2017-06-01, Örebro universitet, Gymnastikhuset, Hörsalen, 09:00 (Swedish)
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Available from: 2020-04-28 Created: 2020-04-28 Last updated: 2020-04-28Bibliographically approved

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Rasoal, DaraKihlgren, AnnicaSvantesson, Mia

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