Positioning Ethics When Direct Patient Care is Prioritized: Experiences from Implementing Ethics Case Reflection Rounds in Childhood Cancer Care.

IF 1.3 4区 哲学 Q3 ETHICS Hec Forum Pub Date : 2024-11-02 DOI:10.1007/s10730-024-09541-6
Pernilla Pergert, Bert Molewijk, Cecilia Bartholdson
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Abstract

Caring for children with cancer involves complex ethical challenges. Ethics Case Reflection (ECR) rounds can be offered to support teams to reflect on challenges and what should be done in patient care. A training course, for facilitators of ECR rounds, has been offered to healthcare professionals (HCPs) in childhood cancer care by a Nordic working group on ethics. During/after the course, the trainees implemented and facilitated ECR rounds in their clinical setting. The aim was to explore the trainees' experiences of implementing ECR rounds in childhood cancer care. HCPs, who participated as trainees in the course, participated in 3 focus group interviews (n = 22) and 27 individual interviews (n = 17). Interview data were analysed concurrently with data collection following classic grounded theory. Positioning ethics is the core category in this study, used to resolve the main concern of doing ethics in a context where direct patient care is prioritized. Being able to take time for ethics reflections, not perceived as the key priority, was considered a luxury in the clinical setting. Strategies for positioning ethics include allying, promoting ethics reflection, scheduling ethics reflection, and identifying ethical dilemmas. These strategies can be more or less successful and vary in intensity. The prioritisation of direct patient care is not surprising, but polarisation between care and ethics needs to be questioned and ethics reflection need to be integrated in standard care. Ethical competence seems to be central in doing ethics and more knowledge on the promotion of ethical competence in practice and education is needed.

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在优先考虑直接患者护理时定位伦理:在儿童癌症护理中实施伦理案例反思查房的经验。
护理癌症患儿涉及复杂的伦理挑战。伦理案例反思(ECR)查房可以帮助团队反思在患者护理过程中遇到的挑战和应该采取的措施。北欧伦理工作组为儿童癌症护理领域的医护专业人员(HCPs)提供了针对 ECR 查房主持人的培训课程。课程期间/结束后,受训人员在其临床环境中实施并主持了 ECR 查房。目的是探讨受训人员在儿童癌症护理中实施 ECR 查房的经验。作为学员参加课程的医疗保健人员参与了 3 次焦点小组访谈(22 人)和 27 次个别访谈(17 人)。在收集数据的同时,还按照经典的基础理论对访谈数据进行了分析。伦理定位是本研究的核心范畴,用于解决在以直接护理病人为优先事项的情况下开展伦理工作的主要问题。在临床环境中,能够抽出时间进行伦理反思被认为是奢侈之举,而伦理反思并不是重中之重。伦理定位的策略包括结盟、促进伦理反思、安排伦理反思的时间以及识别伦理困境。这些策略或多或少会取得成功,力度也各不相同。把直接护理病人放在首位并不奇怪,但护理与伦理之间的两极分化需要受到质疑,伦理反思需要融入标准护理中。伦理能力似乎是伦理工作的核心,需要更多关于在实践和教育中促进伦理能力的知识。
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来源期刊
Hec Forum
Hec Forum ETHICS-
CiteScore
3.70
自引率
13.30%
发文量
34
期刊介绍: HEC Forum is an international, peer-reviewed publication featuring original contributions of interest to practicing physicians, nurses, social workers, risk managers, attorneys, ethicists, and other HEC committee members. Contributions are welcomed from any pertinent source, but the text should be written to be appreciated by HEC members and lay readers. HEC Forum publishes essays, research papers, and features the following sections:Essays on Substantive Bioethical/Health Law Issues Analyses of Procedural or Operational Committee Issues Document Exchange Special Articles International Perspectives Mt./St. Anonymous: Cases and Institutional Policies Point/Counterpoint Argumentation Case Reviews, Analyses, and Resolutions Chairperson''s Section `Tough Spot'' Critical Annotations Health Law Alert Network News Letters to the Editors
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