Background Implementing person-centred care (PCC) in nursing homes is challenging due to a gap between theory and practice. Bridging this gap requires suitable education, which focuses on learning how to attune care to the values and preferences of residents and take moral, relational, and situational aspects into account. Staff’s stories about the care they provide (i.e. caring stories) may deliver valuable insights for learning about these aspects. However, there is limited research on using staff's narratives for moral learning. Objective This (...) study aims to provide insight into the perspectives of nursing staff on using their caring stories to learn about PCC. Research design In this qualitative research, we conducted two rounds of interviews with 17 participants working in nursing homes. We wanted to obtain nursing staff’s perceptions of working with their caring stories and the impact on PCC. Ethical considerations Participation was voluntary, and participants provided written consent. The study protocol is approved by The Institutional Review Board of the Medical Ethical Committee Leiden-Den Haag-Delft. Findings Working with caring stories enables nursing staff to provide PCC and improves job satisfaction. It increases awareness of what matters to residents, fosters information rich in context and meaning, and enhances voice and vocabulary. Through in-depth team reflections, nursing staff discussed the significant moments for residents, which centralizes the discussions on the moral quality of care. Discussion Working with caring stories fosters dialogue on PCC and enhances reflection on ethical situations in daily encounters, contributing to the moral development of nursing staff. Putting nursing staff’s narratives at the centre of learning suits their daily practice and intrinsic motivation. Therefore, the outcomes of this study are an addition to the existing literature about using narratives in long-term care. Conclusion Using nursing staff's narratives contributes to PCC and positively impacts nursing staff. We recommend using staff's caring stories as a vehicle for moral learning in the transition to PCC. (shrink)

Introduction: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. Background: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of (...) existence, as well as compassion in relieving suffering, and ontological interdependency. Aim: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. Research design: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. Participants and research context: Focus group interviews with caregivers in nursing homes. Ethical considerations: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. Findings: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. Discussion: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. Conclusions: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others. (shrink)

Ethical challenges are traditionally described in a negative light, even though moral conflict can express the individual ability to perceive when something is not working and promote change. The true question, therefore, is not to how to silence moral conflict but how to educate it. Although the need for ethical support of health- and social-care professionals in elderly care is clearly perceived, there is no universal method for providing effective interventions. The authors hypothesize that adequate training sessions can help care (...) professionals enhance this skill, once clear goals and specific educational techniques are set. This research tests the hypothesis on twenty care professionals working in acute and residential care settings for the elderly, building on the ethics round method. Mixed methods drawn from literature and the experience of educators were adapted to meet different educational goals. Moral issues can hardly be removed from a context characterized by increasing demand and decreasing resources, but they can be recognized and addressed with common efforts, a critical attitude, and a growth mindset. Enhancing these skills in qualified workers can help them accept the reality of work, release pressure, and identify common team goals. Introducing these skills before graduation can help future workers avoid unreal expectations and reduce frustration and early job quit rates. (shrink)

BackgroundInternationally, clinical ethics support has yet to be implemented systematically in community health and care services. A large-scale Norwegian project attempted to increase ethical competence in community services through facilitating the implementation of ethics support activities in 241 Norwegian municipalities. The article describes the ethics project and the ethics activities that ensued.MethodsThe article first gives an account of the Norwegian ethics project. Then the results of two online questionnaires are reported, characterizing the scope, activities and organization of the ethics activities (...) in the Norwegian municipalities and the ethical topics addressed.ResultsOne hundred and thirty-seven municipal contact persons answered the first survey, whereas 217 ethics facilitators from 48 municipalities responded to the second. The Norwegian ethics project is vast in scope, yet has focused on some institutions and professions whilst seldom reaching others. Patients and next of kin were very seldom involved. Through the ethics project employees discussed many important ethical challenges, in particular related to patient autonomy, competence to consent, and cooperation with next of kin. The “ethics reflection group” was the most common venue for ethics deliberation.ConclusionsThe Norwegian project is the first of its kind and scope, and other countries may learn from the Norwegian experiences. Professionals have discussed central ethical dilemmas, the handling of which arguably makes a difference for patients/users and service quality. The study indicates that large scale implementation of CES structures for the municipal health and care services is complex, yet feasible. (shrink)

Systematic ethics support in community health services in Norway is in the initial phase. There are few evaluation studies about the significance of ethics reflection on care. The aim of this study was to evaluate systematic ethics reflection in groups in community health , - from the perspectives of employees participating in the groups, the group facilitators and the service managers. The reflection groups were implemented as part of a research and development project.

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

Empirische Forschungsarbeiten zur Ethik im Gesundheitswesen können entsprechende Implementationsprojekte unterstützen. Inzwischen gibt es eine Vielfalt von Ethikberatungsansätzen und -strukturen, die jedoch noch nicht in allen Gesundheitseinrichtungen genutzt werden. Bedarfserhebungen können wichtige Daten zu Strategie- und Projekterfordernissen darstellen. Die Bedeutung und Gründe für die Einschätzung des Bedarfs an klinischer Ethikberatung werden in der Fachliteratur vielfach diskutiert. Im vorliegenden Beitrag werden die Ergebnisse aus der Literaturanalyse im Hinblick auf vorhandene Erhebungsinstrumente zusammengefasst und ein Konzept zur Entwicklung eines Bedarfserhebungsinstruments beschrieben. Das Konzept beinhaltet (...) Daten zum Erhebungsbereich, zu den Forschungsfragen, zur Zielformulierung und zu den Zielgruppen. Anschließend wird das vorläufig entwickelte Instrument kurz vorgestellt. Ziel des Erhebungsinstruments ist es zunächst, empirische Daten von handelnden Pflegepersonen zu erheben, um so eine Grundlage für den konkreten Unterstützungsbedarf zu erhalten. (shrink)

Empirische Forschungsarbeiten zur Ethik im Gesundheitswesen können entsprechende Implementationsprojekte unterstützen. Inzwischen gibt es eine Vielfalt von Ethikberatungsansätzen und -strukturen, die jedoch noch nicht in allen Gesundheitseinrichtungen genutzt werden. Bedarfserhebungen können wichtige Daten zu Strategie- und Projekterfordernissen darstellen. Die Bedeutung und Gründe für die Einschätzung des Bedarfs an klinischer Ethikberatung werden in der Fachliteratur vielfach diskutiert. Im vorliegenden Beitrag werden die Ergebnisse aus der Literaturanalyse im Hinblick auf vorhandene Erhebungsinstrumente zusammengefasst und ein Konzept zur Entwicklung eines Bedarfserhebungsinstruments beschrieben. Das Konzept beinhaltet (...) Daten zum Erhebungsbereich, zu den Forschungsfragen, zur Zielformulierung und zu den Zielgruppen. Anschließend wird das vorläufig entwickelte Instrument kurz vorgestellt. Ziel des Erhebungsinstruments ist es zunächst, empirische Daten von handelnden Pflegepersonen zu erheben, um so eine Grundlage für den konkreten Unterstützungsbedarf zu erhalten. (shrink)

Empirische Forschungsarbeiten zur Ethik im Gesundheitswesen können entsprechende Implementationsprojekte unterstützen. Inzwischen gibt es eine Vielfalt von Ethikberatungsansätzen und -strukturen, die jedoch noch nicht in allen Gesundheitseinrichtungen genutzt werden. Bedarfserhebungen können wichtige Daten zu Strategie- und Projekterfordernissen darstellen. Die Bedeutung und Gründe für die Einschätzung des Bedarfs an klinischer Ethikberatung werden in der Fachliteratur vielfach diskutiert. Im vorliegenden Beitrag werden die Ergebnisse aus der Literaturanalyse im Hinblick auf vorhandene Erhebungsinstrumente zusammengefasst und ein Konzept zur Entwicklung eines Bedarfserhebungsinstruments beschrieben. Das Konzept beinhaltet (...) Daten zum Erhebungsbereich, zu den Forschungsfragen, zur Zielformulierung und zu den Zielgruppen. Anschließend wird das vorläufig entwickelte Instrument kurz vorgestellt. Ziel des Erhebungsinstruments ist es zunächst, empirische Daten von handelnden Pflegepersonen zu erheben, um so eine Grundlage für den konkreten Unterstützungsbedarf zu erhalten. (shrink)