Team members perspectives on conflicts in clinical ethics committees.
Clinical ethics
communication
ethics consultation
qualitative evaluation
team conflicts
Journal
Nursing ethics
ISSN: 1477-0989
Titre abrégé: Nurs Ethics
Pays: England
ID NLM: 9433357
Informations de publication
Date de publication:
Historique:
pubmed:
3
4
2019
medline:
24
3
2020
entrez:
3
4
2019
Statut:
ppublish
Résumé
Clinical ethics committees have been broadly implemented in university hospitals, general hospitals and nursing homes. To ensure the quality of ethics consultations, evaluation should be mandatory. The aim of this article is to evaluate the perspectives of all people involved and the process of implementation on the wards. The data were collected in two steps: by means of non-participating observation of four ethics case consultations and by open-guided interviews with 28 participants. Data analysis was performed according to grounded theory. The study received approval from the local Ethics Commission (registration no.: 32/11/10). 'Communication problems' and 'hierarchical team conflicts' proved to be the main aspects that led to ethics consultation, involving two factors: unresolvable differences arise in the context of team conflicts on the ward and unresolvable differences prevent a solution being found. Hierarchical asymmetries, which are common in the medical field, support this vicious circle. Based on this, minor or major disagreements regarding clinical decisions might be seen as ethical conflicts. The expectation on the clinical ethics committee is to solve this (communication) problem, but the participants experienced that hierarchy is maintained by the clinical ethics committee members. The asymmetrical structures of the clinical ethics committee reflect the institutional hierarchical nature. They endure, despite the fact that the clinical ethics committee should be able to detect and overcome them. Disagreements among care givers are described as one of the most difficult ethically relevant situations and should be recognised by the clinical ethics committee. On the contrary, discussion of team conflicts and clinical ethical issues should not be combined, since the first is a mandate for team supervision. To avoid dominance by physicians and an excessively factual character of the presentation, the case or conflict could be presented by both physicians and nurses, a strategy that strengthens the interpersonal and emotional aspects and also integrates both professional perspectives.
Sections du résumé
BACKGROUND
BACKGROUND
Clinical ethics committees have been broadly implemented in university hospitals, general hospitals and nursing homes. To ensure the quality of ethics consultations, evaluation should be mandatory.
RESEARCH QUESTION/AIM
OBJECTIVE
The aim of this article is to evaluate the perspectives of all people involved and the process of implementation on the wards.
RESEARCH DESIGN AND PARTICIPANTS
METHODS
The data were collected in two steps: by means of non-participating observation of four ethics case consultations and by open-guided interviews with 28 participants. Data analysis was performed according to grounded theory.
ETHICAL CONSIDERATIONS
METHODS
The study received approval from the local Ethics Commission (registration no.: 32/11/10).
FINDINGS
RESULTS
'Communication problems' and 'hierarchical team conflicts' proved to be the main aspects that led to ethics consultation, involving two factors: unresolvable differences arise in the context of team conflicts on the ward and unresolvable differences prevent a solution being found. Hierarchical asymmetries, which are common in the medical field, support this vicious circle. Based on this, minor or major disagreements regarding clinical decisions might be seen as ethical conflicts. The expectation on the clinical ethics committee is to solve this (communication) problem, but the participants experienced that hierarchy is maintained by the clinical ethics committee members.
DISCUSSION
CONCLUSIONS
The asymmetrical structures of the clinical ethics committee reflect the institutional hierarchical nature. They endure, despite the fact that the clinical ethics committee should be able to detect and overcome them. Disagreements among care givers are described as one of the most difficult ethically relevant situations and should be recognised by the clinical ethics committee. On the contrary, discussion of team conflicts and clinical ethical issues should not be combined, since the first is a mandate for team supervision.
CONCLUSION
CONCLUSIONS
To avoid dominance by physicians and an excessively factual character of the presentation, the case or conflict could be presented by both physicians and nurses, a strategy that strengthens the interpersonal and emotional aspects and also integrates both professional perspectives.
Identifiants
pubmed: 30935285
doi: 10.1177/0969733019829857
pmc: PMC7323753
doi:
Types de publication
Journal Article
Langues
eng
Pagination
2098-2112Références
Nurs Ethics. 2013 Nov;20(7):771-83
pubmed: 23715555
J Clin Ethics. 1996 Summer;7(2):127-38
pubmed: 8889888
J Nurs Adm. 1998 Sep;28(9):47-51
pubmed: 9745661
J Med Ethics. 2013 Nov;39(11):681-5
pubmed: 23328983
J Clin Ethics. 2002 Summer;13(2):131-45
pubmed: 12448188
Bioethics. 2017 May;31(4):237-245
pubmed: 28417519
Camb Q Healthc Ethics. 2009 Fall;18(4):406-19
pubmed: 19715627
HEC Forum. 2007 Sep;19(3):185-206
pubmed: 17882510
HEC Forum. 2011 Sep;23(3):225-38
pubmed: 21544679
J Clin Ethics. 2014 Winter;25(4):281-90
pubmed: 25517564
J Oncol Pract. 2013 Sep;9(5):240-5
pubmed: 23943899
Nurs Ethics. 2015 Dec;22(8):870-80
pubmed: 25542405
J Med Ethics. 2009 Mar;35(3):147-52
pubmed: 19251963
Bioethics. 2017 May;31(4):258-266
pubmed: 28417517
BMC Med Ethics. 2016 May 21;17(1):31
pubmed: 27209161
J Med Ethics. 2007 Jan;33(1):51-7
pubmed: 17209113
J Med Ethics. 2008 May;34(5):399-406
pubmed: 18448726
HEC Forum. 2017 Jun;29(2):127-143
pubmed: 28070806
Med Klin Intensivmed Notfmed. 2014 Jun;109(5):354-63
pubmed: 24652508
J Clin Ethics. 1996 Summer;7(2):109-15
pubmed: 8889885
J Clin Ethics. 1997 Summer;8(2):136-49
pubmed: 9302631