Two years of ethics reflection groups about coercion in psychiatry. Measuring variation within employees' normative attitudes, user involvement and the handling of disagreement.
Attitudes
Clinical ethics support
Coercion
Constructive disagreement
Ethics reflection groups
Mental health care
Moral case deliberation
Outcomes evaluation
Repeated cross-sectional survey
User involvement
Journal
BMC medical ethics
ISSN: 1472-6939
Titre abrégé: BMC Med Ethics
Pays: England
ID NLM: 101088680
Informations de publication
Date de publication:
12 05 2023
12 05 2023
Historique:
received:
21
12
2020
accepted:
26
04
2023
medline:
15
5
2023
pubmed:
13
5
2023
entrez:
12
5
2023
Statut:
epublish
Résumé
Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees' attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. We used panel data in a longitudinal design study to measure variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0-T1-T2). Mixed models were used to account for dependence of data in persons who participated more than once. In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since-despite the intrinsic value of participating in ERG or MCD-CES inherently aims, and should aim, at improving clinical practices.
Sections du résumé
BACKGROUND
Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees' attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams.
METHODS
We used panel data in a longitudinal design study to measure variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0-T1-T2). Mixed models were used to account for dependence of data in persons who participated more than once.
RESULTS
In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data.
CONCLUSIONS
This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since-despite the intrinsic value of participating in ERG or MCD-CES inherently aims, and should aim, at improving clinical practices.
Identifiants
pubmed: 37173770
doi: 10.1186/s12910-023-00909-w
pii: 10.1186/s12910-023-00909-w
pmc: PMC10182617
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
29Informations de copyright
© 2023. The Author(s).
Références
Bioethics. 2017 May;31(4):258-266
pubmed: 28417517
J Med Ethics. 2013 Nov;39(11):681-5
pubmed: 23328983
Psychiatr Serv. 2003 Aug;54(8):1119-23
pubmed: 12883139
Am J Bioeth. 2007 Feb;7(2):42-4
pubmed: 17366193
Clin Ethics. 2007 Dec 1;2(4):187-192
pubmed: 18677421
J Psychosoc Nurs Ment Health Serv. 2007 May;45(5):45-50
pubmed: 17526330
Nurs Ethics. 2015 Jun;22(4):452-66
pubmed: 25091004
Bioethics. 2017 Feb;31(2):144-152
pubmed: 28060434
Psychiatr Q. 2008 Jun;79(2):97-109
pubmed: 18172765
Int J Ment Health Nurs. 2002 Mar;11(1):10-7
pubmed: 12400102
Nurs Ethics. 2020 May;27(3):838-854
pubmed: 31742473
J Clin Ethics. 1996 Summer;7(2):127-38
pubmed: 8889888
J Clin Ethics. 2006 Summer;17(2):168-80
pubmed: 16913152
Soc Sci Med. 1999 Jun;48(11):1507-15
pubmed: 10400253
BMC Med Ethics. 2011 May 11;12:8
pubmed: 21569295
BMC Med Ethics. 2014 Jan 03;15:1
pubmed: 24387594
BMC Med Ethics. 2018 Nov 6;19(1):85
pubmed: 30400913
Am J Bioeth. 2007 Feb;7(2):13-25
pubmed: 17366184
J Med Ethics. 2008 Aug;34(8):594-7
pubmed: 18667647
BMJ. 2004 Apr 17;328(7445):950-2
pubmed: 15087349
J Med Ethics. 2012 Apr;38(4):210-4
pubmed: 22167385
JAMA. 2003 Sep 3;290(9):1166-72
pubmed: 12952998
Am J Bioeth. 2016;16(3):3-14
pubmed: 26913651
BMC Med Ethics. 2018 Jun 5;19(1):54
pubmed: 29871682
BMC Med Ethics. 2020 Jul 2;21(1):53
pubmed: 32616048
BMC Med Ethics. 2014 Apr 08;15:30
pubmed: 24712735
Soc Sci Med. 2010 Aug;71(4):677-84
pubmed: 20580142
Soc Sci Med. 2013 Apr;83:125-32
pubmed: 23410684
BMC Med Ethics. 2015 Apr 17;16:25
pubmed: 25889307
Bioethics. 2017 May;31(4):234-236
pubmed: 28417520
J Med Ethics. 2008 Feb;34(2):120-4
pubmed: 18234952
Bioethics. 2017 May;31(4):237-245
pubmed: 28417519
Int J Nurs Stud. 2013 May;50(5):587-92
pubmed: 23159157
Ann Intern Med. 2000 Jul 4;133(1):59-69
pubmed: 10877742
Perspect Psychiatr Care. 2014 Jul;50(3):155-66
pubmed: 25040212
Expert Rev Neurother. 2014 Feb;14(2):131-41
pubmed: 24382132
Nurs Ethics. 2006 Jul;13(4):416-27
pubmed: 16838572
BMC Med Ethics. 2014 Dec 04;15:82
pubmed: 25475895
Camb Q Healthc Ethics. 2009 Fall;18(4):406-19
pubmed: 19715627
Med Health Care Philos. 2008 Mar;11(1):43-56
pubmed: 18165908
Qual Health Res. 2018 May;28(6):900-915
pubmed: 29310541
Crit Care Med. 2000 Dec;28(12):3920-4
pubmed: 11153636
Nurs Ethics. 2000 Jan;7(1):47-62
pubmed: 10703423
HEC Forum. 2016 Dec;28(4):321-338
pubmed: 27147521
Health Care Anal. 2009 Sep;17(3):217-35
pubmed: 19139992
Camb Q Healthc Ethics. 2011 Jul;20(3):389-95
pubmed: 21676326
BMC Med Ethics. 2015 Jan 16;16:4
pubmed: 25591923
HEC Forum. 2017 Mar;29(1):59-74
pubmed: 27743277
Nurs Ethics. 2013 Sep;20(6):617-31
pubmed: 23426235
Int J Soc Psychiatry. 2010 Jul;56(4):412-23
pubmed: 19617275
Br J Psychiatry. 2007 Oct;191:298-303
pubmed: 17906239
J Med Ethics. 2007 Jan;33(1):51-7
pubmed: 17209113
HEC Forum. 2011 Sep;23(3):207-24
pubmed: 21792683
BMC Med Ethics. 2017 May 25;18(1):37
pubmed: 28545519
BMC Med Ethics. 2016 Nov 24;17(1):76
pubmed: 27881139
Nurs Ethics. 2013 Feb;20(1):96-108
pubmed: 22918061
Int J Law Psychiatry. 2008 Oct-Nov;31(5):417-22
pubmed: 18817973
BMC Med Ethics. 2016 Jul 22;17(1):45
pubmed: 27448597
Health Aff (Millwood). 2005 Jul-Aug;24(4):961-71
pubmed: 16136635
J Clin Ethics. 2011 Summer;22(2):151-64
pubmed: 21837887
Int J Psychiatry Clin Pract. 2006;10(4):247-51
pubmed: 24941142
Soc Sci Med. 2016 May;156:204-11
pubmed: 27054304
J Med Ethics. 2000 Jun;26(3):198-203
pubmed: 10860213
Bioethics. 2008 Feb;22(2):113-20
pubmed: 18251771
Cochrane Database Syst Rev. 2019 Jul 22;7:CD012636
pubmed: 31424106
Bioethics. 2017 May;31(4):277-285
pubmed: 28417521
Int J Law Psychiatry. 2018 Mar - Apr;57:106-112
pubmed: 29548497
BMC Med Ethics. 2019 Jul 15;20(1):48
pubmed: 31307458
Nurs Ethics. 2015 Dec;22(8):870-80
pubmed: 25542405
Med Health Care Philos. 2018 Dec;21(4):467-477
pubmed: 29243015
Int J Ment Health Nurs. 2015 Jun;24(3):231-40
pubmed: 25394674