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Received Oct 30; Accepted Apr article source. This article has been cited by other articles in PMC. Abstract Background Systematic ethics support in community health services in Norway is in the initial phase.
Acknowledgments This work was supported, in part, by grants from the W. All participants staff members, facilitators and managers were informed verbally and in writing about the evaluation and that it was voluntary to write a paper on community health. What is the ethical problem? You can share your struggles with colleagues. Teaching ethics in the clinic. After choosing the aim sauthors need to identify a target audience and choose a potential journal. Be careful when citing articles not to misrepresent the authors. How will the partnership determine who is responsible for writing each section?
There are few evaluation studies about the significance of ethics reflection wriite care. The aim of this study was to evaluate systematic ethics reflection in groups in community health click nursing homes and residency- 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.
Methods A mixed-methods design with qualitative focus group interviews, observations and written reports were used to evaluate. The study was conducted at write nursing homes, two home care districts and a residence for people with learning disabilities.
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Participants were employees, facilitators and service managers. The study was guided by ethical standard principles and was approved by the Norwegian Social Science Data Services. Results We found support for ethics reflection as a valuable measure to strengthen clinical practice. New and improved solutions, more cooperation between employees, and improved collaboration with patients and their families are some of the results. No negative experiences were found. Instead, the ethics reflection based on experiences and challenges in the workplace, was described as a win-win situation. The evaluation also revealed what is needed to succeed and useful tips for further development of ethics support in community health services.
Resources needed to succeed were managerial support, and anchoring ethics sessions in the routine of daily work. Ethics reflection, Community health services, Evaluation Background There is extensive evidence that employees in health care services, both in hospitals, nursing homes, and home care services, frequently struggle with ethical challenges [ 1 - 8 ]. Although ethics support in hospitals is relatively well developed, both nationally and internationally [ 9 - 15 ], the development of ethics support seems to be sparser in community health services [ 1516 ].
However, there is a need for ethics support in community health also [ 8 ]. Previous research indicates that ethics support in community health services should be closely tailored to the workplace, facilitated by a colleague [ 1 ] and concerned with the everyday ethical challenges employees experience [ 117 ].
However, there are few evaluation studies about the impact of ethics support in community health [ 18 ]. Recent research indicates that systematic ethics reflection is seen as a positive learning process among those participating [ 19 ]. Learning to reflect on the ethical challenges the employees face in their everyday work, and experiencing the benefits of it, such as relief of moral distress, are described as key reasons and motivations for implementing ethics reflection in clinical practice [ 2021 ].
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This paper presents the results from an evaluation study where ethics reflection in groups was implemented in community health services in a municipality in the central eastern part of Norway. Norwegian municipalities differ with regard to size, population and continue reading, but health services offered are generally public. Norwegians have community health legal right to preventive health services, home-based nursing and institutional care services, e.
The community health services participating in this study are located in a municipality with approximatelyinhabitants, where the publicly funded home-based nursing care is divided into six districts. Aims and context of the study The aim of this research was to explore how ethics reflection in colleague groups was experienced and evaluated by the employees, facilitators, and service managers. The study was part of a larger research and development project carried out as collaboration between five health care services in the community two nursing homes, two home-based nursing care service districts and one residential care home for persons with learning disabilitiesthe community health management, and the Centre for Medical Ethics CME at the University of Oslo.
CME was responsible for the research and evaluation part of the project, and participated also as expert consultants and teachers in other parts of the project. The authors - researchers in clinical ethics at CME - along with eight resource persons from the five community health services played key roles throughout the project.
Five of the resource persons from the community health care services - four nurses and one social educator - had their daily work in the community health care services. In addition, they were all trained as facilitators of ethics reflection in their departments. The other three resource persons from the community health services were responsible for quality improvement work in the health care services, and one of them served as the leader of the larger research and development project. The project was carried out in the period —and consisted of three phases.
Phase one; a survey and group interviews focusing on: Findings from the survey have already been published [ 1 write. Phase two; implementation of article source support based on the survey and interviews. Several measures were identified as needed, and implemented.
A brief description of the ethics reflection groups is given in the text below. This phase also included education and training of staff members to facilitate the ethical reflection on wards. In order to make course correction the project was evaluated every six months.
When it happens, I make a case of it. Comunity tone of this section should be balanced and realistic. How is authorship order determined? Despite the limited data, we have positive experiences that suggest that multidisciplinary groups have a positive impact on the reflection process. If conflicts arise anywhere in the authorship process, a neutral third party may need to intervene.
Write a paper on community health three; two years of systematic ethics reflection groups that included all employees. Despite being invited, the doctors did not participate. The evaluation study focused on phase two and three. The research questions we wanted to answer in the evaluation communiyt were: What ethical challenges have been discussed? What have been the success factors and barriers to participation in reflection groups?
Ethics reflection groups The organisation of ethics reflection groups relied on close collaboration between the ward leader and the facilitator. The groups please click for source open without fixed members; and those who were at work had the opportunity to participate.
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The health care professionals sat down together and collectively reflected on ethical challenges from their daily practice. Those participating brought cases to reflect upon, and the group chose which case to discuss. At one location they used constructed cases, based on current challenges on the ward.
The reflection was carried out systematically, led by the facilitator and structured by the CME Method: What is the write a paper on community health problem? Communigy are the facts of the case? Who is involved, and what are their views? Which values, laws and guidelines are relevant? What wfite the alternative courses of action? In addition to the CME Method, the groups developed rules article source the activity, such as: We will listen to each other.
We will not judge each other. We will strive to understand each other. We help each other to respect confidentiality. Methods We conducted three focus group interviews at the end of phase three. The participants were managers or other employees facilitators and participants in ethics reflection groups on wards of health "write a paper on community health" services in this ethics project.
The project leader, employee of the municipality, was responsible for the recruitment, and gave potential participants oral and written information about the evaluation project. With the exception of one of the two participating nursing homes, all workplaces participating in the project were represented in the interview. The second interview had five ethics facilitators, all members of the resource team, and representing all workplaces participating in the project.
The final interview was conducted with five service managers representing the five participating health care departments. Different levels of expertise or power may hinder the participants in focus groups from expressing what they think or feel [ 23 ]. The reason for dividing the participants into three distinct groups for different kinds of stakeholders was that we wanted to communjty an environment where the participants felt comfortable to share their experiences and insights, even negative, experiences that they could be more reluctant to report if e.
We prepared three different interview guides, and the questions posed to each group differed slightly, to elicit answers to the research questions from the participants various perspectives, experiences and responsibilities. For example, when staff and facilitators where mainly asked about haelth experience of possible changes in practice related to the ethics reflection groups, managers where mainly asked about the signals they had received, what they had been told and possibly observed of changes in practice. Each interview took about two hours and was audiotaped and transcribed verbatim.
We were two interviewers the authors ; one primarily responsible for interviewing, the other responsible for the technical equipment and follow-up questions. The reason for using focus group interviews was that it can facilitate an exchange of experiences and views among participants when group members hear the ideas of others, they are more able to identify other things that could potentially help or not ; we can include several participants in each interview, and thus generate richer data.
We acknowledged the risk of participants agreeing with others in the group as a potential problem, and encouraged the participants to express their opinion, especially if it differed from what others in the group expressed. For the interviews we used a thematically organised communty guide with three main topics: In addition to the interviews, we also had written documentation from the facilitators, notes from the reflection hezlth and bi-annual evaluation.
The notes contained descriptions of how ethics reflection groups were implemented in the department, ethically challenging situations discussed, and the number of staff that had participated in the ethics reflection groups. The notes also contained reflections upon the impact this initiative had on quality of health care.
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Furthermore, we took field notes during observation e. Data analysis The tape-recorded data was transcribed and then analysed. We conducted a qualitative content analysis of the transcriptions and written notes, commjnity for answers to our three research questions see above. Both researchers read the written material, and analysed the various parts of the texts together. Then the first author had the primary responsibility for more detailed analysis and condensation. A basic issue when performing qualitative content analysis is to decide whether the analysis should focus on manifest or latent content [ 24 ].
After agreeing on the main themes and subthemes, we categorised and condensed the relevant content of the text. Ethical considerations When designing the evaluation, we were guided by ethical standard principles [ 27 ]. All participants staff members, facilitators and no were informed verbally and in writing about the evaluation and that it was click here to participate.
They gave their written consent to participate before the interviews started. When referring to situations in the interviews that had been discussed in the reflection groups, we reminded the participants to remove person-identifying information. REC, which was consulted in the planning of our study, defined this study to be outside the legal definition of medical and health research in Norway. Results Starting out with our three questions, we identified seven themes. In the following we will focus our presentation on the analysed and thematised findings which answer the research questions.
Findings answering the research question that asks what ethical challenges that have been discussed are analysed and thematised as: These themes will briefly be summarised in the beginning. Findings answering the question of the significance of ethics reflection groups are analysed and thematised as: