Ethische Entscheidungssituationen im pflegeberuflichen Handlungskontext sind oft vielfältig und komplex. Die Komplexität ergibt sich aus der situativen Vielgestaltigkeit der pflegeberuflichen Handlungssituationen und ist insbesondere in der jeweils individuellen Vulnerabilität der Betroffenen und Beteiligten begründet. Aufgrund der Heterogenität gesellschaftlicher und professioneller Wertvorstellungen gestalten sich ethische Entscheidungen als beziehungsreich und spannungsvoll. In dieser Situation sind strukturierte und ethisch begründete Reflexions- und Entscheidungsfindungsprozess hilfreich. Der hierfür notwendige, inhärent interprofessionelle Dialog ist ein wichtiges Element professionellen Pflegehandelns. Strukturierte ethische Reflexion und systematisierte Prozesse der ethischen (...) Entscheidungsfindung – das heißt Ethikarbeit in einem interprofessionellen und transdisziplinären Setting und Verständnis – werden in diesem Kapitel als unterstützende Elemente verstanden und deren zentrale Eckpunkte und Elemente ausgeführt. (shrink)

Pflegerisches Handeln begründen, reflektieren und professionell entscheiden! Dieses Buch richtet sich an Ethikberater, Pflegende, Lehrende, Studenten von Pflege- und Gesundheitsstudiengängen und Weiterbildungsteilnehmer und bietet konkrete Unterstützung bei der ethischen Begründung von Entscheidungen im Praxisalltag. Pflegende entscheiden oft situativ, denn viele Umstände erfordern schnelle Entschlüsse und vorausschauendes Handeln. Doch nach welchen Kriterien werden diese Entscheidungen getroffen? Welche Faktoren bestimmen ergänzend zur Fachkompetenz die durchgeführten oder anstehenden Maßnahmen? Die Autoren verdeutlichen die ethischen Aspekte von evidenzbasierten, fachlich fundierten Pflegehandlungen und die Notwendigkeit von (...) systematischen Methoden für eine gute Entscheidungsfindung. Lernen Sie durch Fallbeispiele und erlangen Sie mehr Sicherheit für die Herausforderungen in Ihrem Wirkungsbereich! (shrink)

ZusammenfassungDie aktuellen Entwicklungen und Anforderungen in der pflegeberuflichen Bildung, das Ausbildungsziel im Pflegeberufegesetz vom 17. Juli 2017 und die Explikationen in der dazugehörigen Ausbildungs- und Prüfungsverordnung für die Pflegeberufe fordern eine stärkere Ausrichtung auf die Entwicklung ethischer Kompetenzen explizit ein. Bislang liegen tendenziell übergreifende Definitionen und Darlegungen zu ethischen Kompetenzen in der Pflege vor, deren Verdienst es ist, das Spezifische der Pflegeethik zu konturieren und erstmals ethische Kompetenzen für das Feld zu konkretisieren. In methodischer und didaktischer Hinsicht ist indes eine (...) spezifische Differenzierung gemäß unterschiedlicher Bildungsniveaus relevant. Lehrende werden ihre Lehre nicht mehr nur im Sinne einer allgemeinen Förderung ethischer Kompetenz entwickeln können, sondern müssen dabei den jeweiligen Verantwortungsbereich und das angezielte Qualifikationsniveau der Lernenden berücksichtigen. Ziel der Darlegungen ist es, konkrete Kompetenzniveaus für die Anbahnung professionsethischer Kompetenzen zu operationalisieren, die einerseits die Anforderungen aus dem zukünftigen Pflegeberufegesetz aufgreifen und andererseits anstehende curriculare Entwicklungsprozesse unterstützen. (shrink)

ZusammenfassungZwischenfälle, Behandlungsfehler und tragische Verläufe können im Medizinalltag schwerwiegende Auswirkungen auf Patientinnen und Patienten haben, aber auch auf beteiligte Gesundheitsfachpersonen. Don Berwick, ehemaliger Leiter des Institute for Healthcare Improvement in Boston, hob in einem Interview die Unterstützung von „second victims“ als „ethische Angelegenheit“ hervor. Es besteht aber keine Klarheit darüber, was darunter zu verstehen ist. Der vorliegende Beitrag unternimmt eine Klärung dieser Frage aus der Perspektive der Organisationsethik. Ausgehend von Daten aus der Literatur zur Wirksamkeit der Unterstützung von „second victims“ (...) werden Herausforderungen beschrieben und aus organisationsethischer Sicht beurteilt. Es gibt Hinweise, dass Angebote der Unterstützung von „second victims“ zwar bestehen, aber nicht wirksam genug sind, um die psychischen Folgen von unerwünschten Ereignissen zu bewältigen. Dies wirkt sich auf betroffene Fachpersonen negativ aus und kann zu einer erneuten Gefährdung der Patientensicherheit führen. Angesichts dieser Befunde bedarf es eines organisationsethischen Ansatzes, um Don Berwicks Forderung nachzukommen, den Umgang mit „second victims“ als „ethische Angelegenheit“ wahrzunehmen. Dieser Ansatz fördert die Kongruenz zwischen den deklarierten und den faktisch gelebten Werten der Organisation. Sein normatives Fundament besteht in den Fürsorgepflichten der Organisation, gegenüber Patientinnen, Patienten und Mitarbeitenden. Die Organisationsethik ermöglicht es, die Unterstützung von „second victims“ verbindlich und sichtbar in der Sicherheitskultur der Organisation zu verankern. Sie konkretisiert sich in ihrer Verpflichtung, für die Mechanismen der Entstehung des Phänomens zu sensibilisieren und Ressourcen bereitzustellen, die einen effektiven Umgang damit ermöglichen. Dazu gehören evidenzbasierte ethische Leitlinien, standardisierte Prozesse, Schulungen sowie niederschwellige Coaching-Angebote. (shrink)

Conceived as a solution to clinical dilemmas, and now required by organizations for hospital accreditation, ethics committees have been subject only to small-scale studies. The wide use of ethics committees and the diverse roles they play compel study. In 1999 the University of Pennsylvania Ethics Committee Research Group (ECRG) completed the first national survey of the presence, composition, and activities of U.S. healthcare ethics committees (HECs). Ethics committees are relatively young, on average seven years in operation. Eighty-six percent of ethics (...) committees report that they play a role in ongoing clinical decision making through clinical ethics consultation. All are engaged in developing institutional clinical policy. Although 4.5% of HECs write policy on managed care, 50% of HEC chairs feel inadequately prepared to address managed care. The power and activity of ethics committees parallels the composition of those committees and the relationship of members to their institutions. The role of ethics committees across the nation in making policies about clinical care is greater than was known, and ethics committees will likely continue to play an important role in the debate and resolution of clinical cases and clinical policies. (shrink)

ZusammenfassungEthik-Cafés in der geriatrischen Langzeitpflege dienen auch der ethischen Weiterbildung und sollen den Beteiligten in ungezwungener Atmosphäre einen offenen Diskurs über moralische Fragen mit Bezug zum Arbeitsalltag ermöglichen. In der Literatur werden ihnen diverse Eigenschaften wie Verbesserung der Analysefähigkeit und der Kommunikation, Erhöhung der ethischen Sensibilität und der Entscheidungskompetenz und weitere zugeschrieben. Diese Eigenschaften resultieren vorwiegend aus theoriegeleiteten Modellen. Gegenstand dieser Studie ist die empirische Untersuchung der Wirksamkeit von Ethik-Cafés innerhalb der Pflegezentren Mattenhof-Irchelpark, Zürich. Des Weiteren geht die Studie der (...) Frage nach, ob sich die subjektiven Einschätzungen der Eigenschaften von Pflegenden und anderen Berufsgruppen unterscheiden. Zur Erfassung der Eigenschaften wurde ein Fragebogen konstruiert, in dem die Teilnehmenden während der Erhebungszeit 16 Aussagen zu bewerten hatten. Die Bewertung konnte mittels einer 5-stufigen Likert-Skala angegeben werden. In einer Untergruppe wurde zwischen „Pflege“ und „Nicht-Pflege“ unterschieden. Zusammenfassend konnte festgestellt werden, dass die postulierten Eigenschaften mit einer sehr hohen Zustimmung bestätigt werden. Die Ethik-Cafés leisten nach Meinung der Befragten einen wichtigen Beitrag zur Befähigung des Personals, schwierige Situationen klarer zu analysieren, ethisch sensibler zu entscheiden und die getroffene Entscheidung zu begründen. Die Interdisziplinarität der Ethik-Cafés fördert das Verständnis für die Sichtweisen und Argumentationen der verschiedenen Bereiche und Hierarchien. Die Unterschiede der Berufsgruppen sind teilweise hoch-signifikant. Es kann festgehalten werden, dass die im Fragebogen attribuierten Eigenschaften von der Pflege generell stärker und bedeutsamer wahrgenommen werden. (shrink)

Ethics support in primary health care has been sparser than in hospitals, the need for ethics support is probably no less. We have, however, limited knowledge about how to develop ethics support that responds to primary health-care workers’ needs. In this article, we present a survey with a mixture of closed- and open-ended questions concerning: How frequent and how distressed various types of ethical challenges make the primary health-care workers feel, how important they think it is to deal with these (...) challenges better and what kind of ethics support they want. Five primary health-care institutions participated. Ethical challenges seem to be prominent and common. Most frequently, the participants experienced ethical challenges related to scarce resources and lack of knowledge and skills. Furthermore, ethical challenges related to communication and decision making were common. The participants welcomed ethics support responding to their challenges and being integrated in their daily practices. (shrink)

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (...) (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available. (shrink)

As ethics committees and programs become integrated into the “usual business” of healthcare organizations, they are likely to face the predicament of responding to greater demands for service and higher expectations, without an influx of additional resources. This situation demands that ethics committees and programs allocate their scarce resources (including their time, skills and funds) strategically, rather than lurching from one ad hoc request to another; finding ways to maximize the effectiveness, efficiency, impact and quality of ethics services is essential (...) in today’s competitive environment. How can Hospital Ethics Committees (HECs) begin the process of strategic priority-setting to ensure they are delivering services where and how they are most needed? This paper describes the creation of the Clinical Ethics Needs Assessment Survey (CENAS) as a tool to understand interprofessional staff perceptions of the organization’s ethical climate, challenging ethical issues and educational priorities. The CENAS was designed to support informed resource allocation and advocacy by HECs. By sharing our process of developing and validating this ethics needs assessment survey we hope to enable strategic priority-setting in other resource-strapped ethics programs, and to empower HECs to shift their focus to more proactive, quality-focused initiatives. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Objectives: To assess whether according to healthcare providers, the creation of an ethics service responds to a need; assess the importance of an ethics service for healthcare providers; determine what ethics services should be offered and the preferred formats of delivery; and identify key issues to be initially dealt with by the ethics service.Design: A survey of healthcare providers in Québec’s Centre Local de Services Communautaires , healthcare institutions dedicated to community health and social services.Findings: 96 respondents agreed that an (...) ethics service was needed, and on average the ethics service project was judged to be very important. Preferred formats for ethics consultation and education were identified, as well as key concerns such as the need of respect for the patient as a person, elder abuse and ethical issues in home care.Conclusion: This survey is helping in the implementation of an ethics service and can guide others in similar healthcare institutions. (shrink)

Clinical ethics consultation has become an important resource, but unlike other health care disciplines, it has no accreditation or accepted curriculum for training programs, no standards for practice, and no way to measure effectiveness. The Clinical Ethics Credentialing Project was launched to pilot‐test approaches to train, credential, privilege, and evaluate consultants.

patient care at the rural academic medical center. The purpose of this study was to (1) identify and describe the ethical issues perceived by registered nurses employed at a rural academic medical center and (2) analyze the variables influencing the registered nurses' ethical decision making and the process used by these registered nurses when resolving ethical issues. The 17 registered nurses who completed the survey identified a total of 21 ethical issues that they had experienced during the last year. The (...) ethical issues that nurses recalled were significantly more likely to be relationship issues, whereas issues documented within the ethics consultation service were significantly more likely to involve limiting treatment. Communication was a major variable influencing nurse's ethical decision making. Nurses felt the ethical issue resolved satisfactorily when the patient's needs were met, communication occurred with the patient and/or family, the entire healthcare team was involved and in agreement, and there was sufficient time available to make a decision. The nurses did not feel that the ethical situation was resolved satisfactorily when not handled from the patient's perspective; the patient suffered; there was a lack of teamwork, agreement, and/or support; and the process took too long. The nurses' recommendations for resources needed to assist with the resolution of ethical issues included accessible ethics mechanisms, education, improved interprofessional relationships and collaboration, and unbiased support for patient and family decision making. Implications for nurse managers are discussed and future research questions are identified.... (shrink)

Ethics support is called for to improve the quality of care in elderly institutions. Various forms of ethics support are presented, but the needs for ethics support remain unknown. Using a mixed-methods design, this article systematically investigates the specific needs for ethics support in elderly care. The findings of two surveys, two focus groups and 17 interviews demonstrate that the availability of ethics support is limited. There is a need for ethics support, albeit not unconditionally. Advice-based forms of ethics support (...) are less appropriate as they are removed from practice. Ethics support should be tailored to the often mundane and easily overlooked moral issues that arise in long-term care. Attention should also be given to the learning styles of nurses who favour experiential learning. Raising awareness and developing a climate of openness and dialogue are the most suitable ways to deal with the mundane moral issues in elderly care. (shrink)

Next SectionObjective The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. Methods This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. Findings Most respondents see a (...) need for ethics support. This need is related to the complexity of contemporary healthcare, the contribution of ethics support to the core business of the organisation and to the surplus value of paying structural attention to ethical issues. The need for ethics support is, however, not unconditional. Reasons for a lacking need include: aversion of innovations, negative associations with the notion of ethics support service, and organisational factors like resources and setting. Conclusion There is a conditioned need for ethics support in Dutch healthcare institutions. The promotion of ethics support in healthcare can be fostered by focusing on formats which fit the needs of (practitioners in) healthcare institutions. The emphasis should be on creating a (culture of) dialogue about the complex situations which emerge daily in contemporary healthcare practice. (shrink)

IntroductionOne of the most important duties of hospital ethics committees is to provide medical ethics consultation to the staff and patients. This study was conducted with the aim of the needs assessment of the staff for optimal provision of medical ethics consultation services.Materials and methodsThe data collection tool was a self-administered questionnaire. Hospital managers, chief nursing officers, ward managers, and head nurses of all hospitals affiliated with Tehran and Iran University of Medical Sciences entered the study. The questionnaire together with (...) an invitation letter was sent to the samples. In the next stage, telephone follow-up of the incomplete forms was performed by the research team.ResultsA total of 448 persons participated in this study (response rate: 54.2%). The mean frequency of the need for ethics consultation in each ward was 5.2 times in the last 3 months with a median of 3. The highest needs for consultation, which were common in all wards, were observed in treatment rejection by the patient, providing necessary information to obtain informed consent and obtaining consent to high risk procedures, conflict between the decisions made by the patient and the family members, decision making for the high risk patient, request for futile or inappropriate treatments, giving bad news, and decision making for the incompetent patient.ConclusionThe prevalence of ethical issues in clinical wards is variably high. The ethical issues in the clinical setting are mainly related to respect for the patient’s autonomy and competency for decision making. (shrink)