Clergy contributions to healthcare ethics committees

The Accessibility of Inpatient Pediatric Ethics Consultation Services to Patient Caregivers

BACKGROUND

Ethics consultation services (ECS) support clinical decision-making when there are values conflicts. Accessibility to ECS by patients and families is required to benefit from the service. Multiple national guidelines encourage ready availability of ECS to all stakeholders including patients and families.

METHODS

All facilities registered with the Children's Hospital Association (n = 190) were contacted using a protocol modeled after an adult ethics consultation practice study. After an online search to identify an ethics contact, calls were made to hospital operators, and each transfer was documented as well as time to ECS contact. If no contact was identified on progression through the call protocol or on completion of the call pathway on 3 occasions each spaced by 1 week, the ECS was labeled "unreached."

RESULTS

Only 36 (19%) ECS contacts were identified via online search with the remainder 154 (81%) requiring phone calls. Fewer than one-quarter of operators (n = 34/154, 22%) could identify a contact name or number for ECS. Thirty ECS (16%) remained unreachable after completion of the call pathway or 3 separate attempts. Successful ECS contact required an average of 2.9 attempts. Maximum call hold duration was 25 minutes. Callback times averaged 5.8 business days after voicemail.

CONCLUSIONS

This study revealed limited reachability of ECS. ECS should make their contact information available online and improve information available to operators.

Ethics education in clinical pastoral education: prevalence and types

Chaplains frequently serve on ethics committees, as ethics consultants, and as Institutional Review Board (IRB) members in hospitals. However, little is known about how Clinical Pastoral Education (CPE) residents are trained in ethics and whether this training is appropriate or adequate for chaplains' subsequent work in health care settings. We created a survey to canvas 222 CPE residency programs in the United States accredited by the ACPE: The Standard for Spiritual Care (ACPE) to inquire about the prevalence of ethics curricula within residency programs, the educational structure of ethics curricula, and challenges associated with teaching ethics within CPE. We received a total of 84 responses for a 38% response rate. Of these, three-quarters of the programs had a required ethics curriculum, another 10% were in the process of developing one, and 18% had none. There was a great deal of variability in the ethics curricula among the different programs. Developing guidelines for a standardized ethics curriculum could help healthcare chaplains provide more effective service on ethics committees, as ethics consultants, and as IRB members.

Employee Perceptions on Ethics, Racial-Ethnic and Work Disparities in Long-Term Care: Implications for Ethics Committees

This study explored the perceptions of ethics among long-term care employees (N275) in order to test two hypotheses. A cohort cross-sectional survey examined employees' perceptions of an ethics environment, racial-ethnic, and position disparities (HO1; ANOVA), and, secondarily, ethics in relationship to select, research-grounded work features measured as manage disagreements, effectiveness, work satisfaction, and opinions of care, the latter including intention to remain (HO2; Pearson Correlations). Established questionnaires with robust psychometrics were employed. Response rate was 51%. Non-significant differences between sample and population on key variables supported extrapolation of results. Statistically significant differences between racial-ethnic (p < 0.03; F 2.42) and work positions (p <0.0001; F 6.24) were revealed on ethics (3.16; HO1). Statistically significant relationships (p <0.0001; r = 0.26-0.68; HO2) between ethics and employees' work features also were found, confirming both hypotheses. Perceptions of ethics based on racial-ethnic and position disparities, as well as the robust links with employee work features, offered potential avenues for decreasing disparities at work and improving the quality of long-term care. Noted further on ethics item scoring were relatively low scores indicating less involvement in, and access to, ethics discussions and decisions. In contrast, the literature review substantiated the importance of empowerment and retention, which were enhanced by employee involvement in work, notably, discussions and decisions. Thus, implications of ethics committees in long-term care sites as ways to potentially enhance employees' work and quality of care, especially work satisfaction and retention, were explored; relevant concerns raised by the Covid pandemic were, briefly, discussed.

The role of chaplains in end-of-life decision making: results of a pilot survey

OBJECTIVE

The overall aim of this study was to discover how chaplains assess their role within ethically complex end-of-life decisions.

METHODS

A questionnaire was sent to 256 chaplains working for German health care institutions. Questions about their role and satisfaction as well as demographic data were collected, which included information about the chaplains' integration within multi-professional teams.

RESULTS

The response rate was 59%, 141 questionnaires were analyzed. Respondents reported being confronted with decisions concerning the limitation of life-sustaining treatment on average two to three times per month. Nearly 74% were satisfied with the decisions made within these situations. However, only 48% were satisfied with the communication process. Whenever chaplains were integrated within a multi-professional team there was a significantly higher satisfaction with both: the decisions made (p = 0.000) and the communication process (p = 0.000). Significance of the results: Although the results of this study show a relatively high satisfaction among surveyed chaplains with regard to the outcome of decisions, one of the major problems seems to reside in the communication process. A clear integration of chaplains within multi-professional teams (such as palliative care teams) appears to increase the satisfaction with the communication in ethically critical situations.

Ethics Environment in Long-Term Care

This study assesses three hypotheses regarding a long-term care facility’s ethics environment and the relationships between ethics environment, employees’ work features, and residents’ outcomes. Validated questionnaires measure ethics environment, work satisfaction, managing disagreement, goal attainment, care and work opinion including retention, and mental health status among full-time employees ( N = 110; 53%) and residents ( N = 139; 57%) who volunteered for this cross-sectional cohort analysis. Ethics environment is rated above average (> 3.0, 1-5 scale) by employees and residents, with statistically significant ( p = .001) Spearman correlations between ethics environment and employees’ attainment of goals, opinion of care, and work satisfaction; between residents’ ethics environment and care opinion and mental status (MCS, SF-36). Among others, ethics environment is revealed as a robust correlate to two critical factors for quality care: employees’ care opinion including retention and residents’ mental health. It is possible to develop and sustain ethics environments, thus these findings are applicable to clinical practice.