Hospital ethics committees and nurses' participation

Team members perspectives on conflicts in clinical ethics committees

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:

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:

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:

The study received approval from the local Ethics Commission (registration no.: 32/11/10).

Findings:

‘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:

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:

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.

Nurses performance in clinical ethics committees and commissions: An integrative review

BACKGROUND

The research on nursing professionals in Clinical Ethics Committees and Nursing Ethics Commissions occurs in different parts of the world; however, little information on this subject is found in the literature.

OBJECTIVE

This study analyzed national and international publications in relation to the participation of nursing professionals in Clinical Ethics Committees.

RESEARCH DESIGN

This was an integrative review of articles published in national and international journals between 1994 and 2016 which described the participation of nursing professionals in ethics commissions.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 35 articles were selected.

DISCUSSION AND CONCLUSION FOR THIS ARTICLE

The thematic categories were the need for time to discuss ethical issues; ethics committee to reduce the moral suffering of professionals; competencies required for participation; and barriers/difficulties and facilitators for implementation/ performance. It was concluded that professionals recognize the need for ethics committees to foster discussions. However, barriers hamper operation and fundamental competencies for participation. Communication of committee activities to professionals and educational activities may be major allies to improve the functioning of these committees.

Nurses serving on clinical ethics committees

The competency profile underlying higher nursing education in the Netherlands states that bachelor-prepared nurses are expected to be able to participate in ethics committees. What knowledge, skills and attitudes are involved in this participation is unclear. In five consecutive years, groups of two to three fourth-year (bachelor) nursing students conducted 8 to 11 semi-structured interviews each with nurses in ethics committees. The question was what competencies these nurses themselves say they need to participate in such committees. This article reports the aggregate of the 52 interviews in these five studies. Regarding knowledge, the article reports on health law, ethics and professional knowledge. Regarding skills, communication is mentioned, as are professional skills and skills for ‘doing ethics’. An open and respectful attitude towards patients and fellow committee members is required, as well as commitment to patient care, committee work and professional ethics. The right attitude for a nurse in an ethics committee is said to include a reflective and perceptive attitude, along with an awareness of one’s own limitations and convictions. A detailed competency profile for nurses’ participation in ethics committees as outlined in the recommendations may serve nursing education, institutional committees and nurses themselves to meet the demands of nurses’ preparation for clinical ethics consultations.

Organizational ethics: A literature review

The aim of the study was to report the results of a systematically conducted literature review of empirical studies about healthcare organizations’ ethics and management or leadership issues. Electronic databases MEDLINE and CINAHL yielded 909 citations. After a two stage application of the inclusion and exclusion criteria 56 full-text articles were included in the review. No large research programs were identified. Most of the studies were in acute hospital settings from the 1990s onwards. The studies focused on ethical challenges, dilemmas in practice, employee moral distress and ethical climates or environments. Study samples typically consisted of healthcare practitioners, operational, executive and strategic managers. Data collection was mainly by questionnaires or interviews and most of the studies were descriptive, correlational and cross-sectional. There is need to develop conceptual clarity and a theoretical framework around the subject of organizational ethics and the breadth of the contexts and scope of the research needs to be increased.

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.

Ethical attitudes of nurse, physician, and unaffiliated members of institutional review boards

PURPOSE

To evaluate the recommendation for adding unaffiliated members to institutional review boards (IRB) by comparing the attitudes and influence of IRB members of different backgrounds, primarily nurses, physicians, and unaffiliated members.

DESIGN

Survey.

METHOD

A closed-ended self-administered questionnaire concerning ethical issues in human subjects research was completed by 284 IRB members in a nonprobability sample of 27 IRBs in 12 U.S. states. The attitudes and influence of IRB members with different backgrounds were compared.

FINDINGS

Nurses rated most of the issues as more important than did all other members; physicians rated most of the issues as less important than did all other members; and unaffiliated IRB members rated the issues similar to the whole. Nurses and unaffiliated members were ranked the least influential IRB members, and IRB chairs and physicians were ranked the most influential.

CONCLUSIONS

The responses of the IRB members in this study indicate that adding more unaffiliated members to IRBs is unlikely to increase IRB concerns with ethical issues. Adding more nurse members to IRBs might increase IRB concerns with ethical issues if the level of influence of the nurses is increased.