Empirische Forschungsarbeiten zur Ethik im Gesundheitswesen können entsprechende Implementationsprojekte unterstützen. Inzwischen gibt es eine Vielfalt von Ethikberatungsansätzen und -strukturen, die jedoch noch nicht in allen Gesundheitseinrichtungen genutzt werden. Bedarfserhebungen können wichtige Daten zu Strategie- und Projekterfordernissen darstellen. Die Bedeutung und Gründe für die Einschätzung des Bedarfs an klinischer Ethikberatung werden in der Fachliteratur vielfach diskutiert. Im vorliegenden Beitrag werden die Ergebnisse aus der Literaturanalyse im Hinblick auf vorhandene Erhebungsinstrumente zusammengefasst und ein Konzept zur Entwicklung eines Bedarfserhebungsinstruments beschrieben. Das Konzept beinhaltet (...) Daten zum Erhebungsbereich, zu den Forschungsfragen, zur Zielformulierung und zu den Zielgruppen. Anschließend wird das vorläufig entwickelte Instrument kurz vorgestellt. Ziel des Erhebungsinstruments ist es zunächst, empirische Daten von handelnden Pflegepersonen zu erheben, um so eine Grundlage für den konkreten Unterstützungsbedarf zu erhalten. (shrink)

Background Healthcare ethics consultants require specific competencies to perform their duties. In recent years, these competencies have been systematized and seen as part of professionalizing ethics consultation (e.g., in American Society for Bioethics and Humanities’ “Core Competencies” or the Akademie für Ethik in der Medizin’s “Ethics Consultation Curriculum”). While there is clarity and agreement regarding the necessary competencies (e.g., knowledge of ethical reasoning approaches, skills for conducting case consultations), the conceptual foundation of the associated competence management (as deliberate governance of (...) competencies) remains relatively thin (e.g., competence models and profiles). Such management helps to deliberately shape the personal and organizational development of ethical competencies and, thus, promote the transfer of ethics within an organization, the quality of ethics consultation, and the care processes as a whole. Objective This article examines the transferability of established concepts of competence management to the field of ethics consulting. Method The article explains basic terms, concepts, and methods of competence management in the field of human resource management and organizational development and draws on the authors’ practical experience to show how this knowledge can be used for personal and organizational competence development in healthcare ethics consultation. Results (1) Fundamentals: competence models, competence profiles, competence management. (2) Individual competence development: tools for ethics consultants as individuals and in collaboration with others (in teams). (3) Organizational competence development: organizational responsibility for the development of ethics competencies. Conclusion The framework for ethics competencies needs to be expanded to include organizational aspects. Effective competence development requires systematic competence management. To this end, established tools from human resources management and organizational development should be used, which would need to be included in training ethics coordinators. (shrink)

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 Entscheidungsfindungsprozesse 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)

Background Advance directives (ADs) document the patient’s preferences regarding future medical care and are used to ensure goal-concordant care and patient autonomy when the patient becomes incapacitated. In a clinical setting, goals of care (GOC) discussions are a tool that helps health care providers (HCPs) provide goal-concordant care. A lack of documentation of the patient’s wishes, either as AD or following GOC discussions, can, especially in emergency or critical situations, lead to moral distress among HCPs, a psychological disequilibrium that stems (...) from the perceived inability to act in the best interests of the patient. Objectives This study aimed to (1) assess attitudes toward GOC discussions among patients and HCPs in general wards at Vienna General Hospital, (2) identify barriers and facilitators for their implementation, and (3) measure and compare moral distress between HCPs. Methods A cross-sectional survey was conducted between October 2022 and June 2023 across six wards (cardiology, pulmonology, infectious diseases, maxillofacial surgery, palliative care, and chronic haemodialysis). Paper-based questionnaires were administered to patients ( n = 47) and HCPs ( n = 75). Moral distress among HCPs was assessed using a culturally adapted German translation of the Measure of Moral Distress – Health Care Professionals (MMD-HP). Ethical considerations The study was approved by the ethics committee and the data protection commission of the Medical University of Vienna. Informed consent was obtained from all participants. The questionnaires contained no identifying information. Participation was voluntary and not participating carried no disadvantages. Results Most patients (70.5%) considered GOC discussions appropriate during hospitalisation, 71.4% considered them relieving, and 79.1% considered them helpful. Only 10.9% had ever been asked about ADs during a hospital stay. Among HCPs, the majority considered GOC discussions suitable for patients with multimorbidity (80.0%) and life-shortening conditions (86.7%) as well as those with a simple medical condition (54.7%). However, the majority (51.4%) of HCPs practice GOC discussions for less than 10% of their patients. The lack of standard operating procedures (SOPs), personnel, time, translators, and material were reported as the most relevant barriers. The mean MMD-HP total score was 105.0. Nurses scored significantly higher than physicians (125.7 vs 86.9, p = 0.020). Conclusions Both patients and HCPs expressed strong support for GOC discussions, yet the implementation is hindered by resource limitations and the lack of standardised protocols. At the same time, nurses experience high levels of moral distress. There seems to be a need for organisational and policy measures to facilitate structured GOC discussions and goal-concordant care. (shrink)

Pflegeethik reflektiert berufliches Handeln in unterschiedlichen organisationalen Settings. Damit ethische Reflexion wirksam wird, ist sie selbst in Strukturen und Prozessen zu organisieren. Dazu sind Schritte der Implementierung und Etablierung notwendig, die Aspekte von Organisationskultur, Leitungsverantwortung und Rollenklärung berücksichtigen und unterstützen. Anhand eines Praxisbeispiel ist aufzuzeigen, wie eine institutionalisiere Pflegeethik auch Teil einer interprofessionellen und transdisziplinären Gesundheitsethik wird.