Table 5 Factors facilitating or inhibiting the implementation of an ethical decision-making model
Facilitators, examples | n | Barriers, examples | n | |
|---|---|---|---|---|
Culture/context | ||||
Clinical situations | Patients are older and sicker. METAP tends to be used if: - Nurses reach their limits - If there is disagreement about the appropriateness of a therapy - If the physician does not know what to do | 24 | If there are no problems and everything runs smoothly, METAP is used less often. If everyone has the same opinion, METAP is not necessary. High turnover of patients | 10 |
(Ethical) culture, sensibility | Integration in the daily routine Openness for new procedures Existing awareness for ethical questions | 17 | ||
Collaboration (interprofessional) | All professional groups need to be motivated and engaged. | 5 | If a certain profession does not show engagement. Disagreement between the professions | 11 |
Perception of a need for a model | There is a need for legal protection. Waiting for a guideline because of big problems | 14 | ||
Support by leadership | Support by providing time and organizing a replacement | 10 | Lazy and slow hierarchical structures | 1 |
Total | 70 | Total | 22 | |
Structure/resources | ||||
Time | A discussion in the team is time-saving compared to many one-on-one discussions. It is well invested time. | 10 | Lack of time (e.g. many very sick patients on the ward) Physicians do not have enough time because a lot of other things have to be done. | 34 |
Staff | Lack of personnel (sometimes an ethical case discussion has to be postponed) Fluctuation of staff due to shift work | 15 | ||
Fixed dates | Fixed dates are necessary because of shift work. | 9 | Difficult to find a suitable date for all participants | 2 |
Competition by other projects | Big changes on the ward Many other projects and introductions at the same time | 4 | ||
Total | 19 | Total | 55 | |
METAP/ ethics as such | ||||
Presence/awareness | When you know it. Talking about METAP regularly Word of mouth from users | 10 | If METAP is not known. If it is not used regularly, it is forgotten. | 9 |
Ethics as such | Ethics is a trendy issue. More openness towards ethical themes than in the past | 2 | Ethics is difficult and abstract. Fear of contact with ethics | 8 |
Acceptance | Acceptance by all hierarchical levels If METAP is noticed to be good and is taken seriously | 8 | If one thinks “Oh please! Not another new concept!” | 2 |
Effect | It is important to see an effect, a result. If pressure is reduced | 6 | The impression that it gets nowhere and no change is to be seen | 2 |
Characteristics | Clear and simple presentation in the short version No prescriptions, but a definition of an approach | 3 | Many prescriptions, which cannot be changed | 1 |
Availability | If the material is available. | 2 | Material not available on the ward | 1 |
Total | 31 | Total | 23 | |
Individual level | ||||
Engaged staff members | It takes motivated people, a promoter. | 14 | The members of the “Steuergruppe” are not known. | 1 |
Individual ethical competence | Existing ethical competence No ethical training | 6 | No perception of ethical problems Not familiar with ethical questions | 8 |
Attitude personal characteristics | Positive personal attitude | 1 | Ignorance and lack of motivation No readiness in dealing with a problem | 6 |
Total | 21 | Total | 15 | |