title: Ethics reflection groups in community health services: an evaluation study.
abstract: BACKGROUND
  Systematic ethics support in community health services in Norway is in the initial phase. There are few evaluation studies about the significance of ethics reflection on care. The aim of this study was to evaluate systematic ethics reflection in groups in community health (including nursing homes and residency), - from the perspectives of employees participating in the groups, the group facilitators and the service managers. The reflection groups were implemented as part of a research and development project.
  
  
  METHODS
  A mixed-methods design with qualitative focus group interviews, observations and written reports were used to evaluate. The study was conducted at two nursing homes, two home care districts and a residence for people with learning disabilities. Participants were employees, facilitators and service managers. The study was guided by ethical standard principles and was approved by the Norwegian Social Science Data Services.
  
  
  RESULTS
  We found support for ethics reflection as a valuable measure to strengthen clinical practice. New and improved solutions, more cooperation between employees, and improved collaboration with patients and their families are some of the results. No negative experiences were found. Instead, the ethics reflection based on experiences and challenges in the workplace, was described as a win-win situation. The evaluation also revealed what is needed to succeed and useful tips for further development of ethics support in community health services.
  
  
  CONCLUSIONS
  Ethics reflection groups focusing on ethical challenges from the participants' daily work were found to be significant for improved practice, collegial support and cooperation, personal and professional development among staff, facilitators and managers. Resources needed to succeed were managerial support, and anchoring ethics sessions in the routine of daily work.
authors.affiliation: University of Oslo, P.O.Box 1130, Blindern, NO-0318, Oslo, Norway. lillian.lillemoen@medisin.uio.no.
authors.forename: Lillian
authors.initials: L
authors.lastname: Lillemoen
authors.affiliation: University of Oslo, P.O.Box 1130, Blindern, NO-0318, Oslo, Norway. reidar.pedersen@medisin.uio.no.
authors.forename: Reidar
authors.initials: R
authors.lastname: Pedersen
mesh_terms: D003153:Community Health Services / Q000941:ethics*; D003299:Cooperative Behavior; D016352:Group Homes; D006126:Group Processes; D006282:Health Personnel; D006801:Humans; D009014:Morals; D009664:Norway; D009735:Nursing Homes; D036301:Qualitative Research; D013850:Thinking