title: Managing Ethical Difficulties in Healthcare: Communicating in Inter-professional Clinical Ethics Support Sessions.
abstract: Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support (CES) inspired by Habermas' theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of this study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved.
authors.affiliation: Department of Nursing, Umeå University, 901 87, Umeå, Sweden. catarina.fischer.gronlund@umu.se.
authors.forename: Catarina Fischer
authors.initials: CF
authors.lastname: Grönlund
authors.affiliation: Department of Nursing, Ersta Sköndal University College, P.O. Box 111 89, 100 61, Stockholm, Sweden.
authors.forename: Vera
authors.initials: V
authors.lastname: Dahlqvist
authors.affiliation: Division of Nursing, Department of Health Science, Luleå University of Technology, 971 87, Luleå, Sweden.|Norrbotten County Council, Landstingshuset, 971 89, Luleå, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Zingmark
authors.affiliation: Department of Clinical Science/Psychiatry, Umeå University, 901 87, Umeå, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Sandlund
authors.affiliation: Department of Nursing, Umeå University, 901 87, Umeå, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Söderberg
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making; D026690:Ethics, Clinical; D006801:Humans; D007400:Interprofessional Relations / Q000941:ethics*; D036301:Qualitative Research; D013548:Sweden
keywords: Care ethics; Clinical ethics support; Ethically difficulties; Healthcare-professionals; Inter-professional communication