title: How to introduce medical ethics at the bedside - Factors influencing the implementation of an ethical decision-making model.
abstract: BACKGROUND
  As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field.
  
  
  METHODS
  A medical ethics decision-making model called METAP was introduced on three intensive care units and two geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used.
  
  
  RESULTS
  Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing (explicit) ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary.
  
  
  CONCLUSIONS
  Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and staff can be overcome when people are convinced that the benefits justify the effort.
authors.affiliation: Department of Clinical Ethics, Psychiatric Hospitals and University Hospital Basel, University of Basel, Wilhelm Klein-Strasse 27, 4012, Basel, Switzerland. barbara.meyer@unibas.ch.|Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland. barbara.meyer@unibas.ch.
authors.forename: Barbara
authors.identifier: http://orcid.org/0000-0002-7178-7707
authors.initials: B
authors.lastname: Meyer-Zehnder
authors.affiliation: Department of Clinical Ethics, Psychiatric Hospitals and University Hospital Basel, University of Basel, Wilhelm Klein-Strasse 27, 4012, Basel, Switzerland.|Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
authors.forename: Heidi
authors.initials: H
authors.lastname: Albisser Schleger
authors.affiliation: Department of Clinical Ethics, Psychiatric Hospitals and University Hospital Basel, University of Basel, Wilhelm Klein-Strasse 27, 4012, Basel, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Tanner
authors.affiliation: Department of Clinical Ethics, Psychiatric Hospitals and University Hospital Basel, University of Basel, Wilhelm Klein-Strasse 27, 4012, Basel, Switzerland.
authors.forename: Valentin
authors.initials: V
authors.lastname: Schnurrer
authors.affiliation: Clinical Trail Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland.
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Vogt
authors.affiliation: Department of Clinical Ethics, Psychiatric Hospitals and University Hospital Basel, University of Basel, Wilhelm Klein-Strasse 27, 4012, Basel, Switzerland.
authors.forename: Stella
authors.initials: S
authors.lastname: Reiter-Theil
authors.affiliation: Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
authors.forename: Hans
authors.initials: H
authors.lastname: Pargger
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making / Q000941:ethics*; D004992:Ethics, Medical; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008962:Models, Theoretical; D010564:Personnel, Hospital / Q000600:supply & distribution; D011795:Surveys and Questionnaires; D016526:Workload
keywords: Barriers; Ethical decision-making model; Facilitators; Implementation; Medical ethics