Abstract：
Existing clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care.
We used a participatory development design. We worked together with stakeholders in a Community of Practice throughout the study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.
We distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.
Participatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments.
We used a participatory development design. We worked together with stakeholders in a Community of Practice throughout the study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.
We distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.
Participatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments.
摘要：
现有的临床伦理支持（CES）工具被认为是有用的。然而,用户报告在日常实践中使用它们的障碍。将最终用户和其他利益攸关方纳入开发CES仪器可能有助于克服这些限制。这项研究描述了一种名为CURA的新道德支持工具的开发过程，一种低门槛的四步式仪器,重点是从事姑息治疗的护士和护士助理.
我们使用了参与式开发设计。在整个研究过程中，我们与实践社区的利益相关者一起工作。潜在的最终用户（姑息治疗中的护士和护士助理）在几位飞行员中使用了CURA，并向我们提供了用于改善CURA的反馈。
我们区分了开发过程的三个阶段。第一阶段,识别需求,专注于确定利益相关者和最终用户的需求和偏好，从现有的CES仪器中学习，他们的发展和评估，找出差距。第二阶段,发展,专注于设计，发展,在迭代共同创作的基础上完善和定制乐器。第三阶段,传播,注重实施和传播。仪器,CURA,是促进道德反思的四步低门槛工具。
参与式开发是开发临床伦理支持工具的一种有价值的方法。在我们的开发研究中与最终用户和其他利益相关者合作有助于满足最终用户的需求和偏好，提出完善工具的战略，以提高其可行性，并克服现有临床伦理工具的报道局限性。
我们使用了参与式开发设计。在整个研究过程中，我们与实践社区的利益相关者一起工作。潜在的最终用户（姑息治疗中的护士和护士助理）在几位飞行员中使用了CURA，并向我们提供了用于改善CURA的反馈。
我们区分了开发过程的三个阶段。第一阶段,识别需求,专注于确定利益相关者和最终用户的需求和偏好，从现有的CES仪器中学习，他们的发展和评估，找出差距。第二阶段,发展,专注于设计，发展,在迭代共同创作的基础上完善和定制乐器。第三阶段,传播,注重实施和传播。仪器,CURA,是促进道德反思的四步低门槛工具。
参与式开发是开发临床伦理支持工具的一种有价值的方法。在我们的开发研究中与最终用户和其他利益相关者合作有助于满足最终用户的需求和偏好，提出完善工具的战略，以提高其可行性，并克服现有临床伦理工具的报道局限性。
