PDF(Pubmed)
Abstract：
Although the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting.
HOW THE STUDY WAS PERFORMED AND STATISTICAL TESTS USED: A qualitative case study approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies.
THE MAIN FINDINGS: An overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service\'s role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating.
HOW THE STUDY WAS PERFORMED AND STATISTICAL TESTS USED: A qualitative case study approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies.
THE MAIN FINDINGS: An overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service\'s role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating.
摘要：
背景：尽管临床伦理学在当代临床环境中的重要性已经确立，澳大利亚卫生系统正式临床伦理服务的发展，到目前为止,是临时的。这项研究旨在系统地跟踪和反映新成立的服务的前18个月的活动，检查在澳大利亚医院环境中建立新服务的关键障碍和促进者。
方法：研究如何进行和使用统计测试：采用定性案例研究方法。这项研究使用服务委员会会议的观察来收集和分析数据，议程和会议记录的文件分析，以及与委员会成员的半结构化访谈，以生成语义主题。通过参考国家能力建设资源解释专题调查结果，本研究还旨在为其他卫生机构提供基于实践的思考。
结果：主要发现：数据中确定的首要主题是坚定地致力于支持临床医生面对困难的患者护理决策，并与患者和家属进行艰难的讨论。另一个关键主题是新的临床伦理支持服务在为临床医生提供与组织执行官一起提出全系统问题的途径方面的作用。虽然有很强的临床参与，消费者和社区参与仍然是一个挑战，以及尚未解决的治理问题，以及服务与组织之间需要更明确的政策关系。考虑到与国家能力建设资源有关的这些主题，该研究确定了三个可能需要持续发展和谈判的领域。这些是：临床伦理支持服务作为劳动力和行政人员之间的联系的作用；消费者和患者的合并；和道德推理。提高服务的有效性,有必要提高服务在治理和政策层面的作用的清晰度，以及制定吸引消费者的策略，患者和家属。最后,通过明确讨论各种不同的道德框架和审议方式，可以增强服务对复杂案件的反思能力。
方法：研究如何进行和使用统计测试：采用定性案例研究方法。这项研究使用服务委员会会议的观察来收集和分析数据，议程和会议记录的文件分析，以及与委员会成员的半结构化访谈，以生成语义主题。通过参考国家能力建设资源解释专题调查结果，本研究还旨在为其他卫生机构提供基于实践的思考。
结果：主要发现：数据中确定的首要主题是坚定地致力于支持临床医生面对困难的患者护理决策，并与患者和家属进行艰难的讨论。另一个关键主题是新的临床伦理支持服务在为临床医生提供与组织执行官一起提出全系统问题的途径方面的作用。虽然有很强的临床参与，消费者和社区参与仍然是一个挑战，以及尚未解决的治理问题，以及服务与组织之间需要更明确的政策关系。考虑到与国家能力建设资源有关的这些主题，该研究确定了三个可能需要持续发展和谈判的领域。这些是：临床伦理支持服务作为劳动力和行政人员之间的联系的作用；消费者和患者的合并；和道德推理。提高服务的有效性,有必要提高服务在治理和政策层面的作用的清晰度，以及制定吸引消费者的策略，患者和家属。最后,通过明确讨论各种不同的道德框架和审议方式，可以增强服务对复杂案件的反思能力。
