A Qualitative Study of Norwegian Care Institutions Health Care Workers’ Experiences of Ad Hoc Ethical Reflection During the Workday

HÃ¥kon Johansen,1,2,* Ann Karin Helgesen,1 Ingrid Femdal1,* 1Faculty of Health, Welfare and Organisation, Østfold University College, Fredrikstad, Norway; 2Centre for Development of Institutional and Home Care Services Østfold, Indre Østfold municipality, Mysen, Norway*These authors contributed equally to this workCorrespondence: HÃ¥kon Johansen, Ostfold University College, Postboks 700 NO-1757, Halden, Norway, Tel +4790850670, Email [email protected]/Objectives: The objective of the study was to explore experiences related to ad hoc ethical reflection and how ethical reflection might be structured. There has been limited research on the topic in the context of nursing homes and health care centres. Reflection is an ongoing practice in healthcare, often linked to problem-solving and clinical decision-making.Methods: The study has an exploratory design with a qualitative approach. The researchers conducted four group interviews. The data were analysed with systematic text condensation, which entails condensing meaning units following development of code groups.Results: When health care workers (registered nurses, auxiliary nurses, or care workers) encounter ethical uncertainty or ethical issues, they may perceive these situations as challenging. Occasionally, they take the initiative to conduct ad hoc ethical reflection, where they discuss different perspectives and make decisions collectively. Hence, ethical reflection contributes to collaboration. The structure of ad hoc ethical reflection appears to be shaped by two key components: problem-solving and consensus-building, while also addressing, to some extent, the values involved. Furthermore, ethical reflection often led to health care workers supporting each other.Conclusion: Ad hoc ethical reflection can improve decision-making and foster moral awareness among nursing home health care workers. Moreover, the study identifies a need to implement practices of ad hoc ethical reflection through training programs, such as simulation training. Future research, preferably observational, may provide deeper insight into the prerequisites, structure and performance of ad hoc ethical reflection, and how its conclusions are implemented.Keywords: ad hoc ethical reflection, clinical decision making, nursing home, health care centre