Experiences in Two Dutch Nursing Homes

van der Dam, S., Abama, T., Molewijk, A., Kardol, M., Schols, J., & Widdershoven, G. (2011). Organizing moral case deliberation Experiences in two Dutch nursing homes. Nursing Ethics, 18(3), 327-340.

Moral case deliberation (MCD) is a specific form of clinical ethics, aiming to stimulate ethical reflection in daily practice in order to improve the quality of care. This article focuses on the implementation of MCD in nursing homes. Specifically, it considers the questions of how and where to organize MCD. The purpose of this study was to evaluate one way of organizing MCD in two Dutch nursing homes. In both of these nursing homes the MCD groups had a interdisciplinary composition and were set apart from existing institutional communication structures. The authors conducted a naturalistic evaluation, systematic observations, interviews and focus groups to understand the benefits and challenges of this process.

Their findings indicate that 1) the interdisciplinary composition and 2) keeping the meetings separate from existing communication structures have benefits. However, the participants also reported a challenge with implementing decisions, particularly because these meetings were not part of regular communications structures. Participants would need to take the lessons they learned and attempt to integrate them in their units. The authors suggest that ways of better integrating MCD deliberation in work routines need to be found but at the same time we need to make sure that existing communication patterns (which are often unfriendly or top down) don’t impede reflection.