Gabriella Marx

Physicians’ and nurses’ expectations and objections toward a clinical ethics committee

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account.

Frequency and perceived severity of negative experiences during medical education in Germany--results of an online-survery of medical students.

Aims: Negative experiences during the course of medical education have been reported in many countries, but little is known about the perceived severity of these experiences. We studied for the first time how often students at a medical university in Germany have had negative experiences, and how severe they perceive these to be. Method: We asked medical students in an online survey whether they felt adequately appreciated, had experienced peer rivalry, verbal abuse by their mentors, physical abuse or mistreatment, sexual harassment, racial or ethnic discrimination, or any other kind of mistreatment. Results: Of 391 students, 56% stated that they felt insufficiently appreciated, 51% had experienced rivalry, and 34% had suffered verbal abuse. Fifty-nine percent of the students felt highly aggrieved because of verbal abuse, while 46% were aggrieved by the ongoing rivalry and 32% by the lack of appreciation. Significantly fewer students felt upset because they were passed over or ignored (21%). Generally, female students felt more often aggrieved by these negative experiences than their male colleagues. Conclusion: Of the possible negative experiences, the less prominent ones such as lack of appreciation or verbal abuse are not only frequent, they are also perceived as very upsetting. Medical teachers should reflect this more in their day-to-day dealings with students and aim to improve on their contact with the students accordingly.

Understanding the Needs and Perspectives of Patients with Incurable Pulmonary Disease at the End of Life and their Relatives: Protocol of aQualitative Longitudinal Study

Background: Although patients with COPD sometimes have lesser physical, social, and emotional functioning than those with lung cancer, they rarely receive specialised palliative care support at the end of life. To date, specialised palliative care is not common for patients with non-malignant disease but should be adapted according to the patients’ special health-care-related needs with regard to specific illness trajectories. This longitudinal study aims to get a deep insight into the needs and perspectives of patients suffering from progressive lung diseases, i.e. lung cancer and COPD, over a period of time. Methods: The design of this study is divided into three phases: (1) Qualitative prospective longitudinal study conducting four semi-structured repetitive interviews with a total of 40 patients over a period of 12 month. Data will be analysed content related as well as interpretative using Grounded Theory (2) Four group discussions with bereaved people whose relatives died from COPD or lung cancer. Data will be analysed using documentary method. (3) A oneday multidisciplinary workshop with representatives of different health related fields to derive implications for daily practice. Discussion: By integrating different diseases, the study contributes to shift the focus of palliative care to patients with non-oncologic diseases. As this is the first German study on this issue, results will enrich the current international discussion with a German perspective.

Working as simulated patient has effects on real patient life – Preliminary insights from a qualitative study

Background: Persons who simulate patients during medical education understand the routines and the underlying script of medical consultations better. We aimed to explore how simulated patients (SPs) integrated this new understanding into their daily life, how this work affected their private life as patients, and what we can learn from these changes for concepts of empowerment. Design, setting, and participants: A qualitative interview study. All SPs of Göttingen medical school who had been working longer than three semesters (n=14) were invited and agreed to take part in an open interview about their daily experience with real doctors. Documentary method was used to identify the main issues. Several cases were chosen according to maximum contrast and analysed by in-depth analysis to provide vivid examples of how simulations may affect the real life of the SPs as patients. Results: Our analysis revealed three main changes in the behaviour of SPs as real patients. They were more attentive, had a better understanding of the circumstances under which doctors work, and acted more self-confidently. From the selected cases it became apparent that working as a SP may lead to a constant and significant decrease of fear of hospitals and medical procedures or, in other cases, may enable the SPs to develop new abilities for giving feedback, questioning procedures, and explanations for real doctors. Conclusion: working as a simulated patient seems to be well-suited to understand own progression of diseases, to increase self-responsibility and to a confident attitude as patient.

Implementierung eines Klinischen Ethikkomitees

An der Universitatsmedizin Gottingen (UMG) wurde im Herbst 2010 ein Klinisches Ethikkomitee gegrundet. Damit reiht Gottingen sich in die vor allem im vergangenen Jahrzehnt stetig gewachsene Anzahl universitarer Kliniken ein, die ein solches Gremium an ihrem Hause einrichten (vgl. Frewer et al. 2008; Dorries 2010).

Selbstbestimmung braucht Vertrauen – Entscheidungsfindung am Lebensende

Bereits Norbert Elias macht in seinem Aufsatz ‚Uber die Einsamkeit der Sterbenden in unseren Tagen‘ (1983) darauf aufmerksam, dass die allmahliche Verdrangung des Todes ein Phanomen moderner hochzivilisierter Gesellschaften sei. Durch den stetig voranschreitenden medizinischen Fortschritt, die steigende Lebenserwartung und die Moglichkeiten durch Praventivmasnahmen Krankheiten vorzubeugen, habe der Tod mit der Zeit an Bedrohlichkeit verloren. Die Vorstellung vom Tod sei haufig an ein Bild ‚friedlichen‘ Sterbens gebunden (ebd. 75).

Gruppendiskussionen mit Patientinnen und Patienten: eine Methode in der Versorgungsforschung

Die Forderung nach groserer Selbstverantwortung und Autonomie von Patienten bei der Behandlung chronischer Erkrankungen ist haufig mit einem Aufbrechen gewohnter Interaktionsstrukturen zwischen Arzt und Patient verbunden. Fur Arzte bedeutet dies, sich im Gesprach — besonders bei den therapeutischen Vereinbarungen — offen und flexibel auf die individuellen Bedurfnisse der Patienten einzustellen. Das Wissen um die Patientenperspektive wird daher fur eine angemessene pharmakologische Versorgung zu einer wichtigen Grundlage bei der Behandlung chronischer Erkrankungen. Am Beispiel der arteriellen Hypertonie wird in diesem Beitrag dargestellt, wie mit der Gruppendiskussion als qualitativer Forschungsmethode und einer anschliesenden interpretativen Auswertung die Patientenperspektive rekonstruiert und fur die Arbeit von Hausarzten aufbereitet werden kann.