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Fischer Grönlund, CatarinaORCID iD iconorcid.org/0000-0002-8701-0169
Alternative names
Publications (10 of 15) Show all publications
Wälivaara, B.-M., Zingmark, K. & Fischer Grönlund, C. (2023). Descriptions of long-term impact from inter-professional ethics communication in groups. Nursing Ethics, 30(4), 614-625
Open this publication in new window or tab >>Descriptions of long-term impact from inter-professional ethics communication in groups
2023 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 30, no 4, p. 614-625Article in journal (Refereed) Published
Abstract [en]

Background: On a daily basis, healthcare professionals deal with various ethical issues and it can be difficult to determine how to act best. Clinical ethics support (CES) has been developed to provide support for healthcare professionals dealing with complex ethical issues. A long-term perspective of participating in inter-professional dialogue and reflective-based CES sessions is seemingly sparse in the literature.

Research aim: The aim was to describe experiences of impact of Inter-professional Ethics Communication in groups (IEC) based on Habermas' theory of communicative actions, after 6 months from the perspective of an inter-professional team.

Research design: A qualitative inductive approach was chosen, and individual interviews (n = 13) were conducted. Interview data were analysed using qualitative content analysis.

Participants: The participants, 10 females and two males, represented assistant nurses, registered nurses, physicians, occupational therapists, physiotherapists, welfare officers and psychologists. Each had attended at least four IEC sessions.

Ethical considerations: The study was approved by the Regional Ethical Review Board in Umeå, Sweden, and it has been undertaken in accordance with the Helsinki Declaration.

Findings: Overall, the descriptions expressed a perceived achievement of a deepened and integrated ethical awareness that increased the participants' awareness of ethically difficult situations as well as their own ethical thinking, actions and approaches in daily work. Perspectives were shared and the team become more welded. They carried the memories of the reflections within them, which was perceived as supportive when encountered new ethically situations.

Discussion: Putting words to unarticulated thoughts may stimulate repeated reflections, leading to new insights and alternative thoughts.

Conclusion: The outcome of IEC sessions 6 months following the last session can be described as an incorporated knowledge that enables actions in ethically difficult situations based on an ethical awareness both at a 'We-level' and an 'I-level'.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
healthcare professional, inter-professional ethics communication, long-term impact, qualitative
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-205771 (URN)10.1177/09697330231160007 (DOI)000949004500001 ()36920799 (PubMedID)2-s2.0-85150949938 (Scopus ID)
Funder
Luleå University of Technology
Available from: 2023-03-17 Created: 2023-03-17 Last updated: 2023-12-20Bibliographically approved
Fischer Grönlund, C., Isaksson, U. & Brännström, M. (2023). Moral distress thermometer: Swedish translation, cultural adaptation and validation. Nursing Ethics
Open this publication in new window or tab >>Moral distress thermometer: Swedish translation, cultural adaptation and validation
2023 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Moral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time.

Aim: The aim of this study was to translate the MDT and adapt it to the Swedish cultural context. R

esearch design: The first part of this study concerns the translation of MDT to the Swedish context, and the second part the psychometric testing of the Swedish version.

Participants and research context: 89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch’s ANOVA, Games–Howell post-hoc test and Pearson’s correlation analysis were done.

Ethical considerations: The study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration.

Results: The translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress.

Conclusion: The MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
health care professionals, instrument, moral distress, questionnaire, translation, validation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-215080 (URN)10.1177/09697330231197707 (DOI)2-s2.0-85172656359 (Scopus ID)
Funder
Umeå UniversityKarolinska Institute
Available from: 2023-10-13 Created: 2023-10-13 Last updated: 2023-10-13
Fischer Grönlund, C., Brännström, M. & Isaksson, U. (2023). Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). BMC Medical Ethics, 24(1), Article ID 35.
Open this publication in new window or tab >>Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP)
2023 (English)In: BMC Medical Ethics, E-ISSN 1472-6939, Vol. 24, no 1, article id 35Article in journal (Refereed) Published
Abstract [en]

Background: Moral distress has been described as moral constraints and uncertainty connected with guilty feelings of being unable to give care in accordance with one's values for good care. Various instruments to measure moral distress have been developed. The instrument measure of moral distress for healthcare professionals (MMD-HP) was developed to capture the experience and frequency of moral distress among various healthcare professionals. The MMD-HP has been translated and culturally adapted into the Swedish language and context; however, the translation has not been validated. Therefore, this study aimed to evaluate the validity and reliability of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP).

Methods: Eighty-nine staff from various professions at a hospital in northern Sweden participated in the study. A confirmatory factor analysis was performed to check for consistency with the original version of the MMD-HP. To evaluate internal consistency, Cronbach's alpha was calculated for each domain and for the scale as a whole.

Results: The scale as a whole showed a Cronbach's alpha of 0.96, with a range between 0.84 and 0.90 between the different subscales. A confirmatory factor analysis based on the original four-factor structure showed good fit indices with a χ2/df of 0.67, CFI at 1.00, TLI at 1.02 and NFI at 0.97. RMSEA was at 0.00, and SRMR was at 0.08. A comparison of the total score between three equally large groups of years of experience at the present workplace showed no significant differences (F = 0.09, df = 2, p = 0.912).

Conclusions: We found that the Swedish version of the MMD-HP has shown validity and reliability for use in a Swedish context for measuring moral distress among health personnel.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Moral distress, Instrument, Measure, Healthcare professionals, Psychometrics, Validation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-208781 (URN)10.1186/s12910-023-00916-x (DOI)000997702200001 ()37254086 (PubMedID)2-s2.0-85160608925 (Scopus ID)
Funder
Karolinska InstituteUmeå University
Available from: 2023-05-31 Created: 2023-05-31 Last updated: 2024-07-04Bibliographically approved
Fischer Grönlund, C. & Brännström, M. (2022). Postgraduate nursing students’ experiences of practicing ethical communication. Nursing Ethics, 29(7-8), 1709-1720
Open this publication in new window or tab >>Postgraduate nursing students’ experiences of practicing ethical communication
2022 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 29, no 7-8, p. 1709-1720Article in journal (Refereed) Published
Abstract [en]

Background: Ethics communication has been described as a pedagogical form, promoting development of ethical competence among nursing students. The ‘one to five method’ was developed by this research group as a tool for facilitating ethical communication in groups among healthcare professionals but has not yet been evaluated.

Aim: To explore post-graduate nursing students’ experiences of practicing ethical communication in groups.

Research design: The study design is qualitative.

Participants and research context: The study comprised 12 nursing students on a post-graduate course for Registered Nurses focusing on palliative care. After education the students engaged as participants and facilitators in ethics communication in groups, with support from the ‘one to five method’. Data were derived from the students written reflections and subjected to thematic analysis.

Ethical considerations: The study was performed in accordance with the ethical standards in the 2013 Helsinki Declaration and approved by the Ethics Committee of the Medical Faculty at Umeå University.

Results: An overall theme was identified, ‘being supported to achieve a democratic dialogue concerning ethical problems’ and five themes, related to each step of the ‘one to five method’. The themes concerned: putting the experience of an ethical dilemma into words; being confirmed by shared emotions; defining the value conflict using ethical principles; expressing virtues of empathy and raised awareness; jointly finding various action approaches.

Discussion: Regular ethics communication in groups encourages nursing students to actively seek understanding and clarification of ethically difficult situations.

Conclusions: The results indicate that ethics communication in groups could be a way of developing virtues during education. Interventions using the ‘one to five method’ need to be further studied among student groups from other healthcare contexts.

Place, publisher, year, edition, pages
Sage Publications, 2022
Keywords
Clinical ethical support, democratic dialogue, ethics communication, ethics education, nursing student, ‘the one to five method’
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-198048 (URN)10.1177/09697330221109943 (DOI)000822285000001 ()35773019 (PubMedID)2-s2.0-85133389580 (Scopus ID)
Available from: 2022-07-14 Created: 2022-07-14 Last updated: 2022-12-30Bibliographically approved
Fischer Grönlund, C., Brännström, M. & Zingmark, K. (2021). The 'one to five' method - A tool for ethical communication in groups among healthcare professionals. Nurse Education in Practice, 51, Article ID 102998.
Open this publication in new window or tab >>The 'one to five' method - A tool for ethical communication in groups among healthcare professionals
2021 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 51, article id 102998Article in journal (Refereed) Published
Abstract [en]

Healthcare professionals have expressed a wish for facilitated inter-professional communications about ethical difficulties experienced in clinical practice. The introduction of an easily accessible method for facilitating ethical communication in groups may promote its implementation in everyday clinical practice. The aim of this paper was to draw on previous studies and available knowledge in order to develop and describe a method that enables systematic implementation of inter-professional ethical communication in groups. The ‘one-to-five method’ for facilitated ethical communication in groups is theoretically inspired by Habermas's theory of communicative actions and base on previous studies that accords with the Helsinki Declaration (2013). The ‘one to five method’ supports guidance of ethical communication in five steps: telling the story about the situation; reflections and dialogue concerning the emotions involved; formulation of the problem/dilemma; analysis of the situation and the dilemma; and searching for a choice of action or approach. It offers an easily accessible method for teaching healthcare professionals how to facilitate ethics communication groups. Educating facilitators closely connected to clinical work may lead to ethical dialogue becoming a natural part of clinical practice for healthcare professionals.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Ethical communication method, Inter-professional, Healthcare professionals, Clinical ethics support
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-193663 (URN)10.1016/j.nepr.2021.102998 (DOI)000632918200025 ()33639607 (PubMedID)2-s2.0-85101422010 (Scopus ID)
Funder
Norrbotten County Council
Available from: 2022-04-11 Created: 2022-04-11 Last updated: 2022-04-12Bibliographically approved
Fischer-Grönlund, C., Brännström, M. & Zingmark, K. (2021). The 'one to five' method: A tool for ethical communication in groups among healthcare professionals. Nurse Education in Practice, 51, Article ID 102998.
Open this publication in new window or tab >>The 'one to five' method: A tool for ethical communication in groups among healthcare professionals
2021 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 51, article id 102998Article in journal (Refereed) Published
Abstract [en]

Healthcare professionals have expressed a wish for facilitated inter-professional communications about ethical difficulties experienced in clinical practice. The introduction of an easily accessible method for facilitating ethical communication in groups may promote its implementation in everyday clinical practice. The aim of this paper was to draw on previous studies and available knowledge in order to develop and describe a method that enables systematic implementation of inter-professional ethical communication in groups. The 'one-to-five method' for facilitated ethical communication in groups is theoretically inspired by Habermas's theory of communicative actions and base on previous studies that accords with the Helsinki Declaration (2013). The 'one to five method' supports guidance of ethical communication in five steps: telling the story about the situation; reflections and dialogue concerning the emotions involved; formulation of the problem/dilemma; analysis of the situation and the dilemma; and searching for a choice of action or approach. It offers an easily accessible method for teaching healthcare professionals how to facilitate ethics communication groups. Educating facilitators closely connected to clinical work may lead to ethical dialogue becoming a natural part of clinical practice for healthcare professionals.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Clinical ethics support, Ethical communication method, Healthcare professionals, Inter-professional
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-180964 (URN)10.1016/j.nepr.2021.102998 (DOI)33639607 (PubMedID)2-s2.0-85101422010 (Scopus ID)
Available from: 2021-03-04 Created: 2021-03-04 Last updated: 2021-03-09Bibliographically approved
Fischer Grönlund, C. & Brännström, M. (2021). The Swedish translation and cultural adaptation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). BMC Medical Ethics, 22(1), Article ID 151.
Open this publication in new window or tab >>The Swedish translation and cultural adaptation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP)
2021 (English)In: BMC Medical Ethics, E-ISSN 1472-6939, Vol. 22, no 1, article id 151Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Moral distress has been described as an emotionally draining condition caused by being prevented from providing care according to one's convictions. Studies have described the impact of moral distress on healthcare professionals, their situations and experiences. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team. The aim of this project was to translate and make a cultural adaption of the MMD -HP to the Swedish context.

METHODS: The questionnaire comprises 27 items, rated according to frequency and intensity on a five-point Likert scale (0-4). The procedure for translating MMD-HP followed WHO guidelines (2020). These entailed a forward translation from English to Swedish, a back translation, expert panel validation, pretesting and cognitive face-to-face interviews with 10 healthcare professionals from various professions and healthcare contexts.

RESULTS: The Swedish version of MMD-HP corresponds essentially to the concept of the original version. Parts of some items' had to be adjusted or removed in order to make the item relevant and comprehensible in a Swedish context. Overall, the cognitive interviewees recognized the content of the items which generally seemed relevant and comprehensible.

CONCLUSION: The Swedish version of MMD-HP could be a useful tool for measuring moral distress among healthcare professionals in a Swedish healthcare context.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Health care professionals, Measure moral distress, Questionnaire, Swedish translation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-189517 (URN)10.1186/s12910-021-00722-3 (DOI)000717980000003 ()34772400 (PubMedID)2-s2.0-85118977065 (Scopus ID)
Available from: 2021-11-15 Created: 2021-11-15 Last updated: 2024-07-04Bibliographically approved
Fischer Grönlund, C., Söderberg, A., Dahlqvist, V., Sandlund, M. & Zingmark, K. (2019). Communicative and organizational aspects of clinical ethics support. Journal of Interprofessional Care, 33(16), 724-733
Open this publication in new window or tab >>Communicative and organizational aspects of clinical ethics support
Show others...
2019 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 33, no 16, p. 724-733Article in journal (Refereed) Published
Abstract [en]

Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Clinical ethics support, care ethics, ethically difficult situations, healthcare professionals, inter-professional communication
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-155309 (URN)10.1080/13561820.2018.1551862 (DOI)000493764900015 ()30497309 (PubMedID)2-s2.0-85057527109 (Scopus ID)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2023-03-24Bibliographically approved
Fischer Grönlund, C., Söderberg, A., Dahlqvist, V., Andersson, L. & Isaksson, U. (2019). Development, validity and reliability testing the Swedish Ethical Climate Questionnaire. Nursing Ethics, 26(7-8), 2482-2493
Open this publication in new window or tab >>Development, validity and reliability testing the Swedish Ethical Climate Questionnaire
Show others...
2019 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 7-8, p. 2482-2493Article in journal (Refereed) Published
Abstract [en]

Background: An ethical climate has been described as a working climate embracing shared perceptions about morally correct behaviour concerning ethical issues. Various ethical climate questionnaires have been developed and validated for different contexts, but no questionnaire has been found concerning the ethical climate from an inter-professional perspective in a healthcare context. The Swedish Ethical Climate Questionnaire, based on Habermas’ four requirements for a democratic dialogue, attempts to assess and measure the ethical climate at various inter-professional workplaces. This study aimed to present the construction of and to test the psychometric properties of the Swedish Ethical Climate Questionnaire.

Method: An expert group of six researchers, skilled in ethics, evaluated the content validity. The questionnaire was tested among 355 healthcare workers at three hospitals in Sweden. A parallel analysis (PA), an exploratory factor analysis and confirmatory factor analysis were performed.

Ethical considerations: The participants included in the psychometric analysis were informed about the study, asked to participate in person and informed that they could withdraw at any time without giving any reason. They were also assured of confidentiality in the reporting of the results.

Findings: The parallel analysis (PA) recommended one factor as a solution. The initial exploratory factor analysis with a four-factor solution showed low concordance with a four-factor model. Cronbach’s alpha varied from 0.75 to 0.82; however, since two factors only consisted of one item, alpha could not be reported. Cronbach’s alpha for the entire scale showed good homogeneity (α = 0.86). A confirmatory factory analysis was carried out based on the four requirements and showed a goodness-of-fit after deleting two items. After deletion of these items, Cronbach’s alpha was 0.82.

Discussion: Based on the exploratory factor analysis, we suggest that the scale should be treated as a one-factor model. The result indicates that the instrument is unidimensional and assesses ethical climate as a whole.

Conclusion: After testing the Swedish Ethical Climate Questionnaire, we found support for the validity and reliability of the instrument. We found the 10-item version of Swedish Ethical Climate Questionnaire satisfactory. However, we found no support for measuring different dimensions and, therefore, this instrument should be seen as assessing ethical climate as of whole.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Ethical climate, Habermas, healthcare professionals, psychometric assessment
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-156992 (URN)10.1177/0969733018819122 (DOI)000486024000051 ()30665340 (PubMedID)2-s2.0-85060602906 (Scopus ID)
Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2024-07-02Bibliographically approved
Brännström, M., Fischer Grönlund, C., Zingmark, K. & Söderberg, A. (2019). Meeting in a 'free-zone': clinical ethical support in integrated heart-failure and palliative care. European Journal of Cardiovascular Nursing, 18(7), 577-583
Open this publication in new window or tab >>Meeting in a 'free-zone': clinical ethical support in integrated heart-failure and palliative care
2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 7, p. 577-583Article in journal (Refereed) Published
Abstract [en]

Background: Integrating heart-failure and palliative care combines expertise from two cultures, life-saving cardiology and palliative care, and involves ethically difficult situations that have to be considered from various perspectives. We found no studies describing experiences of clinical ethical support (CES) in integrated cardiology and palliative care teams.

Objective: Our aim is to describe experiences of CES among professionals after a period of three years working in a multidisciplinary team in integrated heart-failure and palliative homecare.

Method: The study design was descriptive qualitative, comprising interviews with seven professionals from one integrated heart-failure and palliative care team who received CES over a three-year period. The interview data were subjected to qualitative content analysis.

Results: The CES was found to offer possibilities for meeting in an ethical ‘free-zone’ where the participants could relate to each other beyond their various professional roles and specialties. The trust within the team seemed to increase and the participants were confident enough to express their points of view. Together they developed an integrated understanding, and acquired more knowledge and a comprehensive view of the ethically difficult situation of concern. The CES sessions were considered a means of becoming better prepared to deal with ethical care issues and developing action strategies to apply in practice, from shared standpoints.

Conclusion: Participating in CES was experienced as meeting in an ethical ‘free-zone’ and seemed to be a means of facilitating integration of palliative and heart-failure care.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Clinical ethical support, heart failure, implementation, palliative care, PREFER study, RiFECC
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-159012 (URN)10.1177/1474515119851621 (DOI)000487801400008 ()31088300 (PubMedID)2-s2.0-85072628164 (Scopus ID)
Available from: 2019-05-16 Created: 2019-05-16 Last updated: 2023-03-23Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-8701-0169

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