Heidi Karlsen

• Karlsen, Heidi; Magelssen, Morten & Thoresen, Lisbeth (2024). Kommunale etikkomiteer kan ikke bæres av enkeltpersoners engasjement alene. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 20(2). doi: 10.7557/14.7168. Full text in Research Archive Show summary

  Mange ansatte i kommunale helse- og omsorgstjenester som opplever etiske utfordringer i sin arbeidshverdag, mangler arenaer for å diskutere slike problemstillinger. I et prosjekt fikk fire kommuner implementeringsstøtte til å etablere kommunale etikkomiteer, et tverrfaglig forum hvor ansatte, pasienter og pårørende kan få hjelp til å drøfte etisk krevende problemstillinger. I kommunehelsetjenesten er etablering av etikkomiteer å anse som et nybrottsarbeid, som hittil har vært lite systematisk undersøkt. Ved prosjektstart oppnevnte deltakerkommunene to ressurspersoner, og disse ble komiteenes ledere eller sekretærer. I denne studien har vi undersøkt disse ressurspersonenes erfaringer med å koordinere og lede kommunenes etikkarbeid, inkludert å lede konkrete etikkdrøftinger. Data fra tre fokusgrupper, supplert og validert med data fra fem dialogseminarer over tre år, ble analysert ved hjelp av refleksiv tematisk analyse. Funnene viser at refleksjon over etiske spørsmål kan ha betydning utover enkeltstående saker, men også at ressurspersonene fikk omfattende arbeidsoppgaver og ansvar innen implementering, kompetansebygging, markedsføring og forankring. For å unngå å være avhengig av enkeltpersoners innsats, bør komiteenes rammevilkår forbedres.

• Karlsen, Heidi; Magelssen, Morten & Thoresen, Lisbeth (2023). "Det er dårlig gjort å ha møte uten oss det gjelder" Erfaringer fra pårørende som har deltatt i etikkdrøftinger med kommunale etikkomiteer. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 9(1), p. 1–7. doi: 10.18261/tfo.9.1.10. Full text in Research Archive Show summary

  Bakgrunn: Det er sjelden at pårørende og pasienter inviteres til å drøfte etisk vanskelige situasjoner i kommunale etikkomiteer. I vår studie deltok pårørende i 10 av 54 drøftinger, mens pasienter ikke deltok i noen. Hva kan vi lære av pårørendes deltakelse i etikkdrøftinger? Metode: Dybdeintervjuer med seks pårørende som har deltatt i etikkdrøftinger. Materialet er analysert ved hjelp av en refleksiv tematisk innholdsanalyse. Hovedresultat: Pårørende var usikre i møte med etikkomiteene. De hadde behov for god og tilpasset informasjon om hva etikkomiteen var, hva formålet med drøftingen skulle være, og hva som var forventet av dem. «Etikkspråket» var et ukjent språk for deltakerne, men de ønsket å medvirke i drøftinger og beslutninger som angikk pasienten. Pårørende formidlet etisk ladede oppfatninger og erfaringer gjennom personlige fortellinger og følelser. Etikkomitémøter synes å være en egnet arena for reell brukermedvirkning for pårørende. Konklusjon: Kommunale etikkomiteer kan bidra til pårørendemedvirkning og bedre samhandling, men fordrer god informasjon, gode prosesser og at pårørendes tilnærming til etikk lyttes til og anerkjennes. En prinsippbasert etikkdrøfting kan utfylles og nyanseres med narrativ etikk.

• Karlsen, Heidi Marie; Magelssen, Morten & Thoresen, Lisbeth (2022). Etikkdrøftinger i kommunale etikkomiteer – hva bidrar det til? En studie av helsepersonells erfaringer. Nordisk sygeplejeforskning. ISSN 1892-2678. p. 1–14. doi: 10.18261/nsf.12.2.2. Full text in Research Archive
• Magelssen, Morten; Karlsen, Heidi Marie & Thoresen, Lisbeth (2021). Establishing Clinical Ethics Committees in Primary Care: A Study from Norwegian Municipal Care. HEC Forum. ISSN 0956-2737. p. 1–14. doi: 10.1007/s10730-021-09461-9. Full text in Research Archive Show summary

  Abstract Would primary care services benefit from the aid of a clinical ethics committee (CEC)? The implementation of CECs in primary care in four Norwegian municipalities was supported and their activities followed for 2.5 years. In this study, the CECs’ structure and activities are described, with special emphasis on what characterizes the cases they have discussed. In total, the four CECs discussed 54 cases from primary care services, with the four most common topics being patient autonomy, competence and coercion; professionalism; cooperation and disagreement with next of kin; and priority setting, resource use and quality. Nursing homes and home care were the primary care services most often involved. Next of kin were present in 10 case deliberations, whereas patients were never present. The investigation indicates that it might be feasible for new CECs to attain a high level of activity including case deliberations within the time frame. It also confirms that significant, characteristic and complex moral problems arise in primary care services.

• Magelssen, Morten & Karlsen, Heidi Marie (2021). Clinical ethics committees in nursing homes: what good can they do? Analysis of a single case consultation. Nursing Ethics. ISSN 0969-7330. doi: 10.1177/09697330211003269. Full text in Research Archive Show summary

  Background: Ought nursing homes to establish clinical ethics committees (CECs)? An answer to this question must begin with an understanding of how a clinical ethics committee might be beneficial in a nursing home context – to patients, next of kin, professionals, managers, and the institution. With the present article, we aim to contribute to such an understanding. Aim: We ask, in which ways can clinical ethics committees be helpful to stakeholders in a nursing home context? We describe in depth a clinical ethics committee case consultation deemed successful by stakeholders, then reflect on how it was helpful. Research design: Case study using the clinical ethics committee’s written case report and self-evaluation form, and two research interviews, as data. Participants and research context: The nursing home’s ward manager and the patient’s son participated in research interviews. Ethical considerations: Data were collected as part of an implementation study. Clinical ethics committee members and interviewed stakeholders consented to study participation, and also gave specific approval for the publication of the present article. Findings/results: Six different roles played by the clinical ethics committee in the case consultation are described: analyst, advisor, support, moderator, builder of consensus and trust, and disseminator. Discussion: The case study indicates that clinical ethics committees might sometimes be of help to stakeholders in moral challenges in nursing homes. Conclusions: Demanding moral challenges arise in the nursing home setting. More research is needed to examine whether clinical ethics committees might be suitable as ethics support structures in nursing homes and community care.

• Magelssen, Morten; Pedersen, Reidar; Karlsen, Heidi Marie & Thoresen, Lisbeth (2020). Implementing clinical ethics committees as a complex intervention: presentation of a feasibility study in community care. BMC Medical Ethics. 21(82). doi: 10.1186/s12910-020-00522-1. Full text in Research Archive Show summary

  Background How should clinical ethics support services such as clinical ethics committees (CECs) be implemented and evaluated? We argue that both the CEC itself and the implementation of the CEC should be considered as ‘complex interventions’. Main text We present a research project involving the implementation of CECs in community care in four Norwegian municipalities. We show that when both the CEC and its implementation are considered as complex interventions, important consequences follow – both for implementation and the study thereof. Emphasizing four such sets of consequences, we argue, first, that the complexity of the intervention necessitates small-scale testing before larger-scale implementation and testing is attempted; second, that it is necessary to theorize the intervention in sufficient depth; third, that the identification of casual connections charted in so-called logic models allows the identification of factors that are vital for the intervention to succeed and which must therefore be studied; fourth, that an important part of a feasibility study must be to identify and chart as many as possible of the causally important contextual factors. Conclusion The conceptualization of the implementation of a CEC as a complex intervention shapes the intervention and the way evaluation research should be performed, in several significant ways. We recommend that researchers consider whether a complex intervention approach is called for when studying CESS implementation and impact.

• Karlsen, Heidi Marie; Gjerberg, Elisabeth; Førde, Reidun; Magelssen, Morten; Pedersen, Reidar & Lillemoen, Lillian (2018). Etikkarbeid i kommunal helse- og omsorgstjeneste – evaluering av etikkrefleksjonens innhold og betydning. Nordisk sygeplejeforskning. ISSN 1892-2678. 8(1), p. 22–36. doi: 10.18261/issn.1892-2686-2018-01-03. Full text in Research Archive Show summary

  Bakgrunn: Ansatte i kommunal helse- og omsorgstjenestene står overfor mange etiske utfordringer i sin arbeidshverdag. Det nasjonale prosjektet «Samarbeid om etisk kompetanseheving (2007–2015)» i regi av KS, hadde som målsetting å styrke den etiske kompetansen i helse-, sosial- og omsorgstjenestene i kommunene. Etikkprosjektet ble avsluttet som prosjekt i 2015. I den forbindelse har Senter for Medisinsk Etikk (SME) gjennomført en evaluering. Målet med studien var å undersøke hvilke saker de ansatte drøftet i etikkrefleksjon, om etikksatsningen har hatt betydning for tjenestekvaliteten og arbeidsmiljøet, og eventuelt hva slags betydning, og i hvilken grad det hadde bidratt til økt etikk-kompetanse. Metode: Studien har et kvalitativt design, hvor fokusgruppeintervju med ansatte i direkte pasientrelatert arbeid er benyttet som metode. Studiens funn er basert på ti fokusgruppeintervjuer, med totalt 56 personer. Resultater: Ansatte i kommunal helse- og omsorgstjeneste erfarer å stå i komplekse utfordringer som fordrer faglig kompetanse, men også kompetanse i etikk og helsejuss. Det var stor variasjon mellom og innad i gruppene om hva man snakket om i refleksjonsgruppene, alt fra begreper og etiske prinsipper til mer konkrete problemstillinger fra egen praksis. Situasjoner som omhandlet ulike verdiavveininger synes å være særlig krevende, og utfordret dem på flere måter. De mest omtalte temaene var bruk av tvang, samhandling med pårørende og beslutninger om behandlingsintensitet. Konklusjon: Studien viser at ansatte i kommunal helse- og omsorgstjeneste opplever at etikksatsingen har vært et viktig bidrag til kvalitetsutvikling og kompetanseheving, for å håndtere etiske utfordringer på en bedre måte og ser ut til å ha stor betydning for yrkesutøvelsen og for arbeidsmiljøet.

• Karlsen, Heidi Marie; Lillemoen, Lillian; Magelssen, Morten; Førde, Reidun; Pedersen, Reidar & Gjerberg, Elisabeth (2018). How to succeed with ethics reflection groups in community healthcare? Professionals’ perceptions. Nursing Ethics. ISSN 0969-7330. 26(4), p. 1243–1255. doi: 10.1177/0969733017747957. Full text in Research Archive Show summary

  Background: Healthcare personnel in the municipal healthcare systems experience many ethical challenges in their everyday work. In Norway, 243 municipalities participated in a national ethics project, aimed to increase ethical competence in municipal healthcare services. In this study, we wanted to map out what participants in ethics reflection groups experienced as promoters or as barriers to successful reflection. Objectives: To examine what the staff experience as promoters or as barriers to successful ethics reflection. Research design: The study has a qualitative design, where 56 participants in municipal healthcare participated in 10 different focus-group interviews. Ethical considerations: The data collection was based on the participants’ informed consent and approved by the Data Protection Official of the Norwegian Centre for Research Data. Results: The informants had different experiences from ethics reflection group. Nevertheless, we found that there were several factors that were consistently mentioned: competence, facilitator’s role, ethics reflection groups organizing, and organizational support were all experienced as promoters and as a significant effect on ethics reflection groups. The absence of such factors would constitute important barriers to successful ethics reflection. Discussion: The results are coincident with other studies, and indicate some conditions that may increase the possibility to succeed with ethics reflection groups. A systematic approach seems to be important, the systematics of the actual reflections, but also in the organization of ethics reflection group at the workplace. Community healthcare is characterized by organizational instabilities as many vacancies, high workloads, and lack of predictability. This can be a hinder for ethics reflection group. Conclusion: Both internal and external factors seem to influence the organization of ethics reflection group. The municipalities’ instabilities challenging this work, and perceived as a clear inhibitor for the development. The participants experienced that the facilitator is the most important success factor for establishing, carrying out, and to succeed with ethics reflection groups.

• Grøndahl, Vigdis Abrahamsen; Fagerli, Liv Berit; Karlsen, Heidi Marie; Hansen, Ellen Rosseland; Johansson, Helena & Mathisen, Anne Gerd [Show all 7 contributors for this article] (2017). Impact of Person-Centered Care on Residents' Perceptions of Care Quality in Nursing Homes: An Intervention Study. The International Journal of Person Centered Medicine. ISSN 2043-7730. 7(2), p. 118–124. Full text in Research Archive

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• Sævareid, Trygve Johannes Lereim; Karlsen, Heidi Marie; Pedersen, Reidar; Heggestad, Anne Kari Tolo & Husebø, Bettina (2020). Belastende besøksstans. Full text in Research Archive
• Magelssen, Morten; Karlsen, Heidi Marie; Pedersen, Reidar & Thoresen, Lisbeth (2020). Correction to: Implementing clinical ethics committees as a complex intervention: presentation of a feasibility study in community care (BMC Medical Ethics, (2020), 21, 1, (82), 10.1186/s12910-020-00522-1). BMC Medical Ethics. 21(1). doi: 10.1186/s12910-020-00534-x. Full text in Research Archive
• Magelssen, Morten; Karlsen, Heidi Marie; Pedersen, Reidar & Lillemoen, Lillian (2018). Hvordan lykkes med etikkarbeidet? Fontene. ISSN 0805-5432. p. 56–61. Full text in Research Archive Show summary

  Artikkelen ble først publisert på sykepleien.no 6.10.17. ( https://sykepleien.no/forskning/2017/10/hvordan-lykkes-med-etikkarbeidet ). Denne lett omarbeidede versjonen ble trykket med tillatelse fra Sykepleien.

• Karlsen, Heidi Marie; Andersen, Beate; Bekkhus, Egil & Lillemoen, Lillian (2018). Å oppdage og behandle akutt sykdom. Tidsskriftet sykepleien. ISSN 0806-7511. doi: 10.4220/Sykepleiens.2018.70161. Full text in Research Archive
• Magelssen, Morten; Karlsen, Heidi Marie; Pedersen, Reidar & Lillemoen, Lillian (2017). Hvordan lykkes med etikkarbeidet? Sykepleien. ISSN 0039-7628. Full text in Research Archive
• Karlsen, Heidi (2023). Hva kan vi lære av erfaringer med å delta i etikkdrøftinger? En kvalitativ studie fra etikkomiteer i norsk kommunehelsetjeneste. Universitetet i Oslo. ISSN 9788234802805. Full text in Research Archive Show summary

  Introduction: Ethical challenges arise daily in the municipal health service. These challenges can be addressed systematically, and ethics committees can play a vital role to facilitate such discussions. The purpose of this study is to explore the experiences of individuals participating in ethical discussions and identify key factors that influence the establishment and operation of these committees. Method: This study adopts a qualitative approach, involving 22 in-depth interviews with healthcare personnel (stakeholders), six interviews with next-of-kin, and three focus group interviews with resource persons. A reflexive thematic content analysis is used. Results: Ethics discussions involved minimum stakeholders and committee members, with occasional inclusion of next-of-kin. No patients participated. Participants found ethics committees valuable, both at systemic and individual levels. Ethical discussions provided support and security in complex decision-making processes, though the ethics language could be unfamiliar and challenging to understand. The establishment and operation of ethics committees required significant effort. This placed substantial responsibility on resource persons. Discussion: Ethics committees offers help facilitate reflecting on crucial values, and can contribute to a broad discussions on challenging ethical issues. The participants experienced this valuable, while use of the specialized ethical language can be alienating. However, this language can also help structure and understand complex questions and emotions. Ethics discussions can promote better communication, when those who are affected are involved. Competence and resources are crucial, and municipal leadership has a key role to succeed.

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