The impact of healthcare ethics educational interventions on participants’ ethical development is rarely reported on and assessed; even less attention is paid to educational interventions that focus on end-of-life ethical issues.
Aim
To evaluate the impact of the Ethical Framework for End-of-Life Care Study Sessions Programme (EOLCSS) on the moral development of healthcare staff who are delivering end-of-life care.
Methods
The EOLCSS was delivered to 20 multi-disciplinary health care staff in Ireland in May 2013. Effect on moral reasoning was measured pre and post education using the Defining Issues Test 2 (DIT2). Inferential statistics were used to examine the relationships between change in DIT2 scores and demographic variables.
Results
Participants experienced moral reasoning development following receipt of EOLCSS. Age and previous ethics education contributed to the observed changes in moral reasoning.
Conclusions
Receipt of the EOLCSS may contribute to moral reasoning development in practicing healthcare professionals.
DonovanH. Quality Standards for End-of-Life Care in Hospitals: Making End-of-life Care Central to Hospital Care, Dublin: Irish Hospice Foundation, 2010.
2.
National Health Service (NHS), Department of Health. End of Life Care Strategy Promoting High Quality Care for all Adults at the End of Life Executive Summary, UK: Department of Health, 2008.
3.
World Health Organisation (WHO). Palliative Care The Solid Facts, Geneva: World Health Organisation, 2004.
4.
GamondiCLarkinPPayneS. Core competencies in palliative care: an EAPC White Paper on Palliative Care Education – Part 1. Eur J Palliat Care2013; 20: 86–91.
5.
GamondiCLarkinPPayneS. Core competencies in palliative care: an EAPC White Paper on Palliative Care Education – Part 2. Eur J Palliat Care2013; 20: 140–145.
6.
DuvalGClarridgeBGenslerG. National survey of U.S. internists' experiences with ethical dilemmas and ethics consultation. J Gen Intern Med2004; 19: 251–258.
7.
HurstSAPerrierAPegoraroR. Ethical difficulties in clinical practice: experiences of European doctors. J Med Ethics2007; 33: 51–57.
8.
Sorta-BilajacIBazdaricKBrozovicB. Croatian physicians' and nurses' experience with ethical issues in clinical practice. J Med Ethics2008; 34: 450–450.
9.
QuinlanCO NeillC. Practitioners’ Perspectives on Patient Autonomy at End of Life, Dublin: Irish Hospice Foundation, 2009.
10.
Mc KeownKHaaseTPratschkeJ. Dying in Hospital in Ireland: An Assessment of the Quality of Care in the Last Week of Life, Report 5, Final Synthesis Report, Irish Hospice Foundation: Dublin, 2010.
11.
Al-JalahmaMFakhrooE. Teaching medical ethics: implementation and evaluation of a new course during residency training in bahrain. Educ Health (Abingdon)2004; 17: 62–72.
12.
ChinJJVooTCKarimSA. Evaluating the effects of an integrated medical ethics curriculum on first-year students. Ann Acad Med Singapore2011; 40: 4–18.
13.
GoldieJSchwartzLMcconnachieA. The impact of a modern medical curriculum on students' proposed behaviour on meeting ethical dilemmas. Med Educ2004; 38: 942–949.
14.
SchuhLABurdetteDE. Initiation of an effective neurology resident ethics curriculum. Neurology2004; 62: 1897–1898.
15.
RestJThomaSEdwardsL. Designing and validating a measure of moral judgment: stage preference and stage consistency approaches. J Educ Psychol1997; 89: 5–28.
16.
RestJThomaSNarvaezD. Alchemy and beyond: indexing the defining issues test. J Educ Psychol1997; 89: 498–507.
17.
RestJNarvaezDBebeauM. A neo-Kohlbergian approach: the DIT and schema theory. Educ Psychol Rev1999; 11: 291–324.
18.
RestJNarvaezDThomaSJ. DIT2: devising and testing a revised instrument of moral judgment. J Educ Psychol1999; 91: 644–659.
19.
RestJNarvaezDThomaSJ. Postconventional moral thinking a neo-Kohlbergian approach, Mahwah, NJ: Lawrence Erlbaum Associates, Inc, 1999.
20.
RestJNarvaezDThomaSJ. A neo-Kohlbergian approach to morality research. J Moral Educ2000; 29: 381–395.
21.
ColbyAKohlbergL. The measurement of moral judgment: Vol. 1. Theoretical Foundations and Research Validation, New York, NY: Cambridge University Press, 1987.
22.
ColbyAKohlbergL. The Measurement of moral judgment: Vol. 2. Standard issue scoring manual, New York, NY: Cambridge University Press, 1987.
23.
DierufK. Ethical decision-making by students in physical and occupational therapy. J Allied Health2004; 33: 24–30.
24.
FleisherWPKristjansonCBourgeois-LawG. Pilot study of the defining issues test. Canadian Med Assoc J2003; 169: 1145–1146.
25.
PackerS. The ethical education of ophthalmology residents: an experiment. Trans Am Ophthalmol Soc2005; 103: 240–269.
26.
ParkMKjervikDCrandellJ. The relationship of ethics education to moral sensitivity and moral reasoning skills of nursing students. Nurs Ethics2012; 19: 568–580.
27.
PatenaudeJNiyonsengaTFafardD. Changes in the components of moral reasoning during students' medical education: a pilot study. Med Educ2003; 37: 822–829.
28.
AuvinenJSuominenTLeino-KilpiH. The development of moral judgment during nursing education in Finland. Nurse Educ Today2004; 24: 538–546.
29.
BebeauMJ. Enhancing professionalism using ethics education as part of a dental licensure board's disciplinary action. Part 2. Evidence of the process. J Am College Dent2009; 76: 32–45.
30.
GeddesLESalvatoriPEvaKW. Does moral judgement improve in occupational therapy and physiotherapy students over the course of their pre-licensure training?Learn Health Social Care2008; 8: 92–102.
31.
BaughcumAEGerhardtCAYoung-SalemeT. Evaluation of a pediatric palliative care educational workshop for oncology fellows. Pediatr Blood Cancer2007; 49: 154–159.
32.
QuinnKHudsonPAshbyM. Palliative care: the essentials: evaluation of a multidisciplinary education program. J Palliat Med2008; 11: 1122–1129.
33.
RogersSBabgiAGomezC. Educational interventions in end-of-life care. Part I: an educational intervention responding to the moral distress of NICU nurses provided by an ethics consultation team. Adv Neonatal Care2008; 8: 56–65.
34.
SchlaefliARestJRThomaSJ. Does moral education improve moral judgment? A meta-analysis of intervention studies using the defining issues test. Rev Educ Res1985; 55: 319–352.
35.
McCarthyJDonnellyMDooleyD. Ethical Framework for End-of-Life Care Study Sessions, Dublin: Irish Hospice Foundation, 2010. http://hospicefoundation.ie/publications/ethics/ (accessed 23 July 2015).
36.
WalkerLJ. The model and the measure: an appraisal of the Minnesota approach to moral development. J Moral Educ2002; 31: 353–367.
SPSS Inc. SPSS Base 14.0 User’s Guide, Chicago: SPSS Inc, 2005.
39.
BebeauMJThomaSJ. Guide for DIT-2: A Guide for Using the Defining Issues Test, Version 2 (‘DIT-2') and the Scoring Service of the Center for the Study of Ethical Development, Minneapolis: Center for the Study of Ethical Development, University of Minnesota, 2003.
40.
RestJRNarvaezD. Moral Development in the Professions Psychology and Applied Ethics, NJ: Lawrence Erlbaum Associates, Inc, 1994.
41.
BebeauMJ. Enhancing professionalism using ethics education as part of a dental licensure board's disciplinary action. Part 1. An evidence-based process. J Am College Dent2009; 76: 38–50.
42.
BebeauMJBrabeckMM. Integrating care and justice issues in professional moral education: a gender perspective. J Moral Educ1987; 16: 189–203.
43.
RestJ. DIT Manual, Minneapolis, MN: Center for the Study of Ethical Development, 1986.
44.
GilliganC. In a Different Voice, Cambridge, MA: Harvard University Press, 1982.
45.
BayD. A critical evaluation of the use of the DIT in accounting ethics research. Crit Perspect Account2002; 13: 159–177.
46.
BernardiRAArnoldDF. An examination of moral development within public accounting by gender, staff level and firm. Contemp Account Res1997; 14: 653–668.
47.
PiperTGentileMParksS. Can Ethics Be Taught?, New York, NY: Praeger, 1993.
