2019, Vol.22, No.4

Korean Journal of Medical Ethics 2024 KCI Impact Factor : 1.15

pISSN : 2005-8284 / eISSN : 2234-3598
https://journal.kci.go.kr/medethics

Clinical Ethics Support Services (CESS) aim to assist those confronting ethical issues that arise in the course patient treatment. CESS enhances the quality of health care by identifying and resolving ethical issues in a systematic fashion. In Korea, while the function of Institutional Ethics Committees varies somewhat from one institution to the next, most committees focus mainly on administrative services related to life-sustaining treatment. Due to improvements in medical technology and a rapidly changing social environment, a multidisciplinary approach is essential to assisting medical personnel in the area of clinical ethics. This study examines the key participants and core competencies of CESS providers and considers what knowledge or skills could improve them. It is argued that the core competencies for CESS are the ability to investigate and evaluate ethical issues and the ability to reach agreements by means of arbitration and conciliation in the case of disputes. Understanding the suffering of individual patients and recognizing the uniqueness of each patient are also essential to effective mediation on critical life-related issues. CESS providers should be trained to understand the difficulties that patients facing existential problems experience and to advocate for those patients.

This study examines people’s experiences with the disclosure of patient safety incidents (DPSI), which is known to be effective in decreasing medical disputes and improving the relationships between patients and medical professionals. Data on people’s experiences with, and the impacts of, patient safety incidents were collected by means of an online survey of 201 individuals. Only 30.3% (n=61) of participants had experienced full DPSI. The study found that those who experienced patient safety incidents with permanent disability or death were significantly less likely to report expressions of sympathy and regret from the relevant medical professionals than those who experienced patient safety incidents with a lower level of harm (p=0.003). The percentage of participants who reported sleep disorders was 35.3% for “no disclosure”, 28.1% for “partial disclosure”, and 31.3% for “full disclosure” (p=0.673). The results of the survey indicate that those who experience patient safety incidents do not in general receive proper responses from the relevant medical professionals. This in turn suggests that detailed guidelines and training programs for DPSI are required and that psychological and other forms of support should be provided to patients and caregivers who experience patient safety incidents.

This study was designed to develop and test a structural model of moral courage based on Kim’s explanatory model of practice domain phenomena. For this study a cross-sectional survey was carried out on 300 nurses recruited from six hospitals in South Korea. The endogenous and exogenous variables of this hypothetical model on moral courage were years of clinical experience, nursing organizational culture, humanism, and compassion. Data were collected from April to June, 2017, and analyzed with SPSS 20.0 and AMOS 22.0. The model showed a good fit: χ2/df=2.79, goodness of fit index (GFI)=.95, root mean squared error of approximation (RMSEA)=.08, standardized root meansquared residual (SRMR)=.04, Tucker-Lewis index (TLI)=.90, comparative fit index (CFI)=.94, Parsimonious Normed of Fit Index (PNFI)=.60. All the explanatory variables for moral courage were statistically significant. Relationship-innovation oriented organizational culture was indirectly significant. The variables explained 43% of moral courage. The results of this study support the establishment of a body of nursing knowledge based on a model of moral courage as a concept of nursing practice domain. Effective strategies for promoting moral courage in nursing practice include relationshipinnovation oriented organizational cultures and the training of nurses in moral competency through working experience.