When things go wrong. Stories of guilt, shame and responsibility in - - PowerPoint PPT Presentation

Research project:

When things go wrong….

Stories of guilt, shame and responsibility in health care.

Forthcoming book: Cappelen Damm Akademsk winter 2014

Terje Mesel Agder University Sørlandet sykehus ABUP

Task

• To analyse how stories of ”When things go wrong”

shape/constitute both professional identity and practice

• To analyse how existential moral concepts are put to play in

these stories

• Can clarification of these concept be useful for coping with

these stories both in relation to self, patients (next-of-kin) and collegues?

• Philosophical analysis:

– Responsibility, guilt, feeling of guilt, feeling of shame – Scapegoating mechanisms.

A qualitative narrative study

• 23 in-depth interviews

– 15 doctors, 2 psychologists, 5 nurses

• 9 narratives

– Thea and the art of balancing (responsiblity) – Per P and the female patient (guilt and responsibility) – Ellen E and 24 hours of rural practice (calibration) – Kari K and the dead infant (scapegoating and guilt) – Frida F and the suicidal patient (shame and coping)

– ……

Summary of findings

• Not stories of bad apples (the many contacts).
• Stories that change identity and practice

– Personal – professional reference points shaping lives – To give up/ get up/ defensive medicine

• To balance the concepts on your own:

– Responsibility and guilt (bad luck/to find the right viewpoint/e.g. Patient suicide in psychiatry – Calibration of moral guilt – feeling of guilt (non-moral guilt) – Shame and collegial nivellation (ethical bridging)

Ethical sustainability

• Sustainable professional responsibility in zones of

moral risk, demands a sustainable context for responsibility

• Professional shared responsibility or individualised

responsibility? – Moral crescendo, moral residue, moral injury

• Moral ventilation or procedures for (obligatory)

retrospective clinical assement – Focus on facts, responsibility, learning – but also possible blameworthiness.