Thesis

174 Chapter 7 The pilot’s second type of reason for resistance – the ‘wish for more focus on actions in practice than on reflection’ – is also present in our main study. Overall, MCD is by definition a reflective intervention. Some professionals may always feel a need for a more practical type of instrument and will never appreciate the strong focus on reflections during MCD. Indeed, sometimes a more pragmatic approach is needed. For example, one team that clearly stated it would help them to have more general teammeetings instead of MCD was excluded from our research and started with more regularly planned team meetings. For the other teams, we made some adjustments to implement MCD in a way that could help impact their practice. For example, we skipped the step of formulating a broad moral question related to the case (usually part of the third step of the dilemma method: Stolper et al., 2016), and instead, formulated only the moral dilemma at the start of the MCD. Skipping that step created more room for the step of translating insights and conclusions into concrete plans at the end of the sessions. By having team-based sessions, Chapter 3 showed, participants experienced the discussed cases as recognizable and therefore useful to discuss for their own practice. Still, participants mentioned more attention should be devoted to improving the transfer of insights from MCD to practice (Ch. 3 and 6). The third reason for resistance from the pilot showed that staff felt ‘unfamiliar with ethics and moral dilemmas’. Based on those findings, we modified our approach to the main study by adding an introduction session for each team before starting with MCD, and advising the facilitators to adjust their ethics vocabulary. For example, making use of other words than moral doubt, moral questions et cetera. Such adjustments seemed to have helped with overcoming this reason for resistance. The introductory meeting of the MCD series was evaluated positively, and facilitators mentioned how it helped create fruitful MCD sessions later. Facilitators got more and more used to the typical DCIA jargon, with many abbreviations, and used less of their ethical jargon they are accustomed to using with health care professionals during MCD. However, a part of the participating prison staff still experienced difficulties when they tried to bring forward a moral dilemma (Ch.3). Unlike in the pilot, in our regulated approach all team members participated in MCD: not always in all sessions, but all team members were part of the MCD series. And so, they learned – became more morally aware – by hearing of moral dilemmas from direct colleagues, they experienced how recognizable such dilemmas were and opened up about their own challenges from practice.

RkJQdWJsaXNoZXIy MjY0ODMw