HERE IS HOW YOU CAN USE THE MOVIE AS A TEACHING TOOL, or as "DIALOGUE PROVOKING" TOOL about Moral Distress


1. FULL FILM : 

Total time required: 90 minutes. [Introduction (10 minutes); film showing (50 minutes); audience dialogue (30 minutes)].

The film can be viewed without interruption by the class, and comments and discussions can be held afterwards under the leadership of a team leader/teacher with previous knowledge of Moral Distress literature. 

Moral distress is a significant factor in clinician well-being and staff retention; it can cause clinicians to believe that they are not fulfilling their moral obligations and that their professional (and personal) integrity is in jeopardy. Determining ways to mitigate and/or resolve it is important to the evolution of healthcare ethics.

Using the film as a touchstone for dialogue, audience participants will be asked to share insights gained into moral distress and its dynamics as played out in an intensive care environment. As well, they should be encouraged to suggest strategies for addressing the reality-based situations of moral distress revealed in the film. How might clinicians and other team members be supported in their ongoing quest to practice ethically in healthcare environments, particularly where “pushing the envelope” is the norm?

A second area of dialogue will also be pursued: is film an effective way to share qualitative research findings in bioethics, to foster deeper understanding of ethical practice issues?

 

2. VIEW WITH INTERRUPTIONS

Discussion: Intermission  1: 

1. ROLE of PHYSICIAN, NURSES and ALLIED PROFESSIONALS, and the power to decide… When to start? When to finish.  How about when staff say to parents,” I am the boss” …? Don’t listen to nurses…

2. How to accommodate DIFFERENT VIEWS – parent’s conflicts between them? Staff differences with parents.

4. Religious beliefs against your OWN.

5. Second thoughts about PICU as a career choice? 

Discussion INTERMISSION  2:

1. Antagonism, conflict with parents

2. How to face the parents who say: don’t take my hope away, when you believe it is for the best for the child to die?

3. How to manage day to day ICU life when you think you frequently feel that what you are doing is not very ethical?   are not doing what is best for your patient in your ethical view?

 Discussion: INTERmission  3:

1. Withdrawal of therapy – language : Should we say – Let nature takes its course, remove technology that does not have a purpose any longer?

2. Children death vs adult/old people’s death: different?

Final Discussion: End of Play Excerpts

·       Being ethical in PICU settings: Constraints; Supports

o   Formal decision-making structures 

o   Variable experiences by discipline

o   Variable attitudes by individual

o   Power and authority

o   Addressing and/or resolving moral distress

Issues

o   Parents refusing treatment

o   Informed consent for treatment

o   End-of-life decision-making

o   Futility of care vs GOALS OF THERAPY : better wording?