The need for such training in practice is high: professionals are confronted with everyday, complex to highly complex dilemmatic situations in the workplace, but according to relevant scientific studies, they are hardly or only insufficiently prepared for them (Basso-Musso, 2012; Monrouxe & Rees, 2017).

The online dilemma training is available in seven languages (German, English, French, Spanish, Italian, Bulgarian, Romanian) following a scientific trial.

Our 'why': raising awareness among carers of contradictory demands in the profession & improving how they deal with them

The project is dedicated to transnational, authentic moral dilemmas in the workplace of (prospective) nurses. Dilemmas are an underestimated reason for extreme stress, which has hardly been addressed practically or empirically to date – and may contribute to (prospective) nurses leaving the profession.

Moral dilemmas are fundamentally characterized by two mutually exclusive options for action, each of which is supported by moral reasons, such as a moral imperative or norm. Example: Would I make a colleague's serious medication error public or conceal it out of loyalty? Should I answer a patient with dementia honestly when she asks whether she will return home, saying that this will very probably never happen again – even at the risk of making her even more restless – or should I say something evasive, perhaps even untrue, but reassuring?

Dilemmas can only be systematically avoided to a limited extent; they can never be fully resolved. They require a decision for or against a reason for action. Moral dilemmas in particular therefore raise questions of moral guilt or innocence. The work of care professionals requires decisions not only in dynamic situations with serious consequences, but also in moments that confront the person acting with responsibility for themselves and others in a special way. According to relevant studies, professionals are unprepared or underprepared for this challenge (e.g. Monrouxe & Rees, 2017; Basso-Musso, 2012). It is not uncommon for dilemmas to be accompanied by lasting regret about not having acted differently.

Our 'how': creating a profession-specific training programme based on authentic dilemmas

Training courses on dealing with dilemmas are rare. There is hardly any specific reference to nursing care. Dilemma_I_care! is breaking new ground and aims for tetra- instead of di-lemma training (Varga von Kibéd & Sparre, 2023). The tetralemma does not increase complexity in decision-making; instead, it encourages thinking beyond a simple either–or framework and opens up additional pathways for action. The training is implemented in Moodle, and its effectiveness is tested in Moodle using a pretest-intervention-posttest design.

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*Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them.

Sources:

  • Basso-Musso, L. (2012). Nursing and the resolution of ethical dilemmas. Invest Educ Enferm. 2012;30(2): 260-268.
  • Monrouxe, L. V., & Rees, C. E. (2017). Healthcare professionalism: improving practice through reflections on workplace dilemmas. John Wiley & Sons.
  • Varga von Kibéd, M. & Sparrer, I. (2023). Ganz im Gegenteil. Tetralemmaarbeit und andere Grundformen systemischer Strukturaufstellungen. Carl-Auer.
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