The need for such training in practice is high: professionals are confronted with everyday, complex to highly complex dilemmatic situations in the workplace, but are hardly or only insufficiently prepared for them according to relevant scientific studies (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': to raise awareness among carers of the contradictory demands of the profession & improve the way 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 and empirically to date - possibly leading to (prospective) nurses leaving their profession.

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

Dilemmas can only be systematically avoided to a limited extent, they can never be resolved. They have to be decided for or against a reason for action and so moral dilemmas in particular raise questions of moral (in)culpability. The work of care professionals requires decisions not only in dynamic situations with serious consequences, which confront the person acting with responsibility for themselves and third parties 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 for not having acted differently.

Our 'how': creating a job-specific training program based on authentic dilemmas

Training courses on dealing with dilemmas are rare. There is hardly any reference to nursing care. Dilemma_I_care! is breaking new ground and is aiming for tetra- instead of di-lemma training (Varga von Kibéd & Sparre, 2023) - i.e. a guided discussion of values and dilemmas that goes beyond the presentation of just two (di-) action options and thus also has context-shaping potential. The training is implemented in Moodle and its effectiveness is tested in Moodle using a pretest intervention posttest design.


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 systemsicher Strukturaufstellungen. Carl-Auer.
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