[The Tübingen Model "Ethics Consultants on the Ward": a pilot project to establish decentralized structures of clinical ethics consultation at a university hospital].

definition of the problemClinical ethics committees form an integral part of ethics management and organizational ethics in clinical healthcare facilities. However, working mostly reactive and not being anchored in the corresponding organizational levels, such instruments are limited in terms of effectiveness. ARGUMENTS: Based on these shortcomings of clinical ethics consultation the multiprofessional working group "Ethics" at the University Hospital Tübingen, Germany has endeavored to design and implement new structures for sustainable ethical decision-making processes on its hospital wards. The Tübingen Model "Ethics Consultants on the Ward" is a pilot project intended to appoint specifically trained nursing staff on all wards as contact partners for ethical issues. Thus, the Tübingen Model represents an extension to established structures of clinical ethics consultation and complements existing top-down strategies.

conclusionsThis article presents the objectives of the Tübingen Model and describes initial experiences in its implementation. After explaining their role within the existing structures of ethics consultation at the hospital, the tasks of the ethics consultants within and across the hospital's wards are presented. Furthermore, the qualification program for ethics consultants (basic and advanced training) as well as a train-the-trainer concept are presented, which support an in-depth development of competencies in nursing as well as medical ethics and provide confidence in the reflection and decision-making processes on the ward.