A European multicenter study on systematic ethics work in nursing homes

Bollig, Georg; Rosland, Jan Henrik; Gjengedal, Eva; Schmidt, G; May, Arndt T.; Heller, Andreas

doi:10.1111/scs.12373

Cited by 11 publications

(15 citation statements)

References 48 publications

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“…A review points toward clashing ethical principles in nursing homes, as well as limited resources, communication issues, and poor care quality (Preshaw et al, 2016). One way to deal with moral issues is implementing systematic ethics work that fosters a greater awareness of ethical aspects, personal and professional development, understanding and respect for colleagues and patients, along with cooperation and new ways to approach difficult situations (Bollig et al, 2017; Magelssen et al, 2018).…”

Section: Review Of Literaturementioning

confidence: 99%

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis

2021

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Introduction Internationally, aging populations have increased needs for health care services, and often specialized care is required. However, services for older people tend to be underfunded, resulting in lack of qualified staff and poor quality care. Resource shortages lead to ethical challenges and insufficient nursing care. Therefore, quality in daily care for older people also depends upon the nurses’ ability to make complex, ethical decisions in their practice. Objectives To explore ethical challenges experienced by nurses caring for older people in clinical practice, and to provide examples of management for the challenges. Methods The data collected were written reflection notes by Norwegian continuous education students in advanced gerontology. Forty two of 83 notes were included and a thematic analysis in six steps was utilized. Findings There are three main themes: (1) meeting vulnerability, discomfort, and suffering, (2) collaboration with relatives, and (3) struggling to perform professional care. Conclusion Nurses strive to “do what is in the patients’ best interest”, and this is fostered through collaboration, professionalism, care, and presence. Nurses’ ethical competencies may develop when reflecting upon their own care performance. Building ethical competencies should be a priority in both nursing education and clinical practice. However, to improve care quality, nurses also need professional knowledge about older people care and ethical awareness should be supported by the workplace.

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Section: Review Of Literaturementioning

confidence: 99%

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis

2021

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“…Chochinov [111] offers a framework for exploring how 'dignity-conserving care' can assist a patient to die with dignity. Recent research by Bollig et al [9] and Bollig [71] highlights the ethical challenges surrounding decision-making and end of life care in nursing homes. Cartwright [112] argues "Health professionals need to understand the fears and concerns of their patients, their preferred place to die and to respect patient autonomy" (p. 57).…”

Section: Discussionmentioning

confidence: 99%

“…However, we may wish to reflect upon the degree to which the social processes of total institutions also lie in ruins, to be replaced by respect, dignity, autonomy and beneficence" (p. 81). For Bolig et al [9] the nursing home setting presents a complex array of ethical issues involving insufficient resources, resident autonomy, use of restraints and decision making regarding end-of-life care.…”

Section: Introductionmentioning

confidence: 99%

Aging, Informed Consent and Autonomy: Ethical Issues and Challenges Surrounding Research and Long-Term Care

Seedsman¹

2019

obm geriatr

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The history surrounding the notion of 'informed consent' is provided in the interest of setting a framework for the emergence of an ethics of aged care. Informed consent negligence is seen as a breach of duty involving potential litigation through the legal concept of 'failure to warn'. Respect for the autonomy of older persons is highlighted as a cornerstone of care by medical professionals and family members. There remains the challenge, however, of caring for older people who do not have full decision-making capacity. Research involving older people creates a range of ethical issues that warrants the use of best practice principles that respect the autonomy, integrity, dignity and safety of older participants. The use of restraints as part of aged care is demonstrated to have implications for infringements of human rights. While promoting the importance between communication and ethics of care, a case is made for the adoption of a person-centred approach that acknowledges both the autonomy and personhood of older people. In relation to the quality of aged care and safety, the message for all caregivers is to ensure that all decisions large or small incorporate a genuine mix of ethical reflection, avoidance of unnecessary risks and prudent judgement that leads to the most beneficial course of action.

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“…The best ways to deal with moral issues in patient care is implementing systematic ethics work raising awareness and fostering a climate of openness and dialogue (30,31). Collective systematic ethics work may foster greater awareness of ethical aspects, personal and professional development, understanding and respect for colleagues and patients, along with cooperation and new ways to approach di cult situations (13,(32)(33)(34).…”

Section: Ethical Challenges In Clinical Practicementioning

confidence: 99%

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care - A Qualitative Thematic Analysis

Rykkje

Holm

Hem

2020

Preprint

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Background: Many countries face an increasingly older population in need of health care services. There are reports of lack of qualified staff and resources, resulting in poor quality and undignified care. Care quality is depended upon factors like organization and staffing, but it is also recommended to focus on what staff members experience in clinical practice. In addition, ethical competence is a precondition for high quality care. The aim of this study is to provide knowledge about ethically challenging situations in caring for older people in institutions such as nursing homes and hospitals, and to gain insight into nurses’ written reflections about their experiences and management of ethical challenges in clinical practice.Methods: The data material consist of reflection notes by continuous education students in advanced gerontology in Norway. Data was collected in 2017–2018. We included 42 of 83 notes and utilized qualitative thematic analysis.Findings: “Doing what is in the patients’ best interest” is the guiding principle for the participants, portrayed through three themes as follows: a) Meeting vulnerability, discomfort and emotional pain, b) Collaboration with relatives, and c) Struggling to perform professional care. Within each theme, we provide a variety of ethically challenging situations in older people care. The findings represent the participants’ written experiences and reflections upon how they manage the situation and their effort to provide the best possible care.Conclusions: Health care professionals’ ethical competences may develop when reflecting upon their care performance. Therefore, building ethical competence should be a priority in education of healthcare professionals and in clinical practice. We acknowledge that ethical reflection does not automatically improve care quality, although we find that it fosters increased awareness of one’s action, and as such, it can act as a potential for change.Implications for practice: How nurses reflect upon and manage challenging situations indicates that quality in care is possible despite scarce resources, and this may contribute to reduce ageism and encourage health care personnel to be willing to work in older people care.

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A European multicenter study on systematic ethics work in nursing homes

Cited by 11 publications

References 48 publications

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis

Aging, Informed Consent and Autonomy: Ethical Issues and Challenges Surrounding Research and Long-Term Care

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care - A Qualitative Thematic Analysis

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