Care Ethics for Supported Decision-making. A Narrative Policy Analysis Regarding Social Work in Cases of Dementia and Self-neglect

Thelin, Angelika

doi:10.1080/17496535.2020.1863998

Cited by 2 publications

(2 citation statements)

References 31 publications

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“…19 Hence, self-determination can result in ethical challenges when people with limited ability must choose and act based on their own choices. 20,21 In the context of ambulance service, older and frail patients have complex care needs, which places great demands on the ACs' ability to identify and manage these needs while respecting the patient's selfdetermination and considering their decision-making ability. Hence, the ACs' attention to the patient relationship, with the aim of promoting and protecting patient autonomy, is central.…”

Section: Introductionmentioning

confidence: 99%

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Ambulance clinicians’ understanding of older patients’ self-determination: A vignette study

Bennesved,

Bremer,

Svensson

et al. 2023

Nurs Ethics

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Background Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. Aim To describe ambulance clinicians’ understanding of older patients’ self-determination when the patient’s decision-making ability is impaired. Research design A qualitative design with an inductive approach, guided by descriptive phenomenology. Participants In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. Findings The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination. Conclusion The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous.

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Section: Introductionmentioning

confidence: 99%

“… 19 Hence, self-determination can result in ethical challenges when people with limited ability must choose and act based on their own choices. 20 , 21 …”

Section: Introductionmentioning

confidence: 99%

Ambulance clinicians’ understanding of older patients’ self-determination: A vignette study

Bennesved,

Bremer,

Svensson

et al. 2023

Nurs Ethics

View full text Add to dashboard Cite

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Human Rights and the Ways Relatives Interpret Participation for People with Dementia in Nursing Homes

Ingard,

Sjölund,

Trygged

2024

J. Hum. Rights Soc. Work

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The exercise of self-determination is a human right; however, for people with dementia (PWD), progressive physical and cognitive impairment negatively affects their decision-making processes. For PWD, it is often relatives who make such decisions. This qualitative study included interviews with sixteen relatives of PWD who live in nursing homes. Research questions are as follows: How do relatives understand the participation of PWD who live in nursing homes? How do co-researchers understand participation and the role of relatives? A co-researcher was consulted when the questions were designed. During the interviews with relatives, photos were used to stimulate discussion. Critical situations in nursing homes were discussed with relatives and later interpreted together with a co-researcher. The findings included an understanding of how relatives played a key role in PWD; however, relatives were concerned that PWD were unable to take part in decisions. In addition, relatives named ways that nursing homes opposed human rights, and the co-researchers also highlighted situations that conflicted with human rights. Classifying dementia as a disability at the policy level could strengthen the rights issues of PWD. The key findings of the study are essential for social workers arranging for placement of PWD in nursing homes.

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Care Ethics for Supported Decision-making. A Narrative Policy Analysis Regarding Social Work in Cases of Dementia and Self-neglect

Cited by 2 publications

References 31 publications

Ambulance clinicians’ understanding of older patients’ self-determination: A vignette study

Ambulance clinicians’ understanding of older patients’ self-determination: A vignette study

Human Rights and the Ways Relatives Interpret Participation for People with Dementia in Nursing Homes

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