Developing and Testing Digital Ethical Reflection in Long-Term Care: Nurses’ Experiences

Abstract

Introduction Nurses working in municipal long-term care face ethical challenges that can lead to moral distress and discomfort for the nurse and affect the quality of patient care. Tools and methods that contribute to increased ethical awareness and support for nurses dealing with moral issues are lacking. Technological innovations may be suitable for ethics work, but little research has been conducted on how such solutions could be designed or their potential benefit. Therefore, this study contributes knowledge about the development and testing of a digital tool for ethics support among nurses. Objective To investigate how digital ethical reflection can support ethics work among nurses working in long-term care. Methods A digital ethical reflection tool was designed and tested in nursing homes and home nursing care in collaboration with two Norwegian municipalities. The study used sequential explanatory mixed-methods design. Over a 6-week period, at the end of each shift, nurses digitally reported the ethical challenges they had experienced. Their responses and experiences were described using descriptive statistics. Additionally, focus group interviews were conducted and analyzed using reflexive thematic analysis (TA). Results During the study period, 17 nurses reported a total of 223 registrations, with 24.8% stating that they had been in an ethically difficult situation. The digital reporting was perceived as practically applicable and helped to increase nurses’ awareness of morally charged situations. The value of the registrations was found to depend on manager participation and the application of the obtained information. The participating nurses become aware that they lacked an arena for meaningful dialogue with and recognition from their manager. Conclusions Information obtained through digital reflection can form the basis for ethical reflections at the departmental level. Digital reflection has the potential to become a tool for managers in their support for employees facing ethical challenges when providing long-term care.

Alone and together: registered nurses’ experiences of work satisfaction in municipal home healthcare

“…The present study underscores the importance of co-worker support in RNs’ work satisfaction, agreeing with a previous finding on co-worker support being crucial for retention [ 15 ]. However, RNs are missing opportunities to reflect upon ethical dilemmas and experience a lack of support from their managers [ 31 ]. Furthermore, RNs’ personal contacts may not be able to provide them with the needed support due to patient confidentiality limitations in HHC [ 32 ].…”

Managers' perceptions of the factors affecting resident and patient safety work in residential settings and nursing homes: A qualitative systematic review

“…Organizations should also support informal learning processes to enhance the process of learning from everyday work (Sujan, 2015; Sujan et al, 2017). New tools and methods, such as digital ethical reflection tools, could become a tool for managers in their support for employees who face ethical challenges when providing long‐term care (Jakobsen et al, 2023).…”

Creating Workplace Environments that Support Ethical Practice

“…Evidence from the literature describes initiatives emphasising the value of reflection, for example, by forming ethics reflection groups and the ethics round. Although it is suggested that discussing norms and values with colleagues contributes to a sense of reflective and moral conformity and fosters an ethical climate (6), nurse managers should also be…”