Ethical problems related to intravenous fluids in nursing homes

Horntvedt, May-Elin Thengs; Romøren, Maria

doi:10.1177/0969733014521093

Cited by 5 publications

(7 citation statements)

References 19 publications

(96 reference statements)

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“…13 Situations involving a conflict between beneficence and non-maleficence are common in nursing. 14,34 This study agrees with another study in that the dilemma is further complicated when next of kin meddle in the treatment and nursing care 39 and as such take control of the patient’s autonomy. Next of kin often believe that they know what is best for the patient and the patient is for various reasons not strong enough or does not dare to contradict their next of kin.…”

Section: Discussionsupporting

confidence: 83%

“…Next of kin who are professional healthcare workers can be perceived as strong and demanding. 39,40 Our study indicates that next of kin themselves may feel a kind of confusion between their role as next of kin and their role as healthcare professionals. Demanding and angry next of kin are often afraid and sad.…”

Section: Discussionmentioning

confidence: 80%

“…At worst, next of kin can insist on treatment and care that does more harm than good to the patient. 39 Our study reveals that acting in the best interests of the patient is challenging, especially when the patient gives conflicting signals about what he wants or when the patient is suffering from cognitive impairment. Divergent signals and uncertainty about the patient’s capacity to make his own choices makes it difficult for the staff to ascertain what the patient really wants and also what is in his best interests.…”

Section: Discussionmentioning

confidence: 89%

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Ethical challenges related to next of kin - nursing staffs’ perspective

Tønnessen

Brinchmann

2016

Nurs Ethics

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 89%

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Ethical challenges related to next of kin - nursing staffs’ perspective

Tønnessen

Brinchmann

2016

Nurs Ethics

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“…Although the Norwegian health law demands more next of kin involvement when residents cannot consent, the providing physician has to make final decisions in cases involving consent incompetence [17]. Besides apparent advantages and benefits of next of kin involvement, this guardianship role may lead to tension, disagreement and conflict between relatives and health care professionals regarding infection treatment [18,19].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators of appropriate antibiotic use in primary care institutions after an antibiotic quality improvement program – a nested qualitative study

2022

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Background Antibiotic prescribing by physicians in primary care institutions is common and affected by several factors. Diagnosis and treatment of infections in a nursing home (NH) resident is challenging, with the risk of both under- and overtreatment. Identifying barriers and facilitators of appropriate antibiotic prescribing in NHs and municipal acute care units (MACUs) is essential to ensure the most adequate antibiotic treatment possible and develop future antibiotic stewardship programs. Methods After implementing a one-year antibiotic quality improvement program, we conducted six semi-structured focus group interviews with physicians (n = 11) and nurses (n = 14) in 10 NHs and 3 MACUs located in the county of Østfold, Norway. We used a semi-structured interview guide covering multiple areas influencing antibiotic use to identify persistent barriers and facilitators of appropriate antibiotic prescribing after the intervention. The interviews were audio-recorded and transcribed verbatim. The content analysis was performed following the six phases of thematic analysis developed by Braun and Clarke. Results We identified thirteen themes containing barriers and facilitators of the appropriateness of antibiotic use in primary care institutions. The themes were grouped into four main levels: Barriers and facilitators 1) at the clinical level, 2) at the resident level, 3) at the next of kin level, and 4) at the organisational level. Unclear clinical presentation of symptoms and lack of diagnostic possibilities were described as essential barriers to appropriate antibiotic use. At the same time, increased availability of the permanent nursing home physician and early and frequent dialogue with the residents’ next of kin were emphasized as facilitators of appropriate antibiotic use. The influence of nurses in the decision-making process regarding infection diagnostics and treatment was by both professions described as profound. Conclusions Our qualitative study identified four main levels containing several barriers and facilitators of appropriate antibiotic prescribing in Norwegian NHs and MACUs. Diagnostic uncertainty, frequent dialogue with next of kin and organisational factors should be targeted in future antibiotic stewardship programs in primary care institutions. In addition, for such programs to be as effective as possible, nurses should be included on equal terms with physicians.

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“…78,82,[87][88][89][90][91][92] Aynı zamanda, hemşirelik etiği ile ilişkili olarak literatürde; etik ikilem, etik sorun, etik eğitimi ve etik karar verme kavramlarına daha çok odaklanıldığı anlaşılmaktadır. 83,85,86,[93][94][95][96] Çalışma kapsamına alınan tezlerin yıllara yönelik dağılımlarına bakıldığında, çoğunlukla 2010 yılından sonra yapıldığı sonucuna varılmıştır. Literatür incelendiğinde, Besen (2016) tarafından gerçekleştirilen hemşirelik alanında yapılan lisansüstü tezlerin incelendiği bir çalışmada, tezlerin büyük çoğunluğunun 2007 yılı ve sonrasında yapıldığı saptanmıştır.…”

Section: Bulgularunclassified