Identifying ethical and legal issues in elder care

Abstract

Background: As a non–European Union member state, Albania is increasingly orienting itself on Western models regarding human rights, patient rights, and legal regulations for healthcare. Due to its limited fiscal and legal power, enforcing legal and ethical regulations poses a major problem. Aim: The aim of this study is to investigate nurse’s knowledge and experiences regarding ethical and legal issues in Albanian elder care in state-funded and privately run institutions. Research design: The study was conducted using an inductive and qualitative design, utilizing a focused ethnographic approach, based on Roper and Shapira’s framework. Method: Data were collected between June 2017 and September 2018 using participant observation, field notes, and semi-structured interviews with 15 nurses in seven different elder care institutions. In total, 100 h of observation and 15 interviews were performed. Data analysis was based on Mayring’s qualitative content analysis. Ethical consideration: The approval for the study was obtained from UMIT—The Health and Life Sciences University, Austria. Findings: The findings of the study fell into the following main categories: “Everyday care issues,” “End-of-life issues,” “Legal issues,” and “Ethical-legal education and conflicts.” Discussion: The participants reported many ethical and legal issues when describing their everyday challenges and displayed a strong lack of ethical and legal education. Despite a wide spectrum in the quality of care between private and state-funded nursing homes, older people mostly do not know their own diagnosis. Conclusion: This study indicates that further ethical and legal education is needed. Furthermore, nurses need to be better prepared for ethical conflicts with families, as strengthening patient rights could come into conflict with traditional rights of the Albanian family.

Patient Autonomy, Decision-making and Cultural Impact in Elder Care in Albania

“…Any issues were resolved by personal discussion and validation within the research team. Furthermore, the professional experience of the first and second authors as nurses and their cultural familiarity with the research participants improved the validity of the research method and results [8].…”

“…An explorative qualitative research design was selected for the study. Data were collected through semi-structured interviews and field notes [8]. These interviews focus on considering the participants in their working environment and considering the researcher's observations.…”

“…After getting permission for the observation within the institutions (seven eldercare institutions) and the interviews, the contact information was shared, and the nurses were contacted. Of 30 initial contacts, 15 nurses were willing to participate in the study and followed through until its completion [8]. Interested nurses received a consent form through mail or email and received verbal information about the project.…”

“…Telling the patient their diagnosis against the family's will is a severe infringement of professional confidentiality. Instead, nurses try to convince families to inform the elderly or communicate the diagnosis nonverbally [8].…”

End of life care during the COVID‐19 pandemic: A qualitative study on the perspectives of nurses and nurse assistants

“…Health care professionals play a significant role in combating this health problem, particularly when patients suffer from severe symptoms that require hospital admission for treatment or even palliative care, as the main providers of end‐of‐life care. Several studies have demonstrated that nurses and nurse‐assistants experience pressure, burden, and emotional challenges concerning an increase in patient deaths (Hanna et al, 2021a , 2021b ; Podgorica, Flatscher‐Thöni, et al, 2021 ; Podgorica, Pjetri, et al, 2021 ; Podgorica, Shabani, et al, 2022 ) and insufficient resources to provide care (Mehta et al, 2021 ; Podgorica, Shabani, et al, 2022 ; Podgorica, Zenzmaier, et al, 2022 ). Previous studies focused on emotional and psychological distress that affected health care professionals' well‐being (Huang et al, 2020 , 2021 ; Mitchinson et al, 2021 ; Rathnayake et al, 2021 ).…”