Nurses' Moral Distress on Caring for Older Adults with Dementia Residing in Long-Term Care Centers

Abstract

This study aimed to understand nurses' experiences of moral distress when caring for elderly dementia patients who reside in long-term care centers. Methods: Colaizzi's phenomenological approach was used for this study. The participants included eight nurses. Semi-structured in-depth interviews were used to collect data from February to August 2019. Results: Three categories emerged from the analysis. The nurses reported experiences of moral distress when caring for older adults with dementia. Theses experiences included "worrying about sincere care", "a sense of guilt about task-oriented care", "a feeling of helplessness because they cannot advocate care". Seven theme clusters and 17 themes emerged in this study. The participants stated feeling conflicted about the meaning of care when they know secondary problemes will occur, but inevitably choose the next-best care option. The nurses could not provide proper care to their patients due to their overburdened workloads. The participants experienced a sense of guilt for caring only about the task at hand, without empathy. They felt helpless because that could not represent human rights and felt the gap between principle and reality as a nurse. Conclusion: These results suggest nurses' moral distress must be considered to improve elderly dementia care. It is ethically and morally necessary for education programs to focus on caring for elderly dementia patients, and these findings can guide the program's content and direction.

Nurses’ Experience of Nursing Workload-Related Issues during Caring Patients with Dementia: A Qualitative Meta-Synthesis

“…Nurses in dementia care were under pressure from demanding workloads and time constraints [ 26 , 31 , 32 ]. As dementia care is time-consuming, nurses’ daily schedules were disrupted, and they experienced time shortages [ 32 ].…”

“…Others reported feeling skeptical toward the nursing profession when dementia patients constantly committed sexual harassment, which is another symptom of dementia [ 27 ]. Some nurses felt guilty when they had to take the second best option: for instance, lying to their patients to pacify dementia symptoms, forcibly suppressing their demands, unwillingly administering necessary medication, or defending themselves using barriers [ 26 ].…”

“…In addition, some nurses found themselves paying less attention to dementia patients when there were other patients who needed physical assistance [ 26 ]. Initially, nurses regretted such decisions; however, they eventually found themselves becoming habituated to such situations, observing that they were becoming emotionally numb [ 26 ].…”

“…In addition, some nurses found themselves paying less attention to dementia patients when there were other patients who needed physical assistance [ 26 ]. Initially, nurses regretted such decisions; however, they eventually found themselves becoming habituated to such situations, observing that they were becoming emotionally numb [ 26 ]. Nurses reported that their occupational identity was at risk, as they were constantly exposed to events such as criticisms from guardians, delusion, aggression from elderly dementia patients, and death of their patients [ 26 , 27 ].…”

“…There were no articles that met all items of the CASP checklist; for instance, some articles did not address potential researcher bias and participant recruitment strategies. However, articles that remained in the final selection were all peer-reviewed, published in reputable academic journals, and included quality information on nurse experiences in dementia care [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]; therefore, they were deemed to have ample value as data for the current study.…”