Research on ethics in nursing care for older people: A literature review

Suhonen, Riitta; Stolt, Minna; Launis, Veikko; Leino‐Kilpi, Helena

doi:10.1177/0969733010361445

Cited by 38 publications

(67 citation statements)

References 73 publications

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“…The findings of this study also underpin the importance of strengthening the moral and ethical awareness of healthcare professionals in NHs. 6,9,18,[20][21][22][23] The daily ethical challenges encountered in NHs require that nurses can reflect critically on their actions. The moral competence of nurses might develop, and moral difficulties may be avoided, if challenging situations are the subjects of critical reflection and review in the NH.…”

Section: Interaction and Decision-making Processesmentioning

confidence: 99%

Ethical problems related to intravenous fluids in nursing homes

Horntvedt

Romøren

2014

Nurs Ethics

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Section: Interaction and Decision-making Processesmentioning

confidence: 99%

Ethical problems related to intravenous fluids in nursing homes

Horntvedt

Romøren

2014

Nurs Ethics

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“…The main focus in the literature seems to be on the patient’s right to be informed and take part in decisions concerning medical treatment and end-of-life care [3, 14, 15, 18–20]. In the present study, theory on family ethics has been useful to sensitize our understanding of the complexity of ACP-conversations, and we ask whether family ethics perspectives may strengthen the nursing home patients’ possibilities to get his or her values and preferences known or expressed.…”

Section: Introductionmentioning

confidence: 99%

“I just think that we should be informed” a qualitative study of family involvement in advance care planning in nursing homes

Thoresen

Lillemoen

2016

BMC Med Ethics

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BackgroundAs part of the research project “End-of-life Communication in Nursing Homes. Patient Preferences and Participation”, we have studied how Advance Care Planning (ACP) is carried out in eight Norwegian nursing homes. The concept of ACP is a process for improving patient autonomy and communication in the context of progressive illness, anticipated deterioration and end-of-life care. While an individualistic autonomy based attitude is at the fore in most studies on ACP, there is a lack of empirical studies on how family members’ participation and involvement in ACP- conversations may promote nursing home patients’ participation in decisions on future treatment and end-of-life care. Based on empirical data and family ethics perspectives, the purpose of this study is to add insights to the complexity of ACP-conversations and illuminate how a family ethics perspective may improve the quality of the ACP and promote nursing home patients’ participation in advance care planning.MethodsParticipant observations of ACP-conversations in eight nursing homes. The observations were followed by interviews with patients and relatives together on how they experienced being part of the conversation, and expressing their views on future medical treatment, hospitalization and end-of-life issues.ResultsWe found that the way nursing home patients and relatives are connected and related to each other, constitutes an intertwined unit. Further, we found that relatives’ involvement and participation in ACP- conversations is significant to uncover, and give the nursing home staff insight into, what is important in the nursing home patient’s life at the time. The third analytical theme is patients’ and relatives’ shared experiences of the dying and death of others. Drawing on past experiences can be a way of introducing or talking about death.ConclusionsAn individual autonomy approach in advance care planning should be complemented with a family ethics approach. To be open to family ethics when planning for the patient’s future in the nursing home is to be open to diversity and nuances and to the significance of the patient’s former life and experiences.

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“…Healthcare professionals in community care experience many and important ethical dilemmas [9, 13, 15, 16]. Van der Dam et al reviewed the literature on ethics support in institutional elderly care and identified 60 papers [10].…”

Section: Introductionmentioning

confidence: 99%

The Norwegian national project for ethics support in community health and care services

et al. 2016

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BackgroundInternationally, clinical ethics support has yet to be implemented systematically in community health and care services. A large-scale Norwegian project (2007–2015) attempted to increase ethical competence in community services through facilitating the implementation of ethics support activities in 241 Norwegian municipalities. The article describes the ethics project and the ethics activities that ensued.MethodsThe article first gives an account of the Norwegian ethics project. Then the results of two online questionnaires are reported, characterizing the scope, activities and organization of the ethics activities in the Norwegian municipalities and the ethical topics addressed.ResultsOne hundred and thirty-seven municipal contact persons answered the first survey (55 % response rate), whereas 217 ethics facilitators from 48 municipalities responded to the second (33 % response rate). The Norwegian ethics project is vast in scope, yet has focused on some institutions and professions (e.g., nursing homes, home-based care; nurses, nurses’ aides, unskilled workers) whilst seldom reaching others (e.g., child and adolescent health care; physicians). Patients and next of kin were very seldom involved. Through the ethics project employees discussed many important ethical challenges, in particular related to patient autonomy, competence to consent, and cooperation with next of kin. The “ethics reflection group” was the most common venue for ethics deliberation.ConclusionsThe Norwegian project is the first of its kind and scope, and other countries may learn from the Norwegian experiences. Professionals have discussed central ethical dilemmas, the handling of which arguably makes a difference for patients/users and service quality. The study indicates that large (national) scale implementation of CES structures for the municipal health and care services is complex, yet feasible.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-016-0158-5) contains supplementary material, which is available to authorized users.

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Research on ethics in nursing care for older people: A literature review

Cited by 38 publications

References 73 publications

Ethical problems related to intravenous fluids in nursing homes

Ethical problems related to intravenous fluids in nursing homes

“I just think that we should be informed” a qualitative study of family involvement in advance care planning in nursing homes

The Norwegian national project for ethics support in community health and care services

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