Aging 4.0? Rethinking the ethical framing of technology-assisted eldercare.

Technological approaches are increasingly discussed as a solution for the provision of support in activities of daily living as well as in medical and nursing care for older people. The development and implementation of such assistive technologies for eldercare raise manifold ethical, legal, and social questions. The discussion of these questions is influenced by theoretical perspectives and approaches from medical and nursing ethics, especially the principlist framework of autonomy, non-maleficence, beneficence, and justice. Tying in with previous criticism, the present contribution is taking these principles as a starting point and as a frame of reference to be critically re-examined. It thus aims to outline how existing ethical frameworks need to be extended or reconsidered to capture the ethical issues posed by technological developments regarding care for older people. In a first step, we provide a brief overview of assistive technologies in eldercare according to their purposes and functions. In the next step, we discuss how the questions and problems raised by new technologies in eldercare call for an expansion, re-interpretation, and revision of the principlist framework. We underline that the inclusion of ethical perspectives from engineering and computer science as well as a closer consideration of socio-political dimensions and fundamental anthropological and praxeological questions are needed.

Ethical Conflicts Experienced by Nurses in Geriatric Hospitals in South Korea: "If You Can't Stand the Heat, Get Out of the Kitchen".

Ethical conflicts among nurses can undermine nurses' psychological comfort and compromise the quality of patient care. In the last decade, several empirical studies on the phenomena related to ethical conflicts, such as ethical dilemmas, issues, problems, difficulties, or challenges, have been reported; however, they have not always deeply explored the meaning of ethical conflicts experienced by nurses in geriatric care. This study aims to understand the lived experiences of ethical conflict of nurses in geriatric hospitals in South Korea. A phenomenological study was conducted. In-depth, face-to-face interviews were performed with nine registered nurses who cared for elderly patients in geriatric hospitals in South Korea between August 2015 and January 2016. Three main themes emerged from the analysis: (1) confusing values for good nursing, (2) distress resulting from not taking required action despite knowing about a problem, and (3) avoiding ethical conflicts as a last resort. It was found that for geriatric nurses to cope with ethical conflicts successfully, clear ethical guidance, continuing ethics education to improve ethical knowledge and moral behaviors, and a supportive system or program to resolve ethical conflicts involving nurses should be established.

Caring for elder patients: Mutual vulnerabilities in professional ethics.

BACKGROUND:: Neglect and abuse of elders in care institutions is a recurring issue in the media. Elders in care institutions are vulnerable due to their physical, cognitive, and verbal limitations. Such vulnerabilities may make them more susceptible to mistreatment by caregivers on whom they are heavily dependent. OBJECTIVES:: The goal was to understand caregivers' concerns about ensuring correct and proper treatment, as well as their experiences with neglect and abuse of older patients. This article examines resources and challenges of professional ethics within the care setting. RESEARCH DESIGN:: A study was conducted to explore the quality of care provided to older patients in nursing homes, geriatrics institutions, and ambulant care in the northwest region of Switzerland. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 23 semi-structured interviews were conducted with nursing staff of varying experience levels. ETHICAL CONSIDERATIONS:: Ethical approval was granted by the competent regional ethics commission, Ethikkomission Nordwest-und Zentralschweiz EKNZ [Ethics Commission Northwest and Central Switzerland] (2014-015). FINDINGS:: Three themes emerged from our data analysis: professional identity, professional context, and professional relationships. Our findings indicate mutual vulnerabilities within these three themes, characterizing the interactions between nursing staff and older patients. Study participants believe that incidences of error, neglect, and abuse are consequences of their own vulnerability since they are not able to meet the demands of an overstraining work situation. DISCUSSION:: Different aspects of this mutual vulnerability are described and critically discussed as challenges for professional ethics. CONCLUSION:: Early education, continuous training as well as better management and response from the institution are necessary to maintain professionalism while handling mutual vulnerabilities.

A humanização da assistência na ótica de profissionais que cuidam de idosos / The humanization of assistance from the perspective of nursing professionals that care for the elderly / La humanización de la atención desde la perspectiva de profesionales de enfermería que asisten a ancianos

Objetivo: Desvelar, a partir da ado

Objective: To know, with the adoption of the Jean Watsoris Theory, the experience of the nursingprofessional in the development of care and relationship with institutionalized elderly. Method: Exploratory, descriptive and qualitative study, based on Watson's Theory of Human Caring, in which participated 24 employees from long-term institutions for the elderly, located in the State of Sao Paulo, Brazil. Data were collected through interviews conducted from November/2012 to February/2013, examined by content analysis and categorization was in accordance with the adopted theoretical framework. Results: Pointed out that care was unveiled in the humanization of care and in the interpersonal relationship between nursing professionals and the elderly. Care anchored in nine of the 10 Ítems of Clinical Caritas Processes and, despite reports expressing its principies, there was some lack of preparation front of the finitude/death. Conclusión: The professionals demonstrated knowing and using essential human elements in elderly care, as advocates Watson; however, they need to (re)construct ways to deal with the events of death.

Objetivo: Conocer, mediante la teoría de Jean Watson, la vivencia del profesional de enfermería en el desarrollo de la asistencia y relación con los ancianos institucionalizados. Metodología: Estudio descriptivo, exploratorio, con abordaje cualitativo, basado en la teoría del cuidado transpersonal de Watson. Participaron 24 empleados de un centro de atención a largo plazo para ancianos, que se encuentra en el estado de Sao Paulo, Brasil. Los datos se recolectaron mediante entrevistas realizadas entre noviembre de 2012 y febrero de 2013, examinadas por análisis de contenido. La categorización ocurrió conforme el marco teórico adoptado. Resultados: El cuidado se da la humanización de la atención y las relaciones interpersonales entre los profesionales de enfermería y los ancianos. Así mismo, está anclado en nueve de los diez factores de los Clinical Caritas Processes. A pesar de que los informes expresan sus principios, se percibió falta de preparación frente a la finitud/muerte. Conclusiones: Los profesionales de enfermería demostraron conocer y utilizar los elementos esenciales del hombre en el cuidado de ancianos, tal como se propone Watson; sin embargo, es necesario reconstruir formas de lidiar con las dimensiones de la muerte.

Using Ethical Frameworks in Times of Transition and Uncertainty.

Health care policy is never easy and always fraught with concerns about quality, access, and cost. Currently, uncertainty abounds regarding new federal and state policies on the horizon for older adult care and quality. Empirics undergird most policy-making decisions regarding risk/benefit, cost, and knowing the best action to put in place for the best results. However, in times of great change in policy direction and political viewpoints, empirical knowledge must be combined with ethical knowledge for planning and implementation. Ethical and moral judgment has long been a mainstay of nursing practice and organizational leadership. Using ethical knowledge as a framework will be a crucial guide for nurses and health professionals and society to prioritize action and decisions in policy. [Journal of Gerontological Nursing, 43(3), 8-12.].

De la enfermera general a la enfermera geriátrica / From the general nurse to the geriatric nurse

Introducción: la definición enfermera está estrechamente ligada a su función y en consecuencia la definición de enfermería. Es un profesional que se dedica al cuidado de la salud de los seres humanos. La historia de la enfermería profesional comenzó con Nightingale, sus postulados sobre la formación de las enfermeras en la instrucción de principios científicos y experiencias prácticas para el desarrollo de habilidades sirvieron de modelo universal para las primeras escuelas de enfermería, lo que devino en la formación de enfermeras en las diferentes especialidades, como la atención al paciente geriátrico. Este temprano acierto en la formación de recursos de enfermería se refleja en las diferentes definiciones de enfermera que se aprecian en las diversas teorías aplicadas a enfermería. Objetivo: indagar sobre la evolución de la definición de enfermera, teniendo en cuenta su indispensable valor en la atención al paciente anciano. Métodos: se realizó análisis de contenido de documentos, que incluyó distintos libros de texto, artículos originales y de revisión publicados de 1993 al 2015 con las siguientes palabras clave, enfermera, geriatría, enfermería en SciELO, Dialnet y elsevier, se identificaron y revisaron 20 artículos de los que fueron útiles 11, así como monografías de varias revistas que permitió el análisis histórico lógico de la evolución de la categoría. Conclusiones: la indagación sobre la evolución de la definición de enfermera geriátrica permitió definir operacionalmente esta categoría, a partir de las particularidades de la enfermera geriátrica y el reto que enfrenta la demanda de servicios de geriatría y de enfermería en correspondencia con la satisfacción de necesidades al paciente geriátrico(AU)

Introduction: The definition of nurse is closely related to the professional's function and, in consequence, the definition of nursing, too. That person is a professional dedicated to caring for the health of human beings. The history of professional nursing started with Nightingale: her postulates about the training of nurses in the instruction of scientific principles and practical experiences for the development of skills served as a universal model for the first nursing schools, which later became the training of nurses in the different specialties, such as the care for the geriatric patient. This positive aspect at the beginning in the training of nursing resources is reflected in the deferent definitions of nursing perceived in the different theories applied to nursing. Objective: Inquire into the evolution of the definition of nurse, considering the indispensable value in the care for the elderly patient. Methods: Documental contents analysis was carried out, which included different text books, original and review articles published from 1993 and 2015 with the following key words: nurse, geriatrics, nursing, in SciELO, Dialnet and Elsevier. We identified and reviewed 20 articles, out of which 11 were useful, as well as monographs from several journals, which permitted the logical-historical analysis of the category's evolution. Conclusions: Inquiries into the evolution of the definition of geriatric nurse permitted to operationally define this category, from the particularities of the geriatric nurse and the challenge before the geriatric and nursing services demand in correspondence with the meeting of the geriatric patient's needs(AU)

MORAL DISTRESS.

Australia has an ageing nursing workforce with many nurses due to retire (Health Workforce Australia, 2014). Coupled with increasing service demands, the need for workers will outstrip the supply (CEPAR - ARC Centre of Excellence in Population Ageing Research, 2014).

Far from a 'fallback' job option, care home nursing is a privilege.

How sad to read that care home nursing is seen as 'something people do when they cannot get a job elsewhere' (News, April 29). I chose care home nursing straight out of university.

Manifestation of respect in the care of older patients in long-term care settings.

BACKGROUND: Respect is fundamental to ethical nursing practice. However, respect in the care of older people is seldom investigated from the perspective of patients and their next of kin. AIM: To describe the manifestation of respect in the care of older patients in long-term care settings from the perspective of older patients with memory disorders and their next of kin. DESIGN AND METHODS: A narrative inquiry on research methodology using open interviews was employed. Transcribed interviews were analysed using inductive content analysis, and from this analysis a typology was produced. SETTINGS: The study settings were patients' own homes supported by professional home care, and nursing homes in three cities in southern Finland. PARTICIPANTS: A purposeful sample (N = 40) of participants (older patient, n = 20 and their next of kin, n = 20) was recruited. Half of the older patient lived at home where they received professional care and the other half lived in nursing homes. RESULTS: Respect in long-term care settings is manifested in patient care through the being and doing of the nurse. A typology of nurses' being and doing described three ways nurses manifested respect: 'I'm here for you', 'I'm here for work' and 'I'm not here for you'. Patient's responses to the typology were as follows: sharing, exploring and withdrawing, respectively. CONCLUSIONS: The analysis and typology of nurses' being and doing increases the understanding of respect in patient care in long-term care settings. Furthermore, this knowledge of respect will make it possible to develop measureable respect indices for use in the evaluation of care.

Validation of the Hospital Ethical Climate Survey for older people care.

BACKGROUND: The exploration of the ethical climate in the care settings for older people is highlighted in the literature, and it has been associated with various aspects of clinical practice and nurses' jobs. However, ethical climate is seldom studied in the older people care context. Valid, reliable, feasible measures are needed for the measurement of ethical climate. OBJECTIVES: This study aimed to test the reliability, validity, and sensitivity of the Hospital Ethical Climate Survey in healthcare settings for older people. DESIGN: A non-experimental cross-sectional study design was employed, and a survey using questionnaires, including the Hospital Ethical Climate Survey was used for data collection. Data were analyzed using descriptive statistics, inferential statistics, and multivariable methods. PARTICIPANTS AND RESEARCH CONTEXT: Survey data were collected from a sample of nurses working in the care settings for older people in Finland (N = 1513, n = 874, response rate = 58%) in 2011. ETHICAL CONSIDERATIONS: This study was conducted according to good scientific inquiry guidelines, and ethical approval was obtained from the university ethics committee. RESULTS: The mean score for the Hospital Ethical Climate Survey total was 3.85 (standard deviation = 0.56). Cronbach's alpha was 0.92. Principal component analysis provided evidence for factorial validity. LISREL provided evidence for construct validity based on goodness-of-fit statistics. Pearson's correlations of 0.68-0.90 were found between the sub-scales and the Hospital Ethical Climate Survey. DISCUSSION: The Hospital Ethical Climate Survey was found able to reveal discrimination across care settings and proved to be a valid and reliable tool for measuring ethical climate in care settings for older people and sensitive enough to reveal variations across various clinical settings. CONCLUSION: The Finnish version of the Hospital Ethical Climate Survey, used mainly in the hospital settings previously, proved to be a valid instrument to be used in the care settings for older people. Further studies are due to analyze the factor structure and some items of the Hospital Ethical Climate Survey.

Ethics and safety in home care: perspectives on home support workers.

Home support workers (HSWs) encounter unique safety issues in their provision of home care. These issues raise ethical concerns, affecting the care workers provide to seniors and other recipients. This paper is derived from a subproject of a larger Canada-wide study, Safety at Home: A Pan-Canadian Home Care Safety Study, released in June 2013 by the Canadian Patient Safety Institute. Semi-structured, face-to-face, audiotaped interviews were conducted with providers, clients and informal caregivers in British Columbia, Manitoba and New Brunswick to better understand their perceptions of patient safety in home care. Using the BC data only, we then compared our findings to findings of other BC studies focusing on safety in home care that were conducted over the past decade. Through our interviews and comparative analyses it became clear that HSWs experienced significant inequities in providing home care. Utilizing a model depicting concerns of and for HSWs developed by Craven and colleagues (2012), we were able to illustrate the physical, spatial, interpersonal and temporal concerns set in the context of system design that emphasized the ethical dilemmas of HSWs in home care. Our data suggested the necessity of adding a fifth domain, organizational (system design). In this paper, we issue a call for stronger advocacy for home care and improved collaboration and resource equity between institutional care and community care.

Ethics and gender issues in palliative care in nursing homes: an Austrian participatory research project.

BACKGROUND: The development of palliative care in nursing homes in German-speaking countries has gained in importance within the past 15-20 years. Ethical and gender issues are core aspects of a palliative care culture and should therefore be better understood. AIMS AND OBJECTIVES: The aim of this study was to highlight insights regarding ethical and gender issues, based on the experiences of professionals in nursing homes. DESIGN: A 2-year participatory action research study was performed in collaboration with three nursing homes in Austria. METHODS: The article focusses on 10 group discussions with interdisciplinary professional teams that were conducted to generate ethical narratives. Thematic and narrative analysis was undertaken both individually and within the interdisciplinary research team. Findings and interpretations were validated with practitioners and researchers. FINDINGS: A total of 36 narratives were collected and summarised within eight themes concerning the theoretical journey of a nursing home resident with relatives from entry into the house until death. The most burdensome ethical dilemmas are not the ones around death and dying but rather those relating to small-scale everyday work/life issues. Sharing experiences and feelings in ethical discussions provides relief. Emotions are important facilitators of insight into ethical dilemmas. Gender issues can be observed in care situations as well as in the organisational structure of nursing homes. CONCLUSIONS: Opportunities to share experiences and perspectives around ethical questions in interdisciplinary group discussions help professionals to better understand difficult issues and find appropriate ways of managing them. IMPLICATIONS FOR PRACTICE: There is a need for communication structures such as facilitated ethical discussions that enable nursing home staff to reflect their everyday decisions. Expression of emotions should be encouraged in ethical decision-making processes in nursing homes. Gender-sensitive reflection supports the development of palliative care as organisational culture.

Re-examining the basis for ethical dementia care practice.

Ethical nursing practice is an important component of quality dementia care. To be ethically competent, and to acquire the language, knowledge and skills required to explore and resolve ethical dilemmas in practice, the nurse needs an understanding of ethics and of the theory behind ethical decision-making. Traditional theories of ethics and ethical principles are commonly used to explore the dilemmas faced in dementia care practice. While these theories remain influential in healthcare practice, more contemporary ethical theories are equally relevant to the examination of the ordinary and extraordinary ethical dilemmas that present in conditions such as dementia. In this article, the ethical considerations central to effective dementia care nursing will be examined.