RESUMO
BACKGROUND: Among a growing population of older persons, many affected by multiple diseases and complex needs, are cared for in nursing homes. Previous studies of nursing homes have highlighted the importance of personalised palliative care. Nevertheless, we know little about whether everyday care practice involving assistant nurses and frail older persons accomplishes ethical encounters, especially in assisted bodily care. Therefore, the aim of this study was to understand and conceptualize the encounter between residents and assistant nurses in bodily care-situations at the end of life in a nursing home. METHODS: Focused ethnographic design was used. Residents and assistant nurses from one nursing home in an urban Swedish area participated in this study. Data were collected for 6 months and consisted of 170 h of fieldwork, including participant observation and interviews. Observations and digitally recorded interviews were analysed thematically. Five public community stakeholders contributed to the analysis by discussing preliminary results and clinical implications in a focus group. RESULTS: Four themes, each encompassing both barriers to and facilitators of ethical encounters in assisted bodily care, were identified: Coping with the impact of workplace demands; Interacting in dialogue and communication; Experiencing involvement in the provision of assisted bodily care; and Adapting to good care and comfort. CONCLUSIONS: The findings suggest that accomplishing ethical encounters in assisted bodily care practice in a nursing home context has many barriers that are related to communication, relationships, and quality of care. Barriers included lack of resources, ineffective communication, and work values, which hinder ethical encounters. Nevertheless, moral sensitivity, genuine interest in resident engagement, and collaborative practices facilitated ethical encounters and are thus central to person-centred care. Uniquely, assistant nurses must be aware of their responsibility for performing their tasks in response to residents' vulnerability. We therefore suggest that moral deliberation over issues of communication, compassion, decision-making, and behavior, with particular consideration for the care relationship. To further improve the quality of care, organisations must provide resources for the building of relationships, as well as time for assistant nurses to recover after long shifts. Additional research is warranted, including implementation of ethically grounded palliative care.
Assuntos
Antropologia Cultural/ética , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/ética , Assistentes de Enfermagem/ética , Casas de Saúde/ética , Cuidados Paliativos/ética , Idoso , Idoso de 80 Anos ou mais , Morte , Idoso Fragilizado , Humanos , Entrevistas como Assunto/métodos , Princípios Morais , Observação , Suécia , População UrbanaRESUMO
AIMS AND OBJECTIVES: To explore barriers to ethical nursing practice for older adults in long-term care facilities from the perspectives of nurses in South Korea. BACKGROUND: The number of older adults admitted to long-term care facilities is increasing rapidly in South Korea. To provide this population with quality care, a solid moral foundation should be emphasised to ensure the provision of ethical nursing practices. Barriers to implementing an ethical nursing practice for older adults in long-term care facilities have not been fully explored in previous literature. DESIGN: A qualitative, descriptive design was used to explore barriers to ethical nursing practice as perceived by registered nurses in long-term care facilities in South Korea. METHODS: Individual interviews were conducted with 17 registered nurses recruited using purposive (snowball) sampling who care for older adults in long-term care facilities in South Korea. Data were analysed using qualitative content analysis. RESULTS: Five main themes emerged from the data analysis concerning barriers to the ethical nursing practice of long-term care facilities: emotional distress, treatments restricting freedom of physical activities, difficulty coping with emergencies, difficulty communicating with the older adult patients and friction between nurses and nursing assistants. CONCLUSIONS: This study has identified methods that could be used to improve ethical nursing practices for older adults in long-term care facilities. Because it is difficult to improve the quality of care through education and staffing alone, other factors may also require attention. RELEVANCE FOR CLINICAL PRACTICE: Support programmes and educational opportunities are needed for nurses who experience emotional distress and lack of competency to strengthen their resilience towards some of the negative aspects of care and being a nurse that were identified in this study.
Assuntos
Cuidados de Enfermagem/ética , Instituições de Cuidados Especializados de Enfermagem/ética , Idoso , Feminino , Humanos , Assistência de Longa Duração/ética , Masculino , Pessoa de Meia-Idade , Princípios Morais , Assistentes de Enfermagem/ética , Qualidade da Assistência à Saúde , República da Coreia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Ethical issues are increasingly being reported by care-providers; however, little is known about the nature of these issues within the nursing home. Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress. OBJECTIVES: The purpose of this review was to identify prior research which focuses on ethical issues in the nursing home and to explore staffs' experiences of ethical issues. METHODS: Using a systematic approach based on Aveyard (2014), a literature review was conducted which focused on ethical and moral issues, nurses and nursing assistants, and the nursing home. FINDINGS: The most salient themes identified in the review included clashing ethical principles, issues related to communication, lack of resources and quality of care provision. The review also identified solutions for overcoming the ethical issues that were identified and revealed the definitional challenges that permeate this area of work. CONCLUSIONS: The review highlighted a need for improved ethics education for care-providers.
Assuntos
Ética Institucional , Ética em Enfermagem , Assistentes de Enfermagem/ética , Casas de Saúde/ética , Recursos Humanos de Enfermagem/ética , Tomada de Decisões/ética , Humanos , Relações Interprofissionais/ética , Assistentes de Enfermagem/psicologia , Recursos Humanos de Enfermagem/psicologia , Pesquisa Qualitativa , Restrição Física/éticaRESUMO
Healthcare assistants must always act in a patient's best interests.
Assuntos
Assistentes de Enfermagem/ética , Assistência Centrada no Paciente , Humanos , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Reino UnidoRESUMO
In Sweden, individuals affected by severe stroke are treated in specialized stroke units. In these units, patients are attended by a multiprofessional team with a focus on care in the acute phase of stroke, rehabilitation phase, and palliative phase. Caring for patients with such a large variety in condition and symptoms might be an extra challenge for the team. Today, there is a lack of knowledge in team experiences of the dilemmas that appear and the consequences that emerge. Therefore, the purpose of this article was to study ethical dilemmas, different approaches, and what consequences they had among healthcare professionals working with the dying patients with stroke in acute stroke units. Forty-one healthcare professionals working in a stroke team were interviewed either in focus groups or individually. The data were transcribed verbatim and analyzed using content analysis. The ethical dilemmas that appeared were depending on "nondecisions" about palliative care or discontinuation of treatments. The lack of decision made the team members act based on their own individual skills, because of the absence of common communication tools. When a decision was made, the healthcare professionals had "problems holding to the decision." The devised and applied plans could be revalued, which was described as a setback to nondecisions again. The underlying problem and theme was "communication barriers," a consequence related to the absence of common skills and consensus among the value system. This study highlights the importance of palliative care knowledge and skills, even for patients experiencing severe stroke. To make a decision and to hold on to that is a presupposition in creating a credible care plan. However, implementing a common set of values based on palliative care with symptom control and quality of life might minimize the risk of the communication barrier that may arise and increases the ability to create a healthcare that is meaningful and dignified.
Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida/ética , Enfermagem em Neurociência/ética , Cuidados Paliativos/ética , Direito a Morrer/ética , Acidente Vascular Cerebral/enfermagem , Assistência Terminal/ética , Atitude do Pessoal de Saúde , Atitude Frente a Morte , Barreiras de Comunicação , Feminino , Humanos , Masculino , Assistentes de Enfermagem/ética , Assistentes de Enfermagem/psicologia , Recursos Humanos de Enfermagem Hospitalar/ética , Recursos Humanos de Enfermagem Hospitalar/psicologia , Equipe de Enfermagem/ética , Fisioterapeutas/ética , Fisioterapeutas/psicologia , Pesquisa Qualitativa , Reabilitação do Acidente Vascular Cerebral , SuéciaRESUMO
Internationally, research on the consequences of errors caused by nurses is quite comprehensive. In contrast, the body of knowledge on the effects that errors have on the nurses themselves is rather small. It is well known that errors can have profoundly negative outcomes on nurses. In some cases, however, errors can have useful ramifications. This paper shows the research results of a representative cross-sectional survey that covers 1,100 nurses working in German hospitals and nursing homes and illustrates the effects of errors on them. Most participants in the sample mentioned feelings of regret/remorse and irritation/annoyance/stress as an effect when they made a mistake. More than half of the nurses state that they also learnt from their errors. Hospital nurses frequently suffer from psychological effects while nursing home nurses experience more often professional or legal consequences. With increasing age and professional experience the nurses indicate a lower error impact. The answers given by nurse assistants differ from those of nurses with a three-year training course. The results suggest an amount of stress that may reduce efficiency and increase susceptibility to mistakes and which, therefore, needs to be remedied.
Assuntos
Instituição de Longa Permanência para Idosos , Erros Médicos/enfermagem , Casas de Saúde , Recursos Humanos de Enfermagem Hospitalar/psicologia , Recursos Humanos de Enfermagem/psicologia , Adaptação Psicológica , Adulto , Atitude do Pessoal de Saúde , Competência Clínica , Estudos Transversais , Coleta de Dados , Ética em Enfermagem , Feminino , Alemanha , Culpa , Instituição de Longa Permanência para Idosos/ética , Humanos , Masculino , Erros Médicos/ética , Pessoa de Meia-Idade , Relações Enfermeiro-Paciente/ética , Assistentes de Enfermagem/ética , Assistentes de Enfermagem/psicologia , Casas de Saúde/ética , Recursos Humanos de Enfermagem/ética , Recursos Humanos de Enfermagem Hospitalar/ética , Vergonha , Inquéritos e Questionários , Adulto JovemAssuntos
Relações Comunidade-Instituição , Satisfação no Emprego , Papel do Profissional de Enfermagem/psicologia , Assistentes de Enfermagem/ética , Atitude do Pessoal de Saúde , Comportamento do Consumidor , Instituição de Longa Permanência para Idosos , Humanos , Assistência de Longa Duração , Narração , Relações Enfermeiro-Paciente , Assistentes de Enfermagem/educação , Casas de Saúde , PercepçãoAssuntos
Assistência de Longa Duração/métodos , Relações Enfermeiro-Paciente , Assistentes de Enfermagem/ética , Cuidados de Enfermagem/ética , Instituição de Longa Permanência para Idosos , Humanos , Assistência de Longa Duração/ética , Narração , Papel do Profissional de Enfermagem , Assistentes de Enfermagem/psicologia , Cuidados de Enfermagem/métodos , Casas de Saúde , Assistência ao Paciente/normas , Assistência ao Paciente/tendênciasAssuntos
Atitude Frente a Morte , Relações Enfermeiro-Paciente/ética , Assistentes de Enfermagem/educação , Competência Profissional , Escolha da Profissão , Empatia , Humanos , Aprendizagem , Masculino , Narração , Papel do Profissional de Enfermagem , Enfermeiros/ética , Enfermeiros/psicologia , Assistentes de Enfermagem/éticaAssuntos
Atitude Frente a Morte , Cuidadores/psicologia , Assistentes de Enfermagem/ética , Assistentes de Enfermagem/psicologia , Cuidadores/ética , Pesar , Instituição de Longa Permanência para Idosos , Humanos , Narração , Papel do Profissional de Enfermagem/psicologia , Relações Enfermeiro-Paciente , Casas de SaúdeAssuntos
Satisfação no Emprego , Relações Enfermeiro-Paciente/ética , Assistentes de Enfermagem/ética , Relações Profissional-Família/ética , Escolha da Profissão , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Narração , Papel do Profissional de Enfermagem , Assistentes de Enfermagem/psicologia , Casas de Saúde , Assistência ao Paciente , Populações VulneráveisAssuntos
Relações Enfermeiro-Paciente/ética , Assistentes de Enfermagem/ética , Lealdade ao Trabalho , Competência Profissional , Escolha da Profissão , Feminino , Cuidados Paliativos na Terminalidade da Vida/ética , Cuidados Paliativos na Terminalidade da Vida/psicologia , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/ética , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/normas , Humanos , Satisfação no Emprego , Narração , Papel do Profissional de Enfermagem , Assistentes de Enfermagem/psicologia , Melhoria de Qualidade , Fatores de TempoAssuntos
Escolha da Profissão , Satisfação no Emprego , Assistentes de Enfermagem/ética , Assistentes de Enfermagem/psicologia , Qualidade de Vida , Idoso de 80 Anos ou mais , Certificação , Correspondência como Assunto , Empatia , Feminino , Humanos , Narração , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente/ética , Fatores de TempoAssuntos
Cuidadores/psicologia , Relações Enfermeiro-Paciente/ética , Assistentes de Enfermagem/ética , Equipe de Enfermagem/ética , Garantia da Qualidade dos Cuidados de Saúde , Certificação , Atenção à Saúde/organização & administração , Feminino , Humanos , Assistência de Longa Duração , Masculino , Avaliação das Necessidades , Papel do Profissional de Enfermagem , Assistentes de Enfermagem/psicologia , Equipe de Enfermagem/organização & administração , Sistemas Automatizados de Assistência Junto ao Leito , Instituições Residenciais , Autocuidado , Estados UnidosAssuntos
Cuidadores/psicologia , Relações Enfermeiro-Paciente/ética , Assistentes de Enfermagem/psicologia , Satisfação Pessoal , Relações Profissional-Família/ética , Escolha da Profissão , Certificação , Empatia , Instituição de Longa Permanência para Idosos , Humanos , Narração , Assistentes de Enfermagem/ética , Casas de Saúde , Assistência ao Paciente/métodosRESUMO
Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.
Assuntos
Atitude do Pessoal de Saúde , Assistência de Longa Duração/ética , Assistentes de Enfermagem , Casas de Saúde , Assistência Terminal/ética , Assistência Terminal/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Morte , Canadá , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistentes de Enfermagem/ética , Assistentes de Enfermagem/normas , Casas de Saúde/normas , Recursos HumanosRESUMO
This article discusses delegation challenges and legal and regulatory oversight associated with delegation in the clinical practice setting. The authors address moral and legal attributes of the roles and responsibilities of health care providers regarding delegating health care interventions. The article also explores guiding principles and rules of delegation within professional standards, national practice guidelines, and state nurse practice acts. Nurse experts provide thoughtful reflection on nursing models and the role of delegation, emphasizing the critical role of delegation in extending the role of the health care professional in patient care services.