To find out which types of ethical challenges and dilemmas occur and are being discussed in nursing home ethics meetings arenas. To investigate whether results from ethics meetings were put into practice. The participants were informed about the study and were given the opportunity to ask clarifying questions before participating.
They were informed about the possibility to withdraw from the study at any time. All informants gave their informed consent to participate. Nursing home staff participating in part 1 of the study was asked to fill out a questionnaire once.
In order to assure confidentiality, the questionnaire was anonymous. To document ethics meetings in part 2 of the study, all ethics meetings were reported by using a questionnaire with description of the case discussed, but without personal data of the patient, relatives or the other participants. The reason for using mixed methods in this study was to provide a bigger and richer picture of ethical challenges and ethics consultation in nursing homes.
The open qualitative question was also used as additional measure to open up for new themes that probably were not covered by the questionnaire. A questionnaire, which had been used in a previous pilot study with leaders and ward head nurses as informants 5 , was modified and given to all employees of a large Norwegian nursing home including staff from nonmedical professions.
The original questionnaire in Norwegian was shortened and some questions were reframed according to the experiences from the pilot study 5. In addition to the multiple choice questions, the informants were asked to describe a recent ethical challenge or ethical dilemma in their own words.
A qualitative question in the questionnaire for nursing home staff was used to emphasise the concerns of the staff members and to open up for descriptions of other challenges or dilemmas that probably were not covered by the questionnaires multiple choice questions. Detailed information on the questionnaire is available on request to the first author. All staff members were informed by their leaders on staff meetings about the study and were given the possibility to contact the researcher in order to ask questions about the study. They were encouraged to participate and were able to participate within their usual working hours.
The participants were asked to fill in the anonymous questionnaire that could be sent directly to the researcher. In addition, there was the possibility to fill out the questionnaire within the usual working hours with the researcher present in order to answer questions and to ensure confidentiality by collecting the questionnaires directly. Analyses of the results from the questionnaire are described by descriptive statistics to summarise the answers and views of the participants from our sample.
In order to give an overview of the types of ethical challenges and dilemmas that occur in nursing homes, a model of good practice for systematic ethics work was sought by the researchers. When the study was planned and started, ethics consultation in nursing homes in Norway was developing; however, it was not possible to find a suitable model of good practice for systematic ethics work in Norway to use in the study.
Therefore, a model of good clinical practice with already implemented systematic ethics work from Austria was used instead. Ethics discussions were documented in a cooperation of nursing homes of Caritas Socialis CS in Vienna. The management of the CS was asked to allow a documentation of all types of systematic ethics discussions throughout the organisation. CS had three nursing homes and two special units for people with dementia living in flats within the city of Vienna, altogether a total of residents. The nursing homes have used systematic ethics meetings since CS in Vienna has established systematic ethics work in four combined arenas for discussing ethical challenges and problems.
These arenas include the following: i assessment and documentation of the resident's will in everyday work which means that the nursing staff of the Caritas Socialis, Vienna, tries to document relevant wishes or expressed values of the residents. The term is connected to the Socratic dialogue where the moderator has the role of a midwife in order to give birth to new knowledge and to aid reasoning.
Socratic dialogue is the preferred method to discuss ethical problems in the CS. It is a method that is grounded on values and virtues that are accepted as ethically good. Usually, a moderator asks a serious of questions that help the other participants to reach a conclusion. CS received the Teleios Award in , a national Austrian award for innovation and sustainability in elderly care, for their efforts to implement systematic ethics work throughout the organisation A questionnaire in German was used to document all ethics discussions on the four different levels that are used by Caritas Socialis in Vienna.
The moderators of the ethics discussions were asked to document each meeting. The analysis of the data from the questionnaire in part 2 was performed in the same way as described under part 1. It highlights that there are differences between the healthcare workers and the other professions. Most of the participants preferred to use informal discussions to handle ethical challenges in everyday work. Ninety per cent of the informants felt that more systematic ethics work was needed in nursing homes.
Respect and privacy have been described as ethical challenges by some of the informants. Three typical examples from these descriptions are as follows:.
In my opinion lack of time for every patient is a big problem because of lack of resources. Some patients do get too little stimulation. Just to be with them more often and to take the patients to some activities can give them a better quality of life. Staff member To mix medication in the jam without informing the resident.
Staff member 5. It is not right that a patient has to die alone. We had a patient where the relatives were not there when he came close to death. When the patient died, he was alone. Afterwards the relatives were in despair and became very sad because of that. Participants in the REM are staff members and representatives of the resident or the resident himself In all 29 cases, the participants agreed on a conclusion that later was put into practice.
No resident participated in the meetings; thus, in three cases, neither the resident nor relatives were represented. The number of participating next of kin varied from 0 to 3 mean 1.
In one case, measures to enhance the patient's quality of life were the main topic of the meeting. The other four ethics meetings were regularly scheduled meetings of the ethics committee of Caritas Socialis. These were used to discuss common ethical challenges, planning educational efforts and work on own ethical guidelines for use in the organisation. The findings from both parts of the study suggest that there is a difference between the type of ethical problems that the nursing home staff experience in their daily work and those discussed in ethics discussion meetings REM and ethics committee.
In daily work, everyday ethical issues seem to play a major role, whereas big ethical problems are more often discussed in official arenas for ethics discussion. Everyday ethical issues, on the other hand, which occur much more frequent, are often hidden under the surface and thus are not properly addressed and therefore receive less attention, although occurring more frequently.
Main findings of part 1 of the present study were that most nursing home staff members experienced ethical challenges in their daily work and that many felt these as a burden. Findings from part 2 showed that 29 of 33 documented ethics discussions were prospective resident ethics meetings where decisions for a resident had to be made. In all 29 cases, consensus was reached and put into practice. Relatives participated in a majority of case discussions, but residents did not participate in any meeting. It is thus obvious that ethical issues are frequent and important for most people working in nursing homes.
Compared with studies from other countries, ethical challenges in Norwegian nursing homes in general are not very different from those reported in the literature 1 - But it is striking that the lack of resources is the most frequently mentioned ethical challenge in a wealthy country such as Norway. Our findings highlight the frequency and importance of everyday ethical issues for the staff and add support to the idea that everyday issues are troubling to many nurses see Fig. The importance of everyday ethical issues and dignity in nursing homes has also been described different authors 9 , 23 - Our findings suggest that closeness to residents seems to increase the percentage of ethical challenges experienced by the informants.
Free ethical dilemma in nursing papers, essays, and research papers. Legal and Ethical Issues in Nursing Ethics asses the values, morals, and principles of. Aim. The aim of the study was to describe the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice. and both a paper and web-based format was made available.
Lillemoen and Pedersen have described similar findings for primary healthcare workers Probably ethical sensitivity or ethical awareness can be enhanced by ethics education that helps to recognise especially everyday ethical challenges 31 , The first step to deal with ethical challenges and dilemmas is to perceive it The experience of ethical dilemmas without the possibility to solve them can cause moral distress It is thus important both to discuss ethical challenges and find solutions to relieve the staff's burden.
Awareness of ethical challenges and time to address these issues therefore seems to have a protective role for the psychological health of the staff. This underlines the necessity of regular ethics discussions in nursing homes. There is a demand for systematic ethics work in nursing homes.
For example, providing nursing care for clients undergoing an abortion may raise ethical and moral concerns and issues for some nurses; and some patients may be affected with a liver transplant rejection because donor livers are not abundant enough to meet the needs of all patients who request it. ABSTRACT This article presents an identification and analysis of ethical issues identified by nurses in relation to patients in a critical condition, who are at imminent risk of death and whose survival depends on advanced means of surveillance, monitoring and therapy. Old Password. The holistic nursing approach is treating a patient through a person centred care approach which thinks about the nursing care as a whole not just one part of the body but social, physical, spiritual and psychological The American Holistic Nurses Association It was not possible from our recordings to determine the reasons why no residents were involved; thus, we could only speculate. New Password. Universal vaccination programs have eliminated smallpox and reduced serious diseases including measles, mumps, rotavirus, and polio.
In order to establish a culture of care in nursing homes, the attention for everyday ethical issues and the inclusion of ethics in everyday meetings and discussions have to be more focused in the future. The implementation of special structures or places for systematic ethics work must be based on sensitisation and awareness of ethical aspects in everyday work and communication 32 , This finding is similar to findings from other studies 5 , 10 , These findings support previous findings from other studies in Norway where staff management and heads of wards were informants 5 , One major benefit for all participants in ethics consultation might be to be heard and to be able to express their concerns.
This is important for healthcare personnel, patients and relatives But ethics education alone is not enough. It is also important that managers, policymakers and politicians participate when lack of resources is addressed and discussed. In both studies, most of the respondents were managers, head nurses and people with leading positions, whereas the informants from the present study were employees from all professions, many of them working in direct patient care, assuming a closer relationship to the residents.
A reason for the difference could be that staff managers and head nurses more often feel that they have to defend their judgements in public and therefore would appreciate consulting a lawyer. Nevertheless, most informants seem to recognise that ethical challenges cannot be solved by consulting a lawyer, but rather through ethics discussions. Covert medication has been described by some of our informants as their most recent ethical dilemma.