'Ethics Between the Lines' - Nurses' Experiences of Ethical Challenges in Long-Term Care.
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ABSTRACT:
SUBMITTER: Munkeby H
PROVIDER: S-EPMC8738871 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThis study uses an interpretive description approach to explore nurses' experiences with pressure sore care in long-term care facilities, highlighting the complexity of their encounters.Methods10 experienced nurses from South Korean small to medium-sized hospitals were chosen via purposive sampling for interviews. Data analysis utilized Braun and Clarke's reflexive thematic analysis.ResultsThe study's findings collectively reflect the intricate journey of nurses in Long-term care facilities as they grapple with the challenges of pressure sore care. These nurses transform their perception of pressure sores, encountering a dynamic shift in their understanding. They face multifaceted challenges in providing optimal care, marked by resource constraints and the absence of standardized guidelines. Emotionally, they navigate a complex terrain of sentiments, oscillating between feelings of accomplishment and helplessness. Despite these hurdles, they persistently strive for excellence in pressure sore nursing, driven by an unwavering commitment to delivering the best possible care within the confines of their healthcare environment.ConclusionThe study enhances understanding of pressure sore care in long-term facilities and suggests avenues for improving nursing practices and care quality through targeted interventions.
| S-EPMC10911102 | biostudies-literature
Project description:Despite rapid and successful development in pediatric cancer treatment, many ethical challenges remain. These challenges have been, and continue to be, the subject of much research, but few qualitative studies have explored the views of nurses, especially in the Middle East. This study, therefore, seeks to fill a knowledge gap in this area and to better understand the concerns of nurses-particularly those in Saudi Arabia and the Middle East. Face-to-face, in-depth interviews were conducted with 17 male and female nurses working in pediatric units at 2 hospitals in Saudi Arabia to explore their views on the ethical challenges in caring for children with cancer. All interviews were recorded and transcribed, then line-by-line encoded, merged, and categorized into themes. Our results show that pediatric cancer is perceived as being "different" from other diseases, and from cancer in adults. Nurses are an integral part of the medical care team and are aware of the importance of their role, as well as the special relationships that they develop with the children. Consent is mandatory and necessary and can be signed by any parent. Assent is important when children become able to give it. Pediatric cancer is seen as a different disease by nurses for various reasons. Their roles and relationships with children and families pose many challenges. Though parental consent and child assent are essential, nurses' collaboration is important for shared decision-making. Our study paves the way for broader studies to understand the concerns of nurses and other health-care providers about treating children with pediatric cancer.
| S-EPMC7160780 | biostudies-literature
Project description:ObjectiveConsidering the importance of out-of-hospital services, the emergence of home care nursing, and the need for an ethical framework in nursing practice, the present study aimed to explore the nurses' experience of ethical values of home care nursing.MethodsThe data of the study was collected using face-to-face individual interviews. Through purposive sampling, 20 nurses who worked in the home care centers in four cities of Iran in 2020 were interviewed. They shared their experiences of the ethical values of home care nursing. Then, the interviews were analyzed based on the content analysis approach and using Graneheim and Lundman method.ResultsIn the present study, 416 codes were extracted. Merging these codes based on the similarity, seven main themes, and 16 sub-themes were extracted. The themes included perception of the professional identity, respect for the client's autonomy, respecting privacy, establishing human interaction, maintaining mutual safety, observance of justice, and cultural-religious competence. The sub-themes included responsibility, development of professional and inter-professional interactions, maintaining the professional status at home, providing the holistic artistic care, patient's privacy, nurse's privacy, and maintaining the confidentiality of information, respect for the client's choice, honestly informing, empathetic interaction, adjusting the power positions, client's safety, nurse's safety, establishing justice, respect for the religious beliefs at home and cultural sensitivity.ConclusionThe participants stated that due to entering the patient's privacy in the home care cases, the ethical values such as perception of the professional identity, privacy, family interactions' management, mutual security, and cultural-religious competence became doubly important compared to the hospital caring.
| S-EPMC9305015 | biostudies-literature
Project description:BackgroundThe critical conditions and life risk scenarios make intensive care nurses susceptible to ethical conflict. Negative consequences were recognized at both the individual level and the professional level which highly compromised the patient care and nurses' well-being. Therefore, ethical conflict has become a major concern in nursing practice. However, the experience of coping with ethical conflict among intensive care nurses remains unclear.AimsThis study aims to explore the experience of intensive care nurses coping with ethical conflict in China.MethodsFrom December 2021 to February 2022, in- depth interviews with 15 intensive care nurses from five intensive care units in a tertiary general hospital in China was performed using purposive sampling. An inductive thematic analysis approach was used to analyze the data. We applied the consolidated criteria for reporting qualitative research for this study.ResultsTwo distinctive themes were found: detachment and engagement, which contained four subthemes: ignoring ethical problems in the workplace, seeking ways to express emotions, perspective-taking, and identifying positive assets. Theses coping strategies demonstrated an ongoing process with different essential features.ConclusionThis study provides a new insight into the experience of intensive care nurses coping with ethical conflict in clinical nursing. Intensive care nurses demonstrated differential experience of coping with ethical conflict including problem-focused, emotion-focused and meaning-making strategies. These findings have implications for policymakers and nursing administrators to develop ethical education and training and supportive environment for intensive care nurses to tackle this issue.
| S-EPMC10687825 | biostudies-literature
Project description:BackgroundWorking in the nursing sector is accompanied by great physical and mental health burdens. Consequently, it is necessary to develop target-oriented, sustainable profession-specific support and health promotion measures for nurses.ObjectivesThe present review aims to give an overview of existing major health problems and violence experiences of nurses in different settings (acute care hospitals, long-term care facilities, and home-based long-term care) in Germany.MethodsA systematic literature search was conducted in PubMed and PubPsych and completed by a manual search upon included studies' references and health insurance reports. Articles were included if they had been published after 2010 and provided data on health problems or violence experiences of nurses in at least one care setting.ResultsA total of 29 studies providing data on nurses health problems and/or violence experience were included. Of these, five studies allowed for direct comparison of nurses in the settings. In addition, 14 studies provided data on nursing working in acute care hospitals, ten on nurses working in long-term care facilities, and four studies on home-based long-term care. The studies either conducted a setting-specific approach or provided subgroup data from setting-unspecific studies. The remaining studies did not allow setting-related differentiation of the results. The available results indicate that mental health problems are the highest for nurses in acute care hospitals. Regarding violence experience, nurses working in long-term care facilities appear to be most frequently affected.ConclusionThe state of research on setting-specific differences of nurses' health problems and violence experiences is insufficient. Setting-specific data are necessesary to develop target-group specific and feasible interventions to support the nurses' health and prevention of violence, as well as dealing with violence experiences of nurses.
| S-EPMC8601565 | biostudies-literature
Project description:BackgroundGeneral practitioners (GPs), nurses and informal caregivers are often jointly involved in healthcare situations in which ethical issues play an important role.ObjectivesTo describe ethical problems from the perspective of these three groups and to investigate whether there is a common experience of ethical issues in primary care.MethodsWe conducted six focus groups with general practitioners, nurses and informal caregivers in Germany. We asked the participants to describe at least one experience of ethical problem in detail and documented the findings by an illustration software that visualized and structured the discussion. We used thematic analysis to identify ethical problems and to develop categories of ethical issues.ResultsProblems reported barely overlapped. GPs had to do mainly with uncertainty about the scope and limits of their responsibility for patients. Nurses were concerned about bureaucratic and other barriers to professional care and about dual loyalty if they had to consider the conflicting interests of patients and family members. They often felt powerless and unable to act according to their professional standards. Informal caregivers reported problems that resulted from role strain and being both a family member and a caregiver. GPs, nurses and informal caregivers sometimes perceived the other parties as a source of ethical problems.ConclusionsAll parties may benefit from ethics support services, a rarity in German primary care so far. Furthermore, nurses' self-confidence towards GPs, demanding patients and family members has to be strengthened. Informal caregivers, the most vulnerable group, need more attendance and tailored support.
| S-EPMC6425460 | biostudies-literature
Project description:BackgroundEthical issues arise daily in the delivery of palliative care. Despite much (largely theoretical) literature, evidence from specialist palliative care practitioners about day-to-day ethical challenges has not previously been synthesised. This evidence is crucial to inform education and adequately support staff.AimTo synthesise the evidence regarding the ethical challenges which specialist palliative care practitioners encounter during clinical practice.DesignSystematic review with narrative synthesis (PROSPERO registration CRD42018105365). Quality was dual-assessed using the Mixed-Methods Appraisal Tool. Tabulation, textural description, concept mapping and thematic synthesis were used to develop and present the narrative.Data sourcesSeven databases (MEDLINE, Philosopher's Index, EMBASE, PsycINFO, LILACS, Web of Science and CINAHL) were searched from inception to December 2019 without language limits. Eligible papers reported original research using inductive methods to describe practitioner-reported ethical challenges.ResultsA total of 8074 records were screened. Thirteen studies from nine countries were included. Challenges were organised into six themes: application of ethical principles; delivering clinical care; working with families; engaging with institutional structures and values; navigating societal values and expectations; philosophy of palliative care. Challenges related to specific scenarios/contexts rather than the application of general ethical principles, and occurred at all levels (bedside, institution, society, policy).ConclusionPalliative care practitioners encounter a broad range of contextual ethical challenges, many of which are not represented in palliative care ethics training resources, for example, navigating institutional policies, resource allocation and inter-professional conflict. Findings have implications for supporting ethical practice and training practitioners. The lack of low- and middle- income country data needs addressing.
| S-EPMC7897798 | biostudies-literature
Project description:BackgroundDue to demographic change and staff shortages nurses suffer under high work strain. As a consequence, caregivers' absenteeism due to mental stress, in particular burnout, is high. To explain the development of nurses' burnout more research is needed on nurses' individual resources and coping strategies. Self-endangering is a potentially harmful coping strategy.ObjectiveTo expand the perspective of the Job Demand-Resources Model by including caregivers' intraindividual resources and the coping construct of self-endangering as a mediator between personal resources and nurses' emotional exhaustion.MethodsA longitudinal questionnaire survey was conducted between July 2020-March 2021 among nurses in long-term care in Germany. The final analysis sample consisted of wave 1 = 416 and wave 1,2 = 50. Data were analysed by a multiverse analytic strategy using regression analysis with measurement repetition and cross-lagged-panel design for waves one and two. Variables used for regression analysis and cross-lagged-panel were: Independent variables: An altruistic job motivation, team identification and self-esteem, dependent variables: Exhaustion and disengagement, and mediators: Self-endangering cognitions and behavior tendencies.ResultsA highly altruistic job motivation leads to more self-endangering cognitions and to more self-endangering behavior tendencies. Mixed model analysis and cross-sectional path analysis confirmed mediation effects from altruism over self-endangering to exhaustion.ConclusionOur findings are at odds with some research findings about altruism in nursing, such that too much altruism can lead to harmful self-endangering. We also introduce a new instrument to capture self-endangering in nursing care. Future research should investigate various facets of self-endangering in nursing. We assume that leadership behavior could have influence on self-endangering. New health policy structures are needed to improve working conditions in nursing and thus prevent self-endangering.
| S-EPMC10482104 | biostudies-literature
Project description:IntroductionEthical issues arise daily in the delivery of palliative care. Despite much (largely theoretical) literature, evidence from specialist palliative care practitioners (SPCPs) about real-world ethical challenges has not previously been synthesised. This evidence is crucial to inform education and training and adequately support staff. The aim of this systematic review is to synthesise the evidence regarding the ethical challenges which SPCPs encounter during clinical practice.Methods and analysisWe will conduct a systematic review with narrative synthesis of empirical studies that use inductive methods to describe the ethical challenges reported by SPCPs. We will search multiple databases (MEDLINE, Philosopher's Index, EMBASE, PsycINFO, LILACS, WHOLIS, Web of Science and CINAHL) without time, language or geographical restrictions. Keywords will be developed from scoping searches, consultation with information specialists and reference to key systematic reviews in palliative care and bioethics. Reference lists of included studies will be hand-searched. 10% of retrieved titles and abstracts will be independently dual screened, as will all full text papers. Quality will be dual assessed using the Mixed-Methods Appraisal Tool (2018). Narrative synthesis following Popay et al (2006) will be used to synthesise findings. The strength of resulting recommendations will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach for qualitative evidence (GRADE-CERQual).Ethics and disseminationAs this review will include only published data, no specific ethical approval is required. We anticipate that the systematic review will be of interest to palliative care practitioners of all backgrounds and educators in palliative care and medical ethics. Findings will be presented at conferences and published open access in a peer-reviewed journal.Trial registration numberCRD42018105365.
| S-EPMC6538058 | biostudies-literature
Project description:BackgroundThe prevalence of vision and hearing loss is higher amongst older individuals with dementia, as well as higher in long-term care settings than in the wider community. However, the incidence of sensory impairment is underreported and often goes untreated. In this study, we aimed to understand nurses' current experiences of screening and caring for long-term care residents who have dementia and sensory impairment.MethodsAs part of a larger study on the sensory screening of long-term care residents with dementia, an environmental scan was conducted with front-line healthcare providers. We report here on the findings from the content analysis of individual, semi-structured interviews with nurses working in two long-term care homes in Southern Ontario, Canada. Twenty regulated nurses, including designated resident assessment coordinators, working full- or part-time with individuals who have dementia, participated across the two sites. All interviews were transcribed, and their contents reviewed and coded for themes by means of inductive thematic analysis.ResultsFollowing a systematic and recursive approach, three analysts identified several themes relating to: 1) the sensory screening process, 2) communication strategies, and 3) quality of life, sensory loss, and dementia. Participants reported on the strengths and limitations of screening procedures, what improvements should be made, which informal strategies are effective, and the continued professional development that is needed.ConclusionsNurses demonstrated insight into the facilitators and barriers to effective screening and care of residents with dementia and sensory impairments, and expressed the need for further education, more suitable screening tools, and formalised accountability within the screening process for vision and hearing loss in these long-term care residents.
| S-EPMC6172849 | biostudies-literature