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'Ethics Between the Lines' - Nurses' Experiences of Ethical Challenges in Long-Term Care.

ABSTRACT: In long-term care, ethical challenges are becoming increasingly apparent as the number of older patients with complex care needs increases, in parallel with growing demands for more cost-efficient care. Scarce resources, cross-pressure and value conflicts are associated with missed care, moral stress and nurses wanting to leave the profession. Through five focus group interviews, this study aimed to explore how nurses working in nursing homes and homecare services perceive, experience and manage ethical challenges in everyday work. Content analysis revealed three main themes: striving to do good; failing and being let down and getting rid of frustrations and learning from experiences. The nurses' morality was mainly expressed through emotions that arose in specific situations. Dedicated spaces for ethical reflection and leaders who recognize that organizational conditions affect the individual nurse-patient relationship are required. Facilitating ethical reflection is an important leadership responsibility, which may also require leaders to actually participate.

SUBMITTER: Munkeby H

PROVIDER: S-EPMC8738871 | biostudies-literature | 2021 Jan-Dec

REPOSITORIES: biostudies-literature

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'Ethics Between the Lines' - Nurses' Experiences of Ethical Challenges in Long-Term Care.

Munkeby Hilde H Moe Aud A Bratberg Grete G Devik Siri A SA

Global qualitative nursing research 20210101

In long-term care, ethical challenges are becoming increasingly apparent as the number of older patients with complex care needs increases, in parallel with growing demands for more cost-efficient care. Scarce resources, cross-pressure and value conflicts are associated with missed care, moral stress and nurses wanting to leave the profession. Through five focus group interviews, this study aimed to explore how nurses working in nursing homes and homecare services perceive, experience and manage ...[more]

PMID: 35005098

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Project description:BackgroundNurses in long-term care (LTC) and home and community care (HCC) are well acquainted with the high workloads and manifold job stressors that pervade these sectors, making it increasingly difficult to employ and retain a strong workforce. In response, nursing bridging education programs have been proposed to enhance recruitment and retention. While the efficacy of such programs is supported, the transition to practice experience of new nurse graduates is often associated with feelings of under-preparedness. Understanding the lived experience of nurses transitioning into new roles in LTC and HCC after completing a bridging program may highlight areas of emphasis for future retention efforts.MethodsHermeneutic phenomenology was employed to explore the experiences of new graduate Registered Practical Nurses (RPNs) and Registered Nurses (RNs) from a tuition reimbursement program supporting students enrolled in nursing bridging education from Personal Support Worker (PSW) to RPN/RN and/or RPN to RN in Ontario as they transitioned to practice within LTC and HCC. A series of in-depth semi-structured virtual interviews and iterative analysis explored the meaning of everyday experiences for nurse participants.ResultsFrom twenty individual interviews (12 initial, 8 follow-up), the experience was embedded in a sense of fulfillment, further considered through four themes - benevolence; growth, eagerness, and anticipation to learn; building from within; and work-life balance.DiscussionThis is the first phenomenological study to report on the meaning of the experience of transitioning to practice for new graduate nurses from bridging education programs as they (re)enter the workforce in LTC and HCC, offering rich insight into their experiences when moving into new roles.ConclusionsBy illuminating the nuances of this experience, the findings may encourage healthcare leaders to develop helpful policies, strategies, and workplace cultures in LTC and HCC that might better promote the recruitment and retention of nurses in these sectors.

Project description:BackgroundIn Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, particularly in small residential and long-term care centers ("Centres d'hébergement et de soins de longue durée"; CHSLDs) located in rural areas. The need to ensure the continuous presence of nurses 24 hours a day in CHSLDs has become more pressing, forcing some facilities to implement exceptional measures such as on-call telephone services to ensure access to a nurse. In light of these challenging circumstances, the Direction nationale des soins et des services infirmiers of Quebec's Ministère de la Santé et des Services sociaux has rolled out a teleconsultation pilot project.ObjectiveThis study aims to explore nurses' and nursing assistants' experience of integrating teleconsultation during night shifts in rural CHSLDs with ≤50 residents.MethodsThe 6-month pilot project was rolled out sequentially in 3 rural CHSLDs located in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 18 semistructured interviews were conducted with 9 nurses and nursing assistants between February and July 2023.ResultsParticipants' experiences revealed that teleconsultation provided significant added value by improving clinical, administrative, and organizational practices. Some practices remained unchanged, indicating stable workflows. Workflow optimization through an expanded scope of practice ensured efficient and safe continuity of care. Enhanced collaboration between nurses and nursing assistants led to improved care coordination and communication. The leadership played a significant role in clarifying professionals' roles and in supporting effective adaptation to teleconsultation.ConclusionsThis pilot project represents a significant step forward in improving care for CHSLD residents in Quebec. Teleconsultation not only makes it possible to overcome recruitment challenges and ensure the continuous presence of nurses during night shifts but also optimizes professional practices while ensuring the safety and quality of care provided to residents.

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.

Project description:Background Due 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. Objective To 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. Methods A 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. Results A 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. Conclusion Our 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.

Dataset Information

'Ethics Between the Lines' - Nurses' Experiences of Ethical Challenges in Long-Term Care.

Publications

'Ethics Between the Lines' - Nurses' Experiences of Ethical Challenges in Long-Term Care.

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