"Comparison of Ethical Issues Experienced during Palliative Care Provision in Nursing Homes in the UK and Canada: Findings from a Cross-sectional Survey"

Deborah Muldrew, Sharon Kaasalainen, Dorry McLaughlin, Kevin Brazil

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Background: Increased dependency on nursing homes to provide palliative care to an ageing population with complex care needs may lead to an increase in ethical issues, which may in turn lead to burnout and moral distress for staff.

Aim: To identify the type of ethical issues and level of associated distress experienced by nurses providing palliative care in nursing homes in the UK and Canada.

Methods: A cross-sectional survey design was utilised. On the day of data collection, all nurses working in 21 nursing homes across the UK and Canada received the “Ethical issues in Palliative Care for Nursing Homes” survey instrument. The EPiCNH instrument consists of 26 items, scored on two subscales; Frequency and Distress. One hundred and twenty three nurses completed the instrument across two days of data collection. Descriptive and inferential statistics were used to compare the frequency and level of distress caused by ethical issues in the UK and Canada.

Results: Frequent ethical issues include upholding resident autonomy, managing family distress, lack of staff communication, and lack of time in both countries. Higher levels of distress resulted from poor communication, insufficient training, lack of time, and family disagreements. Nurses in Canada experienced a greater frequency of ethical issues (p=.022), however, there was no statistical difference in reported distress levels (p=.53).

Conclusions: Nurses’ reported comparable experiences of providing palliative care in UK and Canadian nursing homes. The majority of items overlap between the two countries suggesting pervasiveness of these ethical issues. These findings have implications on the practise of care in nursing homes, including how care is organized as well as capacity of staff to care for residents at the end of life. Training staff to take account of patient and family values during decision-making may address many ethical issues, in line with global policy recommendations.

Funder: Queen’s University Belfast
Original languageEnglish
JournalPalliative Medicine
Publication statusPublished (in print/issue) - 21 May 2019
Event16th World Congress of the European Association for Palliative Care - Estrel Conference Centre, Berlin, Germany
Duration: 23 May 201925 May 2019


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