Ethical Issues Experienced by Healthcare Workers Providing Palliative Care in Nursing Homes: A Mixed Methods Study

Deborah Muldrew, Dorry McLaughlin, Kevin Brazil

Research output: Contribution to journalConference article

Abstract

Aim: To provide a comprehensive understanding of care providers’ experiences of ethical issues during palliative care provision in nursing homes in Northern Ireland.
Methods: An exploratory, sequential, mixed methods research design was used, including semi-structured interviews with 13 Registered Nurses and 10 Healthcare Assistants working in nursing homes in Northern Ireland, and a cross-sectional survey with 69 RNs and 129 HCAs.
Results: The interviews revealed three themes; “Issues in practice;” “Relational Issues;” and “Organisational Issues”. Issues in practice occurred when participants felt conflicted between what was right and their professional duty. One of the most frequently reported ethical issues in the survey was linked to this theme and related to decision making on the resident’s behalf to prevent harm (Mean = 2.68; SD= 1.24). Relational issues included conflicts in staff, family, and resident relationships. This theme included the most frequently cited ethical issue across the whole survey, caring for residents who refused food/fluids (Mean = 2.71; SD= 1.19). Organisational issues were a consequence of the structure and quality of services available. Ethical issues associated with higher distress levels were linked to this theme, including the impact of poor communication on care (Mean = 2.48; SD= 1.39); and lack of time to meet care needs (Mean = 2.36; SD= 1.44). The survey revealed no differences between RNs and HCAs in the frequency of ethical issues (p=.40), or the level of distress these issues caused (p=.81).
Conclusion: The findings reveal the nature of ethical issues present in nursing homes. Implications for practice include the need for increased training and support to build relationships with residents and families, improved communication and shared decision-making between healthcare professionals, residents, and families, and palliative care training for all staff members to improve the care experience.
LanguageEnglish
JournalPalliative Medicine
Volume32
Issue number1_Suppl
DOIs
Publication statusPublished - 20 Apr 2018

Fingerprint

Hospice and Palliative Care Nursing
Nursing Homes
Ethics
Delivery of Health Care
Northern Ireland
Palliative Care
Decision Making
Communication
Interviews
Training Support
Allied Health Personnel
Research Design
Cross-Sectional Studies
Nurses
Food

Cite this

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title = "Ethical Issues Experienced by Healthcare Workers Providing Palliative Care in Nursing Homes: A Mixed Methods Study",
abstract = "Aim: To provide a comprehensive understanding of care providers’ experiences of ethical issues during palliative care provision in nursing homes in Northern Ireland.Methods: An exploratory, sequential, mixed methods research design was used, including semi-structured interviews with 13 Registered Nurses and 10 Healthcare Assistants working in nursing homes in Northern Ireland, and a cross-sectional survey with 69 RNs and 129 HCAs.Results: The interviews revealed three themes; “Issues in practice;” “Relational Issues;” and “Organisational Issues”. Issues in practice occurred when participants felt conflicted between what was right and their professional duty. One of the most frequently reported ethical issues in the survey was linked to this theme and related to decision making on the resident’s behalf to prevent harm (Mean = 2.68; SD= 1.24). Relational issues included conflicts in staff, family, and resident relationships. This theme included the most frequently cited ethical issue across the whole survey, caring for residents who refused food/fluids (Mean = 2.71; SD= 1.19). Organisational issues were a consequence of the structure and quality of services available. Ethical issues associated with higher distress levels were linked to this theme, including the impact of poor communication on care (Mean = 2.48; SD= 1.39); and lack of time to meet care needs (Mean = 2.36; SD= 1.44). The survey revealed no differences between RNs and HCAs in the frequency of ethical issues (p=.40), or the level of distress these issues caused (p=.81). Conclusion: The findings reveal the nature of ethical issues present in nursing homes. Implications for practice include the need for increased training and support to build relationships with residents and families, improved communication and shared decision-making between healthcare professionals, residents, and families, and palliative care training for all staff members to improve the care experience.",
author = "Deborah Muldrew and Dorry McLaughlin and Kevin Brazil",
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day = "20",
doi = "10.1177/0269216318769196",
language = "English",
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Ethical Issues Experienced by Healthcare Workers Providing Palliative Care in Nursing Homes: A Mixed Methods Study. / Muldrew, Deborah; McLaughlin, Dorry; Brazil, Kevin.

In: Palliative Medicine, Vol. 32, No. 1_Suppl, 20.04.2018.

Research output: Contribution to journalConference article

TY - JOUR

T1 - Ethical Issues Experienced by Healthcare Workers Providing Palliative Care in Nursing Homes: A Mixed Methods Study

AU - Muldrew, Deborah

AU - McLaughlin, Dorry

AU - Brazil, Kevin

PY - 2018/4/20

Y1 - 2018/4/20

N2 - Aim: To provide a comprehensive understanding of care providers’ experiences of ethical issues during palliative care provision in nursing homes in Northern Ireland.Methods: An exploratory, sequential, mixed methods research design was used, including semi-structured interviews with 13 Registered Nurses and 10 Healthcare Assistants working in nursing homes in Northern Ireland, and a cross-sectional survey with 69 RNs and 129 HCAs.Results: The interviews revealed three themes; “Issues in practice;” “Relational Issues;” and “Organisational Issues”. Issues in practice occurred when participants felt conflicted between what was right and their professional duty. One of the most frequently reported ethical issues in the survey was linked to this theme and related to decision making on the resident’s behalf to prevent harm (Mean = 2.68; SD= 1.24). Relational issues included conflicts in staff, family, and resident relationships. This theme included the most frequently cited ethical issue across the whole survey, caring for residents who refused food/fluids (Mean = 2.71; SD= 1.19). Organisational issues were a consequence of the structure and quality of services available. Ethical issues associated with higher distress levels were linked to this theme, including the impact of poor communication on care (Mean = 2.48; SD= 1.39); and lack of time to meet care needs (Mean = 2.36; SD= 1.44). The survey revealed no differences between RNs and HCAs in the frequency of ethical issues (p=.40), or the level of distress these issues caused (p=.81). Conclusion: The findings reveal the nature of ethical issues present in nursing homes. Implications for practice include the need for increased training and support to build relationships with residents and families, improved communication and shared decision-making between healthcare professionals, residents, and families, and palliative care training for all staff members to improve the care experience.

AB - Aim: To provide a comprehensive understanding of care providers’ experiences of ethical issues during palliative care provision in nursing homes in Northern Ireland.Methods: An exploratory, sequential, mixed methods research design was used, including semi-structured interviews with 13 Registered Nurses and 10 Healthcare Assistants working in nursing homes in Northern Ireland, and a cross-sectional survey with 69 RNs and 129 HCAs.Results: The interviews revealed three themes; “Issues in practice;” “Relational Issues;” and “Organisational Issues”. Issues in practice occurred when participants felt conflicted between what was right and their professional duty. One of the most frequently reported ethical issues in the survey was linked to this theme and related to decision making on the resident’s behalf to prevent harm (Mean = 2.68; SD= 1.24). Relational issues included conflicts in staff, family, and resident relationships. This theme included the most frequently cited ethical issue across the whole survey, caring for residents who refused food/fluids (Mean = 2.71; SD= 1.19). Organisational issues were a consequence of the structure and quality of services available. Ethical issues associated with higher distress levels were linked to this theme, including the impact of poor communication on care (Mean = 2.48; SD= 1.39); and lack of time to meet care needs (Mean = 2.36; SD= 1.44). The survey revealed no differences between RNs and HCAs in the frequency of ethical issues (p=.40), or the level of distress these issues caused (p=.81). Conclusion: The findings reveal the nature of ethical issues present in nursing homes. Implications for practice include the need for increased training and support to build relationships with residents and families, improved communication and shared decision-making between healthcare professionals, residents, and families, and palliative care training for all staff members to improve the care experience.

U2 - 10.1177/0269216318769196

DO - 10.1177/0269216318769196

M3 - Conference article

VL - 32

JO - Palliative Medicine

T2 - Palliative Medicine

JF - Palliative Medicine

SN - 0269-2163

IS - 1_Suppl

ER -