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 articlepeer-review

4 Citations (Scopus)
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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.
Original languageEnglish
JournalPalliative Medicine
Issue number1_Suppl
Publication statusPublished (in print/issue) - 20 Apr 2018


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