Ethical issues in nursing home palliative care: a cross-national survey

Deborah Muldrew, Sharon Kaasalainen, Dorry McLaughlin, Kevin Brazil

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Abstract

Objectives: With an increased dependency on nursing homes to provide care to the ageing population, it is likely that ethical issues will also increase. This study aimed 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, and pilot the “Ethical issues in Palliative Care for Nursing Homes” (EPiCNH) instrument in Canada.
Methods: A cross-sectional survey design was utilised. One hundred and twenty three nurses located in 21 nursing homes across the UK and Canada completed the EPiCNH instrument.
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). The survey was positively rated for ease of completion, relevance, and comprehensiveness.
Conclusions: Nurses’ reported comparable experiences of providing palliative care in UK and Canadian nursing homes. 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. The EPiCNH instrument has demonstrated international relevance and applicability.
Original languageEnglish
JournalBMJ Supportive and Palliative Care
Publication statusPublished - 18 Dec 2018

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