A typology of nurses' interaction with relatives in emergency situations

Abstract

Background In nursing homes, residents’ relatives represent important sources of support for nurses. However, in the heightened stress of emergency situations, interaction between nurses and relatives can raise ethical challenges. Research objectives The present analysis aimed at elaborating a typology of nurses’ experience of ethical support and challenges in their interaction with relatives in emergency situations. Research design Thirty-three semi-structured interviews and six focus groups were conducted with nurses from different nursing homes in Germany. Data were analysed according to Mayring’s method of qualitative content analysis. Participants and research context Participants were licensed nurses working in nursing homes. Ethical considerations Ethical approval was granted by Ostfalia University of Applied Sciences (02.07.2020) and the Ethics Committee of Hannover Medical School (Nr. 8866_BO_K_2020; 27.01.2020). Interviewees were anonymised and focus group were pseudonymised during transcription. All participants provided written consent. Findings/results In emergency situations, relatives can represent important sources of support for nurses. However, they may also give rise to different challenges, relating to four ethical conflicts: (1) the challenge of meeting the information needs of relatives while providing appropriate care to all residents; (2) the challenge of managing relatives’ demands for hospitalisation when hospitalisation is not deemed necessary by nurses; (3) the challenge of managing relatives’ demands for lifesaving treatment when such treatment contradicts the will of the resident; and (4) the challenge of attempting to initiate hospitalisation when relatives oppose this course of action. Several external factors make these conflicts especially challenging for nurses: fear of legal consequences, a low staffing ratio, and a lack of qualified nursing staff. Conclusions Conflict between nurses and relatives typically revolves around hospitalisation and the initiation of lifesaving treatment. Whether nurses perceive interaction with relatives as supportive or conflictual essentially depends on the quality of the relationship, which may be negatively influenced by a number of external factors.

To do or not to do? A typology of ethical dilemmas in services (TEDS)

“…For instance, McDougall and Sokol's empirically derived typology ( 2008) is based on the issues and challenges faced by doctors in Australia. Another recent example of a challenges-oriented typology from healthcare services discusses ethical situations in nursing, focusing on case-specific conflicts (Primc et al, 2023). To date, perhaps due to the different disciplinary and service settings, we have not identified any research categorizing and synthesizing the full gamut of ethical situations and their key dimensions in services.…”

“…For instance, McDougall and Sokol’s empirically derived typology (2008) is based on the issues and challenges faced by doctors in Australia. Another recent example of a challenges-oriented typology from healthcare services discusses ethical situations in nursing, focusing on case-specific conflicts (Primc et al. , 2023).…”

The influence of supportive work environment on work‐related stress and conflict management style among emergency care nurses: A descriptive correlational study

“…Operating around the clock, EDs create a relentless and fast-paced atmosphere, often leading to feelings of overwhelming pressure and exhaustion among emergency care nurses (Primc et al, 2023).…”

“…The diversity of cases and high acuity level add complexity to the daily responsibilities of emergency care nurses (Satake & Arao, 2019). Operating around the clock, EDs create a relentless and fast‐paced atmosphere, often leading to feelings of overwhelming pressure and exhaustion among emergency care nurses (Primc et al., 2023).…”