Clinical prioritizations and contextual constraints in nursing homes - a qualitative study

Slettebø, Åshild; Kirkevold, Marit; Andersen, Berit; Pedersen, Reidar; Halvorsen, Kristin; Nordhaug, Marita; Nortvedt, Per

doi:10.1111/j.1471-6712.2009.00745.x

Cited by 49 publications

(69 citation statements)

References 14 publications

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“…In a study performed in elderly care, it was found that nurses felt that they were forced to prioritize residents’ physiological needs over their psychosocial needs. The authors conclude that nurses and physicians seldom or never seemed to discuss how to deal with dilemmas in setting priorities and factors of importance in such decisions; it seemed the responsibility rested on the individual professionals’ shoulders (27). A study performed in an emergency department shows that nurses, owing to lack of time, are forced to prioritize medical care or practical tasks and routines, a situation which according to the authors may lead to that their ideals of good care are unattainable (28).…”

Section: Discussionmentioning

confidence: 99%

Healthcare personnel’s experiences of situations in municipal elderly care that generate troubled conscience

Ericson-Lidman¹,

Persson²,

Strandberg³

2012

Scandinavian Caring Sciences

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Healthcare personnel may perceive troubled conscience when feeling inadequate and powerless. It is important to further explore healthcare personnel's descriptions of situations in daily work, which generate troubled conscience to increase the awareness of such situations. This study aimed to describe health care personnel's experiences of situations in municipal elderly care that generate troubled conscience. In this qualitative study, interviews were conducted with Registered and Enrolled nurses and nursing assistants (n = 20) working in municipal elderly care. The interviews were tape-recorded, transcribed verbatim and analysed with content analysis. Situations that generated troubled conscience was (i) Being caught between different demands, comprising being forced to prioritize between different residents' needs, being torn between residents'-/relatives'-/and co-workers' needs and expectations' and between work and private life, (ii) Being torn away from residents to other 'must do's', comprising stealing time from residents' to do housekeeping chore' and to 'obey' rules and recommendations, (iii) Feeling unable to relieve suffering, comprising falling short when striving to help, lacking knowledge, advice and support and time to ease residents' suffering and finally, (iv) Being part of providing care that is or feels wrong, comprising providing poor care and/or witnessing co-workers providing poor care, and being forced to give care that feels wrong. These findings identify important factors that generate stress of conscience (stress caused by troubled conscience), including difficulties with balancing priorities and following rules and recommendations that seem contrary to best care, and the need for interdisciplinary teamwork. Findings point to that sharing what conscience tells in the work team opens up possibilities for healthcare personnel to constructively deal with troubled conscience. Intervention studies are needed to explore whether such measures contribute to relieve the burden of troubled conscience and increase possibilities to provide high quality care.

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Section: Discussionmentioning

confidence: 99%

Healthcare personnel’s experiences of situations in municipal elderly care that generate troubled conscience

Ericson-Lidman¹,

Persson²,

Strandberg³

2012

Scandinavian Caring Sciences

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“…Interestingly, better teamwork and safety climate was related to less rationing in the ADL, caring, and documentation subscale, but more rationing of social care. Based on qualitative studies, care workers ration or neglect psychosocial needs in order to be able to take care of residents' safety and basic care needs (Nortvedt et al, 2008;Slettebø et al, 2010). Accordingly, the rationing of social care under time constraints eventually supports the residents' safety, though careworkers feel guilty about it (Slettebø et al, 2010).…”

Section: Work Environmentmentioning

confidence: 98%

The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes – A cross-sectional study

Zúñiga¹,

Ausserhofer²,

Hamers³

et al. 2015

International Journal of Nursing Studies

107

126

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“…Das Verhältnis zwischen Pflegepersonal pro Anzahl Pflegebedürftiger ist tatsächlich ein Faktor, der die Pflegequalität beeinflusst. Studien zeigen aber, dass die Pflegequalität nicht nur davon abhängt, wie viele Personen eine Pflegefachperson pflegt, sondern auch, wie qualifiziert sie ist (Aiken et al 2012;Slettebø et al 2010). In den Medienbeiträgen finden sich keine Informationen, über welche beruflichen Qualifikationen das Pflegepersonal in den ausländischen Pflegeheimen verfügt.…”

Section: Individualethik Ii: Rolle Der Angehörigen Und Stellvertreterunclassified

„Alt werden im Paradies“ – Die ethischen Aspekte der Migration von pflegebedürftigen Menschen

2017

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Zusammenfassung Seit einigen Jahren erscheinen in deutschsprachigen Medien Beiträge, die einen neuen Trend in der Versorgung von langzeitpflegebedürftigen Menschen beschreiben: die Migration in ausländische Pflegeheime, insbesondere nach Thailand oder Ost-Europa. Diese Art der Migration wird kontrovers aufgenommen. Einige Medienbeiträge beschreiben diese Praxis u. a. als "Greisen-Export", "gerontologischen Kolonialismus" oder "inhumane Deportation". Die Begriffe weisen darauf hin, dass diese Migration aus sogenannten High Income Countries in Low and Middle Income Countries aus ethischer Sicht problematisch sein könnte. Allerdings gibt es bislang keine wahrnehmbare wissenschaftliche ethische Auseinandersetzung mit dem Phänomen. In diesem Beitrag diagnostizieren wir, dass es sich bei der Migration Langzeit-Pflegebedürftiger tatsächlich um ein ethisch relevantes Problem handelt, und wir ordnen die von uns identifizierten ethisch relevanten Bereiche unterschiedlichen Ebenen zu: einer individual-, einer gesellschafts-, und einer global-ethischen Ebene. Auf der individualethischen Ebene diskutieren wir Fragen der Autonomie, der Verwandtschaftsbeziehungen, der Rolle von Kultur und Traditionen und der "guten Pflege". Auf der gesellschaftsethischen Ebene diskutieren wir strukturelle Herausforderungen der Langzeitpflege und Fragen der sozialen Gerechtigkeit. Auf der globalethischen Ebene verbinden wir unser Thema mit der ethischen Diskussion des Medizintourismus und des Brain Drains und mit Fragen C. Bally-Zenger, M.A. ( ) · Dr. V. Wild K C. Bally-Zenger et al. globaler (Gesundheits-)Gerechtigkeit. Um eine weiterführende normative Analyse vornehmen zu können, sind weitere empirische Daten zu dem Phänomen notwendig. AbstractDefinition of the problem The German-language media describes a new trend in long-term care: the migration of persons needing such care to nursing homes abroad, especially to Thailand or East Europe. This type of migration is perceived as a controversial practice. Various articles use terms such as "export of the elderly", "gerontological colonialism" or "inhumane deportation". These terms indicate that the migration of persons in need of long-term care from so-called high income countries to low and middle income countries might be problematic from an ethical point of view. Arguments There has hardly been any academic discussion on this phenomenon. On the basis of the media output and a few scientific articles, we establish that we are dealing with an ethically relevant topic. We then systematically identify relevant ethical aspects. These can be assigned to different levels: an individual-, a societal-, and a global-ethics level. On an individual level we discuss questions of autonomy, relations with relatives, the role of culture and traditions for well-being and best practice in long-term care. On the societal level we discuss structural problems in long-term care, and social justice-related questions. On the global level we connect our topic to the ethics discussion on medical tourism, brain drain a...

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Clinical prioritizations and contextual constraints in nursing homes - a qualitative study

Cited by 49 publications

References 14 publications

Healthcare personnel’s experiences of situations in municipal elderly care that generate troubled conscience

Healthcare personnel’s experiences of situations in municipal elderly care that generate troubled conscience

The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes – A cross-sectional study

„Alt werden im Paradies“ – Die ethischen Aspekte der Migration von pflegebedürftigen Menschen

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