Ethical elements in priority setting in nursing care: A scoping review

Suhonen, Riitta; Stolt, Minna; Habermann, Monika; Hjaltadóttir, Ingibjörg; Vryonides, Stavros; Tønnessen, Siri; Halvorsen, Kristin; Harvey, Clare; Toffoli, Luisa; Pearce, Scott

doi:10.1016/j.ijnurstu.2018.08.006

Cited by 106 publications

(130 citation statements)

References 49 publications

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“…Our ndings suggest that nurses often nd themselves in situations where they must balance the need of several patients and prioritize who should receive their attention, and they were sometimes unable to provide care at the standard they had preferred. An intensi ed work load without the necessary increase of resources, personnel or time, may lead to nurses being forced to decide what care to give, and what care to leave out (15). We support the idea that volunteers should be integrated into the care of older people, as suggested by participants in our study.…”

Section: Struggling To Perform Professional Caresupporting

confidence: 71%

“…Nurses encounter daily challenges related to ethical aspects of care; for example related to priority and allocation of care, patient autonomy, or end-of-life concerns (13)(14)(15). Furthermore, nurses experience ethical and moral questions in relationships with patients and next of kin, the staff and the health system, and ethically di cult situations occur when the reality does not meet the professionals' intentions to deliver high quality care (14,(16)(17)(18).…”

Section: Ethical Challenges In Clinical Practicementioning

confidence: 99%

“…Furthermore, nurses experience ethical and moral questions in relationships with patients and next of kin, the staff and the health system, and ethically di cult situations occur when the reality does not meet the professionals' intentions to deliver high quality care (14,(16)(17)(18). When staff feel they cannot provide high quality care according to their ethical values, this may result in troubled conscience, feelings of guilt, inadequacy and frustration; leading to workplace stress and risk of burnout, sickness, high turnover and personnel shortage (15,19). Moreover, low tolerance for failure, limited conversations about di culties, in exibility, not giving patients possibilities to utilize their resources or participate in decision-making processes, and also the implicit expectation to be professional and endure aggressive behavior from patients, are found to be ethically challenging when caring for older people (12,20).…”

Section: Ethical Challenges In Clinical Practicementioning

confidence: 99%

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Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care - A Qualitative Thematic Analysis

Rykkje

Holm

Hem

2020

Preprint

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Background: Many countries face an increasingly older population in need of health care services. There are reports of lack of qualified staff and resources, resulting in poor quality and undignified care. Care quality is depended upon factors like organization and staffing, but it is also recommended to focus on what staff members experience in clinical practice. In addition, ethical competence is a precondition for high quality care. The aim of this study is to provide knowledge about ethically challenging situations in caring for older people in institutions such as nursing homes and hospitals, and to gain insight into nurses’ written reflections about their experiences and management of ethical challenges in clinical practice.Methods: The data material consist of reflection notes by continuous education students in advanced gerontology in Norway. Data was collected in 2017–2018. We included 42 of 83 notes and utilized qualitative thematic analysis.Findings: “Doing what is in the patients’ best interest” is the guiding principle for the participants, portrayed through three themes as follows: a) Meeting vulnerability, discomfort and emotional pain, b) Collaboration with relatives, and c) Struggling to perform professional care. Within each theme, we provide a variety of ethically challenging situations in older people care. The findings represent the participants’ written experiences and reflections upon how they manage the situation and their effort to provide the best possible care.Conclusions: Health care professionals’ ethical competences may develop when reflecting upon their care performance. Therefore, building ethical competence should be a priority in education of healthcare professionals and in clinical practice. We acknowledge that ethical reflection does not automatically improve care quality, although we find that it fosters increased awareness of one’s action, and as such, it can act as a potential for change.Implications for practice: How nurses reflect upon and manage challenging situations indicates that quality in care is possible despite scarce resources, and this may contribute to reduce ageism and encourage health care personnel to be willing to work in older people care.

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Section: Struggling To Perform Professional Caresupporting

confidence: 71%

Section: Ethical Challenges In Clinical Practicementioning

confidence: 99%

Section: Ethical Challenges In Clinical Practicementioning

confidence: 99%

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Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care - A Qualitative Thematic Analysis

Rykkje

Holm

Hem

2020

Preprint

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“…Nursing practice, however, is only one element of delivering PCC within the healthcare system. This disparity extends between the concept of PCC and its ability to exist within the current healthcare system itself, where time to care is explicitly rationed through budgets that do not allow for individualised person-centred care [47].…”

Section: Discussionmentioning

confidence: 99%

Whose centre is it anyway? Defining person-centred care in nursing: An integrative review

2020

Self Cite

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The aims of this literature review were to better understand the current literature about person-centred care (PCC) and identify a clear definition of the term PCC relevant to nursing practice. Method/Data sources An integrative literature review was undertaken using The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Scopus and Pubmed databases. The limitations were English language, full text articles published between 1998 and 2018 within Australian,

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“…Based on what management scholar Peter Drucker (1998) said “You cannot manage what you don't measure” measuring CNC with the most appropriate tool among those available can have multiple benefits, as it can: Identify the causes and suggest appropriate interventions to prevent or minimize CNC (VanFosson et al, ), thus increasing patient safety and care quality (Aiken et al, ); Facilitate an open discussion about the phenomenon, discourage any punitive approach and give voices to nurses so they can speak freely about the quality of bedside care delivered; Also consider neglected contexts in which both patients and nurses' vulnerability has been reported to be high and in which scarcely any data have been documented to date (e.g., nursing homes, psychiatric, home care settings), thus devoting the same attention merited compared to hospitals, where most studies have been conducted to date (Bassi et al, ); and Develop the basis to undertake actions preventing all of CNC's negative consequences on patients, caregivers, nurses and healthcare institutions (Rochefort & Clarke, ; Suhonen et al, ). …”

Section: Resultsmentioning

confidence: 99%

Developing policies and actions in response to missed nursing care: A consensus process

et al. 2019

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Aim:To support the development of appropriate policies and actions in the field of missed nursing care (MNC).Background: There has been an ever-growing international debate on MNC, interventions that nurses have identified as necessary for their patients, but which for various reasons they are unable to provide or are forced to delay. Despite MNC's relevance, its translation into policies and actions has not been documented to date. Method:A consensus development method was employed involving (a) a nominal group composed of experts in the field, policymakers and the President of the Regional Nursing Professional Boards, and (b) 218 nurses appointed primarily at the managerial levels.Results: A total of eight consensus statements were approved and organized in a series of sub-statements designed to (1) render the concept of MNC culturally acceptable in the Italian context, with the agreement that compromised nursing care (CNC) is the best term to be used in this field, as a synonym for MNC; (2) measure CNC as a strategy to increase patient safety; (3) select an appropriate CNC measurement tool; (4) optimize CNC measurement; (5) conduct effective CNC data analysis; (6) design and implement interventions to prevent and/or minimize CNC; (7) assess and disseminate findings on interventions' effectiveness; and (8) provide final remarks on the way to move forward. Conclusions: We developed a process to introduce the phenomenon of MNC in the Italian culture and agreed firstly on the term compromised nursing care, which better reflects MNC's meaning according to the context and facilitates an open discussion on the phenomenon both within and outside the profession. The following consensus statements emerged represent a systematic approach, starting from the | 1493 PALESE Et AL.

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Ethical elements in priority setting in nursing care: A scoping review

Cited by 106 publications

References 49 publications

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care - A Qualitative Thematic Analysis

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care - A Qualitative Thematic Analysis

Whose centre is it anyway? Defining person-centred care in nursing: An integrative review

Developing policies and actions in response to missed nursing care: A consensus process

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