Ethical issues experienced by healthcare workers in nursing homes

2016 ◽  
Vol 23 (5) ◽  
pp. 490-506 ◽  
Author(s):  
Deborah HL Preshaw ◽  
Kevin Brazil ◽  
Dorry McLaughlin ◽  
Andrea Frolic
Keyword(s):  
Nursing Home ◽  
Healthcare Workers ◽  
Ethics Education ◽  
Moral Distress ◽  
Ethical Issues ◽  
Nursing Assistants ◽  
Care Providers ◽  
Moral Issues ◽  
Staff Burnout

Background: Ethical issues are increasingly being reported by care-providers; however, little is known about the nature of these issues within the nursing home. Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress. Objectives: The purpose of this review was to identify prior research which focuses on ethical issues in the nursing home and to explore staffs’ experiences of ethical issues. Methods: Using a systematic approach based on Aveyard (2014), a literature review was conducted which focused on ethical and moral issues, nurses and nursing assistants, and the nursing home. Findings: The most salient themes identified in the review included clashing ethical principles, issues related to communication, lack of resources and quality of care provision. The review also identified solutions for overcoming the ethical issues that were identified and revealed the definitional challenges that permeate this area of work. Conclusions: The review highlighted a need for improved ethics education for care-providers.

scholarly journals Influenza Vaccination Coverage of Healthcare Workers in Nursing Homes in France and Related Determinants, 2018- 2019 Season: A Cross-Sectional Survey

2021 ◽  
Author(s):  
Sophie Vaux ◽  
Laure Fonteneau ◽  
Anne-Gaëlle Venier ◽  
Arnaud Gautier ◽  
Sophan Soing Altrach ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Healthcare Workers ◽  
Negative Binomial ◽  
Nursing Assistants ◽  
Influenza Vaccines ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Background The burden of influenza morbidity and mortality in nursing homes (NH) is high. Vaccination of residents and healthcare workers (HCW) is the main prevention strategy. Despite recommendations, HCW vaccination coverage is generally low. Methods We performed a nationwide cross-sectional survey of NH using a single-stage stratified random sampling design to estimate influenza vaccination coverage in nursing home HCW in France during the 2019-2020 season, and to identify measures likely to increase it. A multivariate analysis was performed using a negative binomial regression. Results Overall influenza vaccination coverage in HCW was 31.9% (95% CI [29.7-34.1]). It varied according to occupational category: 75.5% [69.3-81.7] for physicians, 42.9% [39.4-46.4] for nurses, 26.7% [24.5-29.0] for nursing assistants, and 34.0% [30.1-38.0] for other paramedical personnel. When considering all professionals (i.e., HCW and non-medical professionals), overall vaccination coverage was 30.6% [28.2-33.0]. Vaccination coverage was higher in private nursing homes, in i) small nursing homes, ii) when vaccination was offered free of charge (RRa: 1.4, [1.1-1.8]), iii) when vaccination promotion for professionals included individual (RRa: 1.6 [1.1-2.1]) or collective (RRa: 1.3 [1.1-1.5]) information sessions, videos or games (RRa: 1.4 [1.2-1.6], iv) when information on influenza vaccines was provided (RRa: 1.2 [1.0-1.3], and finally, vi) when a vaccination point of contact - defined as an HCW who could provide reliable information on vaccination - was nominated within the nursing home (RRa: 1.7 [1.3-2.2]). Conclusions Urgent and innovative actions are required to increase coverage in HCW. Vaccination programmes should include free vaccination and education campaigns, and particularly target nursing assistants. The results of this nationwide study provide keys for improving influenza vaccination coverage in HCW. Programmes should ensure that information on influenza vaccines is provided by a vaccination point of contact in NH using attractive media. Combining the different prevention measures proposed could increase coverage in NH nationwide by over 50%.

Fostering medical staff reflection on the technological alienation of parents in the NICU

2021 ◽  
pp. 147775092110618
Author(s):  
Abram Brummett ◽  
Annie B. Friedrich
Keyword(s):  
Medical Staff ◽  
Moral Distress ◽  
Ethical Issues ◽  
Treatment Refusal ◽  
Healthy Newborn ◽  
Incurable Condition ◽  
Life Sustaining Treatment ◽  
Terminal Diagnosis ◽  
The Relationship

We describe a case of parents refusing a tracheostomy for an otherwise healthy newborn. The refusal was not honored because permitting the refusal would have violated state law, which required a child to have a qualifying condition (e.g. a terminal diagnosis, permanent unconsciousness, incurable condition with severe suffering) to remove or withhold life-sustaining treatment. However, this case strained the relationship between the parents and medical staff, who worried about sending the newborn home with a tracheostomy where she was not wanted. While many ethical issues arise in treatment refusal cases like this, we focus on the opportunity for ethicists to help the medical staff reflect on the technological alienation of the parents, which may help foster empathy, reduce moral distress, and strengthen the quality of the doctor-parent-patient triad.

The vulnerability of nursing home residents to the Covid-19 pandemic

2020 ◽  
Vol 23 (2-3) ◽  
pp. 57-60 ◽  
Author(s):  
Edward H Wagner
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Nursing Assistants ◽  
Nursing Home Care ◽  
Term Care ◽  
Staff Members ◽  
Care Facilities

Residents in nursing homes and other long-term care facilities comprise a large percentage of the deaths from Covid 19. Is this inevitable or are there problems with NHs and their care that increase the susceptibility of their residents. The first U.S. cluster of cases involved the residents, staff, and visitors of a Seattle-area nursing home. Study of this cluster suggested that infected staff members were transmitting the disease to residents. The quality of nursing home care has long been a concern and attributed to chronic underfunding and resulting understaffing. Most NH care is delivered by minimally trained nursing assistants whose low pay and limited benefits compel them to work in multiple long-term care settings, increasing their risk of infection, and work while ill. More comparative studies of highly infected long-term care facilities with those organizations that were able to better protect their residents are urgently needed. Early evidence suggests that understaffing of registered nurses may increase the risk of larger outbreaks.

Quality of Life in the Elderly: Comparisons Between Nursing Home and Community Residents

1988 ◽  
Vol 7 (3) ◽  
pp. 316-330 ◽  
Author(s):  
Robert A. Pearlman ◽  
Richard F. Uhlmann
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Interpersonal Relationships ◽  
Nursing Home Residents ◽  
Elderly Persons ◽  
Care Providers ◽  
Global Quality ◽  
Global Quality Of Life ◽  
Community Residents

Quality of life of older persons is important as a consideration in medical decisions and as a clinical outcome measure. To compare quality of life between elderly nursing home and community residents, we interviewed 47 pairs of age- and sex-matched, nondemented nursing home and community persons. Global quality of life ratings were similar among nursing home and community residents, with ratings suggesting a self-perceived acceptable quality of life. Housing (the nursing home), finances, health, and interpersonal relationships were associated with global quality of life for nursing home residents; for community participants, health, disability, finances, anxiety, and interpersonal relationships were associated with quality of life. Results suggest that health care providers cannot assume that their older nursing home residents perceive their quality of life to be worse than other elderly persons and that some people report that nursing homes improve their quality of life.

scholarly journals Digital Interventions to Reduce Distress Among Health Care Providers at the Frontline: Protocol for a Feasibility Trial (Preprint)

2021 ◽  
Author(s):  
Binh Nguyen ◽  
Andrei Torres ◽  
Walter Sim ◽  
Deborah Kenny ◽  
Lindsay Beavers ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Test Data ◽  
Healthcare Workers ◽  
Moral Distress ◽  
Feasibility Trial ◽  
Care Providers ◽  
Digital Platforms ◽  
Future Studies ◽  
Digital Intervention ◽  
Challenging Situation

BACKGROUND Stress, anxiety, distress and depression are high among healthcare workers during the COVID-19 pandemic and they have reported acting in ways that are contrary to their moral values, integrity, and professional commitments that degrade their integrity. This creates moral distress and injury as a result of constraints they have encountered, such as limited resources. OBJECTIVE The purpose of this study is to develop and show feasibility of digital platform (Virtual Reality (VR) and mobile platform) to understand the causes and ultimately reduce the moral distress of healthcare providers during the COVID-19 pandemic. This project is a proof-of-concept integration of concepts/applications to demonstrate viability over six months and serve as a guide for future studies to develop these state-of-the-art technologies to help frontline healthcare workers work in complex moral contexts. The project will develop innovations which can be used for future pandemics and in other contexts prone to producing moral distress and injury. METHODS This will be a prospective, single cohort, pre- and post-test study examining the effect of brief informative video describing moral distress on perceptual, psychological, and physiological indicators of stress and decision-making during the scenario known to potentially elicit moral distress. To accomplish this, we have developed a VR simulation scenario that will be used before and after the digital intervention for monitoring of short-term impacts. The simulation involves an ICU setting during the COVID-19 pandemic and participants will be placed in a morally challenging situation, the participants will be engaged at the individual, team, and organizational levels. During each test, data will be collected for a) physiological measures of stress and after each test, data will be collected regarding b) thoughts, feelings and behaviors during a morally challenging situation, and c) perceptual estimates of psychological stress. We aim to create an effective compound intervention that is composed of the VR-based simulation educational intervention that is verified through the data collection of mental health questionnaires. In addition, participants will continue to be monitored for moral distress and other psychological stresses for 8 weeks through our Digital intervention/intelligence Group mobile (DiiG) platform for longer-term impact. A baseline comparison will be conducted using machine learning and statistical techniques to analyze the short- and long-term impacts of the VR intervention. RESULTS Funded in (November, 2020), approved by REB in (March, 2021), study is ongoing. CONCLUSIONS This project aims to demonstrate the feasibility of using digital platforms to understand the continuum of moral distress that can lead to moral injury. Demonstration of feasibility will lead to future studies to examine the efficacy of digital platforms to reduce moral distress. CLINICALTRIAL Trial registry name: ClinicalTrials.gov Registration/identifier number: NCT05001542 URL: https://clinicaltrials.gov/ct2/show/NCT05001542

scholarly journals Ethics for Laboratory Medicine

2019 ◽  
Vol 65 (12) ◽  
pp. 1497-1507 ◽  
Author(s):  
Ann M Gronowski ◽  
Melissa M Budelier ◽  
Sheldon M Campbell
Keyword(s):  
Informed Consent ◽  
Healthcare Workers ◽  
Patient Autonomy ◽  
Ethics Education ◽  
Ethical Issues ◽  
Laboratory Medicine ◽  
Reference Intervals ◽  
Biomedical Ethics ◽  
Ethical Standards ◽  
Ethical Practice

Abstract BACKGROUND Laboratory medicine, like other areas of medicine, is obliged to adhere to high ethical standards. There are particular ethical issues that are unique to laboratory medicine and other areas in which ethical issues uniquely impact laboratory practice. Despite this, there is variability in ethics education within the profession. This review provides a foundation for the study of ethics within laboratory medicine. CONTENT The Belmont Report identifies 3 core principles in biomedical ethics: respect for persons (including autonomy), beneficence (and its corollary nonmalfeasance), and justice. These core principles must be adhered to in laboratory medicine. Informed consent is vital to maintain patient autonomy. However, balancing patient autonomy with the desire for beneficence can sometimes be difficult when patients refuse testing or treatment. The use of leftover or banked samples is fundamental to the ability to do research, create reference intervals, and develop new tests, but it creates problems with consent. Advances in genetic testing have created unique ethical issues regarding privacy, incidental findings, and informed consent. As in other professions, the emergence of highly contagious and deadly infectious diseases poses a difficult ethical dilemma of helping patients while protecting healthcare workers. CONCLUSIONS Although many clinical laboratorians do not see or treat patients, they must be held accountable to the highest ethical and professional behavior. Recognition and understanding of ethical issues are essential to ethical practice of laboratory medicine.

The ethics of interprofessional collaboration

2013 ◽  
Vol 20 (4) ◽  
pp. 426-435 ◽  
Author(s):  
Joyce Engel ◽  
Dawn Prentice
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Moral Distress ◽  
Ethical Issues ◽  
Interprofessional Collaboration ◽  
Care Providers ◽  
Quality Health Care ◽  
Health Care Outcomes ◽  
Quality Health ◽  
Interprofessional Competencies

Interprofessional collaboration has become accepted as an important component in today’s health care and has been guided by concerns with patient safety, quality health-care outcomes, and economics. It is widely accepted that interprofessional collaboration improves patient outcomes through enhanced communication among health-care providers and increased accessibility to services. Although there is a paucity of research that provides confirmatory evidence, interprofessional competencies continue to be incorporated into the curricula of health-care students. This article examines the ethics of interprofessional collaboration and ethical issues that arise from the mainstream adoption of interprofessional competencies and the potential for moral distress in nursing.

scholarly journals Clarification and Mitigation of Ethical Problems Surrounding Withdrawal of Extracorporeal Membrane Oxygenation

2016 ◽  
Vol 36 (5) ◽  
pp. 56-65 ◽  
Author(s):  
Susan B. Williams ◽  
Michael D. Dahnke
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Moral Distress ◽  
Life Support ◽  
Ethical Issues ◽  
Advanced Practice Nurses ◽  
Advanced Practice ◽  
Care Providers ◽  
Ethical Problems ◽  
Practice Nurses ◽  
Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is temporary life-support technology that provides time to rest the cardiac and respiratory system of critically ill people with acute, reversible medical conditions. Health care providers face emotional and challenging situations, where death may result, when withdrawing ECMO. A deepening of understanding of the ethical issues involved can aid clinicians in handling such difficult situations, leading to a possible mitigation of the moral problems. Toward this end, the ethical issues raised in the consideration of ECMO withdrawal are analyzed with respect to the ethical principles and concepts of autonomy, nonmaleficence/beneficence, medical futility, moral distress, and justice. In particular, these issues are considered in relation to how they affect and can be addressed by staff nurses and advanced practice nurses in the intensive care unit. Advanced practice nurses in particular can represent the voice of nurses to promote a healthier workplace in situations of moral distress related to stopping ECMO life-support technology and in developing clear and consistent guidelines for ceasing ECMO treatment, all leading toward clarification and mitigation of the ethical problems surrounding the withdrawal of this critical technology.

Moral distress and moral competences in midwifery: A latent variable approach

2018 ◽  
Vol 25 (13-14) ◽  
pp. 2340-2351 ◽  
Author(s):  
Stephan Oelhafen ◽  
Eva Cignacco
Keyword(s):  
Health Professionals ◽  
Latent Variable ◽  
Moral Distress ◽  
Ethical Issues ◽  
Negative Consequences ◽  
Variable Approach ◽  
Moral Competences ◽  
Latent Variable Approach ◽  
Impaired Quality

Like other health professionals, midwives need moral competences in order to cope effectively with ethical issues and to prevent moral distress and negative consequences such as fatigue or impaired quality of care. In this study, we developed and conducted a survey with 280 midwives or midwifery students assessing the burden associated with ethical issues, moral competences, and negative consequences of moral distress. Results show that ethical issues associated with asymmetries of power and authority most often lead to the experience of distress. The results are critically discussed in the context of the conceptualization and operationalization of moral distress.

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