Caring for elder patients: Mutual vulnerabilities in professional ethics

2017 ◽  
Vol 25 (8) ◽  
pp. 1004-1016 ◽  
Author(s):  
Karin Nordström ◽  
Tenzin Wangmo
Keyword(s):  
Nursing Staff ◽  
Professional Ethics ◽  
Older Patients ◽  
Professional Relationships ◽  
Structured Interviews ◽  
Continuous Training ◽  
Elder Patients ◽  
Central Switzerland ◽  
Ethical Approval ◽  
Ethics Commission

Background: Neglect and abuse of elders in care institutions is a recurring issue in the media. Elders in care institutions are vulnerable due to their physical, cognitive, and verbal limitations. Such vulnerabilities may make them more susceptible to mistreatment by caregivers on whom they are heavily dependent. Objectives: The goal was to understand caregivers’ concerns about ensuring correct and proper treatment, as well as their experiences with neglect and abuse of older patients. This article examines resources and challenges of professional ethics within the care setting. Research design: A study was conducted to explore the quality of care provided to older patients in nursing homes, geriatrics institutions, and ambulant care in the northwest region of Switzerland. Participants and research context: A total of 23 semi-structured interviews were conducted with nursing staff of varying experience levels. Ethical considerations: Ethical approval was granted by the competent regional ethics commission, Ethikkomission Nordwest-und Zentralschweiz EKNZ [Ethics Commission Northwest and Central Switzerland] (2014-015). Findings: Three themes emerged from our data analysis: professional identity, professional context, and professional relationships. Our findings indicate mutual vulnerabilities within these three themes, characterizing the interactions between nursing staff and older patients. Study participants believe that incidences of error, neglect, and abuse are consequences of their own vulnerability since they are not able to meet the demands of an overstraining work situation. Discussion: Different aspects of this mutual vulnerability are described and critically discussed as challenges for professional ethics. Conclusion: Early education, continuous training as well as better management and response from the institution are necessary to maintain professionalism while handling mutual vulnerabilities.

scholarly journals 22 Coping with Medicines After Hospital Discharge; the Invisible Work of Older Patients and Their Care-Givers

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i7-i11
Author(s):  
J Tomlinson ◽  
H Smith ◽  
J Silcock ◽  
K Karban ◽  
B Fylan
Keyword(s):  
Older Patients ◽  
Structured Interviews ◽  
Medicines Management ◽  
Post Discharge ◽  
General Internal ◽  
Care Givers ◽  
Invisible Work ◽  
Ethical Approval ◽  
Discharge From Hospital ◽  
The Invisible

Abstract Introduction Older patients often experience medication-related problems following discharge from hospital. These can be categorised as issues with obtaining medication, taking medication, medication effects or problems with communication or care co-ordination (Nicosia et al., Journal of General Internal Medicine, 2019, https://doi.org/10.1007/s11606-019-05463-z). The aim of this study was to explore older adults’ experiences of post-discharge medicines management, including the strategies they use to safely manage their changed medicines. Methods Following ethical approval, patients aged 75 and above, with a change in their long term medicines, were recruited during admission to one of two hospitals in Yorkshire. Semi-structured interviews took place with the participants in their own homes, approximately two weeks after discharge. Interviews were audio recorded and transcribed. Data were analysed using the Framework method. Results Twenty-seven patients (mean age 85 years; 6 males) consented to be interviewed. They described multiple self-management and safety strategies used to support medicines management in the early post-discharge phase. The work done included adaptations (to routines, the home environment and action plans), scaffolding (where patients and their care-givers support the primary care system by providing additional documentation or prompts to ensure medicines were supplied on time and were correct) and error avoidance (seeking information, performing checks and balances). Conclusion Older patients experience gaps in their post-discharge medicines-related care which they had to bridge through implementing their own strategies or by enlisting support from others. This study shines a spotlight on to the invisible work that patients have to do in order to make post-discharge medicines management fit for purpose. Further work should consider those patients who are not able to carry out these tasks or who do not have any care-givers available for support and how this potential gap in care can be addressed.

Significados de Morte: o Discurso do Sujeito Coletivo da Enfermagem / Meaning of Death: the collective subject speech of the nursing staff

1970 ◽  
Vol 6 (1) ◽  
pp. 52-58
Author(s):  
Fellipe Afonso de Azevedo ◽  
Noé D’jalma Araújo ◽  
Néliton Célio de Novais ◽  
José Vítor da Silva ◽  
Renato Augusto Passos
Keyword(s):  
Nursing Staff ◽  
Hospital Setting ◽  
Field Research ◽  
Structured Interview ◽  
Minas Gerais ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Emergency Units ◽  
Methodological Guidelines

RESUMOObjetivo: o presente trabalho teve como objetivo identificar os significados de morte emergentes das equipes de enfermagem que atuam nas unidades de Pronto Socorro e Unidade de Terapia Intensiva (UTI) em uma entidade de médio porte situada no Sul de Minas Gerais. Materiais e métodos: estudo de abordagem qualitativa, do tipo descritivo, de campo e transversal. A amostra estudada foi composta de oito enfermeiros, 22 técnicos e quatro auxiliares de enfermagem, totalizando 34 profissionais, sendo utilizado o instrumento de caracterização pessoal e profissional da equipe de enfermagem e o roteiro de entrevista semiestruturada. A amostragem foi proposital. A coleta de dados foi realizada através de entrevista semiestruturada, gravada e transcrita. As diretrizes metodológicas do Discurso do Sujeito Coletivo foram utilizadas para a seleção das ideias centrais e expressões-chave correspondentes, a partir das quais foram extraídos os discursos dos sujeitos, no cenário da instituição hospitalar. Resultados e Discussão: ao analisar o tema “significados de morte”, obtiveram-se as seguintes ideias centrais: “passagem”, “diversos significados”, “fim da vida” e “fim e começo de outra vida”. Conclusão: As concepções acerca do tema morte para os profissionais participantes deste trabalho reforça a necessidade de estudos sobre o tema durante a formação acadêmica. Certos de que irão vivenciar este tipo de situação no dia-a-dia profissional, é preciso prepará-los psicologicamente para isso.Palavras-chave: Morte, Equipe de enfermagem, Assistência ao paciente.ABSTRACTObjective: This study aimed to identify the meanings of emerging death of the nursing staff working in the Emergency Units and Intensive Care Unit (ICU) in a medium-sized entity located in southern Minas Gerais. Materials and methods: A cross-sectional qualitative field research. The sample was composed of 8 nurses, 22 technicians and 4 nursing assistants, totaling 34 professionals. It was used a tool of personal and professional characterization of the nursing team and a semi-structured interview. Sampling was intentional. Data collection was conducted through semi-structured interviews, that were recorded and transcribed. The methodological guidelines of the Collective Subject Speech were used for the selection of the central ideas and corresponding key expressions, from which the speeches of the subjects were taken, in the hospital setting. Results and discussion: to examine the topic "death meanings" yielded the following core ideas: "pass", "different meanings", "end of life" and "end and beginning of another life." Conclusion: The conceptions about the death theme for the professional participants of this study reinforces the need for studies on the subject during their academic training. It is certain that they will experience this type of situation on their daily professional routine, therefore there is a need to prepare them psychologically for this.Keywords: Death, Nursing staff, Patient care.

scholarly journals The dimensioning of the nursing staff in a intensive care unit

2012 ◽  
Vol 6 (2) ◽  
pp. 252
Author(s):  
Hérvora Santuzza Pereira Araújo ◽  
Ildone Forte de Morais ◽  
Cecília Nogueira Valença ◽  
Marquiony Marques dos Santos ◽  
Raimunda Medeiros Germano
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nursing Staff ◽  
Rio Grande ◽  
Exploratory Research ◽  
Structured Interviews ◽  
Personnel Downsizing ◽  
Qualitative Descriptive ◽  
Terapia Intensiva ◽  
Investigación Cualitativa

ABSTRACTObjective: to discuss the nursing staff's project in the context of the Intensive Care Unit (ICU) of Hospital Regional do Seridó, Caicó-RN. Method: qualitative descriptive-exploratory research. 19 semi-structured interviews were performed with professional nursing staff working in the ICU. The data were analyzed according to thematic content analysis, which consists of: pre-analysis, material exploration and processing of results. The study was approved by the Ethics Committee in Research of Universidade do Estado do Rio Grande do Norte as Protocol 027/10 and CAAE 0026.0.428.000-10, according to Resolution 196/96. Results: it was showed that the quantity of graduated professionals in nursing staff is unsatisfactory for the development of the necessary assistance to the ICU. Conclusion: this study reflects that the dimensioning of the nursing staff should involve the participation of hospital managers for researching and raising the critical points of functioning of the service, through promoting teamwork. Descriptors: personnel downsizing; intensive care unit; nursing team.RESUMOObjective: discutir o dimensionamento da equipe de enfermagem no contexto da Unidade de Terapia Intensiva do Hospital Regional do Seridó (HRS) em Caicó- RN. Método: pesquisa descritivo-exploratória qualitativa. Foram realizadas 19 entrevistas semiestruturadas com profissionais da equipe de enfermagem que trabalham na UTI. As informações foram analisadas de acordo com a análise de conteúdo temática, que consiste em: pré-análise, exploração do material e tratamento dos resultados obtidos. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Universidade do Estado do Rio Grande do Norte conforme protocolo nº 027/10 e CAAE 0026.0.428.000-10, de acordo com a Resolução 196/96. Resultados: apontaram que o quantitativo dos profissionais de nível superior em enfermagem é insatisfatório para o desenvolvimento da assistência necessária para a UTI. Conclusão: o estudo reflete que o dimensionamento da equipe de enfermagem deve envolver a participação dos gestores do hospital, para pesquisar e levantar os pontos críticos do funcionamento do serviço, através da promoção do trabalho em equipe. Descritores: downsizing organizacional; unidades de terapia intensiva; equipe de enfermagem.RESUMENObjetivo: discutir la dimensión del equipo de enfermería en el contexto de la Unidad de Cuidados Intensivos (UCI) del Hospital Regional de Seridó en Caico-RN. Método: investigación cualitativa descriptivo-exploratoria. Fueron realizadas 19 entrevistas semi-estructuradas con los profesionales del equipo de enfermería que trabajan en la UCI. Los datos fueron analizados según el análisis de contenido temático, que consiste en: pre-análisis, exploración de materiales y tratamiento de los resultados. El estudio fue aprobado por el Comité de Ética en Investigación de la Universidad del Estado de Rio Grande do Norte como Protocolo 027/10 y CAAE 0026.0.428.000-10, de acuerdo con la Resolución 196/96. Resultados: mostraron que el cuantitativo de profesionales de nivel superior en enfermería no es satisfactorio para el desarrollo de la asistencia necesaria a la UCI. Conclusión: este estudio refleja que la escala del equipo de enfermería debe incluir la participación de los administradores del hospital para investigar y levantar los puntos críticos de la funcionamiento del servicio, promoviendo el trabajo en equipo. Descriptores: reducción de personal; unidades de terapia intensiva; grupo de enfermería.

scholarly journals Working relationally with clients who have experienced abuse: Exploring counselling psychologists’ experiences using ipa

2020 ◽  
Vol 8 (1) ◽  
pp. 144-162
Author(s):  
Carly Malcolm ◽  
Richard Golsworthy
Keyword(s):  
Interpretative Phenomenological Analysis ◽  
Holding Environment ◽  
Structured Interviews ◽  
Relational Dynamics ◽  
Therapeutic Work ◽  
Client Group ◽  
Ethical Approval ◽  
Therapeutic Space ◽  
The University ◽  
External Communications

Whilst much research has been conducted into the efficacy of and guidelines for technical interventions in the treatment of abuse, it is argued that a relational or process approach to therapeutic work should become more integrated into the use of technical interventions to aid therapeutic outcome. The study aims to explore counselling psychologists’ experiences when working with clients who have experienced abuse. Semi-structured interviews were conducted and analysed using Interpretative Phenomenological Analysis (IPA). Six participants were recruited and asked to share their experiences of their therapeutic work with the client group. The research was given ethical approval by the ethics committee of the university. Three superordinate themes emerged from the data: ‘The Holding Environment’, ‘The Personal versus The Professional’ and ‘Internal Responses, External Communications’. These were supported by various subthemes within the accounts and were generated as a result of a double hermeneutic engagement with each interview transcript. This research contributes towards a deeper understanding of the processes involved in creating a therapeutic space for the work and the relational dynamics involved in providing therapy to clients who have experienced abuse. The dynamic process between empathising and ‘detaching’ in session, as well as counselling psychologists’ use of supervision, are highlighted as areas for further study.

scholarly journals Shared clinical decision-making experiences in nursing: A qualitative study

2021 ◽  
Author(s):  
Fen-Fang Chung ◽  
Shu-Chuan Lin ◽  
Yu-Hsia Lee ◽  
Pao-Yu Wang ◽  
Hon-Yen Wu ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Education ◽  
Nursing Staff ◽  
Cultural Sensitivity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Information Communication ◽  
Structured Interviews ◽  
Clinical Nursing ◽  
Basic Ability

Abstract Background Shared decision making (SDM) is a patient-centred nursing concept that emphasises the autonomy of the patient. It is a co-operative process of exchanging information, communication and response, and treatment decisions made between medical staff and patients. In this study, we explored the experience of clinical nursing staff participating in SDM. Methods We adopted a qualitative research method. Semi-structured interviews were conducted with 21 nurses at a medical centre in northern Taiwan. The data obtained from interview recordings were transferred to verbatim manuscripts. Content analysis was used to analyse and summarise the data. Results Clinical nursing staff should have basic professional skills, communication and response skills, respect and cultural sensitivity, the ability to form a co-operative team, the ability to search for and integrate empirical data, and the basic ability to edit media to participate in SDM. Conclusions The results of this study describe the experiences of clinical nursing staff participating in SDM, which can be used as a reference for nursing education and nursing administrative supervisors to plan and enhance professional nursing SDM in nursing education.

scholarly journals What are essential elements of high-quality palliative care at home? An interview study among patients and relatives faced with advanced cancer

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
M. G. Oosterveld-Vlug ◽  
B. Custers ◽  
J. Hofstede ◽  
G. A. Donker ◽  
P. M. Rijken ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Nursing Staff ◽  
Information Transfer ◽  
Essential Elements ◽  
Community Nursing ◽  
Structured Interviews ◽  
High Quality ◽  
Care At Home ◽  
At Home

Abstract Background In the Netherlands, general practitioners (GPs) and community nurses play a central role in the palliative care for home-dwelling patients with advanced cancer and their relatives. To optimize the palliative care provision at home, it is important to have insight in the elements that patients and relatives consider essential for high-quality palliative care, and whether these essentials are present in the actual care they receive. Methods Qualitative semi-structured interviews were conducted with 13 patients with advanced cancer and 14 relatives. The participants discussed their experiences with the care and support they received from the GP and community nurses, and their views on met and unmet needs. Interview data were analysed according to the principles of thematic analysis. Results Patients as well as relatives considered it important that their GP and community nursing staff are medically proficient, available, person-focused and proactive. Also, proper information transfer between care professionals and clear procedures when asking for certain resources or services were considered essential for good palliative care at home. Most interviewees indicated that these essential elements were generally present in the care they received. However, the requirements of ‘proper information transfer between professionals’ and ‘clear and rapid procedures’ were mentioned as more difficult to meet in actual practice. Patients and relatives also emphasized that an alert and assertive attitude on their own part was vital in ensuring they received the care they need. They expressed worries about other people who are less vigilant regarding the care they receive, or who have no family to support them in this. Conclusions Medical proficiency, availability, a focus on the person, proper information transfer between professionals, clear procedures and proactivity on the part of GPs and community nursing staff are considered essential for good palliative care at home. Improvements are particularly warranted with regard to collaboration and information transfer between professionals, and current bureaucratic procedures. It is important for care professionals to ensure that the identified essential elements for high-quality palliative care at home are met, particularly for patients and relatives who are not so alert and assertive.

scholarly journals Academic Social Networking Sites are Smaller, Denser Networks Conducive to Formal Identity Management, Whereas Academic Twitter is Larger, More Diffuse, and Affords More Space for Novel Connections

2020 ◽  
Vol 15 (1) ◽  
pp. 226-228
Author(s):  
Scott Goldstein
Keyword(s):  
Network Analysis ◽  
Social Networking ◽  
Online Social Networks ◽  
Social Networking Sites ◽  
Information Science ◽  
Identity Management ◽  
Social Networking Site ◽  
Professional Relationships ◽  
Structured Interviews ◽  
Ego Networks

A Review of: Jordan, K. (2019). Separating and merging professional and personal selves online: The structure and processes that shape academics’ ego-networks on academic social networking sites and Twitter. Journal of the Association for Information Science and Technology, 70(8), 830-842. https://doi.org/10.1002/asi.24170 Abstract Objective – To examine the structure of academics’ online social networks and how academics understand and interpret them. Design – Mixed methods consisting of network analysis and semi-structured interviews. Setting – Academics based in the United Kingdom. Subjects – 55 U.K.-based academics who use an academic social networking site and Twitter, of whom 18 were interviewed. Methods – For each subject, ego-networks were collected from Twitter and either ResearchGate or Academia.edu. Twitter data were collected primarily via the Twitter API, and the social networking site data were collected either manually or using a commercial web scraping program. Edge tables were created in Microsoft Excel spreadsheets and imported into Gephi for analysis and visualization. A purposive subsample of subjects was interviewed via Skype using a semi-structured format intended to illuminate further the network analysis findings. Transcripts were deductively coded using a grounded theory-based approach. Main Results – Network analysis replicated earlier findings in the literature. A large number of academics have relatively few connections to others in the network, while a small number have relatively many connections. In terms of reciprocity (the proportion of mutual ties or pairings out of all possible pairings that could exist in the network), arts and humanities disciplines were significantly more reciprocal. Communities (measured using the modularity algorithm, which looks at the density of links within and between different subnetworks) are more frequently defined by institutions and research interests on academic social networking sites and by research interests and personal interests on Twitter. The overall picture was reinforced by the qualitative analysis. According to interview participants, academic social networking sites reflect pre-existing professional relationships and do not foreground social interaction, serving instead as a kind of virtual CV. By contrast, Twitter is analogized to a conference coffee break, where users can form new connections. Conclusion – Academic social networking sites exhibit networks that are smaller, denser, more clustered around discrete modularity classes, and more reciprocal. Twitter networks are larger and more diffuse, which is more conducive to fostering novel connections. The author makes suggestions for how academic social networking sites could encourage network building and rethink how academic reputation is measured.

scholarly journals Organization Ethics in Healthcare

2000 ◽  
Vol 9 (2) ◽  
pp. 145-146 ◽  
Author(s):  
Patricia H. Werhane ◽  
Mary V. Rorty
Keyword(s):  
Patient Care ◽  
Clinical Ethics ◽  
Professional Ethics ◽  
Applied Ethics ◽  
Care Patient ◽  
Professional Relationships ◽  
Healthcare Organizations ◽  
Clinical Patient ◽  
Organization Ethics ◽  
Professional Guidelines

Bioethics, clinical ethics, and professional ethics are mature, well-developed fields of applied ethics that focus on medical research, patient autonomy and patient care, patient–healthcare professional relationships, and issues that arise in clinical and other medical settings. However, despite these developments, little attention has been paid to the organizational aspects of healthcare in these fields. This is surprising, because in the last 30 years healthcare has become more and more institutionalized in provider, management, and insurer organizations. Despite JCAHO's preoccupation with organizational ethics during the last decade, the philosophical underpinnings of their requirements have been less explored in the literature. Clinical ethics remains preoccupied with clinical patient care and professional ethics with individual professional guidelines; even the American College of Healthcare Executives focuses primarily on healthcare managers, not on healthcare organizations.

scholarly journals Decision-making in an emergency department: A nursing accountability model

2019 ◽  
Vol 27 (2) ◽  
pp. 567-586 ◽  
Author(s):  
Alfonso Rubio-Navarro ◽  
Diego José García-Capilla ◽  
Maria José Torralba-Madrid ◽  
Jane Rutty
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Participant Observation ◽  
Ethics Committees ◽  
Healthcare Institution ◽  
Structured Interviews ◽  
Ethical Considerations ◽  
Clinical Nursing ◽  
Ethical Approval ◽  
Acute Patients

Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified and triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen.

Experiences of engaging in therapeutic storytelling

2020 ◽  
Vol 25 (1) ◽  
pp. 47-61
Author(s):  
Lucho Aguilera ◽  
Kirk Reed ◽  
Josie Goulding
Keyword(s):  
New Zealand ◽  
Evidence Base ◽  
Study Data ◽  
Oral Traditions ◽  
Structured Interviews ◽  
Content Type ◽  
Transformative Experiences ◽  
Adult Participants ◽  
Ethical Approval ◽  
Therapeutic Storytelling

Purpose The purpose of this study is to seek answer to the following question: Does participating in storytelling changes participants’ life experiences in their journey of recovery? The study explores participants’ experiences of engaging in a storytelling programme in a community mental health team in a large New Zealand city. The programme aims to provide a safe environment to support and increase participants’ engagement with services and the community. Currently, there is limited literature on consumer’s experiences of engaging in therapeutic storytelling programmes in the international or New Zealand context. Design/methodology/approach Following ethical approval, eight adult participants were recruited to the study. Data were collected through semi-structured interviews and analysed using the six-phase process of thematic analysis, developed by Braun and Clarke. Findings Three main themes emerged from the data. The first theme, breaking barriers, was described by participants as to how they overcame barriers. The second theme, creating positive memories, uncovered the positive experiences that participants gained from the programme. The final theme, becoming a new person, described some of the transformative experiences that emerged through participation in the programme. Originality/value This is the first qualitative study in the New Zealand context that has explored the value of a storytelling programme from a consumer’s perspective. The findings suggest that participating in a storytelling programme can contribute to a participant’s journey of recovery; the use of myths, legends and group work is fundamental to those from collective cultures with oral traditions. The ongoing value of storytelling as a therapeutic tool requires further research and the development of a clearer evidence base to inform practice.

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