The general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services.
This study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations (n = 122), memos and informal interviews with registered nurses (n = 8), and nurse assistants (n = 4). The transcribed texts were analyzed with interpretive content analysis.
The inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues.
This study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.
Henderson EJ, Caplan GA. Home sweet home? Community Care for Older People in Australia. J Am Med Dir Assoc. 2008;9:88–94. CrossRef
Mentsen T, Hellzen O, Enmarker I. The Experience of Nurses Providing Home Nursing Care to Oldest Old Persons Living Alone in Rural Areas. An Interview Study. 2015;5:8.
Low L-F, Yap M, Brodaty H. A systematic review of different models of home and community care services for older persons. BMC Health Serv Res. 2011;11:93. CrossRef
Genet N, Boerma W, Kroneman M, Hutchinson A, Saltman R. Home care across Europe: case studies. Utrecht, The Netherlands: European observatory on Health System and Policies; 2013. https://www.narcis.nl/publication/RecordID/publicat%3A1002336. Accessed 11 Nov 2016.
Lindahl AK. Norway: Int Health Care System Profiles. The Commonwealth Fund. n.d. https://international.commonwealthfund.org/countries/norway/. Accessed 27 Oct 2018.
HOD H 1999. Patient and Service User Law. HOD 1999-07-02-63. Lov om pasient- og brukerrettighet. Oslo. p. 1999. https://lovdata.no/dokument/NL/lov/1999-07-02-63
Ekman I. Personcentrering inom hälso-och sjukvård: från filosofi till praktik; 2014.
Ekman I, Hedman H, Swedberg K, Wallengren C. Commentary: Swedish initiative on person centred care. BMJ. 2015;350:160. CrossRef
Sandman L, Granger BB, Ekman I, Munthe C. Adherence, shared decision-making and patient autonomy. Med Health Care Philos. 2012;15:115–27. CrossRef
Mounier E. Personalism. Indiana: Read Books Ltd; 2013.
Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, et al. Person-centered care — ready for prime time. Eur J Cardiovasc Nurs. 2011;10:248–51. CrossRef
Tousignant M, Dubuc N, Hébert R, Coulombe C. Home-care programmes for older adults with disabilities in Canada: how can we assess the adequacy of services provided compared with the needs of users? Health Soc Care Community. 2007;15:1–7. PubMed
Parks JA. No place like home?: feminist ethics and home health care. Bloomington: Indiana University Press; 2003.
Sims-Gould J, Tong CE, Wallis-Mayer L, Ashe MC. Reablement, reactivation, rehabilitation and restorative interventions with older adults in receipt of home care: a systematic review. J Am Med Dir Assoc. 2017;18:653–63. CrossRef
Jokstad K, Landmark BT, Hauge S, Skovdahl K-I. Eldres erfaringer med hverdagsrehabilitering - Mestring og muligheter − krav og støtte i et dynamisk samspill. Tidsskr Omsorgsforskning. 2016;2:212–21. CrossRef
Karlsson M, Karlsson C, Barbosa da Silva A, Berggren I, Söderlund M. Community nurses’ experiences of ethical problems in end-of-life care in the patient’s own home. Scand J Caring Sci. 2013;27:831–8. CrossRef
Anstey KW, Wagner F. Community healthcare Ethics Camb Textb Bioeth. 2002;:299.
Slettebø Å, Bunch EH. Solving ethically difficult care situations in nursing homes. Nurs Ethics. 2004;11:543–52. CrossRef
Altun I. Burnout and nurses’ personal and professional values. Nurs Ethics. 2002;9:269–78. CrossRef
Bentzen G, Harsvik A, Brinchmann BS. Values that vanish into thin air: nurses’ experience of ethical values in their daily work. Nurs Res Pract. 2013;2013:e939153.
Grönlund CF. Doctoral thesis / doktorsavhandling. In: Experiences of being in ethically difficult situations and an intervention with clinical ethics support. Umeå University; 2016.
Jameton A. Nursing practice: the ethical issues. Englewood cliffs: Prentice-Hall; 1984. https://repository.library.georgetown.edu/handle/10822/800986. Accessed 11 Nov 2016.
Erlen JA. Moral distress: a pervasive problem. Orthop Nurs. 2001;20:76–80. CrossRef
Maluwa VM, Andre J, Ndebele P, Chilemba E. Moral distress in nursing practice in Malawi. Nurs Ethics. 2012;19:196–207. CrossRef
Austin W, Kelecevic J, Goble E, Mekechuk J. An overview of moral distress and the paediatric intensive care team. Nurs Ethics. 2009;16:57–68. CrossRef
Ulrich C, O’Donnell P, Taylor C, Farrar A, Danis M, Grady C. Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Soc Sci Med. 2007;65:1708–19. CrossRef
Hermsen M, van der Donk M. Nurses’ moral problems in dialysis. Nurs Ethics. 2009;16:184–91. CrossRef
Bartholdson C, Lützén K, Blomgren K, Pergert P. Experiences of ethical issues when caring for children with cancer. Cancer Nurs. 2015;38:125–32. CrossRef
Åström G, Jansson L, Norberg A, Hallberg IR. Experienced nurses’ narratives of their being in ethically difficult care situations: The problem to act in accordance with one’s ethical reasoning and feelings. Cancer Nurs. 1993;16:179. PubMed
Schaffer MA. Ethical problems in end-of-life decisions for elderly Norwegians. Nurs Ethics. 2007;14:242–57. CrossRef
Norberg A, Norberg B, Gippert H, Bexell G. Ethical conflicts in long-term care of the aged: nutritional problems and the patient-care worker relationship. Br Med J. 1980;280:377–8. CrossRef
Nordam A, Torjuul K, Sørlie V. Ethical challenges in the care of older people and risk of being burned out among male nurses. J Clin Nurs. 2005;14:1248–56. CrossRef
Wilmot S, Legg L, Barratt J. Ethical issues in the feeding of patients suffering from dementia: a focus group study of hospital staff responses to conflicting principles. Nurs Ethics. 2002;9:599–611. CrossRef
Enes SPD, de VK. A survey of ethical issues experienced by nurses caring for terminally ill elderly people. Nurs Ethics. 2004;11:150–64. CrossRef
DuVal G, Clarridge B, Gensler G, Danis M. A national survey of US internists’ experiences with ethical dilemmas and ethics consultation. J Gen Intern Med. 2004;19:251–8. CrossRef
Murchison J. Ethnography Essentials. In: Designing, conducting, and presenting your research: Wiley; 2010.
Venzon Cruz E, Higginbottom G. The use of focused ethnography in nursing research. Nurse Res. 2013;20:36–43. CrossRef
Spradley JP. The ethnographic interview. US: Harcourt, Brace, Jovanovich; 1979.
Atkinson P, Coffey A, Delamont S, Lofland J, Lofland L. Handbook of Ethnography: SAGE; 2001.
Fetterman DM. Ethnography: step-by-step. Thousand oaks: SAGE publications; 2010.
Bazeley P, Jackson K. Qualitative data analysis with NVivo. Sec. Thousand Oaks: SAGE; 2013.
Krippendorff K. Content analysis: an introduction to its methodology. 3th ed. Los Angeles: Sage Publications; 2012.
Lov om kommunale helse- og omsorgstjenester. (Healthcare law). 2016. https://lovdata.no/dokument/NL/lov/2011-06-24-30. Accessed 26 Oct 2016.
Departementet för hälsa och välfärd. Lagrådsremiss: värdigt liv i äldreomsorgen. (Ministry of Health and Social Affairs. The council of legislation remittance: dignity life in elderly care]. Stockholm, Sweden; 2010. https://www.regeringen.se/rattsliga-dokument/proposition/2010/03/prop.-200910116/.
Health Care Law. Stockholm, Sweden: Socialstyrelsen; 2006. https://www.socialstyrelsen.se/english.
SFS 2001:453 Socialtjänstlagen. [The Social Service Act]. Stockholm, Sweden; 2001. http://www.riksdagen.se/sv/dokument-lagar/?doktyp=sfs&dokstat=g%c3%a4llande+sfs. Accessed 11 Nov 2016.
Teeri S, Leino-Kilpi H, Välimäki M. Long-term nursing Care of Elderly People: identifying ethically problematic experiences among patients, relatives and nurses in Finland. Nurs Ethics. 2006;13:116–29. CrossRef
Tønnessen S, Solvoll BA, Brinchmann BS. Ethical challenges related to next of kin - nursing staffs’ perspective. Nurs Ethics. 2016;23:804–14. CrossRef
Wagner N, Tabak N. The old get equal care: myth or reality. Int J Nurs Pract. 1998;4:234–9. CrossRef
O’Brien M, Fiester A. Who’s at the table? Moral obligations to equal-priority surrogates in clinical ethics consultations. J Clin Ethics. 2014;25:273–80. PubMed
Rees J, King L, Schmitz K. Nurses’ perceptions of ethical issues in the Care of Older People. Nurs Ethics. 2009;16:436–52. CrossRef
Rasoal D, Kihlgren A, James I, Svantesson M. What healthcare teams find ethically difficult captured in 70 moral case deliberations. Nurs Ethics. 2015;23:825–37. CrossRef
Fischer Grönlund CE, Söderberg AI, Zingmark KM, Sandlund SM, Dahlqvist V. Ethically difficult situations in hemodialysis care – nurses’ narratives. Nurs Ethics. 2015;22:711–22. CrossRef
Leuter C, Petrucci C, Mattei A, Tabassi G, Lancia L. Ethical difficulties in nursing, educational needs and attitudes about using ethics resources. Nurs Ethics. 2013;20:348–58. CrossRef
Cohen J, Erickson J. Ethical dilemmas and moral distress in oncology nursing practice. Clin J Oncol Nurs. 2006;10:775–83. CrossRef
Paola FA, Walker R. Ethicians, ethicists and the goals of clinical ethics consultation. Intern Emerg Med. 2006;1:5–14. CrossRef
Jeffery R. Normal rubbish: deviant patients in casualty departments. Sociol Health Illn. 1979;1:90–107. CrossRef
Dingwall R, Murray T. Categorization in accident departments: “good” patients, “bad” patients and “children.”. Sociol Health Illn. 1983;5:127–48. CrossRef
Morgan S, Yoder LH. A concept analysis of person-centered care. J Holist Nurs. 2012;30:6–15. CrossRef
Mc Cormack B, Mc Cance T. Theory and Practice. In: Person-Centred Practice in Nursing and Health Care. 2nd ed. West Sussex: John Wiley & Sons; 2016.
Henricson M. Vetenskaplig teori och metod- från ide till examination inom omvårdnad. (Scientific theory and methodology- From idea to examination in Nurs Pract). Lund: Studentlitteratur; 2012.
Gadamer H. Hermeneutics as theoretical and practical problem. 1979. https://www.jstor.org/stable/2184785?origin=crossref&seq=1/analyze. Accessed 8 Mar 2016.
Lincoln YS, Guba EG., Naturalistic Inquiry, 1st edition. Newbury Park,California: SAGE Publications; 1985.
Rasoal D, Skovdahl K, Gifford M, Kihlgren A. Clinical ethics support for healthcare personnel: an integrative literature review. HEC Forum. 2017.
- Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II