Ethical Issues Encountered by Nurse Managers Working With Older Adults in Long-Term Care Settings: A Qualitative Interview Study

IF 3.7 2区 医学 Q2 MANAGEMENT
Anna-Liisa Arjama, Riitta Suhonen, Mari Kangasniemi
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引用次数: 0

Abstract

Introduction: Nurse managers (NM) face ongoing ethical issues when they work with older adults in long-term care settings (LTCS), including around end-of-life care. Legislation and healthcare ethics guide the provision of ethical care to older adults in a changing societal and global context.

Research Aim: Our aim was to describe the ethical issues encountered by NMs.

Methods: This qualitative study involved 23 NMs from seven randomly selected organisations who participated in semistructured focus group interviews in 2021. We analysed the data using inductive content analysis.

Ethical Considerations: The subject of this study was sensitive and reflected the participants’ individual views. They provided informed consent and their anonymity was guaranteed.

Results: Ethical issues faced by NMs are related to residents’ rights to self-determination, ethical decision-making about staff and procedures, providing ethical leadership despite having conflicting roles, and defending ethics in LTCS on a societal level. NMs struggled to spend sufficient time supporting their staff during everyday care.

Conclusions: The ethical issues encountered by NMs are multidimensional and have both external and internal causes. NMs often deal with ethical issues on their own. Structuring their roles so that they can focus more on daily care could help NMs to provide more effective leadership and get more involved in their organisation’s decision-making. Further research into the impact of NMs’ backgrounds on their performance and responsibilities could provide new insight which would be useful in educating NMs and designing relevant organisational structures.

Implications for Nursing Management: Our research can be applied to practice, policy, education and research.

Practice: NMs’ daily work should be organised in a way that enables them to work closely with residents and staff. Reducing their secondary tasks could increase the time available to manage staff and provide individual coaching for those with different independent abilities. Being present during daily care would make it easier to deal with ethical issues in a timely manner, which could reduce staff’s moral distress and increase their well-being at work.

Policy: Understanding the importance of the role of NMs could help policy makers in planning LTCS care. Involving NMs in decision-making in organisations and society could increase awareness about the relevant ethical issues and improve the care that residents receive and the well-being of staff and new members. For example, how many employees a single NM can manage could be defined in the same way as the number of staff per resident has been determined. Implementing ethics committees in LTCS could provide a mechanism for considering the views of NMs.

Education: Ethical issues in the care of older adults should be included in the curriculum of those studying for the profession. Ethical issues change over time as the world around them changes. Addressing ethical issues should be a continuous theme in continuing education for relevant workers.

Research: This qualitative study gave a voice to LTCS NMs in a society with a rapidly ageing population and labour shortages. Ethical issues faced by NMs were related to implementation of nursing and healthcare values in the daily care of residents. In the future, generalisable knowledge is needed about what is the ethical climate in LTCS workplaces, and what is the role of NMs’ and care workers’ ethical competencies and attitudes towards ageing when performing daily care in the LTCS. In addition, it is noteworthy that the ethical issues’ NMs faced were related to policy decisions made in the surrounding society, and NMs felt they had no power or ability to influence on them. In the future, more knowledge is needed to understand how NMs in LTCS, but also in other areas of nursing, identify and consider their role in ethical issues related to health policy.

护士管理人员在长期护理环境中与老年人一起工作时遇到的伦理问题:一项定性访谈研究
导言:护士管理者(NM)在长期护理环境(LTCS)中与老年人一起工作时,面临着持续的道德问题,包括临终关怀。立法和保健伦理指导在不断变化的社会和全球背景下向老年人提供道德护理。研究目的:我们的目的是描述NMs遇到的伦理问题。方法:本定性研究涉及来自7个随机选择的组织的23名管理人员,他们于2021年参加了半结构化焦点小组访谈。采用归纳内容分析法对数据进行分析。伦理考虑:本研究的主题是敏感的,反映了参与者的个人观点。他们提供了知情同意,他们的匿名性得到了保证。结果:长期护理中心面临的伦理问题涉及居民自决权、人员和程序的伦理决策、角色冲突的伦理领导以及社会层面的伦理维护。NMs努力在日常护理中花足够的时间来支持他们的员工。结论:网络管理人员面临的伦理问题是多维的,既有外因,也有内因。网络管理员经常自己处理道德问题。调整她们的角色,使她们能够更多地专注于日常护理,可以帮助护士提供更有效的领导,并更多地参与组织的决策。进一步研究管理人员的背景对其绩效和职责的影响,可以为管理人员的教育和相关组织结构的设计提供新的见解。对护理管理的启示:我们的研究可以应用于实践、政策、教育和研究。实践:护士的日常工作安排应使他们能够与住院医生和员工密切合作。减少他们的次要任务可以增加管理员工的时间,并为具有不同独立能力的人提供个别指导。在日常护理中在场,更容易及时处理道德问题,从而减少员工的道德困扰,增加员工在工作中的幸福感。政策:了解护士角色的重要性可以帮助政策制定者规划长期护理服务。让护士参与组织和社会的决策,可以提高对相关道德问题的认识,改善住院医生得到的照顾,以及员工和新员工的福祉。例如,单个NM可以管理多少员工,可以用与确定每个居民的员工数量相同的方式来定义。在长期服务中心设立道德委员会,可提供一种机制,以考虑管理人员的意见。教育:照顾老年人的道德问题应列入为该专业学习的人的课程。随着时间的推移,道德问题也随着周围世界的变化而变化。解决道德问题应成为相关工作者继续教育的一个持续主题。研究:这一定性研究在人口迅速老龄化和劳动力短缺的社会中为LTCS NMs发出了声音。护士面临的伦理问题与护理和保健价值观在住院医生日常护理中的实施有关。在未来,我们需要了解什么是长期护理中心工作场所的道德氛围,以及在长期护理中心进行日常护理时,护士和护理人员的道德能力和对老龄化的态度是什么。此外,值得注意的是,网络管理员所面临的伦理问题与周围社会的决策有关,网络管理员认为自己没有权力或能力对其施加影响。在未来,需要更多的知识来了解护士在LTCS以及其他护理领域如何识别和考虑他们在与卫生政策相关的伦理问题中的作用。
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来源期刊
CiteScore
9.40
自引率
14.50%
发文量
377
审稿时长
4-8 weeks
期刊介绍: The Journal of Nursing Management is an international forum which informs and advances the discipline of nursing management and leadership. The Journal encourages scholarly debate and critical analysis resulting in a rich source of evidence which underpins and illuminates the practice of management, innovation and leadership in nursing and health care. It publishes current issues and developments in practice in the form of research papers, in-depth commentaries and analyses. The complex and rapidly changing nature of global health care is constantly generating new challenges and questions. The Journal of Nursing Management welcomes papers from researchers, academics, practitioners, managers, and policy makers from a range of countries and backgrounds which examine these issues and contribute to the body of knowledge in international nursing management and leadership worldwide. The Journal of Nursing Management aims to: -Inform practitioners and researchers in nursing management and leadership -Explore and debate current issues in nursing management and leadership -Assess the evidence for current practice -Develop best practice in nursing management and leadership -Examine the impact of policy developments -Address issues in governance, quality and safety
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