Volume 9, Issue 2 (Apr- June 2020)
JCHR 2020, 9(2): 129-138 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rasoal D. Coaxing as a strategy to deal with ethical issues in community home care: An ethnographic study. JCHR 2020; 9 (2) :129-138
URL: http://jhr.ssu.ac.ir/article-1-602-en.html
URL: http://jhr.ssu.ac.ir/article-1-602-en.html
School of Health, Care and Social Welfare, Malardalen University,Vasteras, Sweden , dara.rasoal@mdh.se
Abstract: (2868 Views)
Abstract
Introduction: The provision of home health care services increases as a desirable option in the western society. Previous studies indicate that health care professionals encounter ethically difficult situations when providing home care services. There is a lack of studies describing ethically difficult situations through observation. This study aimed to explore ethical issues experienced by healthcare staff when providing community home care services.
Methods: Qualitative design, using ethnographical approach. Data gathered as fieldwork in terms of memos, non-participant observation and informal interview with registered nurses (n=8), and nurse-assistants (n=4) during three weeks (in total 148 hours, 7am -5pm)
Results: The result generated two main categories: 1) To balance stakeholders’ requirements, and, 2) Strategy to deal with ethical issues. Coxing was used as a strategy to deal with ethically difficult situations in patient care. The results showed that the complexity of the ethical issues is often related to personal values and organisational impact. The staff experienced need for a structured approach to assist them in identifying, analysing, and resolving ethical issues that arise in clinical practice. Health care organisations, personnel and patients are disagreed about values and choices that could lead to the best course of actions.
Conclusion: This study reveals that the ethically difficult situations in the context of community home care services are complex and are influencing the provision of care. The personnel enforced to find a balance between different expectations and from different stakeholders. To deal with these situations coaxing was used as a strategy for managing ethical issues.
Introduction: The provision of home health care services increases as a desirable option in the western society. Previous studies indicate that health care professionals encounter ethically difficult situations when providing home care services. There is a lack of studies describing ethically difficult situations through observation. This study aimed to explore ethical issues experienced by healthcare staff when providing community home care services.
Methods: Qualitative design, using ethnographical approach. Data gathered as fieldwork in terms of memos, non-participant observation and informal interview with registered nurses (n=8), and nurse-assistants (n=4) during three weeks (in total 148 hours, 7am -5pm)
Results: The result generated two main categories: 1) To balance stakeholders’ requirements, and, 2) Strategy to deal with ethical issues. Coxing was used as a strategy to deal with ethically difficult situations in patient care. The results showed that the complexity of the ethical issues is often related to personal values and organisational impact. The staff experienced need for a structured approach to assist them in identifying, analysing, and resolving ethical issues that arise in clinical practice. Health care organisations, personnel and patients are disagreed about values and choices that could lead to the best course of actions.
Conclusion: This study reveals that the ethically difficult situations in the context of community home care services are complex and are influencing the provision of care. The personnel enforced to find a balance between different expectations and from different stakeholders. To deal with these situations coaxing was used as a strategy for managing ethical issues.
Review: Research |
Subject:
Health care management
Received: 2020/01/21 | Accepted: 2020/06/29 | Published: 2020/06/29
Received: 2020/01/21 | Accepted: 2020/06/29 | Published: 2020/06/29
References
1. 1. Chandler J, Williams M, Maconachie M, et al. Living Alone: Its Place in Household Formation and Change. Sociological Research Online . 2004 ; 9(3): 42-54. [DOI:10.5153/sro.971]
2. Mentsen Ness 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. Open Journal of Nursing. 2015; 5(4): 336-344. [DOI:10.4236/ojn.2015.54036]
3. Low LF, Yap M, Brodaty H. A systematic review of different models of home and community care services for older persons. BMC Health services research. 2011; 11(1): 93-107. [DOI:10.1186/1472-6963-11-93]
4. Henderson EJ, Caplan GA. Home Sweet Home? Community Care for Older People in Australia. Journal of the American Medical Directors Association. 2008; 9(2): 88-94. [DOI:10.1016/j.jamda.2007.11.010]
5. HOD H 1999. Patient and Service User Law. HOD 1999-07-02-63. Lov om pasient- og brukerrettighet. Oslo, Norway; 1999. Report No.: 1999070263.Available at: URL: https://lovdata.no/dokument/NL/lov/1999-07-02-63
6. Health Care Law. Stockholm, Sweden: Socialstyrelsen; 2006. Report No: 1982: 763.
7. Tousignant M, Dubuc N, Hébert R, et al. 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 & Social Care in the Community. 2007; 15(1): 1-7.
8. Parks JA. No Place Like Home?: Feminist Ethics and Home Health Care. Indiana University Press. 2003.
9. Karlsson M, Karlsson C, Barbosa da Silva A, et al. Community nurses' experiences of ethical problems in end-of-life care in the patient's own home. Scandinavian Journal of Caring Sciences. 2013; 27(4): 831-838. [DOI:10.1111/j.1471-6712.2012.01087.x]
10. Anstey KW, Wagner F. Community healthcare ethics. The Cambridge Textbook of Bioethics. 2002; 299. [DOI:10.1017/CBO9780511545566.045]
11. Aroskar M. Community health nurses. Their most significant ethical decision-making problems. The Nursing clinics of North America. 1989; 24(4): 967-75.
12. SFS 2001:453 Socialtjänstlagen. [The Social Service Act] [Internet]. Stockholm, Sweden
13. 2001 [cited 2016 Nov 11]. Available from: http://www.riksdagen.se/sv/Dokument-Lagar/Laga r/Svenskforfattningssamling/Socialtjanstlag-2001453_sfs-2001-
14. 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. Nursing ethics. 2006; 13(2): 116-129. [DOI:10.1191/0969733006ne830oa]
15. Slettebø Å, Bunch EH. Solving Ethically Difficult Care Situations in Nursing Homes. Nursing Ethics. 2004; 11(6): 543-552. [DOI:10.1191/0969733004ne737oa]
16. Altun I. Burnout and nurses' personal and professional values. Nursing Ethics. 2002; 9(3): 269-278. [DOI:10.1191/0969733002ne509oa]
17. Beagan B, Ells C. Values That Matter, Barriers That Interfere: The Struggle of Canadian Nurses to Enact Their Values. Canadian Journal of Nursing Research Archive. 2007; 39(4): 36-57.
18. Bentzen G, Harsvik A, Brinchmann BS. Values That Vanish into Thin Air: Nurses' Experience of Ethical Values in Their Daily Work. Nursing Research and practice. 2013: e939153. [DOI:10.1155/2013/939153]
19. Rasoal D, Kihlgren A, James I, et al. What healthcare teams find ethically difficult: Captured in 70 moral case deliberations. Nursing Ethics. 2015; 23(8): 825-837. [DOI:10.1177/0969733015583928]
20. Jameton A. Nursing Practice: The Ethical Issues. Englewood Cliffs: Prentice-Hall; 1984 [cited 2016 Nov 11]. 331 p. Available from: https://repository.library.georgetown.edu/handle/10822/800986.
21. Erlen JA. Moral distress: a pervasive problem. Orthopaedic Nursing. 2001; 20(2): 76-80. [DOI:10.1097/00006416-200103000-00015]
22. Maluwa VM, Andre J, Ndebele P, et al. Moral distress in nursing practice in Malawi. Nursing Ethics. 2012; 19(2): 196-207. [DOI:10.1177/0969733011414968]
23. Austin W, Kelecevic J, Goble E, et al. An overview of moral distress and the paediatric intensive care team. Nursing Ethics. 2009; 16(1): 57-68. [DOI:10.1177/0969733008097990]
24. Ulrich C, O'Donnell P, Taylor C, et al. Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Social Science & Medicine. 2007; 65(8): 1708-1719. [DOI:10.1016/j.socscimed.2007.05.050]
25. Hermsen M, van der Donk M. Nurses' moral problems in dialysis. Nursing Ethics. 2009; 16(2): 184-191. [DOI:10.1177/0969733008100078]
26. 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. Nursing Ethics. 2002; 9(6): 599-611. [DOI:10.1191/0969733002ne554oa]
27. Uden G, Norberg A, Lindseth A, et al. Ethical reasoning in nurses' and physicians' stories about care episodes. Journal of Advanced Nursing. 1992; 17(9): 1028-1034. [DOI:10.1111/j.1365-2648.1992.tb02036.x]
28. Bartholdson C, Lützén K, Blomgren K, et al. Experiences of ethical issues when caring for children with cancer. Cancer Nursing. 2015; 38(2): 125-132. [DOI:10.1097/NCC.0000000000000130]
29. Fischer Grönlund C. Experiences of being in ethically difficult care situations and an intervention with clinical ethics support (Doctoral dissertation, Umeå universitet). 2016.
30. Åström G, Jansson L, Norberg A, et al. 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 Nursing. 1993; 16(3): 179-187. [DOI:10.1097/00002820-199306000-00003]
31. Schaffer MA. Ethical Problems in End-of-Life Decisions for Elderly Norwegians. Nursing Ethics. 2007; 14(2): 242-257. [DOI:10.1177/0969733007073707]
32. Norberg A, Norberg B, Gippert H, et al. Ethical conflicts in long-term care of the aged: nutritional problems and the patient-care worker relationship. British Medical Journal. 1980; 280(6211): 377-378. [DOI:10.1136/bmj.280.6211.377]
33. Nordam A, Torjuul K, Sørlie V. Ethical challenges in the care of older people and risk of being burned out among male nurses. Journal of clinical nursing. 2005; 14(10): 1248-1256. [DOI:10.1111/j.1365-2702.2005.01230.x]
34. Enes SPD, Vries K de. A Survey of Ethical Issues Experienced by Nurses Caring for Terminally Ill Elderly People. Nursing Ethics. 2004; 11(2): 150-164. [DOI:10.1191/0969733004ne680oa]
35. DuVal G, Clarridge B, Gensler G, et al. A national survey of US internists' experiences with ethical dilemmas and ethics consultation. Journal of General Internal Medicine. 2004; 19(3): 251-258. [DOI:10.1111/j.1525-1497.2004.21238.x]
36. Cruz EV, Higginbottom G. The use of focused ethnography in nursing research. Nurse Researcher. 2013; 20(4): 36-43. [DOI:10.7748/nr2013.03.20.4.36.e305]
37. Emerson RM, Fretz RI, Shaw LL. Writing Ethnographic Fieldnotes. University of Chicago Press; 2011. [DOI:10.7208/chicago/9780226206868.001.0001]
38. Bazeley P, Jackson K. Qualitative Data Analysis with NVivo. SAGE publications limited. 2013.
39. Hammersley M, Atkinson P. Ethnography: Principles in Practice. 3rd edition. New York, US: Routledge. 2007. [DOI:10.4324/9780203944769]
40. Murchison J. Ethnography Essentials: Designing, Conducting, and Presenting Your Research. John Wiley & Sons. 2010: 258.
41. Galanti GA. How to do ethnographic research. Western Journal of Medicine. 1999; 171(1): 19-20.
42. Jeffery R. Normal rubbish: Deviant patients in casualty departments. Sociology of Health & illness. 1979; 1(1): 90-107. [DOI:10.1111/1467-9566.ep11006793]
43. Dingwall R, Murray T. Categorization in accident departments: 'good' patients, 'bad' patients and 'children'. Sociology of Health & illness. 1983; 5(2): 127-148. [DOI:10.1111/1467-9566.ep10491496]
44. McCormack B, McCance T. Person-Centred Practice in Nursing and Health Care: Theory and Practice. John Wiley & Sons. 2016: 289.
45. Rees J, King L, Schmitz K. Nurses' Perceptions of Ethical Issues in the Care of Older People. Nursing Ethics. 2009; 16(4): 436-452. [DOI:10.1177/0969733009104608]
46. Fajer MA. Authority, Credibility, and Pre-Understanding: A Defense of Outsider Narratives in Legal Scholarship, Essay. Georgetown Law Journal. 1993- 1994; 82: 1845-1868.
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution 4.0 International License. |
