Abstract
There are many existing ethical challenges in nursing homes. Although different methods and approaches to discussing the ethical challenges have been established, systematic ethics work is not yet a standard in all nursing homes. The aim of the present study was to explore ethical challenges and approaches to implementing systematic ethics work in nursing homes. Data from five institutions in Austria, Germany and Norway were collected, and a mixed-methods two-tiered study approach was chosen. Documentation of ethics discussions was combined with qualitative focus group interviews with staff members regarding the implementation of systematic ethics work in nursing homes. One hundred and five ethics meetings were documented. The main topics were advance care planning, ethical challenges associated with artificial nutrition, hospitalisation and end-of-life decision-making. Of the meetings, 33% focused mainly on everyday ethical challenges. In 76% of prospective case discussions, agreements about a solution were reached; however, in 29% of these no residents or relatives participated. The advantages of systematic ethics work described by the staff were enhanced openness and dialogue, overall, and a greater ethical awareness. Many voiced a need for structure and support from the administration. Systematic ethics work is greatly appreciated by the staff and helps to reach a consensus in the majority of case discussions. It should be implemented in all nursing homes. Attention to everyday ethical challenges is important. The participation of relatives and physicians could be improved. The participation of the residents' in ethics discussions should be encouraged to strengthen their autonomy and dignity.
Highlights
In elderly care and the ‘nursing home world’, many ethical challenges and dilemmas have to be faced
The main topics were advance care planning (ACP), insertion of a percutaneous endoscopic gastrostomy tube (PEG) or ethical challenges associated with PEG use, hospitalisation and end-of-life decision-making
Many meetings focused on decision-making for residents with dementia (Table 5)
Summary
In elderly care and the ‘nursing home world’, many ethical challenges and dilemmas have to be faced. Both ‘everyday ethical issues’ and ‘big ethical issues’ have been described in the literature [1,2,3,4,5,6,7,8,9,10,11]. The Norwegian Association of Local and Regional Authorities started the ‘Cooperation for building ethics competence’ in order to improve competence in ethics through ethics education and reflection on ethics in nursing homes and primary care in 2007 [13]. The project showed that the sustainability of ethics work depends on an assignment from the administration, ethics competence and methods for structuring ethical reflection [14]
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