Identifying ethical and legal issues in elder care.

Abstract

As a non-European Union member state, Albania is increasingly orienting itself on Western models regarding human rights, patient rights, and legal regulations for healthcare. Due to its limited fiscal and legal power, enforcing legal and ethical regulations poses a major problem. The aim of this study is to investigate nurse's knowledge and experiences regarding ethical and legal issues in Albanian elder care in state-funded and privately run institutions. The study was conducted using an inductive and qualitative design, utilizing a focused ethnographic approach, based on Roper and Shapira's framework. Data were collected between June 2017 and September 2018 using participant observation, field notes, and semi-structured interviews with 15 nurses in seven different elder care institutions. In total, 100 h of observation and 15 interviews were performed. Data analysis was based on Mayring's qualitative content analysis. The approval for the study was obtained from UMIT-The Health and Life Sciences University, Austria. The findings of the study fell into the following main categories: "Everyday care issues," "End-of-life issues," "Legal issues," and "Ethical-legal education and conflicts." The participants reported many ethical and legal issues when describing their everyday challenges and displayed a strong lack of ethical and legal education. Despite a wide spectrum in the quality of care between private and state-funded nursing homes, older people mostly do not know their own diagnosis. This study indicates that further ethical and legal education is needed. Furthermore, nurses need to be better prepared for ethical conflicts with families, as strengthening patient rights could come into conflict with traditional rights of the Albanian family.