title: Ethical problems related to intravenous fluids in nursing homes.
abstract: BACKGROUND
  Intravenous fluids and/or antibiotics are applied to only a limited extent in Norwegian nursing homes, and the patients are often sent to hospital in these situations. A transfer and a stay in hospital may be unnecessary strains for frail older patients. Given this background, a collaborative research project was initiated in a Norwegian county in 2009. A teaching programme was developed, which aimed to strengthen the awareness of ethics, assessments and practical procedures related to intravenous fluid and/or antibiotics among healthcare professionals.
  
  
  OBJECTIVE
  This qualitative study aimed to increase our knowledge of the ethical problems experienced by nursing home nurses in situations related to the administration of intravenous fluids and/or antibiotics.
  
  
  METHODS
  An exploratory design was used, and five focus group interviews were conducted with 26 registered nurses. A hermeneutic analytic approach was applied.
  
  
  METHODS
  This study was reported to the Norwegian Social Science Data Services in May 2010. The Regional Committee for Medical and Health Research Ethics approved the collaborative research project.
  
  
  RESULTS
  The analysis showed that the nurses experienced difficult decision-making situations, which were interpreted as external pressure and internal pressure. External pressure emerged in interactions with patients and relatives. Organizational factors were also interpreted as external pressure. Internal pressure was interpreted as the nurses' experience of feeling inadequate in situations where it was difficult to protect the dignity of patients.
  
  
  CONCLUSIONS
  These findings correspond with international studies, which show that ethical problems often arise during decision-making situations.
  
  
  CONCLUSIONS
  In agreement with the definition of an ethical problem, we found that the nurses experienced uncertainty and disagreements about how situations should be managed. External and internal pressures related to intravenous fluids and/or antibiotics in nursing homes have not been reported in previous studies. Thus, these findings merit further exploration.
authors.affiliation: Buskerud and Vestfold University College, Norway may-elin.t.horntvedt@hbv.no.
authors.forename: May-Elin T
authors.initials: ME
authors.lastname: Horntvedt
authors.affiliation: University of Oslo and Vestfold Hospital Trust, Norway.
authors.forename: Maria
authors.initials: M
authors.lastname: Romøren
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Norway.
authors.forename: Betty-Ann
authors.initials: BA
authors.lastname: Solvoll
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004993:Ethics, Nursing; D017144:Focus Groups; D006801:Humans; D007262:Infusions, Intravenous / Q000941:ethics*; D009664:Norway; D009735:Nursing Homes / Q000941:ethics*; D036301:Qualitative Research
chemical_list: D000900:Anti-Bacterial Agents
keywords: Decision-making; elderly; ethical problem; intravenous fluid; nursing home; relative