Ethical challenges in nursing homes--staff's opinions and experiences with systematic ethics meetings with participation of residents' relatives.
BACKGROUND
Many ethical problems exist in nursing homes. These include, for example, decision-making in end-of-life care, use of restraints and a lack of resources.


OBJECTIVE
The aim of the present study was to investigate nursing home staffs' opinions and experiences with ethical challenges and to find out which types of ethical challenges and dilemmas occur and are being discussed in nursing homes.


METHODS
The study used a two-tiered approach, using a questionnaire on ethical challenges and systematic ethics work, given to all employees of a Norwegian nursing home including nonmedical personnel, and a registration of systematic ethics discussions from an Austrian model of good clinical practice.


RESULTS
Ninety-one per cent of the nursing home staff described ethical problems as a burden. Ninety per cent experienced ethical problems in their daily work. The top three ethical challenges reported by the nursing home staff were as follows: lack of resources (79%), end-of-life issues (39%) and coercion (33%). To improve systematic ethics work, most employees suggested ethics education (86%) and time for ethics discussion (82%). Of 33 documented ethics meetings from Austria during a 1-year period, 29 were prospective resident ethics meetings where decisions for a resident had to be made. Agreement about a solution was reached in all 29 cases, and this consensus was put into practice in all cases. Residents did not participate in the meetings, while relatives participated in a majority of case discussions. In many cases, the main topic was end-of-life care and life-prolonging treatment.


CONCLUSIONS
Lack of resources, end-of-life issues and coercion were ethical challenges most often reported by nursing home staff. The staff would appreciate systematic ethics work to aid decision-making. Resident ethics meetings can help to reach consensus in decision-making for nursing home patients. In the future, residents' participation should be encouraged whenever possible.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.|Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway.|Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, HELIOS Klinikum Schleswig, Schleswig, Germany.
Georg
G
Bollig
Caritas Socialis Vienna, Nursing Home Pramergasse, Vienna, Austria.
Gerda
G
Schmidt
Department of Clinical Medicine, University of Bergen, Bergen, Norway.|Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway.|Centre for Pain Management and Palliative Care, Haukeland University Hospital, Bergen, Norway.
Jan Henrik
JH
Rosland
Institute of Palliative Care and Organizational Ethics, IFF (Faculty for Interdisciplinary Research and Further Education), Faculty of University Klagenfurt, Vienna, Graz, Austria.
Andreas
A
Heller
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001317:Austria; D003657:Decision Making; D017041:Ethics Committees / Q000592:standards; D005260:Female; D006707:Homes for the Aged / Q000941:ethics* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D009735:Nursing Homes / Q000941:ethics* / Q000592:standards; D009740:Nursing Staff / Q000941:ethics* / Q000523:psychology*; D010820:Physicians / Q000941:ethics* / Q000523:psychology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics* / Q000592:standards; D055815:Young Adult
ethical deliberation; ethical problems; ethics; ethics committee; ethics consultation; nursing home; nursing home staff; relatives; residents