title: Ethical challenges related to next of kin - nursing staffs' perspective.
abstract: BACKGROUND
  Patients in clinical settings are not lonely islands; they have relatives who play a more or less active role in their lives.
  
  
  OBJECTIVE
  The purpose of this article is to elucidate the ethical challenges nursing staff encounter with patients' next of kin and to discuss how these challenges affect clinical practice.
  
  
  METHODS
  The study is based on data collected from ethical group discussions among nursing staff in a nursing home. The discussions took place in 2011 and 2012. The data were analysed and interpreted by using hermeneutic methodology.
  
  
  METHODS
  All the data have been anonymised and handled with confidentiality. Written informed consent was obtained from all participants.
  
  
  RESULTS
  Ethical challenges relating to patients' next of kin were found to be an issue frequently discussed in the groups. Our findings indicate that next of kin have different characteristics, categorised as 'the professionals' and 'the shadows'. In this article, we will describe the next of kin's characteristics and the ethical challenges and practical implications that nursing staff experience in this connection.
  
  
  CONCLUSIONS
  We will discuss the findings in the light of the four basic principles of medical ethics and propose interventions to help nurses manage ethical challenges related to next of kin.
  
  
  CONCLUSIONS
  The study reveals the need to enhance nursing staffs' communicative and ethical skills on an individual level, but most importantly, to establish routines in clinical settings for informing and following up next of kin in a systematic and structured way.
authors.affiliation: Buskerud and Vestfold University College, Norway Siri.tonnessen@hbv.no.
authors.forename: Siri
authors.initials: S
authors.lastname: Tønnessen
authors.affiliation: University of Nordland, Norway.
authors.forename: Betty-Ann
authors.initials: BA
authors.lastname: Solvoll
authors.affiliation: University of Nordland, Norway.
authors.forename: Berit Støre
authors.initials: BS
authors.lastname: Brinchmann
mesh_terms: D001291:Attitude of Health Personnel; D004645:Empathy; D004993:Ethics, Nursing; D005190:Family; D017144:Focus Groups; D006801:Humans; D024802:Nurse's Role; D009723:Nurse-Patient Relations / Q000941:ethics; D009735:Nursing Homes; D009740:Nursing Staff / Q000941:ethics*; D011368:Professional-Family Relations / Q000941:ethics
keywords: Ethics; next of kin; nurses; nursing home; nursing staff; reflection groups