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Title: Ethical issues experienced by healthcare workers providing palliative care in nursing homes : a mixed methods study
Author: Preshaw, Deborah Hazel Louise
ISNI:       0000 0004 6499 9263
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2017
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Background: Ethical issues experienced by healthcare providers can be associated with detrimental outcomes, however, little is known about the nature of these issues within palliative care provision in nursing homes. Aim: To provide a comprehensive understanding of care providers’ experiences of ethical issues during palliative care provision in nursing homes in the United Kingdom. Methods: A two phase, exploratory, sequential, mixed methods design was utilised. Semi-structured interviews with 13 Registered Nurses and ten Healthcare Assistants were used to explore ethical issues during palliative care provision. An instrument was developed measuring the frequency and level of distress associated with these ethical issues and utilised in a cross-sectional survey with 69 RNs and 129 HCAs. Results: Three themes grouped experiences of ethical issues. Issues in practice were found when conflicts arose between what felt right and the duty of care. Within this theme, making decisions in the residents’ best interests to prevent them from coming to harm (Mean = 2.68; SD= 1.24) was most frequently reported. Relational issues focused on conflicts within interpersonal relationships. Caring for residents who were only accepting small amounts or refusing food/fluids (Mean = 2.71; SD= 1.19) occurred most frequently. Organisational issues resulted from the structure and quality of services. Poor staff communication (Mean = 2.48; SD= 1.39); and lack of time (Mean = 2.36; SD= 1.44) resulted in the highest distress scores. No significant differences were identified between RNs and HCAs in the frequency (t= -.85, d.f. =196, p=.40), or level of distress (t= -.24, d.f. =176, p=.81) associated with ethical issues. Conclusions: Ethical issues within the UK nursing homes focus on acting within the duty of care, interpersonal relationships, and coping with a routinized organisational structure. Improved communication between healthcare professionals, residents, and families, and palliative care training may improve the palliative care experience.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available