Fjelltun Aud-Mari Sohini, Henriksen Nils, Norberg Astrid, Gilje Fredricka, Normann Hans Ketil
Department of Nursing and Health Sciences, University of Tromso, Tromsø, Norway.
J Clin Nurs. 2009 Nov;18(22):3079-88. doi: 10.1111/j.1365-2702.2008.02663.x. Epub 2009 Apr 3.
The aim of this paper was to explore carers' and nurses' appraisals concerning if and when nursing home placement for frail older people awaiting placement was needed and to illuminate ethical issues involved in decisions regarding nursing home placement.
Requesting nursing home placement can be a complicated decision for carers, causing feelings of failure, anxiety and guilt. After the necessity of nursing home care is determined, the names of the older people are put on waiting lists. While waiting, home health care provides support services. Even with this care, many of the older people and their carers face difficult life situations.
This is a descriptive and comparative cross-sectional study using qualitative methods.
The convenience sample (n = 36) comprised 11 carers of older people on a nursing home placement waiting list in Norway and 11 nurses caring for these older people. Every one willingly participated in interviews that were transcribed and analysed by qualitative content analysis.
Various similarities and differences between nurses' and carers' appraisals were found. Complex ethical issues of justice, equality, autonomy, beneficence and justifiability in nursing were involved in decision making concerning nursing home placement. Four categories constructed were: 'appraising nursing home to be the level of care needed', 'appraising the older people as able to continue living at home', 'being ambivalent about nursing home placement' and 'being sceptical about use of coercion regarding nursing home placement'.
Not all of the older people awaiting nursing home placements could be placed in nursing homes when beds became available. The situations were complex and involved ethical issues.
Despite insufficient resources in home health care, providing appropriate support for older people and their carers means that nurses have to consider individual concerns in each situation, cooperate with carers, respect their appraisals of needs and argue for the timely nursing home placement of older people.
本文旨在探讨护理人员和护工对于体弱老年人等待安置期间是否需要以及何时需要安置到养老院的评估，并阐明养老院安置决策中涉及的伦理问题。
对于护理人员而言，要求将老人安置到养老院可能是一个复杂的决定，会引发失败感、焦虑和内疚感。在确定需要养老院护理后，老年人的名字会被列入等候名单。在等待期间，家庭医疗保健提供支持服务。即便有这种护理，许多老年人及其护理人员仍面临艰难的生活状况。
这是一项采用定性方法的描述性比较横断面研究。
便利样本（n = 36）包括挪威养老院安置等候名单上11位老年人的护理人员以及照顾这些老年人的11名护士。每个人都自愿参与访谈，访谈内容经转录后采用定性内容分析法进行分析。
发现护士和护理人员的评估存在各种异同。养老院安置决策涉及护理中复杂的正义、平等、自主、行善和正当性等伦理问题。构建的四个类别为：“评估养老院是所需护理级别”、“评估老年人能够继续居家生活”、“对养老院安置矛盾纠结”以及“对养老院安置使用强制手段持怀疑态度”。
并非所有等待养老院安置的老年人在有空床位时都能被安置进去。情况复杂且涉及伦理问题。
尽管家庭医疗保健资源不足，但为老年人及其护理人员提供适当支持意味着护士必须考虑每种情况下的个体问题，与护理人员合作，尊重他们对需求的评估，并争取为老年人及时安排养老院安置。
