McClement Susan, Lobchuk Michelle, Chochinov Harvey Max, Dean Ruth
Faculty of Nursing, University of Manitoba, Winnipeg.
J Clin Ethics. 2010 Fall;21(3):201-11.
Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.
加拿大人口正在老龄化，老年人是该国增长最快的人口群体。老年人所经历的慢性健康问题、有限的社会支持、功能衰退和认知障碍可能使他们有必要入住个人护理院（PCH）直至去世。临终患者护理中出现的伦理问题众多且复杂。然而，在个人护理院中照顾临终老年人的工作主要由一线工作人员提供，如医疗护理员（HCA），他们通常在姑息治疗或伦理方面接受的培训很少。在各种临床环境中，已经从护士和医生的角度对临终护理中伦理问题的识别和解决进行了研究，但个人护理院中医疗护理员的声音在临床伦理中几乎没有体现。鉴于在临床实践中无法令人满意地解决伦理问题与内疚感、无力感、避免与患者接触、未能提供良好的身体护理以及员工流动率增加有关，因此有必要对医疗护理员在伦理挑战性情况下的经历进行实证研究。我们进行了一项现象学研究，以了解在私立和非私立护理院工作的医疗护理员（N = 12）在为临终老年人提供临终护理时遇到他们认为具有伦理挑战性的情况时的生活经历。此处报告的研究结果阐明了：（1）对医疗护理员来说存在伦理问题的情况类型；（2）他们赋予这些情况的意义；以及（3）这些情况对临终护理提供的影响。
