1 Anglia Ruskin University, Cambridge, UK.
2 International Observatory on End of Life Care, Lancaster University, Lancaster, UK.
Palliat Med. 2017 Oct;31(9):853-860. doi: 10.1177/0269216316682894. Epub 2017 Feb 1.
Caring for dying people can contribute to moral distress experienced by healthcare professionals. Moral distress can occur when this caring is restricted by organisational processes, resources or the provision of futile care. These factors apply to end of life care in nursing homes but research is lacking.
To describe how nursing home staff experience moral distress when caring for residents during and at the end of life.
An interpretive descriptive design, using the critical incident technique in semi-structured interviews to collect data from nursing home staff. Data were analysed using a thematic analysis approach.
Four nursing homes in one large metropolitan area.
A total of 16 staff: 2 nurse managers, 4 nurses and 10 care assistants.
Participants described holding 'good dying' values which influenced their practice. The four practice-orientated themes of advocating, caring, communicating and relating with residents were found to influence interactions with residents, relatives, general practitioners, and colleagues. These led staff to be able to 'do the right thing' or to experience 'powerlessness', which could in turn lead to staff perceiving a 'bad death' for residents.
When there are incongruent values concerning care between staff and others involved in the care of residents, staff feel powerless to 'do the right thing' and unable to influence care decisions in order to avoid a 'bad death'. This powerlessness is the nature of their moral distress.
照顾临终患者可能会导致医护人员产生道德困境。当这种关怀受到组织流程、资源或无效护理的限制时，就会出现道德困境。这些因素适用于养老院的临终关怀，但相关研究却很匮乏。
描述养老院工作人员在临终和生命末期照顾居民时经历的道德困境。
采用解释性描述设计，使用关键事件技术对养老院工作人员进行半结构化访谈，以收集数据。使用主题分析方法对数据进行分析。
一个大城市的四家养老院。
共 16 名工作人员：2 名护士长、4 名护士和 10 名护理助理。
参与者描述了他们持有的“善终”价值观，这些价值观影响了他们的实践。发现了四个以实践为导向的主题，即倡导、关怀、沟通和与居民建立关系，这些主题影响了与居民、家属、全科医生和同事的互动。这些因素使工作人员能够“做正确的事”，或者感到“无能为力”，这反过来又使工作人员认为居民面临“糟糕的死亡”。
当工作人员与参与居民护理的其他人在护理价值观上存在不一致时，他们会感到无能为力，无法“做正确的事”，也无法影响护理决策，以避免“糟糕的死亡”。这种无能为力就是他们道德困境的本质。
