Hovenga Nina, Landeweer Elleke, Vinckers Floor, Leget Carlo, Zuidema Sytse
Department of Primary- and Long-term Care, University Medical Center Groningen, Groningen, Netherlands.
Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands.
J Adv Nurs. 2024 Jan;80(1):200-213. doi: 10.1111/jan.15794. Epub 2023 Jul 17.
To explore the moral dimension of family experiences with being involved in the care of their loved one with dementia in the nursing home, using the care ethical framework of Tronto.
This qualitative study used a care ethical approach in which empirical data and care ethical theory were dialectically related and mutually informing.
Fifteen close family members of nursing home residents with dementia were interviewed between February 2020 and October 2020. Forty-two interviews were conducted, based on a semi-structured open-ended design. A thematic narrative approach combined with the five phases of care as defined by Tronto was used to analyse the empirical data. Subsequently, Tronto's identified ethical qualities were used to identify the moral dimension of these empirical findings.
We found that in the care process (1) family can find it difficult to recognize their loved one's care needs; (2) both family and staff are reluctant to discuss the allocation of responsibilities with each other; (3) family sometimes feels insecure when it comes to connecting with their loved one; (4) family is often reluctant to provide feedback to staff when they are critical about the care that has been given; and (5) family is generally mild in judging staff, due to staff shortages. The care ethical interpretation of these findings showed that the moral qualities of attentiveness, responsibility, competence, responsiveness, and solidarity are under pressure to a certain extent.
Family experiences moral distress during the care process, which hinders family involvement in nursing homes for people with dementia.
Nursing home staff can look for and pilot strategies focused on supporting families to act more in accordance with the moral qualities that are under pressure. This can improve family involvement in practice.
No Patient/Public Contribution.
IMPLICATIONS FOR PRACTICE/POLICY: Nursing home staff paying more attention to families' emotional struggles related to the decline of their loved one, could help families to be more attentive to noticing true care needs of the resident. Both family and nursing home staff should take more often initiatives to evaluate the division of care responsibilities with each other. Nursing home staff should help family connect with their loved one during their visits if they experience difficulties in doing so. Nursing home staff taking more often initiatives to contact family and ask them how they perceive the care for their loved one, can positively affect the responsiveness of both family and staff. It would be helpful if nursing home management could ensure the presence of sufficient and qualified staff so that the first four phases of the care process are not hindered by the lack of staff.
运用特龙托的关怀伦理框架，探讨家庭在养老院照顾患有痴呆症的亲人的经历中的道德维度。
这项定性研究采用关怀伦理方法，其中实证数据与关怀伦理理论辩证相关且相互影响。
2020年2月至2020年10月期间，对15名患有痴呆症的养老院居民的近亲进行了访谈。基于半结构化开放式设计进行了42次访谈。采用主题叙事方法并结合特龙托定义的五个关怀阶段来分析实证数据。随后，运用特龙托确定的伦理品质来确定这些实证研究结果的道德维度。
我们发现，在护理过程中：（1）家人可能难以识别其亲人的护理需求；（2）家人和工作人员都不愿相互讨论责任分配问题；（3）家人在与亲人联系时有时会感到不安；（4）当家人对所提供的护理不满意时，通常不愿向工作人员反馈；（5）由于人员短缺，家人对工作人员的评判通常较为温和。对这些结果的关怀伦理解读表明，专注、责任、能力、响应性和团结等道德品质在一定程度上受到压力。
家人在护理过程中经历道德困扰，这阻碍了家庭对痴呆症患者养老院护理的参与。
养老院工作人员可以寻找并试行专注于支持家庭的策略，使其行为更符合受到压力的道德品质。这可以改善家庭在实际护理中的参与度。
无患者/公众贡献。
对实践/政策的启示：养老院工作人员更多地关注家庭与亲人衰退相关的情感挣扎，有助于家庭更留意居民真正的护理需求。家人和养老院工作人员都应更频繁地主动评估护理责任的划分。如果家人在探访时难以与亲人联系，养老院工作人员应帮助他们建立联系。养老院工作人员更频繁地主动联系家人并询问他们对亲人护理的看法，会对家人和工作人员的响应性产生积极影响。如果养老院管理层能够确保有足够的合格工作人员，以便护理过程的前四个阶段不因人员短缺而受阻，将很有帮助。
