Cliquant, Kim

DEWITTE, MAGALI

Petrovic, Mirko

Piers, Ruth

Steeman, Els

Van Den Noortgate, Nele

Velghe, Anja

English

Ghent University Academic Bibliography

NURSES’ MORAL DISTRESS IN THE CARE OF OLDER PERSONS AT THE END-OF-LIFE: THE IMPORTANCE OF CARE SETTING AND INVOLVEMENT IN END-OF-LIFE DECISIONS Ruth Piers1, Magali Dewitte1, Els Steeman2, Kim Clinquant3, Mirko Petrovic1, Anja Velghe1, Nele Van Den Noortgate1 1Department of Geriatrics Ghent University Hospital, Ghent, Belgium, 2 Department of Social Health and Nursing Sciences, Ghent University, Ghent, Belgium, 3   Aims Moral distress (MD) occurs when the healthcare provider feels certain of the ethical course of action but is constrained from taking that action. Purpose of this pilot project is identifying risk factors for MD and exploring differences between settings.  Method Nurses were recruited from 3 hospitals (response rate (RR) =103/191) and 20 nursing homes (RR=119/197) in Flanders. MD was assessed with a self-report questionnaire, adapted from the Moral Distress Scale (Corley, 2001).   Results The mean score on a scale from 0 to 4 per item for frequency and intensity is 1.1 and 2.3 respectively. The product score reflects the actual experienced MD. Highest ranked are situations involving futile care (unwarranted continuing of life support (mean product score 4.8), parenteral feeding (3.6), tests and treatments (4.4)) and working together with incompetent colleagues (4.34). Responding to request for euthanasia (0.76) and hastening patient’s death by increasing morphine (1.16) are least causing MD. There is a difference between settings in MD frequency scores (21.4 in geriatric wards versus 16.9 in nursing homes, p<0.001) but not in intensity scores (41.2 versus 40.2, p=0.596). After adjustment for sociodemographic factors; geriatric ward (B=5.384, p=0.008) and lack of involvement of nurses in end-of-life decisions (B=13.566, p=0.039) were associated with MD.  Conclusion Aggressive and inadequate care at end-of-life mostly cause MD in geriatric nurses rather than euthanasia and disuse of pain medication. MD situations occur more frequently in geriatric wards compared to nursing homes. Another important contributing factor is lack of engagement in end-of-life decisions by nurses.   Note Fundation by the the Special Research Fund UGent 

Nurses' moral distress in the care of older persons at the end-of-life : the importance of care setting and involvement in end-of-life decisions

https://biblio.ugent.be/publication/1270305/file/1865569.pdf

Nurses' moral distress in the care of older persons at the end-of-life : the importance of care setting and involvement in end-of-life decisions

Abstract

Similar works

Full text

Available Versions

Ghent University Academic Bibliography