Abstract
There are studies on the normative ethical frameworks used by long-term care staff and studies proposing how staff should reason, but few studies explore how staff actually reason. This study reports on the ethical reasoning process and experiences of moral distress of long-term care staff in the provision of social care. Seven interdisciplinary focus groups were conducted with twenty front-line staff. Staff typically did not have difficulty determining the ethical decision and/or action; however, they frequently experience moral distress. To manage these experiences of moral distress in making ethical decisions, staff 1) comply with being told what to do out of fear of consequences, 2) defer decisions to family, 3) “have a meeting,” 4) socialization into and acceptance of workplace culture. Findings suggest that to better understand how and why staff make ethical decisions and improve quality and ethical care, we must explore the interaction between front-line practice and organizational and public policy.
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References
Abma, T.A., B. Molewijk, and G. Widdershoven. 2009. Good care in ongoing dialogue. Improving the quality of care through moral deliberation and responsive evaluation. Journal of Health Philosophy and Policy 17(3): 217–235.
Acocella, I. 2012. The focus groups in social research: Advantages and disadvantages. Quality & Quantity 46(4): 1125–1136.
Agich, G.J. 2003. Dependence and autonomy in old age: An ethical framework for long-term care. Cambridge, UK: Cambridge University Press.
Austin, W., G. Lemermeyer, L. Goldberg, V. Bergum, and M.S. Johnson. 2005. Moral distress in healthcare practice: The situation of nurses. HEC Forum 17(1): 33–48.
Baines, B. 2007. Long-term care homes legislation: Lessons from Ontario. Canadian Women’s Health Network 10(1). http://www.cwhn.ca/en/node/39381.
Baldwin C. 2015. Narrative ethics for narrative care. Journal of Aging Studies 34: 183-189.
Barter, C., and E. Renold. 2000. “I wanna tell you a story”: Exploring the application of vignettes in qualitative research with children and young people. International Journal of Social Research Methodology 3(4): 307–323.
Beauchamp, T.L., and J.F. Childress. 1989. Principles of biomedical ethics (3rd ed.). New York: Oxford University Press.
Bollig, G., G. Schmidt, J.H. Rosland, and A. Heller. 2015. Ethical challenges in nursing homes—Staff’s opinions and experiences with systematic ethics meetings with participation of residents’ relatives. Scandinavian Journal of Caring Sciences 29(4): 810–823.
Bolmsjö, I.Å., A.K. Sandman, and E. Andersson. 2006. Everyday ethics in the care of elderly people. Nursing Ethics 13(3): 249–263.
Bolmsjö, I.Å., A.K. Edberg, and L. Sandman. 2006. Everyday ethical problems in dementia care: A teleological model. Nursing Ethics 13(4): 340–359. https://doi.org/10.1191/0969733006ne890oa
Card, C. 1991. Feminist ethics. Lawrence, Kan: University Press of Kansas.
Carr, D., and J.W. Steutel. 1999. Virtue ethics and moral education. London: Routledge.
Carter, M.W. 2002. Advancing an ethical framework for long-term care. Journal of Aging Studies 16(1): 57–71.
Collopy, B., P. Boyle, and B. Jennings. 1991. New directions in nursing home ethics. Hastings Center Report 1–15.
Crowe, M. 2004. Discourse analysis: Towards an understanding of its place in nursing. Journal of Advanced Nursing 51(1): 55–63.
Dierckx de Casterlé, B., S. Izumi, N.S. Godfrey, and K. Denhaerynck. 2008. Nurses’ responses to ethical dilemmas in nursing practice: Meta-analysis. Journal of Advanced Nursing 63(6): 540–549.
Dilshad, R.M., and M.I. Latif. 2013. Focus group interview as a tool for qualitative research: An analysis. Pakistan Journal of Social Sciences 33(1): 191–198.
Dunn, M., M. Sheehan, T. Hope, and M. Parker. 2012. Toward methodological innovation in empirical ethics research. Cambridge Quarterly of Healthcare Ethics 21(4): 466–480.
Dunworth, M., and P. Kirwan. 2009. Ethical decision-making in two care homes. Practice 21(4): 241–258.
Edwards, M.P., S.E. McClement, and L.R. Read. 2013. Nurses’ responses to initial moral distress in long-term care. Journal of Bioethical Inquiry 10(3): 325–336.
Estabrooks, C.A., J.E. Squires, H.L. Carleton, G.G. Cummings, and P.G. Norton. 2015. Who is looking after mom and dad? Unregulated workers in Canadian long-term care homes. Canadian Journal on Aging 34(1): 47–59.
Fairclough, N. 1989. Language and power. Essex, England: Longman House.
Finch, J. 1987. The vignette technique in survey research, Sociology 21: 105–111.
Finlayson, J.G. 2005. Habermas: A very short introduction. Oxford: Oxford University Press.
Fleming, D.A. 2007. Responding to ethical dilemmas in nursing homes: Do we always need an “ethicist”? HEC forum 19(3): 245–259.
Gill, P., K. Stewart, E. Treasure, and B. Chadwick. 2008. Methods of data collection in qualitative research: Interviews and focus groups. British Dental Journal 204(6): 291-295.
Given, L.M. 2008. Vignettes. In The Sage encyclopedia of qualitative research methods online. http://srmo.sagepub.com/view/sage-encyc-qualitative-research-methods/n482.xml.
Greason, M. 2017. Empirical ethics in long term care: Using delphi method as a form of consensus building. SAGE, Research Method Cases, Part 2.
Hughes, R., and M. Huby. 2004. The construction and interpretation of vignettes in social research. Social Work & Social Sciences Review 11(1): 36–51.
Jakobsen, R., and V. Sørlie, 2010. Dignity of older people in a nursing home: Narratives of care providers. Nursing Ethics 17(3): 289–300.
Jameton, A. 1984. Nursing practice: The ethical issues, Prentice-hall series in the philosophy of medicine. Englewood Cliffs, N.J.: Prentice-Hall.
Jansson, L., and A. Norberg. 1992. Ethical reasoning among registered nurses experienced in dementia care. Scandinavian Journal of Caring Sciences 6(2): 219–227.
Korte, R. 2007. The socialization of newcomers into organizations: Integrating learning and social exchange processes. https://files.eric.ed.gov/fulltext/ED504550.pdf.
Krueger, R.A. 1988. Focus groups: A practical guide for applied research. Newbury Park, CA: Sage Publications.
Kuczewski, M.G. 1999. Ethics in long-term care: Are the principles different? Theoretical Medicine and Bioethics: Philosophy of Medical Research and Practice 20(1): 15–29.
Linstone, H.A. 1978. The Delphi technique. In Handbook of futures research, edited by J. Fowles and R.B. Fowles, 271–300. Westport, CT: Greenwood Press.
Mattiasson, A.C., and L. Andersson. 1995. Moral reasoning among professional caregivers in nursing homes. Western Journal of Nursing Research 17(3): 277–291.
McDaniel, C., J.K. Roche, and E. Veledar. 2011. Ethics environment in long-term care. Journal of Applied Gerontology 30(1): 67–84.
Messikomer, C. M., and C.C. Cirka. 2008. Managing everyday ethics in assisted living: A research-based case analysis for the classroom. Gerontology & Geriatrics Education 28(4): 71–93.
Morgan, D.L. 1997. Focus groups as qualitative research. Newbury Park, CA: Sage Publications.
Mysak, S. 1997. Strategies for promoting ethical decision-making. Journal of Gerontological Nursing 23(1): 25–31.
Peek, L., and A. Fothergill. 2007. Using focus groups for qualitative research. Conference Papers—American Sociological Association 1.
Pijl-Zieber, E.M., O. Awosoga, S. Spenceley, B. Hagen, B. Hall, and J. Lapins. 2016. Caring in the wake of the rising tide: Moral distress in residential nursing care of people living with dementia. Dementia 17(3): 315–336.
Powers, B.A. 2000. Everyday ethics of dementia care in nursing homes: A definition and taxonomy. American Journal of Alzheimer’s Disease and Other Dementias 15(3): 143–151.
———. 2001. Ethnographic analysis of everyday ethics in the care of nursing home residents with dementia. Nursing research 6(50): 332–339. https://doi.org/10.1097/00006199-200111000-00002
Rees, J., L. King, and K. Schmitz. 2009. Nurses’ perceptions of ethical issues in the care of older people. Nursing Ethics 16(4): 436–452.
Renold, E. 2002. Using vignettes in qualitative research. Building Research Capacity 3: 1–12.
Slettebø, Å., and E.H. Bunch. 2004. Solving ethically difficult care situations in nursing homes. Nursing Ethics 11(6): 543–552. https://doi.org/10.1191/0969733004ne737oa
Solum, E.M., A. Slettebø, and S. Hauge. 2008. Prevention of unethical actions in nursing homes. Nursing Ethics 15(4): 536–548.
Spenceley, S., C.S. Witcher, B. Hagen, B. Hall, and A. Kardolus-Wilson. 2017. Sources of moral distress for nursing staff providing care to residents with dementia. Dementia 16(7): 815–834.
van der Dam, S., T. Abma, A. Molewijk, M. Kardol, J. Schols, and G. Widdershoven. 2011. Organizing moral case deliberation experiences in two Dutch nursing homes. Nursing Ethics 18(3): 327–340.
van Dijk, T.A. 1993. Principles of critical discourse analysis. Discourse & Society 4(2):249–283.
van Thiel, G., and J. Van Delden. 2001. The principle of respect for autonomy in the care of nursing home residents. Nursing Ethics: An International Journal for Health Care Professionals 8(5): 419–431.
Waymack, M. 1998. Old ethical frameworks: What works, what doesn’t? Generations 22(3): 11–14.
Widdershoven, G., T. Abma, and B. Molewijk. 2009a. Empirical ethics as dialogical practice. Bioethics 23(4): 236–248.
Widdershoven, G., B. Molewijk, and T. Abma. 2009b. Improving care and ethics: A plea for interactive empirical ethics. American Journal of Bioethics 9(6-7): 99–101.
Wodak, R., and M. Krzyżanowski. 2008. Qualitative discourse analysis in the social sciences. England: Palgrave Macmillan.
Woods, M. 2005. Nursing ethics education: Are we really delivering the good(s)? Nursing Ethics 12(1): 5–18.
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The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research was supported by Mitacs Accelerate Internship and the Social Sciences and Humanities Research Council [Joseph Armand Bombardier Canada Graduate Scholarship-Master’s].
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Greason, M. Ethical Reasoning and Moral Distress in Social Care Among Long-Term Care Staff . Bioethical Inquiry 17, 283–295 (2020). https://doi.org/10.1007/s11673-020-09974-x
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DOI: https://doi.org/10.1007/s11673-020-09974-x