Ragnhild Skaar

Ethical challenges in care for older patients who resist help

Background: Situations where patients resist necessary help can be professionally and ethically challenging for health professionals, and the risk of paternalism, abuse and coercion are present. Research question: The purpose of this study was to examine ethical challenges in situations where the patient resists healthcare. Research design: The method used was clinical application research. Academic staff and clinical co-researchers collaborated in a hermeneutical process to shed light on situations and create a basis for new action. Participants and research context: Four research groups were established. Each group consisted of six to eight clinical co-researchers, all employees with different health profession backgrounds and from different parts of the municipal healthcare services, and two scientific researchers. Ethical considerations: The study was conducted in compliance with ethical guidelines and principles. Participants were informed that participation was voluntary and that confidentiality would be maintained. They signed a consent form. Findings: The findings showed that the situations where patients opposed help related to personal hygiene, detention in an institution and medication associated with dental treatment. The situations were perceived as demanding and emotionally stressful for the clinicians. Discussion: The situations can be described as everyday ethics and are more characterised by moral uncertainty and moral distress than by being classic ethical dilemmas. Conclusion: Norwegian legislation governing the use of force seems to provide decision guidance with the potential to reduce uncertainty and moral stress if the clinicians’ legal competence had been greater.

Preserving dignity in end-of-life nursing home care: Some ethical challenges:

A central task in palliative care is meeting the needs of frail, dying patients in nursing homes. The aim of this study was to investigate how healthcare workers are influenced by and deal with ethical challenges in end-of-life care in nursing homes. The study was inspired by clinical application research. Researchers and clinical staff, as co-researchers, collaborated to shed light on clinical situations and create a basis for new practice. The analysis resulted in the main theme, ‘Dignity in end-of-life nursing home care’, and the sub-categories ‘Challenges regarding life-prolonging treatment’ and ‘Uncertainty regarding clarification conversations’. Our findings indicate that nursing homes do not provide necessary organizational frames for the team approach that characterizes good palliation, and therefore struggle to give dignified care. Ethical challenges experienced by healthcare workers are closely connected to inadequate organizational frames.

To be a trained and supported volunteer in palliative care - a phenomenological study

BackgroundIt has been found that including volunteers in palliative care is a positive contribution to seriously ill patients. It is, however, recommended that the volunteers are trained and supported. The aim of this study was to describe a group of trained and supported volunteers’ lived experiences as volunteers in palliative care within the community health care services.MethodsThis study adopted a descriptive phenomenological approach featuring individual interviews with nine volunteers. The interviews were analysed using the descriptive phenomenological research method according to Giorgi.ResultsBeing a volunteer in palliative care was both a positive and meaningful experience. It was a privilege being able to help those in need, which yielded positive returns. As a volunteer, it was important to be present for the ill persons and to follow them in their various physical and psychical states, which also implied that the volunteer had to face and deal with challenging situations. However, volunteers stated it was crucial to possess knowledge and life experience, as well as a clarified role, and they stressed the importance of being followed up by a mentor.ConclusionsThe findings showed that trained and supported volunteers among seriously ill or dying people within the realm of community health care services play an independent and important role in the palliative care team. A coordinator in palliative care is especially suitable for training and supporting the volunteers.

Feriereise kan ha positiv innvirkning på pasienter med demenslidelse

Aim. To gain knowledge about how a holiday trip to Spain with adapted cultural activities may affect a group of patients with dementia disorder. Background. With the increasing number of people suffering from dementia, it will be important to focus on activities that may affect well-beeing in this group. Method. A focus group interview was conducted with six healthcare workers, who participated in a trip to Spain together with six patients suffering from dementia. A qualitative content analysis was used. Findings. The findings were interpreted in one main theme: Close follow-up in unfamiliar environment and participation in adapted cultural activities may contribute to that a holiday will be a positive experience. The theme was based on three categories: Increased social competence, Increased stamina and coping ability and Good balance between activity and rest. The patients got improved language, ADL-functions and were calmer during the holyday trip. Conclusion. The study showed that patients who suffer from dementia have hidden resources that can be made visible through close monitoring by healthcare workers with good knowledge of people with a dementia disorder. A holiday trip can be considered as a positive experience for the target group.

Behov for praktisk hjelp og sosial kontakt — En intervjustudie blant hjemmeboende eldre i Norge

Aim. The aim of this study was to elucidate a group of older home-dwelling peoples perception of needs of care and services that were not met by home care services, and how these needs could be met. Background. As a result of a higher number of older people in the future there will be increased needs of care and services. Method. Nine older persons were interviewed. A qualitative content analysis was used. Findings. The findings were interpreted in one main theme: Informal networks important to meet requirements for practical help and social contact. The theme was based on two categories: Practical help (subcategories: getting help with snow shovelling/gardening, house work, transportation, being accompanied to the doctor and assisted there, and shopping) and social contact (subcategories: having someone to talk to, participating in a fellowship, meeting someone of the same age and background with similar interests, and activities). Conclusion. The needs for practical help and social contact were not satisfied for all informants. To meet these needs, co-operation between formal and informal caregivers is necessary. This will contribute to enabling older people to live in their own home as long as possible.