Older patients’ autonomy when cared for at emergency departments
BackgroundOlder patients in emergency care often have complex needs and may have limited ability to make their voices heard. Hence, there are ethical challenges for healthcare professionals in establishing a trustful relationship to determine the patient’s preferences and then decide and act based o...
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| Format: | Electronic Article |
| Language: | English |
| Check availability: | HBZ Gateway |
| Journals Online & Print: | Drawer...
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| Fernleihe: | Fernleihe für die Fachinformationsdienste |
| Published: |
Sage
2022
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| In: |
Nursing ethics
Year: 2022, Volume: 29, Issue: 5, Pages: 1266-1279 |
| Further subjects: | B
Phenomenology
B Ethics B Nurses B Aged B Autonomy B emergency department |
| Online Access: |
Volltext (kostenfrei) |
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| 520 | |a BackgroundOlder patients in emergency care often have complex needs and may have limited ability to make their voices heard. Hence, there are ethical challenges for healthcare professionals in establishing a trustful relationship to determine the patient’s preferences and then decide and act based on these preferences. With this comes further challenges regarding how the patient’s autonomy can be protected and promoted.AimTo describe nurses’ experiences of dealing with older patients’ autonomy when cared for in emergency departments (EDs).Research designThis study adopted reflective lifeworld theory and a phenomenological design.Participants and research contextA total of 13 open-ended interviews were performed with nurses working at two EDs in Sweden.Ethical considerationsThe study was reviewed by the Ethical Advisory Board in South East Sweden and conducted according to the Declaration of Helsinki. All participants gave consent.FindingsNurses’ experiences of dealing with older patients’ autonomy in EDs are characterized by moving in a conflicting uphill struggle, indicating obscure thoughts on how patient autonomy can be protected in an ethically challenging context. The phenomenon is further described with its meaning constituents: ‘Being hampered by prioritization under stress’, ‘Balancing paternalism and patient autonomy’, ‘Making decisions without consent in the patient’s best interests’ and ‘Being trapped by notions of legitimate care needs’.ConclusionStressful work conditions and lacking organizational strategies in EDs contribute to nurses maintaining unjustified paternalistic care, regardless of the patient’s ability and medical condition, and questioning who has legitimacy for participating in decisions about care. The nurses’ protection and promotion of older patients’ autonomy is dependent on the opportunity, ability and willingness to create a patient relationship where the patient’s voice and preferences are valued as important. Consequently, strategies are needed to improve patient autonomy in EDs based on the idea of ‘relational autonomy’. | ||
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