Older persons' ethical problems involving their health

Korean Nursing Students’ Ethical Problems and Ethical Decision Making

This Korean study replicated a previously published American study. The conceptual framework and method combined ethical enquiry and phenomenology. The research questions were: (1) What is nursing students’ experience of ethical problems involving nursing practice? and, (2) What is nursing students’ experience of using an ethical decision-making model? The participants were 97 senior baccalaureate nursing students, each of whom described one ethical problem and chose to use one of five ethical decision-making models. From 97 ethical problems, five content categories emerged, the largest being health professionals (69%). The basic nature of the ethical problems was the students’ experience of conflict, resolution and rationale. Using an ethical decision-making model helped 94% of the students. A comparison of the Korean and American results yields important implications for nursing ethics education, practice and research.

Artificial nutrition and hydration at the end of life

Considerable controversy surrounds the issue of care at the end of life (EOL) for older adults. Technological advances and the legal, ethical, clinical, religious, cultural, personal, and fiscal considerations in the provision of artificial hydration and nutrition support to older adults near death are presented in this comprehensive review.

Ethical problems in end-of-life decisions for elderly Norwegians

Norwegian health professionals, elderly people and family members experience ethical problems involving end-of-life decision making for elders in the context of the values of Norwegian society. This study used ethical inquiry and qualitative methodology to conduct and analyze interviews carried out with 25 health professionals, six elderly people and five family members about the ethical problems they encountered in end-of-life decision making in Norway. All three participant groups experienced ethical problems involving the adequacy of health care for elderly Norwegians. Older people were concerned about being a burden to their families at the end of their life. However, health professionals wished to protect families from the burden of difficult decisions regarding health care for elderly parents at the end of life. Strategies are suggested for dialogue about end-of-life decisions and the integration of palliative care approaches into health care services for frail elderly people.

Concept analysis of good death in the Japanese community

PURPOSE

To describe the meaning of a good death in the Japanese community.

ORGANIZING FRAMEWORK

Rogers's (2000) concept analysis strategy.

METHODS

A review of the literature was done in March 2004, with a focus on older adults' experiences of good death in the Japanese community; "good death" was the subject heading or key words; and literature was published in English or Japanese.

FINDINGS

Attributes of a good death include sociocultural norms, personal experiences, and continuous process. The person's experience of dying, the social context, the patient's autonomy and control over the dying process, and quality of end-of-life health care are the consequences of the concept. When good death occurs, it leads to family satisfaction, positive bereavement process, and work satisfaction for healthcare professionals.

CONCLUSIONS

Integration of findings from the concept analysis and field research results in more accurate understanding of good death. Knowing the individual concept of good death enables nurses to provide culturally competent care to achieve an optimum death experience for both patients and families.

Palliative care as a framework for older people’s long-term care

This article draws on the findings from several years of research on the health problems, quality of life and care of older people, especially during the later years of life, and argues that there is a need to develop and provide care according to the principles of palliative care. The findings indicate that palliative care, including a focus on symptom management, psychosocial and existential issues, may be appropriate for the long-term care of older or very old people - not just those at the very end of life. However, the way that palliative care is provided to older people at the very end of life needs to be adjusted. It should be adapted to the situation that accompanies advanced age and having lived a long life. It should recognize that symptom management ought to address clusters of health complaints rather than isolated symptoms, bodily changes and how they are perceived. Palliative care for older people should also take into consideration the importance of the social network as well as common fears of dying and the very essence of death, and fear of being separated from one's loved ones and the activities valued in life.

Death and dying from old people's point of view. A literature review

Providing high-quality end-of-life care to older people is a requirement especially for countries with a high proportion of old and very old people. This calls for an understanding of older people's view of death and dying, and one way forward is to investigate the current knowledge base. This study aimed at reviewing the literature of empirical studies about older people's view of death and dying, whether in a terminal phase of life or not. A total of 33 publications were included, identified in a stepwise literature search done in Medline, CINAHL and PsychInfo, using the terms "death", "attitude to death", "death" and "dying" in combination with "aged". Very few studies focused solely on the oldest old. The designs were mainly cross-sectional, quantitative or qualitative, using personal interviews. Some common themes of importance for further research were revealed, such as older people's readiness to talk about death and dying, conceptions of death, after-death and dying, and were seemingly related to anxiety about death, the impact on and of those close by, having both negative and positive connotations, especially related to balancing closeness, being a burden and dependency, death anxiety and its possible antecedents, the fine line between natural sadness and suffering from depression, and worry about the end-of-life phase. The lack of studies dealing with older people's view of death and dying, and the heterogeneity with regard to research questions and samples implies that findings may serve mainly as inspiration for further research.

The future nursing voice

Based on some articles in the journal Nursing Ethics, the author outlines some of the areas of major importance for nursing in the future. These areas - the care of elderly people, long-term home-based care, genetics, international research and conflict and war - demand a new voice of nursing, which is a political voice. The rationale for a political voice is the ICN Code of ethics for nurses and the fourfold responsibilities laid on nurses: to promote health, to prevent illness, to restore health, and to alleviate suffering. Some indications are given on how nurses can engage in political work.