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Ethical arrangements in nursing homes
Transdisciplinary Narratives
Elisabeth Reitinger, Klaus Wegleitner, Katharina Heimerl,
Andreas Heller, Sabine Pleschberger, Stefan Dinges
IFF-Department of Palliative Care and Organisational Ethics
University of Klagenfurt, Vienna
BACKGROUND
AIMS AND QUESTIONS
Living and dying in dignity in nursing homes highly depend on the quality of ethical decisions
(Wettreck 2005). Nursing homes are challenged by a significant change in their client-structure. Frail
elderly people in need of care often suffer from dementia. Structural restrictions as reduction of staff
and cost savings as well as family and team conflicts impose high pressure on working, living and
dying in nursing homes. So the question how client-orientation in ethical sensible situations can be
arranged is a challenge every day. Clients, their relatives, friends, professionals of the nursing
homes as well as management and cooperating services are highly interested in processing these
ethical questions in a balanced way (Heller, Heimerl, Husebø 2007; Kojer 2002).
In order to address this issues, a transdisciplinary research
project was undertaken to investigate what kind of ethical
decisions are processed in nursing homes. Leading questions in
our transdisciplinary multilogue were:
♦ What are the experiences with ethical decisions:
Typical ethical situations, resources, conflicts, processes?
♦ Does the gender perspective have any impact on these
situations?
♦ How can nursing homes as organisations deal with ethical
decision making?
RESULTS
♦ Ethical situations in nursing homes mainly include “every
day decisions” that highlight the importance of the
awareness for “tacit indicators”. Emotions and feelings are
qualified for making this silence explicit.
♦ End-of-life care in nursing homes raises central ethical
questions, especially: Should we leave dying residents in
the nursing home or send them to hospital? Finding out
the needs of dying persons with dementia and dealing
with grieve of relatives and professionals after death.
♦ Concerning the gender issue it is interesting that empirical
evidence shows its obvious significance on one hand. On
the other hand it does not seem to be an important
question in many ethical problems of the practitioners.
♦ “Talking about it provides relief” - this sentence has been
a frequent feedback after the workshops about ethical
issues. It shows a need within the interprofessional team
to take time for ethical reflection and dialogue.
♦ Responsibilities for decisions cannot be taken over by a
single person or professional in most of the cases.
Therefore it is necessary to find out, who has to be
involved into the process of decision making.
“Transfer him to
hospital...!
No, leave him here!”
CONCLUSIONS
Interdisciplinary ethical rounds encourage
professionals to bring together their different
perspectives, find typical patterns and work
on clarifications of next steps.
Gender has to be integrated as a category of
observation more closely (Frey 2003).
Elements of organisational ethics in nursing
homes have to take the issues of “care
ethics” (Conradi) seriously. Management has
to take over responsibility to organise time,
space and social arrangements for discussing
ethical issues. This helps finding appropriate
common agreements in ethical decisions
(Heller, Krobath 2003).
Angela Sommerhoff
METHODS AND SAMPLE
Situations and examples for ethical decisions have been elaborated as narratives (e.g. Bruner 1987)
within transdisciplinary workshops. Transdisciplinary cooperation in this context encompasses
participation of an interdisciplinary research team, management and interprofessional care teams.
10 Workshops were conducted in three Austrian nursing homes with different organisational structure
and institutional background. Participants were invited to discuss critical situations from their
everyday work life. Overall 36 situations have been referred.
Typical situations have been identified after reflecting, analysing and trying to discover basic
contradictions that cause the raised conflicts. These stories have been combined and reformulated
so that no involved person could be identified. Issues that affect organisational belongings have been
presented for group-discussions with management. Presentations on different hierarchical levels
involved a variety of perspectives and gave actors the opportunity for diversity in interpretation
(Reitinger 2008).
“How can we, as organisation understand your needs,…?”
© PlanSinn
References
Funding
Bruner JS (1987): Life as narrative. Social Research, 54, 1-17
Conradi E (2001): Take Care. Grundlagen einer Ethik der Achtsamkeit. Frankfurt: Campus
Frey R (2003): Gender im Mainstreaming. Geschlechtertheorie und -praxis im internationalen Diskurs. Königstein: Ulrike Helmer
Heller A; Heimerl K; Husebø S (Eds.) (2007): Wenn nichts mehr zu machen ist, ist noch viel zu tun, 3.ed. Freiburg (Br.): Lambertus
Heller A; Krobath Th (Ed.) (2003): OrganisationsEthik.Organisationsentwicklung in Kirchen, Caritas und Diakonie. Freiburg (Br.):
Lambertus
Kojer M (Ed.) (2002): Alt, krank und verwirrt. Einführung in die Praxis der palliativen Geriatrie. Freiburg (Br.): Lambertus
Reitinger E (Ed.) (2008): Transdisziplinäre Praxis. Forschen im Sozial- und Gesundheitswesen. Heidelberg: Verlag für Systemische
Forschung - Carl Auer
Wettreck R (2005): “Das ist doch mein Leben.”Selbstbestimmung, Vernetzung, Entscheidungsqualität in der letzten Lebensphase.
In: Zeitschrift für Ethik in der Medizin 15, S. 87-96
The project has been funded by the Austrian Federal Ministry of Science and
Research, Department of Social Sciences. Project duration: April 2005 November 2007. For further information about the research-programme please
visit: http://www.trafo-research.at/
Acknowledgments
We would like to thank our colleagues Larissa Krainer, Erich Lehner, Marina Kojer, Christian Metz, Georg Zepke, Anna Hostalek
and Ilona Wenger for inputs, critical comments and other support during the process of the study, as well as Angela Sommerhoff
and PlanSinn for the pictures.
Contact of Presenting Author
Ass. Prof. Dr. Elisabeth Reitinger
Department of Palliative Care and Organisational Ethics
IFF-University of Klagenfurt
Schottenfeldgasse 29/1, 1070 Vienna, Austria
[email protected]