Nursing Home Staff's Experience of Moral Distress when Caring for Residents at the End of Life.

Young, Amanda (2015) Nursing Home Staff's Experience of Moral Distress when Caring for Residents at the End of Life. PhD thesis, Lancaster University.

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Abstract

Eighteen percent of the older population die in nursing homes in the United Kingdom (UK). Moral distress in healthcare professionals has been linked to end of life issues but there has been a lack of investigation of the concept in the nursing home context and how staff in this environment experiences it. The aim of the study was to understand how nursing home staff experienced moral distress when they cared for residents coming to the end of life. The study used an interpretive descriptive design, which utilised the critical incident technique to collect data from 16 participants from nursing homes using semistructured interviews. The interviews focused on positive and challenging incidents the staff experienced when caring for residents at the end of life. Data were analysed using a thematic analysis approach. The staff were found to hold values about 'good dying' which influenced their practice of advocating, caring, communicating and relating with residents, relatives, GPs, and colleagues, when a resident was on the journey through the complex living and dying trajectory. Incongruent values with others contributed to the staff not being able to 'do the right thing' leading to 'powerlessness' which was found to be the characteristic of their moral distress. Participants were found to experience moral distress because the incongruent values could lead to care decisions which staff felt contributed to 'bad dying' or a 'bad death'. Nursing home residents are vulnerable and the staff need support to provide good quality end of life care. Understanding the experience of moral distress by staff working in this environment will inform and improve the appropriateness of the support I can offer them as an end of life facilitator for care homes.