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Older patients’ autonomy when cared for at emergency departments
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. (Centre of Interprofessional Collaboration within Emergency care (CICE))ORCID iD: 0000-0003-2515-9774
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Uppsala University, Sweden;Region Sörmland, Sweden. (Centre of Interprofessional Collaboration within Emergency care (CICE))ORCID iD: 0000-0003-1878-0992
Region Blekinge, Sweden.
Region Kronoberg, Sweden.
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2022 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 29, no 5, p. 1266-1279Article in journal (Refereed) Published
Abstract [en]

Background: Older 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 pref- erences. With this comes further challenges regarding how the patient’s autonomy can be protected and promoted.

Aim: To describe nurses’ experiences of dealing with older patients’ autonomy when cared for in emergency departments (EDs).

Research design: This study adopted reflective lifeworld theory and a phenomenological design. Participants and research context: A total of 13 open-ended interviews were performed with nurses working at two EDs in Sweden.

Ethical considerations: The study was reviewed by the Ethical Advisory Board in South East Sweden and conducted according to the Declaration of Helsinki. All participants gave consent.

Findings: Nurses’ 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’.

Conclusion: Stressful 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 pro- motion 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’.

Place, publisher, year, edition, pages
Sage Publications, 2022. Vol. 29, no 5, p. 1266-1279
Keywords [en]
Aged, autonomy, emergency department, ethics, nurses, phenomenology
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-114635DOI: 10.1177/09697330221105637ISI: 000814159900001PubMedID: 35727146Scopus ID: 2-s2.0-85132696850Local ID: 2022OAI: oai:DiVA.org:lnu-114635DiVA, id: diva2:1674277
Available from: 2022-06-21 Created: 2022-06-21 Last updated: 2022-10-11Bibliographically approved

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Frank, CatharinaHolmberg, MatsBremer, Anders

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