As an aged care worker, a person’s duty is to care for the elderly resident, usually, that means acting in the resident’s best interest.
But sometimes aged care workers, as well as other health professionals, find themselves in a position of “moral distress”.
Moral distress occurs when one knows the ethically correct action to take but feels powerless to take that action.
When working in aged care, there are often issues of workload, stress, and emotional demands of caring for fragile, and often ill older people.
An example that moral distress is seen here;
Mr. Anderson, a 92 year old man living in a nursing home and has had Alzheimer’s disease for over 10 years. He reaches the stage where he is no longer able to swallow food effectively. He has been hospitalized with aspiration pneumonia four times in the last year.
The man’s eldest child, who lives in the same town, has a durable power of attorney, and visits regularly, insists that a feeding tube is inserted. He has the support of his two siblings.
The staff feels that a feeding tube would be distressing to the patient. Besides, they say, “He swats away our hands when we try to hold him down to insert the tube, and he always pulls the tube out.”
In this situation, what would the right thing to do be? Follow the childrens’ orders or to not distress the resident?
Being faced with situations where a care worker feels helpless, or that the wrong course of action is being taken, can take a toll on their physical and mental health.
Psychological effects of moral distress include demoralisation, anger and frustration, with some aged care workers noting that they became callous and bitter.
Further consequences include staff suffering burnout, and thus leaving the profession due to this distress.
Moral distress is more common than people would think. One research looked specifically at the frequency of moral distress in Australian aged care workers.
Preliminary results found that 97 per of aged care workers have experienced moral distress during their career, with 47 per cent have considered quitting or leaving a position.
1 in 6 ended up leaving a position while 1 in 5 have ended up taking a break from work.
It was also found that 73 per cent have never received education or professional development related to moral distress, indicating that education is needed to help aged care staff handle situations where they feel there is an ethical dilemma.
Addressing the situations and realities of “moral dilemma” in aged care can improve the quality of working life for the aged care workforce.
By reducing adverse physical and psychological effects that staff may suffer, not only creates a healthier workforce, but better quality of care.
What do you have to say? Comment, share and like below.
It is good that this subject has been bought to light as it is not something that has been always discussed in the past . I myself recall suffering moral distress. I was burning out, could not keep up, could not provide the care needed and could not change what was happening around me. I have come to realise it was not my fault the system and the way we were headed was not supporting people like myself in my role. I also sadly have seen many others leave the failing system as they just could not do it anymore or make change. We are revising and looking at how we improve care and deliver better quality services to older people. We also need to look at how we better support staff, educate and equip them with tools they need . This includes self care and own wellbeing .There is a lot more we can be doing that perhaps is outside the box of what we have previously thought was acceptable and ok.
well if it’s for long term nutrition he should be getting a PEG rather than a NG tube for starters.
Interesting article but where is the Medical Officer in this it is not Best Practice to insert NG or Peg for residents with Alzheimers or other types of Dementia. Many concerns are raised here if a resident was continually pulling a tube out (any tube) would the family then want them restrained I think not.
A multi- disciplinary family meeting is called for here.
I looked after an elderly man i the same position as the above mentioned. He pulled 2 ng tubes out. It would make no difference what u inerted, he still pulls them out. When trying to insert the tube he would become physically violent. It is against the law to physically restrain someone in this manner. I agree a family meeting should be organised with the relevent multidisciplinary medical personell.
Exactly. Can lead to elder abuse by family if they have the only say. GP or Aged Care Consultant would have a treatment plan and advice to family. Certainly a family meeting required to make sure all on the same page. Aged care staff are very special people and need a lot more support, care and back up training in this changing world of aged care.
If you dont want something to happen to you health wise when you are no longer able to say what you want you need the paperwork to say it for you. As heart breaking it is to see the above happen and I have its all about the paperwork and making sure what you want is written down. You dont want to be kept alive artificially you need to make sure you legalize it. Aged care are stuck between a rock and a hard place. You must abide by the law and law states family have the right over facilities
Ethics don’t count. The law does. You cannot force a service or treatment that is without consent. Swatting away of hands, pulling the cord out is a signal of non-consent.
I feel for the workers when having to deal with these situations, however I don’t think education on its own will fix the problem. I would think that the family of the residents would also need education on this matter. Then perhaps getting the family member to be present if possible when things like the case with the feeding tube take place. Also the care home management/board of directors mum increase staffing. Thank you to all workers trying their best and blessings to you all.
It is important to have a comprehensive end of life wishes plan as then you can state what you want to happen in circumstances such as these. I wouldn’t want it, or CPR or anything like it and have stated so in my plan.
I think everyone who wants to put a tube down someone else’s throat should try one out themselves and see how uncomfortable it might be. Can a person with a tube in his throat tell you if his throat hurts or if he feels like he’s strangling? Is the patient able to hold a sippy cup or bottle or a babyfood pouch where he can take in as much as he can swallow. In his condition and age, his life isn’t going to get any better. Personally, I wouldn’t want to live with a feeding tube or being restrained. My 76 year old husband has had dementia for about 5 years now. Fortunately he can still feed and dress himsel and I hope I will be able to keep him at home and take care of him myself until the end. I only have one to take care of, I feel for the caregivers who have to divide their time among several.
After 15 years of working as an RN in Aged Care I can honestly say that this is an example of a series of huge problems in Aged Care. To begin with the understaffing is at the crux of many problems. Nursing staff are worked to the bone with very little satisfaction of having made the elderlie’s last years a personal and pleasant time. There is very little time for any individual and personal care for the elderly. The task orientated duties consume 99% of the care of the elderly. My heart would ache to be able to sit with an elderly person and provide some comfort and individual emotional care for them during a shift but the demands of task based duties left me with no time at all. Staff very often missed lunch breaks or any break at all and management were well aware of this but to cover themselves management would simply send a memo stating that “staff must take regular breaks” and if anything went wrong the exhausted staff member was always blamed and management was covered. Aged care has been in crisis for decades. I no longer work in Aged Care. I became totally burnt out both mentally and physically. I began working in Ages Care believing that I could make a difference to the elderly in their last years but I was just working like a machine unable to make any difference for most of the time.
I currently have a Level 3 HCP. My Carer has left Residential Aged Care for the reasons and others stated in the above article. She is a wonderful Carer whose sole aim when she is with me is to care for me in any way that I need care. That differs from day to day, but she is flexible about my needs and accommodates them wherever possible – including extra time if need be. She is a huge loss to the residential care sector but I am the beneficiary of their loss. She has said to me that residential care burned her out, but coming to me on a daily basis renews her each and every day and I can most definitely return the compliment, as my life has improved dramatically since she came to support me. Sadly, it is those like my Carer who leave and never return are the ones who are the most valuable and the greatest loss to those in residential aged care.
Well said Carmel – I completely agree.
I have been a nurse for over 40 years. It pains my heart when I see family trying to hold onto their parents that little bit longer. They don’t want to loose them and I really think they don’t understand that force feeding is just torture to their parent who has had enough and wants to pass on in peace. It is so wrong but I also blame the doctors who should be advocating for these patients to be able to die in peace. The nurses have to follow orders or lose their job. The doctor could meet with family and explain the force feeding is only going to prolong the death of their parent and add to the suffering of their last days, whereas palliative care will help them pass on in peace.
There seems to be a lot of Nurses complaining about being stressed & working long hours these days , good on them for choosing this as their way of life & i hope conditions inprove fir the unbelievable work they do , but isn’t this the path they chose ? Everyone has issue’s with work & become stressed in one way or another with problems every day ! It’s the path in life we all chose to take ! I think the medical industry do a fantastic job & as said conditions need to improve for everyone involved so well done to all involved 😆👍
This is a reason why i left the position, also the bullying culture, as carers we learn a lot , finding bed sores, skin tears, bruises, changing cathiter bags, stomors etc but yet to be told when to go to morning tea or yelled at for going to the toilet by a nurse – not on the only difference is we dont have a certificate.
I’m now on Residential Support- the amount of care and funding these guys get compared to the aged care is unbelievable. The big wigs need to wake up and fix this system. AFTER ALL THEY ARE HUMAN BEINGS who have worked all their lives, raised family and to be treated with so little regard is horrendous.