Ethics in long-term care: exploring the interaction between provincial and organizational policy and frontline ethical decision-making

Abstract

In partnership with five long term care (LTC) facilities in New Brunswick, this research project is on empirical ethics in LTC practices. There are studies on the normative ethical frameworks used by LTC staff, and studies proposing how staff should reason, but few studies explore how staff actually reason. The first stage of the project explores the ethical reasoning process of LTC staff in the provision of social care. Seven interdisciplinary focus groups were conducted with twenty frontline staff. Findings suggest staff typically do not have difficulty determining the ethical decision and/or action, though they frequently experience moral distress as they feel restricted to act in the ways they believe to be right as a result of institutional constraints. Participants describe a number of institutional constraints impacting their ability to act in the ways they believe to be right. The majority of the reported constraints are structural, meaning they could be solved, or at least reduced, by examining and addressing the larger sociopolitical factors influencing LTC organizational policies and procedures, and thus the ethical decision-making environment. To better understand these organizational constraints, the second stage of the project adopts a qualitative Delphi methodology, drawing on the views of stakeholder experts to explore the interaction between public policy and organizational policies and how these interactions impact frontline staff’s ethical decisions/actions. This Delphi study used a two-round interview process to engage 24 stakeholder experts from the LTC sector in an iterative process of knowledge production, reflection and translation. The relative consensus achieved by Delphi participants suggest public and organizational policies influence organizational ethical cultures and thus the ethical decision-making environments of staff. In order to overcome the constraints identified by staff in the focus groups, and foster change, innovation, and positive ethical cultures in LTC the sector must focus on: 1) establishing the right culture, leadership, and frontline staff in LTC organizations; 2) implementing strategic hiring processes; 3) create on-going and appropriate training; 4) providing government leadership, focus, and policies; and 5) creating a collaborative sector. Future possibilities are discussed.