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Ethical issues in nursing home palliative care: a cross-national survey
  1. Deborah H. L. Muldrew1,
  2. Sharon Kaasalainen2,
  3. Dorry McLaughlin3 and
  4. Kevin Brazil3
  1. 1 Institute of Nursing and Health Research, Ulster University Jordanstown, Newtownabbey, UK
  2. 2 School of Nursing, McMaster University, Hamilton, Ontario, Canada
  3. 3 School of Nursing and Midwifery, Queen’s University, Belfast, UK
  1. Correspondence to Dr Deborah H. L. Muldrew, Institute of Nursing and Health Research, Ulster University Jordanstown, Newtownabbey BT37 0QB, UK; d.muldrew{at}


Objectives With an increased dependency on nursing homes to provide care to the ageing population, it is likely that ethical issues will also increase. This study aimed to identify the type of ethical issues and level of associated distress experienced by nurses providing palliative care in nursing homes in the UK and Canada, and pilot the Ethical issues in Palliative Care for Nursing Homes (EPiCNH) instrument in Canada.

Methods A cross-sectional survey design was used. One hundred and twenty-three nurses located in 21 nursing homes across the UK and Canada completed the EPiCNH instrument.

Results Frequent ethical issues include upholding resident autonomy, managing family distress, lack of staff communication and lack of time in both countries. Higher levels of distress resulted from poor communication, insufficient training, lack of time and family disagreements. Nurses in Canada experienced a greater frequency of ethical issues (p=0.022); however, there was no statistical difference in reported distress levels (p=0.53). The survey was positively rated for ease of completion, relevance and comprehensiveness.

Conclusions Nurses’ reported comparable experiences of providing palliative care in UK and Canadian nursing homes. These findings have implications on the practice of care in nursing homes, including how care is organised as well as capacity of staff to care for residents at the end of life. Training staff to take account of patient and family values during decision-making may address many ethical issues, in line with global policy recommendations. The EPiCNH instrument has demonstrated international relevance and applicability.

  • palliative care
  • nursing homes
  • Ethics
  • ethical issues
  • survey

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  • Contributors All authors have agreed on the final version and meet at least one of the following criteria (recommended by the ICMJE:

  • Funding This study was funded by the Benevolent Fund for Nurses in Northern Ireland’s Marcia Mackie Scholarship, Queen’s University Belfast

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was sought from the Queen’s University School of Nursing and Midwifery’s Research Ethics Committee (Ref: 29.DPreshaw.12.15.M4.V2) and the Hamilton Integrated Research Ethics Board (Ref: 1198). Governance was sought from the manager of each nursing home prior to data collection.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional information relating to the project can be accessed by contacting the corresponding author.