The Ethical Dilemma of Nursing Homes
It has been about more than a year I have started working in the nursing home. My experience was quite varied given I got the opportunity to work in several facilities during than short period of time. However, I can not deny the fact that I was not able to grasp the necessity of nursing homes in the light of my Filipino culture. This has somehow affected how I perform my duties in the nursing home as my work goes against my cultural norms and beliefs. Although through time especially in the last few days, I gained significant realizations about it regarding the ethical considerations of the concept of nursing home. This will be the focus of my blogpost.
Hospice versus Rehabilitation
Hospice care compose of actions directed to patients who are in the terminal phase of their lives, while rehabilitation refers to measures focused on an individual's optimum level of functioning. It is therefore appropriate to say that nursing homes is part of rehabilitating a patient, a concept uncommon for us who come from the Philippines, wherein the health focus is treatment and diagnosis. Rehabilitation is an important aspect in providing holistic care to patients, but hospice care seems to be encompassing holism as well but more palliative in nature to alleviate discomforts and meet the primary needs of the patient.
The ethical dilemma exists when most of the patients in a nursing home are unlikely to improve physically and pyschologically. Does nursing home mean a place for people to wait for death when health improvement becomes possible? I felt initially that it seemed that my patients are just waiting for their "turn", and no matter what I do that will not do any change to the patient's disease. Indeed, that could be the case for some, but it affects me as health provider knowing some of my patients will no longer have the chance to be even better, and rather I would just serve as both a witness and mitigator of their sufferings.
Need versus Excuse
The first thing that I realized after working several weeks in the nursing home is the facility's necessity. Practically, we health providers were just facilitating the patient's routine from morning care to nutrition to sleep. That I consider far from the challenge of working in a fast-paced working ennvironment like the hospital or a clinic. This has led me to begin questioning on the usefulness of nursing home or whether it is just an unnecessary use of resources, which could be prevented or minimize. In addition, I was quite curious whether the family members really do not have the capacity to aid their own relatives in doing those simple activities of daily living.
A dilemma exists when patients in the nursing homes get visits from their relatives and friends very seldom. Some get it once in three months. It would be lucky and rare for a patient to be visited once in three days or more often. I understand that the patient's significant others are busy enough to facilitate care themselves to their relatives, but a visit that seldom lasts 30 minutes is not a big workload I think in a Filipino perspective. This kept me thinking on whether nursing homes have become an excuse for some family members not to participate in any way in the care of their significant others, making the excuse look like a need but in reality not?
Work versus Care
Honestly, given that I need to satisfy visa requirements, I certainly need to force myself to work. For now, the most possible place is the nursing home. For I am an educated nurse so working in a large hospital would be a better idea, but that is not the case. So in my experience, the intention of helping vulnerable patients is quite uncertain, when one considers the voluntariness and purity of the act. One needs to earn for a living and since caring for patients is a work that earns well in Norway, the problem arises when health providers merely what tasks they need to do, rather than go beyond to the point of genuine compassion and care.
As a health care provider, a dilemma is evident when work itself makes one tired, and exerting more effort to care which could be unappreciated leads to more exhaustion. Many times I have have done extra services like sacrificing by not eating or drinking to prioritize patients, but got only criticisms from the patient relatives on small things. It somehow gave me the notion that especially us foreign workers are treated like nearly like modern-day slaves, who should not complain and deserve no appreciation at all given that everything is only part pf our work. Now, how does see the difference between work and caring as one's work?
Lastly, I know I could not entirely fathom the depth and scope of these dilemma. I could certainly describe them, but I would be impossible to find concrete solutions. Perhaps even after my lifetime, we in this world could not even provide right answers or even prescriptive measures to address these concerns. What matters for me now is for me to continue doing what I am supposed to do and attempt to go further from what is expected not my own benefit, but primarily for the patients themselves.