Patient Autonomy, Decision-making and Cultural Impact in Elder Care in Albania

Nertila Podgorica; Zamira Shabani; Andreas W. Müller; Julian Kraja; Daniela Deufert; Susanne Perkhofer

doi:10.3889/oamjms.2022.9393

Authors

Nertila Podgorica Department of Nursing Science, Health University of Applied Sciences, Tyrol, Austria; Department of Nursing Science and Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria https://orcid.org/0000-0002-0131-0815
Zamira Shabani Department of Nursing, Faculty of Natural Sciences, University of Shkodra “Luigj Gurakuqi”, Shkoder, Albania
Andreas W. Müller Department of History, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
Julian Kraja Department of Nursing, Faculty of Natural Sciences, University of Shkodra “Luigj Gurakuqi”, Shkoder, Albania
Daniela Deufert Department of Nursing Science and Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
Susanne Perkhofer Department of Nursing Science, Health University of Applied Sciences, Tyrol, Austria

DOI:

https://doi.org/10.3889/oamjms.2022.9393

Keywords:

Elder care, Albania, Palliative care, Nursing homes, Autonomy, Decision-making, Nurse

Abstract

BACKGROUND: Maintaining patients’ autonomy and including them in the decision-making process is crucial in eldercare. This study explores the cultural impact of independence in Albanian nursing homes. This paper follows previous publications from the same project.

AIM: Based on the previous research on ethical and legal issues, the aim was to identify how and why autonomy is frequently compromised.

METHODS: An exploratory qualitative study with semi-structured interviews and field notes was conducted. The field notes and interviews were analyzed using inductive category formation following a qualitative content analysis approach to identify potential causes and core themes. For this study, 15 nurses from three public nursing homes, two private nursing homes, one palliative care center, and one daily care center in Albania were included in the study. The observations and interviews were conducted between June and August 2018 in 7 eldercare institutions.

RESULTS: The study shows that autonomy is frequently compromised in this setting. Although residents have some freedom concerning movement, nutrition, and hygiene, they are mainly excluded from the decision-making process in treatment or palliative care. Patients are purposely misinformed about their diagnosis so that they live life “normally until the last day.” Here, a robust cultural aversion to talking about death comes together with a firm reliance on the family’s decision-making.

CONCLUSION: The study indicates that strengthening patients’ rights by improving nurses’ education can lead to more severe family conflicts. Expanding patient rights can be perceived as limiting the rights of the family. This demonstrates the difficulty of imposing “western” health regulations in different cultural contexts. In addition to legal and ethical education, preparing nurses for conflicts with the residents’ families and creating awareness for fundamental patient rights among their relatives are critical steps to improve patients’ autonomy in Albania.

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