Am I receiving good care? A qualitative study exploring the moral experiences of MDRO carriers in Dutch hospitals and nursing homes.

INTRODUCTION

Carriership of multi-drug resistant organisms (MDROs) and associated infection prevention and control (IPC) measures can negatively affect hospital patients and nursing home residents. Little is known about how carriers appraise these experiences in light of what matters to them - i.e. the moral dimension. This study explores the moral experiences of carriers receiving care in hospitals and nursing homes.

METHODS

We conducted a qualitative analysis of moral experiences present in semi-structured interviews with 20 MDRO carriers.

RESULTS

Carriers reported that some values were upheld, whereas others were undermined during care. We identified four themes. First, carriers felt responsible for protecting loved ones or the public by preventing transmission, yet perceived inconsistencies in IPC protocols generated doubt, frustration and feelings of injustice. Second, carriers described being visited less frequently or treated differently by healthcare providers (HCPs). Some felt guilty towards HCPs and other patients that their care required additional staff time. Third, carriers experienced burdens in receiving care like not seeing HCPs' faces, loss of freedom or feeling dirty, but also moments of compassion from empathic HCPs. Fourth, concerns about carriership extended beyond hospital care, with uncertainties about implications in daily life.

DISCUSSION: Identifying which values carriers perceive as upheld or undermined can guide more proportionate and equitable IPC policies and improve quality of care. HCPs should support carriers in navigating the many questions and uncertainties they face during care and in their daily lives. Future research should normatively evaluate IPC policies and explore how to address undermined values in care.