Evolving technology and scientific advancement have increased the chances of survival of the extremely premature baby; however, such survival can be associated with some severe long-term morbidities.
The research investigates the caregiving and ethical dilemmas faced by neonatal nurses when caring for extremely premature babies (defined as ≤24 weeks’ gestation). This article explores the issues arising for neonatal nurses when they considered the philosophical question of ‘what if it was me and my baby’, or what they believed they would do in the hypothetical situation of going into premature labour and delivering an extremely premature baby.
Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia.
Relevant ethical approvals have been obtained by the researchers.
A qualitative approach was used to analyse the data. The theme ‘imagined futures’ was generated which comprised three sub-themes: ‘choice is important’, ‘not subjecting their own baby to treatment’ and ‘nurses and outcome predictions’. The results offer an important and unique understanding into the perceptions of nursing staff who care for extremely premature babies and their family, see them go home and witness their evolving outcomes. The results show that previous clinical and personal experiences led the nurses in the study to choose to have the belief that if in a similar situation, they would choose not to have their own baby resuscitated and subjected to the very treatment that they provide to other babies.
The theme ‘imagined futures’ offers an overall understanding of how neonatal nurses imagine what the life of the extremely premature baby and his or her family will be like after discharge from neonatal intensive care. The nurses’ past experience has led them to believe that they would not want this life for themselves and their baby, if they were to deliver at 24 weeks’ gestation or less.
The research question for this study was as follows: Is the Code of Ethics for Nurses in Italy (Code) a valid or useful decision-making instrument for nurses faced with ethical problems in their daily clinical practice?
Focus groups were conducted to analyze specific ethical problems through 11 case studies. The analysis was conducted using sections of the Code as well as other relevant documents. Each focus group had a specific theme and nurses participated freely in the discussions according to their respective clinical competencies.
The executive administrative committee of the local nursing licensing council provided approval for conducting this project. Measures were taken to protect the confidentiality of consenting participants.
The answer to the research question posed for this investigation was predominantly positive. Many sections of the Code were useful for discussion and identifying possible solutions for the ethical problems presented in the 11 cases.
We concluded that the Code of Ethics for Nurses in Italy can be a valuable aid in daily practice in most clinical situations that can give rise to ethical problems.
Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered.
Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability.
A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson’s r was the statistical method used to analyze three primary and two secondary research questions.
A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected.
Approval to conduct this study was obtained by the Adelphi University Institutional Review Board.
A relationship between intuition and perceived ethical decision-making ability (r = .252, p = .001) was a significant finding in this study.
This study is one of the first of this nature to make a connection between intuition and nurses’ ethical decision-making ability.
This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions.
Written reflections on practice are frequently requirements of nursing curricula. They are widely accepted as necessary for improving critical thinking and problem-solving skills. Faculty, are expected to review reflections and provide feedback that helps professional development and facilitates good practice. It is less clear what the actions of nurse educators should be when ethical infractions are revealed in the narratives.
We had two aims: 1) To combine insights from a literature review of empirical and theoretical research related to responding to ethical issues revealed in student reflections with our experiences reviewing the reflections of undergraduate nursing and midwifery students, and 2) to construct and analyze a hybrid case from these insights in order to develop guidelines for nurse educators.
A literature review was conducted using CINAHL, MEDLINE, PsycINFO, SocINDEX and ERIC databases and pertinent key words. A hybrid case was constructed of commonly encountered ethical issues using insights from the literature review and the authors’ experiences. The case was analyzed by combining Beauchamp and Childress’ principlist approach with Campbell and McCarthy’s ethical decision-making tool (Table 1).
No human participants
A gap in the literature exists related to addressing ethical issues revealed in student practice reflections. However, a combination of insights from the literature and the authors’ experiences facilitated the development of a hybrid case. Subsequent case analysis facilitated the development of a series of guidelines that can be utilized to address a range of issues commonly emerging in the reflections of nursing students during practice experiences.
A number of recommendations and guidelines are provided to enable the safeguarding of students and staff and support them in practicing ethically.
Structured ethical analysis of a constructed hybrid reflection of commonly revealed ethical issues was useful in developing guidelines for educators.
Coercion in mental healthcare has led to ethical debate on its nature and use. However, few studies have explicitly explored patients’ moral evaluations of coercion.
The purpose of this study is to increase understanding of patients’ moral views and considerations regarding coercion.
Semi-structured focus-group and individual interviews were conducted and data were analysed through a thematic content analysis.
A total of 24 adult participants with various mental health problems and experiences with coercion were interviewed in 2012–2013 in three regions of Norway.
Ethical approval and permissions were obtained according to required procedures. Informed consent and confidentiality were also secured.
Ethical considerations regarding coercion included seven main themes: the need for alternative perspectives and solutions, the existence of a danger or harm to oneself or others, the problem of paternalism, the problem of discrimination and stigma, the need for proportionality, the importance of the content and consequences of coercion and concerns about way that coercion is carried out in practice.
The participants’ views and considerations are in line with previous research and reflect the range of normative arguments commonly encountered in ethical and legal debates. The study accentuates the significance of institutional factors and alternative voluntary treatment opportunities, as well as the legal and ethical principles of proportionality and purposefulness, in moral evaluations of coercion.
Broader perspectives on coercion are required to comprehend its ethical challenges and derive possible solutions to these from a patient perspective.
The midwifery profession in Sweden has a history since the early 1700s when government training for midwives began. Midwifery is historically well described, but the idea of caring within midwifery is not described.
The aim was to describe the patterns of ideas of caring as they appeared in midwifery during the first half of the 20th century. Research design: This study has a hermeneutic approach and the method is history of ideas. Sources of material are taken from the journal Jordemodern (Midwifery), textbooks for midwives, and midwifery regulations. The study has a caring science perspective according to Eriksson.
This study is conducted in accordance with the ethical guidelines for good scientific practice issued by The Finnish Advisory Board on Research Integrity. The special demands on approach to the analyzed text in history of ideas have been met.
Three themes were identified: Serving as a way of life, Acting in a redemptive spirit, and Having independence with heavy responsibility. The various themes are not refined, but current ideas are woven into the weave that were characteristic of midwifery during the first half of the 20th century.
History of ideas is a fruitful method for understanding and re-finding valuable cultural goods. We can once more stress the manner of being within the midwife’s profession where inner values, ethos, shape the manner of conduct in the care of women in childbirth.
When conducting qualitative research, participants usually share lots of personal and private information with the researcher. As researchers, we must preserve participants' identity and confidentiality of the data.
To critically analyze an ethical conflict encountered regarding confidentiality when doing qualitative research.
Case study.
one of the participants in a study aiming to explain the meaning of living with HIV verbalized his imminent intention to commit suicide because of stigma of other social problems arising from living with HIV. Given the life-threatening situation, the commitment related to not disclosing the participant's identity and/or the content of the interview had to be broken. To avoid or prevent suicide, the therapist in charge of the case was properly informed about the participant's intentions. One important question arises from this case: was it ethically appropriate to break the confidentiality commitment?
confidentiality could be broken if a life-threatening event is identified during data collection and participants must know that. This has to be clearly stated in the informed consent form.
Heart failure is a major growing problem and affects not only patients but also their families and community networks and reduces the functional capacity of patients and impairs their social life.
This study was conducted to investigate relationship between illness-related worries and social dignity in patients with heart failure.
The study had a descriptive-analytic design, and data collection was carried out by means of two specific questionnaires.
A total of 130 inpatients from cardiac wards in hospitals affiliated with Tehran and Shahid Beheshti University of Medical Sciences participated.
This study was approved by the Research Committee of Shahid Beheshti University of Medical Sciences.
The highest mean score of illness-related worries was attributed to the dimension of patient’s worry of physical–mental complications, and the least mean score was related to the dimension of the worry about the future of disease. The highest mean score of social dignity was associated with the dimension of social communication and support, and the least is attributed to the dimension of burden to others (economic). Pearson’s statistical test showed a significant correlation (r = 0.455, p < 0.05) between the score of illness-related worries and social dignity.
As the result of this study showed that reducing illness-related worries in patients with heart failure can improve their social dignity, using strategies to decrease worries and promote social dignity in these patients is recommended.
This study affirms the importance of careful evaluation of individual patients to determine their needs related to dignity. We hope these results will help to promote actions by patient-care staff that honor and support patient dignity, resulting in benefits to patients and developing the quality of care based on human rights.
Nurses are often faced with complex situations that made them to make ethical decisions; and to make such decisions, they need to possess the power of moral reasoning. Studies in Iran show that the majority of nursing students lack proper ethical development. Socratic teaching is a student-centered method which is strongly opposed to the lecturing method.
This study was conducted to evaluate the impacts of Socratic questioning on the moral reasoning of the nursing students.
In a quasi-experimental study, Crisham’s Nursing Dilemma Test was used to evaluate the results of three groups before, immediately after, and 2 months after intervention. The data were analyzed using the SPSS statistical software (v 15).
Through random allocation, 103 nursing students were divided into three groups. In experiment group 1 (37 students), intervention consisted of Socratic questioning-based sessions on ethics and how to deal with moral dilemmas; experiment group 2 (33 students) attended a 4-h workshop; and the control group (33 students) was not subject to any interventions.
This research was approved by the Ethics Committee of the University. All the participants signed written informed consents.
There were significant differences between experiment group 1 and experiment group 2’s pre-test and post-test scores on moral reasoning (p ≤ 0.001, p ≤ 0.001), nursing principled thinking (p ≤ 0.001, p ≤ 0.001), and practical considerations (p ≤ 0.001, p ≤ 0.031).
Both the teaching approaches improved the subjects’ moral reasoning; however, Socratic questioning proved more effective than lecturing. Compared to other similar studies in Iran and other countries, the students had inadequate moral reasoning competence.
This study confirms the need for the development of an efficient course on ethics in the nursing curriculum. Also, it appears that Socratic questioning is an effective method to teach nursing ethics and develop nursing students’ competence of moral reasoning.
Ethics, being a fundamental component of nursing practice, must be integrated in the nursing education curriculum. Even though different bodies are promoting ethics and nursing researchers have already carried out work as regards this concept, it still remains difficult to clearly identify the components of this competence.
This integrative review intends to clarify this point in addition to better defining ethical competence in the context of nursing practice.
An integrative review was carried out, for the 2009–2014 period, in the CINAHL, MEDLINE, and EMBASE databases and in the journal Nursing Ethics. The keywords nursing ethics or ethical competence were used in order to make sure to widely encompass the concept of "ethical competence" in the case of a university curriculum in nursing. In the end, 89 articles were selected.
We have respected the ethical requirements required regarding the sources and authorship. There is no conflict of interest in this literature review.
Ethical sensitivity, Ethical knowledge, Ethical reflection, Ethical decision-making, Ethical action, and Ethical behavior are the most frequently used terms with regard to ethical competence in nursing. They were then defined so as to better ascertain the possible components of ethical competence in nursing.
Even though ethical competence represents a sine qua non competence in nursing practice, no consensus can be found in literature with respect to its definition. The identification of its components and their relationships resulting from this integrative review adds to the clarification of its definition. It paves the way for other studies that will contribute to a better understanding of its development, especially among nursing students and practicing nurses, as well as the factors that may exert an influence. More adapted education strategies can thus be put forward to support its development.
Moral distress occurs when nurses experience ethical dilemmas. Issues related to these dilemmas are addressed in some nursing education courses. Nurses’ reaction to dilemma such as moral distress is relatively less noticed.
This study aimed to identify and describe the various types of perceptions of moral distress exhibited by nurses.
This study applied Q methodology to explore the perspectives of nurses regarding moral distress. Data were collected in two stages. First, in-depth interviews were conducted to collect nurses’ opinions. Sentences that best fit the concepts of moral distress were extracted for the construction of Q statements. Second, nurses subjectively ranked these Q statements so that the relevant severity of moral distress could be determined using Q sorts. The study participants were nurses at a regional teaching hospital in northeast Taiwan. A total of 60 participants were invited to rank 40 moral distress Q statements.
The study protocol was approved by the institutional review board of National Yang-Ming University Hospital. Only the participants who signed an informed consent form participated in the study. The respondents’ right to withdraw from the study was respected.
Five types of responses were identified regarding the nurses’ perspectives. These types were "conflict with personal values," "excessive of workload," "curbing of autonomy," "constraint engendered by organizational norms," and "self-expectation frustration."
The findings regarding nurses’ experiences of moral distress can be used to construct multifaceted policies and solutions and to incorporate ethical education in training programs.
Previous research has linked missed nursing care to nurses’ work environment. Ethical climate is a part of work environment, but the relationship of missed care to different types of ethical climate is unknown.
To describe the types of ethical climate in adult in-patient cancer care settings, and their relationship to missed nursing care.
A descriptive correlation design was used. Data were collected using the Ethical Climate Questionnaire and the MISSCARE survey tool, and analyzed with descriptive statistics, Pearson’s correlation and analysis of variance.
All nurses from relevant units in the Republic of Cyprus were invited to participate.
The research protocol has been approved according to national legislation, all licenses have been obtained, and respondents participated voluntarily after they have received all necessary information.
Response rate was 91.8%. Five types identified were as follows: caring (M = 3.18, standard deviation = 1.39); law and code (M = 3.18, standard deviation = 0.96); rules (M = 3.17, standard deviation = 0.73); instrumental (M = 2.88, standard deviation = 1.34); and independence (M = 2.74, standard deviation = 0.94). Reported overall missed care (range: 1–5) was M = 2.51 (standard deviation = 0.90), and this was positively (p < 0.05) related to instrumental (r = 0.612) and independence (r = 0.461) types and negatively (p < 0.05) related to caring (r = –0.695), rules (r = –0.367), and law and code (r = –0.487).
The reported levels of missed care and the types of ethical climates present similarities and differences with the relevant literature. All types of ethical climate were related to the reported missed care.
Efforts to reduce the influence of instrumental and independence types and fostering caring, law and code, and rules types might decrease missed nursing care. However, more robust evidence is needed.
Through the Norwegian ethics project, ethics activities have been implemented in the health and care sector in more than 200 municipalities.
To study outcomes of the ethics activities and examine which factors promote and inhibit significance and sustainability of the activities.
Two online questionnaires about the municipal ethics activities.
A total of 137 municipal contact persons for the ethics project answered the first survey (55% response rate), whereas 217 ethics facilitators responded to the second survey (33% response rate).
Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services.
Around half of the respondents found the ethics project to have been highly significant for daily professional practice. Outcomes include better handling of ethical challenges, better employee cooperation, better service quality, and better relations to patients and next of kin. Factors associated with sustainability and/or significance of the activities were sufficient support from stakeholders, sufficient available time, and ethics facilitators having sufficient knowledge and skills in ethics and access to supervision.
This study shows that ethics initiatives can be both sustainable and significant for practice. There is a need to create regional or national structures for follow-up and develop more comprehensive ethics training for ethics facilitators.
It is both possible and potentially important to implement clinical ethics support activities in community health and care services systematically on a large scale. Future ethics initiatives in the community sector should be designed in light of documented promoting and inhibiting factors.
Values are the basis of nursing practice, especially in making decisions about complicated ethical issues. Despite their key role in nursing, little information exists on the factors affecting their development and manifestation in nursing students.
This study identifies and describes the facilitators and inhibitors of the development and manifestation of professional values based on the experiences of nursing students and instructors and nurses.
Data were collected through 29 semi-structured interviews and two focus group interviews in 2013–2015 and were analyzed using the conventional content analysis method of Elo and Kyngäs.
In total, 18 nursing undergraduates, five nursing instructors, and five nurses from Shiraz University of Medical Sciences and one of the teaching hospitals in Shiraz were selected through purposive sampling.
The research was approved by the Ethics Committee of Shiraz University of Medical Sciences and the teaching hospital examined.
The findings consisted of two categories: personal and environmental factors. Personal factors consisted of the two subcategories of personal stimuli (work experience and past relationships, inner beliefs and acting on values, belief in God and a divine worldview) and personal inhibitors (the lack of professional motivation and enthusiasm, negative emotions). Environmental factors consisted of the two subcategories of environmental stimuli (cooperation, order and discipline) and environmental inhibitors (unfavorable work environment, society’s negative attitude toward nursing, the violation of rights).
Given the impact of personal and environmental factors on the development and manifestation of professional values in nursing students, it is upon the education authorities to take account of them in their planning, and nursing managers are also recommended to further address these factors in their development of a proper work environment, provision of standard facilities and removal of barriers.
Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions.
An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions.
This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies.
Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions.
Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended.
Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as ‘incompetent’ decision makers regarding their own care.
The aim of the study was to deepen the understanding of stroke team members’ reasoning about truth-telling in end-of-life care due to acute stroke.
Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis.
A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated.
The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden.
The main findings were the team members’ dynamic movement between the categories ‘Truth above all’ and ‘Hide truth to protect’. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others.
The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient’s best interest first.
The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.
Trust has been identified as a vital value in the nurse–patient relationship. Although increasingly the subject of empirical inquiries, the specific processes used by nurses to foster trust in nurse–patient relationships with older immigrants of non-English speaking backgrounds hospitalised for end-of-life care have not been investigated.
To explore and describe the specific processes that nurses use to foster trust and overcome possible cultural mistrust when caring for older immigrants of non-English speaking backgrounds hospitalised for end-of-life care.
A qualitative descriptive approach was used. Twenty-two registered nurses were recruited from four metropolitan health services in Melbourne, Australia.
Research approval was granted by the Human Research Ethics Committees of the host institution and four participating health services.
Thematic analysis revealed that fostering trust encompassed the following three commensurate stages: establishing trust, strengthening trust and sustaining trust. Underpinning the successful achievement of these stages was the nurses’ moral commitment (reflected in their intentional, conscious and conscientious approach) to fostering trust as an essential ingredient of quality end-of-life care.
This study has shown that while professional competencies are important to providing quality end-of-life care to older immigrant patients of non-English speaking backgrounds, it is a nurse’s moral commitment to fostering trust that may ultimately lay the foundations for a trusting quality care relationship to be established and sustained.
This study has captured the processes used by nurses to foster trust as an essential element of quality end-of-life care in older immigrants. The characteristics of trust and the different factors influencing its expression in diverse cultural contexts are, however, under-researched. Accordingly, gaps remain in the knowledge and understanding of the specific cultural nuances and manifestations of trust across and within different cultures. This is an area that is germane to further cross-cultural and international collaborative scholarly inquiry and research.
Rationing of various needed services, for example, nursing care, is inevitable due to unlimited needs and limited resources. Rationing of nursing care is considered an ethical issue since it requires judgment about potential conflicts between personal and professional values.
The present research sought to explore aspects of rationing nursing care in Iran.
This study applied qualitative content analysis, a method to explore people’s perceptions of everyday life phenomena and interpret the subjective content of text data. Data collection was performed through in-depth, unstructured, face-to-face interviews with open-ended questions.
The study population included Iranian nurses of all nursing positions, from clinical nurses to nurse managers. Purposive sampling was employed to select 15 female and 3 male nurses (11 clinical nurses, 3 supervisors, 1 matron, 1 nurse, and 2 members of the Nursing Council) working in hospitals of three cities in Iran.
The study protocol was approved by Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all participants.
According to the participants, rationing of nursing care consisted of two categories, that is, causes of rationing and consequences of rationing. The first category comprised three subcategories, namely, patient needs and demands, routinism, and VIP patients. The three subcategories forming the second category were missed nursing care, patient dissatisfaction, and nurses’ feeling of guilt.
Levels at which healthcare practices are rationed and clarity of the rationing are important structural considerations in the development of an equal, appropriate, and ethical healthcare system. Moreover, the procedure of rationing is critical as it not only influences people’s lives but also reflects the values that dominate in the society. Therefore, in order to minimize the negative consequences of rationing of nursing care, further studies on the ethical dimensions of this phenomenon are warranted.
A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population.
To identify challenges in implementing the ‘Let Me Decide’ advance care planning programme in long-term-care.
This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families.
long-term-care residents in two nursing homes and one community hospital.
The local research ethics committee granted ethical approval.
Following implementation, over 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training.
The challenges encountered were largely concerned with preserving resident’s autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources.
Although it may be too late for many long-term-care residents to complete their own advance care directive, the ‘Let Me Decide’ programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice.
There is growing awareness that patient care suffers when nurses are not respected. Therefore, to improve outcomes for patients, it is crucial that nurses operate in a moral work environment that involves both recognition respect, a form of respect that ought to be accorded to every single person, and appraisal respect, a recognition of the relative and contingent value of respect modulated by the relationships of the healthcare professionals in a determined context.
The purpose of this study was to develop better understandings of perceptions of nursing’s professional respect in community and hospital settings in England.
The research design was qualitative. Focus groups were chosen as the most appropriate method for eliciting discussion about nursing’s professional respect.
A total of 62 nurses who had been qualified for at least a year and were working in two localities in England participated in this study.
Data were collected using 11 focus group sessions. The data were analysed by means of an inductive content analysis, extracting meaning units from the information retrieved and classifying the arising phenomena into conceptually meaningful categories and themes.
To conduct the research, permission was obtained from the selected universities.
Recognition respect of human beings was perceived as ingrained in the innermost part of nurses. Regarding appraisal respect, a great importance was placed on: the interactions among healthcare professionals, the time to build trust in these relationships, the influences of the workplace characteristics and nurses’ professional autonomy and decision-making.
Recognition respect of persons was embedded in the inmost part of nurses as individuals. Concerning appraisal respect, it was thought to be deeply enshrined in the inter- and intra-healthcare professional interactions. The forging of trusting relationships over time was deemed to be strongly associated with good quality interactions with other healthcare professionals.
Nurses are confronted daily with ethical issues while providing patient care. Hospital ethical climates can affect nurses’ job satisfaction, organizational commitment, retention, and physician collaboration.
At a metropolitan academic medical center, we examined nurses’ perceptions of the ethical climate and relationships among ethical climate factors and nurse characteristics.
We used a descriptive correlational design and nurses (N = 475) completed Olson’s Hospital Ethical Climate Survey. Data were analyzed using STATA.
Approvals by the Nursing Research Council and Institutional Review Board were obtained; participants’ rights were protected.
Nurses reported an ethical climate total mean score of 3.22 ± 0.65 that varied across factors; significant differences were found for ethical climate scores by nurses’ age, race, and specialty area.
These findings contribute to what is known about ethical climate and nurses’ characteristics and provides the foundation to develop strategies to improve the ethical climate in work settings.
Empathy is of great importance in nursing, as it helps us to see and meet the needs of patients and hence to care for patients in an appropriate way. Therefore, it is of great importance that nursing students and nurses develop their ability to empathize.
The study aimed at gaining knowledge on what characterizes undergraduate nursing students’ ability to empathize with patients during their first practice in a nursing home. In addition, the aim of the study was to investigate what nursing students think is important with regard to upholding their ability to empathize with patients in a professional way.
This research has a phenomenological and hermeneutic design, based on qualitative interviews.
A total of 11 undergraduate nursing students participated in interviews during or right after their first practice in a nursing home.
Norwegian Social Science Data Services approved the study. Participants were informed that their participation was voluntary. The participants were also assured confidentiality, and they were informed that they could withdraw from the study at any time, without providing any reasons.
What the findings show is that affective empathy is strong among undergraduate nursing students in their first practice. They think the emotions are important to be able to empathize, and they are afraid of becoming indifferent. At the same time, they are afraid that the feelings will hinder them from acting in a professional manner.
The findings are discussed in light of previous theories on empathy, and especially perspectives on empathy, emotions, and morality.
Affective empathy seems to be strong among nursing students, and this may be of great importance to be sensitive to patients’ well-being. However, affective and cognitive empathy should be balanced if nurses will have to meet patients in a professional way.
Professional nurses provide holistic healthcare to people and deal with patients closely. Furthermore, patients need nurses to do self-care and patients trust them for their treatments. Therefore, trust is extremely important in a professional care relationship and in satisfactory patient outcomes.
The aim of this study was to examine the patients’ views on the trust status toward nurses and the factors important for the development of trust in a nurse–patient relationship.
This research was planned as a descriptive cross-sectional study.
The study was carried out between April and July 2014 at the oncology hospital of a university in Ankara, Turkey. The sample size was calculated by power analysis and was composed of 356 inpatients diagnosed with cancer. For data collection, a questionnaire and the "Trust in Nurses Scale" were used.
Approval from the University Clinical Research Ethics Committee was obtained. Written approval was obtained from the hospital and consent letter from the patients.
The average score on the scale was 24.5 ± 3.9, meaning that patients had a high level of trust toward nurses in this hospital. The patients who were in the 50–59 age group and men had statistically higher scores compared with other groups. Patients’ answers revealed that themes of "Personal and Professional Characteristics" were important when developing trust, however "Mistreatment, Professional Incapability, and Communication Problem" were important causing mistrust toward the nurses.
In this study, the nurses’ professional competencies and interpersonal caring attributes emerged as most important in developing trust. This study paid attention to the values and attitudes that develop patients’ trust toward nurses. Moreover, the findings raise ethical questions about how the patients’ basic rights are to be protected and how their trust level can be heightened. Nurse managers need to assess continuously how trust toward nurses is developed, protected, and maintained in their institutions.
The purpose of this study was to describe the current situation of moral distress and to explore its influencing factors among Chinese nurses.
This is an exploratory, descriptive design study. A total of 465 clinical nurses from different departments in three Grade-III, Level-A hospitals in Jinan, Shandong Province, completed the questionnaires, including demographics questionnaire, Chinese version of Moral Distress Scale–Revised, and Job Diagnostic Survey.
The study was approved by the university ethics board and the local health service director.
The total score of Moral Distress Scale–Revised was 36.01 ± 24.02 points. The mean frequency and intensity scores of moral distress were 1.13 ± 0.49 and 1.09 ± 0.58, respectively. The level of moral distress among Chinese clinical nurses was low, and the frequency and intensity of moral distress were on low to moderate level. The level of moral distress experienced by clinical nurses is associated with demographics features and job characteristics, including age, education degree, department, task significance, autonomy, and dealing with others.
Our conclusion suggests that hospital and organizational administrations should attach much importance to the moral distress experienced by clinical nurses in China. Further studies should focus on interventions about how to reduce the levels of the frequency and intensity of moral distress among clinical nurses.
Since moral distress affects psychological aspects of psychiatric nurses, it is an important theme. Previous studies showed relationships between moral distress and job satisfaction; however, there are few studies which investigate relationships between moral distress and other effective variables and then we highlighted relationships among these variables.
This study aimed to (1) examine relationships among moral distress, sense of coherence, mental health, and job satisfaction and (2) clarify the most predictive variable to job satisfaction.
This study is a cross-sectional study. Participants were 130 psychiatric nurses in a hospital in Japan. They completed the Moral Distress Scale for Psychiatric nurses (Unethical conduct, Low staffing, and Acquiescence to patients’ rights violations), the sense of coherence scale (Comprehensibility, Manageability, and Meaning), the General Health Questionnaire, and the Job Satisfaction scale.
This study was approved by the ethical board of St Mary’s College. Nurses participated voluntarily and were anonymous.
Results showed that subscales of the Moral Distress Scale for Psychiatric nurses negatively correlated to the sense of coherence and the Job Satisfaction. A multiple regression analysis showed that "Acquiescence to patients’ rights violations" of the Moral Distress Scale for Psychiatric nurses and "Meaning" of the sense of coherence influenced the Job Satisfaction much more than other variables. These two variables were correlated to job satisfaction scale, and other variables without them did not significantly correlate to job satisfaction scale.
These results suggest that moral distress negatively related to sense of coherence and job satisfaction, a subscale of the Moral Distress Scale for Psychiatric nurses and that of the sense of coherence affected the job satisfaction the most.
Decreasing of acquiescence to patients’ rights violations and finding meaning in nursing may improve job satisfaction.
Patient safety, which is a patient’s right, can be threatened by nursing errors. Furthermore, nurses’ feeling of "being a wrongdoer" in response to nursing errors can influence the quality of care they deliver.
To explore the meaning of Iranian nurses’ experience of "being a wrongdoer."
A phenomenological approach was used to explore nurses’ lived experiences. Nurses were recruited purposively to take part in semistructured interviews, and the data collected from these interviews were analyzed using Van Manen’s thematic analysis.
Eight nurses working in three private or governmental hospitals in Tehran, Iran.
The research design was approved in each participating hospital, and all interviews were carried out at a predetermined time in a private place.
Five themes were extracted from the data: "wandering in unpleasant feelings" (with two subthemes: "unpleasant physical feelings" and "unpleasant emotions"), "wandering in the conscience court" (with three subthemes: "being the accused," "being the victim," and "being the judge"), "being arrested in time," "time for change" (with three subthemes: "promoting accountability," "promoting learning," and "strengthening supportive relationships"), and "spiritual exercise."
Some of our results are supported by the model of self-reconciliation and the recovery trajectory of "second victims" theory.
The meaning of "being a wrongdoer" has positive and negative aspects. Feelings of wandering provide nurses the opportunity to reflect on and re-embrace the professional and moral responsibility of nursing. Nursing managers can convert their "defeats" into a prelude to learning, increase their accountability, and improve the quality of nursing care.
The ability to consent promotes children’s access to health services. Healthcare providers should assess and arrive at a clinical judgement about the child’s maturity and mental capacity to obtain valid consent.
The objective of the study was to determine practices employed by South African healthcare providers to obtain consent for treatment from children.
A qualitative, explorative, descriptive research design was used and the study was contextual.
In all, 24 healthcare providers (professional nurses and medical practitioners) were purposively sampled from a hospital and primary health clinics. Semi-structured interviews were used.
Ethical approval was obtained from the Institutional Review Board and gatekeepers. Written informed consent was obtained from each participant.
Healthcare providers’ current practices in obtaining consent from children revealed inconsistency in implementation as well as the yardstick used to determine children’s mental capacity. Building trust with children, sharing information and assessment were interlinked in obtaining consent.
The inconsistent practice has implications for children’s access to healthcare services.
Inconsistent practices in the implementation of consent laws have the potential to violate children’s rights to bodily and psychological integrity, access to health services and having their opinions heard and be taken into consideration. Through uncovering the current perceptions and practices and a literature review, guidelines intended for use by the Department of Health could be developed.
Suffering in a suicidal crisis includes feelings such as despair, loneliness, anxiety, fear, shame, guilt and hopelessness. This study highlights the experiences of patients in the aftermath of suicide attempts. The research question was, what do suicidal patients see as meaningful help in care and treatment situations?
The methodology is inspired by Gadamer’s hermeneutics, where the parts are understood in light of the whole, and the whole is understood in light of the parts. Qualitative interviews were employed.
A total of 10 persons, 4 women and 6 men 21–52 years old, were informed and asked to participate by specialists in psychology at two emergency psychiatric wards and by one crisis resolution team. Nine of the participants had experienced one or more suicide attempts using drugs and alcohol. Forced hospitalization prevented one of the 10 participants from attempting suicide.
Before the participants signed an informed consent form, the interviewer met all participants to provide the written information, talking about the interview. A meeting to terminate contact was arranged after the participants had read their own interviews.
Three themes were generated by the methodology we applied: (1) experiencing hope through encounters, (2) experiencing hope through the atmosphere of wisdom and (3) experiencing a ray of hope from taking back responsibility.
The findings are discussed in the light of Eriksson’s suffering theory and Lindström’s theory about psychiatric care, as well as earlier research and theories about suicidality.
The study reinforces possibilities that hope in suicidal patients can be inspired in encounters with healthcare personnel and within caring cultures. Through dialogue and cooperation, patients’ safety and ability to cope with suffering is created and thereby the hope and will to struggle for life.
Identifying, maintenance, and promotion of dignity in different patients of various cultures is an ethical responsibility of healthcare workers.
This study was conducted to investigate factors related to dignity in patients with heart failure and test the validity of Dignity Model.
The study had a descriptive-correlational design, and data collection was carried out by means of four specific questionnaires.
A total of 130 in-patients from cardiac wards in hospitals affiliated with Tehran and Shahid Beheshti University of Medical Sciences participated.
This study was approved by the Research Committee of Shahid Beheshti University of Medical Sciences.
Significant correlation showed the following: between illness related worries with dignity conserving repertoire score, between illness related worries with social dignity, between illness related worries with dignity conserving repertoire score, and between social dignity with dignity score. Goodness Fit Index and Comparative Fit Index were calculated greater than 0.9.
This study affirms the importance of careful evaluation of individual patients to determine their needs related to dignity.
According to the results, the necessity of using appropriate tools to assess various aspects of patients’ dignity by clinical healthcare staff and design activities with particular focus on the main factors affecting dignity such as illness related worries and social dignity is recommended. Attention to this issue in everyday clinical practice can facilitate health professionals/nurses to potentially improve their patients’ dignity, develop quality of care and treatment, and improve patients’ satisfaction.
Compassionate care is an international priority of healthcare professionals. There is little understanding about how workplace issues impact provision of compassionate care in nursing practice. Therefore, it is important to address the workplace issues and organizational factors which may hinder compassionate care delivery within nursing practice.
The aim of this study was to explore workplace and organizational barriers to compassionate care from the nurses’ perspective.
The study used a qualitative exploratory design, and data were analyzed by conventional content analysis.
A total of 15 nurses working in different fields of nursing were recruited from four hospitals at northwest of Iran. Participants were selected by purposive sampling. Semistructured interviews were conducted for data collection.
Ethical approval of this study was gained from the Ethical Review Board of Tabriz University of Medical Sciences.
The main theme which emerged from data analysis was "unsupportive organizational culture." This theme had two main categories including "excessive workload alongside inadequate staffing" and "the lack of value on compassionate care."
Organizational barriers to development of compassionate in clinical practice were identified in this study. A closer examination of these barriers is required to move compassionate practice from an individual responsibility to a collective responsibility that is owned and shared by organizations.
For compassionate care to flourish, policy makers, managers, and healthcare providers must foster an organizational atmosphere conducive to compassionate care.
An ongoing challenge for clinical ethics consultation is learning how colleagues in other healthcare professions understand, make use of, and evaluate clinical ethics consultation services.
In pursuing such knowledge as part of clinical ethics consultation service quality assessment, clinical ethics consultation services can learn important information about the issues and concerns that prompt colleagues to request ethics consultation. Such knowledge allows for greater outreach, education, and responsiveness by clinical ethics consultation services to the concerns of clinician colleagues.
This quality assessment project explores consultation requests and follow-up questionnaire responses voluntarily submitted from nurses who requested clinical ethics consultation. We present qualitative data analyzed using content analysis and constant comparison methods to identify key concerns that prompted requests as well as common themes among nurse requestors’ evaluations of what was most important in clinical ethics consultations.
A total of 41 nurses requesting clinical ethics consultation and 15 who returned the follow-up questionnaire.
Our Office of Research Compliance and Quality Improvement determined that our project was not considered human subjects research and so did not require institutional review board approval or exemption. However, efforts were made to avoid any sense of coercion and all data were de-identified prior to analysis.
Our analysis revealed six main categories of issues that prompted nurses’ requests for ethics consultation, as well as unifying themes around nurses’ experiences, advocacy, and family support while caring for patients in the intersections of patients, families, and physicians.
The insights gained from analyzing nurses’ requests for and responses to clinical ethics consultation may serve as a resource for clinical ethics consultation services seeking to identify, respond to, and educate regarding issues of importance to nurse colleagues and may be a resource for nursing administrators and leadership seeking to identify and address common ethical issues nurses face.
Ongoing work on clinical ethics consultation service quality improvement and engagement with our nursing colleagues about their concerns prompting—and their evaluations of—clinical ethics consultation are necessary.
Although the link between adolescents’ health choices in relation to rights, duties and responsibilities is acknowledged, little is studied in this subject.
To identify, describe and synthesize previous studies on adolescents’ health choices in relation to rights, duties and responsibilities.
Ethical approval is not needed as it is an integrative review of published literature.
The integrative review was used to review and synthesize current knowledge. Electronic and manual searches from 2009 to March 2014 were used to systematically identify earlier studies.
The review identified 13 studies. Adolescents’ health choices were linked to unsuccessfully exercised rights, arising from questioned autonomy and freedom, and their duties were hardly mentioned.
Research into adolescents’ health choices in relation to their rights, duties and responsibilities is still methodologically fragmented. In future, more research is needed to support adolescents’ health promotion initiatives and increase their involvement opportunities.
As nurses’ ethical competence in their own fields is essential, clinical ethics support services help nurses improve ethical competence.
The purpose of this study was to identify the unmet needs of ethical support for nurses in clinical settings and explore the differences by nursing units.
Focus group interview design was applied.
Data were collected via four rounds of focus group interviews with 37 nurses at intensive care units, medical-surgical units, emergency departments and oncology units. Major questions were as follows: ‘What is nurses’ experience of ethical difficulties while working as a clinical nurse?’ and ‘What kinds of clinical ethics support services do nurses require in different clinical settings?’ Inductive content analysis was performed to analyse the data.
Ethical approval was obtained from the institutional review of board at the College of Nursing.
Five categories (with 14 subcategories) were identified: difficulty providing evidence-based care, lack of support in maintaining patients’ and family members’ dignity, insufficient education regarding clinical ethics, loss of professional self-esteem and expectations concerning organizational support. Nurses’ desire for ethical support varied according to department.
Nurses face both practical and existential ethical issues that require rapid solution each day. There is a need for ethical counselling to prevent compassion fatigue and identify means via which nurses reflect on their daily lives in their own fields. In-house training should be provided for each unit, to improve ethical competence and facilitate the development of pragmatic, sensible solutions.
Midwife health is intrinsically linked to the quality of safe patient care. To ensure safe patient care, there is a need to deliver emotional support to midwives. One option that midwives may turn to may be a confidential online intervention, instead of localised, face-to-face support.
Following the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards, this realist synthesis approach explores the ethical considerations in permitting confidentiality, anonymity and amnesty in online interventions to support midwives in work-related psychological distress. An iterative search methodology was used to select nine papers for review. To assimilate information, papers were examined for ideas relating to ethical dimensions of online interventions to support midwives in work-related psychological distress. This review takes a narrative approach.
Online interventions can support the development of insight, help seeking and open discussion. Additionally, Internet support groups can become morally persuasive in nature. Anonymity and confidentiality are both effective and therapeutic features of online interventions when used in collaboration with effective online moderation. Yet, ethical dilemmas remain where users cannot be identified.
Confidentiality and anonymity remain key components of successful online interventions. However, sanctioning the corollary component of amnesty may provoke moral discomfort for those seeking immediate accountability. For others, amnesty is seen as essential for open disclosure and help seeking. Ultimately, the needs of midwives must be balanced with the requirement to protect the public and the professional reputation of midwifery.
In supporting midwives online, the principles of anonymity, confidentiality and amnesty may evoke some resistance on ethical grounds. However, without offering identity protection, it may not be possible to create effective online support services for midwives. The authors of this article argue that the principles of confidentiality, anonymity and amnesty should be upheld in the pursuit of the greatest benefit for the greatest number of people.
Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students.
The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students.
The research employed a descriptive-correlational design to explore the relationships between and among moral distress, moral sensitivity, and moral courage of undergraduate nursing students.
A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study.
Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.
Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency (r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity (r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity.
Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators.
It is essential to pay attention to and respect the dignity of nurses to maintain them in their profession while they deliver skilled nursing care. Little is known, however, about how a sense of dignity influences the practitioner.
The purpose of this study is to describe nurses’ experiences of threats to their dignity occurring within clinical settings, which generates an intention to leave clinical practice.
The study was performed using qualitative content analysis. The participants were 21 clinical nurses with work experience who were employed across a range of clinical posts. Data obtained from the semi-structured interviews were analyzed and interpreted using a content analysis approach.
The study was approved by the Ethics Committee of Tabriz University of Medical Sciences and was guided by the ethical principles of voluntary enrolment, anonymity, privacy, and confidentiality.
Within data analysis, three main themes and nine categories were extracted as follows: (1) lack of professional pride (physician’s dominance, intangible nature of nursing, and negative attitude toward clinical nurses); (2) oppressive work environment (high workload, disrespect, discrimination, and lack of support); and (3) suppression of progressivism (lack of appreciation and attention to meritocracy).
Almost all of the participants have experienced some degree of disrespect and violation of dignity. In general, attempts made by the participants to show their objection to the threats and to support and protect their dignity have not been effective and in fact made them more inclined to leave the clinical work.
According to the views of nurses themselves, identification of the factors threatening nurses’ dignity can be one of the appropriate solutions for the broader and deeper investigation of this phenomenon and can help promote and support nurses’ dignity and their retention within the profession.
There have been a number of debates in the field of nursing ethics. Researchers have focused on various aspects of nursing ethics, such as professional ethics, professional, nursing and ethical values. Within this research, a variety of literature reviews have been conducted, but to the best of our knowledge, bibliometric mapping has not yet been used.
This article aims to analyse the production of literature within nursing ethics research.
In order to examine publishing patterns, we focused on publishing dynamics, prolific research entities and the most-cited articles. We additionally visualised the content of the literature using a novel mixed-method approach, combining bibliometric analysis and mapping with thematic analysis.
In our study, ethical review was not required.
A total of 1416 information sources were found in the Scopus database. Overall, literature production has increased; however, in recent years, the quantity of published material has begun to decrease. The most prolific countries are the United States, the United Kingdom and Canada, and the most prolific source titles are Nursing Ethics, Journal of Advanced Nursing and Nursing Times. Lately, research in the field of nursing ethics has been focused more on life care (providing for the basic needs of older residents), moral distress and community nursing.
The dynamics of research literature production showed an exponential rise in the number of published information sources – a rise which started in the period between 1974 and 1998. Since that period, the trend has stabilised, which might indicate that nursing ethics research is starting a transition to a mature phase.
The innovative use of bibliometric analysis and mapping, together with thematic analysis, is a useful tool for analysis of research production in the field of nursing ethics. The results presented can be an excellent starting point for literature reviews and more exhaustive data, information and knowledge seeking.
Through the framework of Ricoeur’s philosophy, Fredriksson and Eriksson develop an influential ethics of the caring conversation, which instructs nurses to have caritas, self-esteem, and autonomy on one hand and to engage respectfully and responsibly in caring conversations on the other. This article brings the ethics of the caring conversation into dialogue with Ricoeur’s philosophy again. While Fredriksson and Eriksson draw upon Ricoeur’s little ethics, this article relies on Ricoeur’s dialectic of love and justice. The dialogue throws light on other aspects of caritas, which is vital in Fredriksson and Eriksson’s ethics. It shows a need for nurses to strike a balance between love and justice and, also, to cultivate love.
Experiencing moral distress is traumatic for nurses. Ignoring moral distress can lead to job dissatisfaction, improper handling in the care of patients, or even leaving the job. Thus, it is crucial to use valid and reliable instruments to measure moral distress.
The purpose of this study was to determine the reliability and the validity of the Persian version of the Moral Distress Scale–Revised among a sample of Iranian nurses.
In this methodological study, 310 nurses were recruited from all hospitals affiliated with the Qazvin University of Medical Sciences from February 2014 to April 2015. Data were collected using a demographic questionnaire and the Moral Distress Scale–Revised. The construct validity of the Moral Distress Scale–Revised was evaluated using principal component analysis and confirmatory factor analysis. Internal consistency reliability was assessed with Cronbach’s alpha.
This study was approved by the Regional Committee of Medical Research Ethics. The ethical principles of voluntary participation, anonymity, and confidentiality were considered.
The construct validity of the scale showed four factors with eigenvalues greater than one. The model had a good fit ( 2(162) = 307.561, 2/df = 1.899, goodness-of-fit index = .904, comparative fit index = .927, incremental fit index = .929, and root mean square error of approximation (90% confidence interval) = .049 (.040–.057)) with all factor loadings greater than .5 and statistically significant. Cronbach’s alpha coefficients were .853, .686, .685, and .711for the four factors. Moreover, the model structure was invariant across different income groups.
The Persian version of the Moral Distress Scale–Revised demonstrated suitable validity and reliability among nurses. The factor analysis also revealed that the Moral Distress Scale–Revised has a multidimensional structure. Regarding the proper psychometric characteristics, the validated scale can be used to further research about moral distress in this population.
Moral distress is increasingly recognized as a problem affecting healthcare professionals, especially nurses. If not addressed, it may create job dissatisfaction, withdrawal from the moral dimensions of patient care, or even encourage one to leave the profession. Spiritual well-being is a concept which is considered when dealing with problems and stress relating to a variety of issues.
This research aimed to examine the relationship between spiritual well-being and moral distress among a sample of Iranian nurses and also to study the determinant factors of moral distress and spiritual well-being in nurses.
A cross-sectional, correlational design was employed to collect data from 193 nurses using the Spiritual Well-Being Scale and the Moral Distress Scale-Revised.
This study was approved by the Regional Committee of Medical Research Ethics. The ethical principles of voluntary participation, anonymity, and confidentiality were considered.
Mean scores of spiritual well-being and moral distress were 94.73 ± 15.89 and 109.56 ± 58.70, respectively. There was no significant correlation between spiritual well-being and moral distress (r = –.053, p = .462). Marital status and job satisfaction were found to be independent predictors of spiritual well-being. However, gender and educational levels were found to be independent predictors for moral distress. Age, working in rotation shifts, and a tendency to leave the current job also became significant after adjusting other factors for moral distress.
This study could not support the relationship between spiritual well-being and moral distress. However, the results showed that moral distress is related to many elements including individual ideals and differences as well as organizational factors. Informing nurses about moral distress and its consequences, establishing periodic consultations, and making some organizational arrangement may play an important role in the identification and management of moral distress and spiritual well-being.
Ethics play an important role in activating the manpower and achieving the organizational goals. The nurse leaders’ ethical behavior can promote the care quality by affecting the nurses’ performance and bringing up several positive consequences for the organization.
The aim of this study was to identify and describe the ethical competency of nurse leaders in cultural domains and the working conditions of the Iranian healthcare setting to arrive at a more comprehensive and specific perspective.
This was a qualitative conventional content analysis study conducted with the participation of 14 nurse leaders at various levels. The participants were selected using the purposive sampling method, and the required data were collected using deep interview and also semi-structured interview. A deductive method of content analysis was applied in data analysis.
This study was conducted in accord with the principles of research ethics and national rules and regulations relating to informed consent and confidentiality.
Data analysis resulted in 17 subcategories that were subsequently grouped into three major categories including empathetic interactions, ethical behavior, and exalted manners.
Our findings are consistent with previous ones, yet presenting a more complete knowledge about aspects of ethical competency of nurse leaders. The nurse leaders can provide a proper behavioral model for the work environment through the use of new information.
The nurse leaders introduced various aspects of ethical competency, so the leaders’ ethical competency could be promoted via planning and managing some ethical development programs. More future research is needed regarding the experiences of the subordinates and other related parties.
The importance of trust between patients and healthcare personnel is emphasised in nurses’ and physicians’ ethical codes. Trust is crucial for an effective healthcare personnel–patient relationship and thus for treatment and treatment outcomes. Cultural and linguistic differences may make building a trusting and positive relationship with ethnic minority patients particularly challenging. Although there is a great deal of research on cultural competence, there is a conspicuous lack of focus on the concepts of trust and distrust concerning ethnic minority patients, particularly in relation to the concept of ‘othering’.
To study which factors help build trust or create distrust in encounters between healthcare professionals and hospitalised ethnic minority patients, as well as study the dynamic complexities inherent within the process of ‘othering’.
Qualitative design, in-depth interviews and hermeneutic analysis.
The interviewees were 10 immigrant patients (six women and four men – eight Asians, two Africans – ages 32–85 years) recruited from a south-eastern Norwegian hospital.
Study approval was obtained from the hospital’s Privacy Ombudsman for Research and the hospital’s leadership. Participation was voluntary and participants signed an informed consent form.
Distrust and othering may be caused by differences in belief systems, values, perceptions, expectations, and style of expression and behaviour. Othering is a reciprocal phenomenon in minority ethnic patient–healthcare personnel encounters, and it influences trust building negatively. Besides demonstrating general professional skill and competence, healthcare personnel require cultural competence to create trust.
Ethical sensitivity has been identified as a foundational component of ethical action. Diminished or absent ethical sensitivity can result in ethically incongruent care, which is inconsistent with the professional obligations of nursing. As such, assessing ethical sensitivity is imperative in order to design interventions to facilitate ethical practice and to ensure nurses recognize the nature and extent of professional ethical obligations.
To review and critique the state of the science of nurse ethical sensitivity and to synthesize findings across studies.
Whittemore and Knafl’s revised framework for integrative reviews guided the analysis.
A comprehensive, computer-assisted search of literature published in Cumulative Index of Nursing and Allied Health Literature and PubMed was performed. A systematic approach was used to extract, reduce, and synthesize the data.
Four major conceptualizations of ethical sensitivity emerged from the literature. A sample of 25 reports met inclusion criteria, including 17 empirical reports and 8 theoretical reports.
Despite the existence of a concept analysis and a validated tool, ethical sensitivity remains a highly theoretical concept with multiple, and at times competing, conceptualizations. Ethical sensitivity has been assessed extensively in the context of ethical dilemmas; however, little attention has been paid to the way the concept operates in day-to-day practice.
Future research should focus on better ways to operationalize and assess the concept, with particular attention to nurse awareness of the ethical content of everyday practice.
The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals (4–12) to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework’s five decision-making dimensions of reasoning, evidence, procedures, values, attitudes and defences. The design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students.
Explicating nurses’ moral identities is important given the powerful influence moral identity has on the capacity to exercise moral agency.
The purpose of this study was to explore how nurses narrate their moral identity through their understanding of their work. An additional purpose was to understand how these moral identities are held in the social space that nurses occupy.
The Registered Nurse Journal, a bimonthly publication of the Registered Nurses’ Association of Ontario, Canada, features a regular column entitled, ‘In the End ... What Nursing Means to Me ...’ These short narratives generally include a story of an important moment in the careers of the authors that defined their identities as nurses. All 29 narratives published before June 2015 were analysed using a critical narrative approach, informed by the work of Margaret Urban Walker and Hilde Lindemann, to identify a typology of moral identity.
Ethics approval was not required because the narratives are publicly available.
Two narrative types were identified that represent the moral identities of nurses as expressed through their work: (1) making a difference in the lives of individuals and communities and (2) holding the identities of vulnerable individuals.
Nurses’ moral identities became evident when they could see improvement in the health of patients or communities or when they could maintain the identity of their patients despite the disruptive forces of illness and hospitalization. In reciprocal fashion, the responses of their patients, including expressions of gratitude, served to hold the moral identities of these nurses.
Ultimately, the sustainability of nurses’ moral identities may be dependent on the recognition of their own needs for professional satisfaction and care in ways that go beyond the kind of acknowledgement that patients can offer.
Whenever there has been a worldwide contagious disease outbreak, there have been reports of infection and death of healthcare workers. Particularly because emergency nurses have contact with patients on the front line, they experience ethical problems in nursing while struggling with infectious diseases in an unfavorable environment.
The objective of this study was to explore emergency nurses’ ethical problems and to identify factors influencing these problems during the outbreak of Middle East respiratory syndrome–coronavirus in Korea.
For this cross-sectional study, a questionnaire survey was conducted with emergency nurses working in six hospitals selected through convenience sampling from the hospitals designated for Middle East respiratory syndrome–coronavirus patients in the capital area.
Data were collected from 169 emergency nurses in Korea during August 2015.
This research was approved by the Institutional Review Board of G University in Korea.
The findings of this study suggest that during the Middle East respiratory syndrome–coronavirus outbreak, emergency nurses experienced ethical problems tied to a mind-set of avoiding patients. Three factors were found to influence emergency nurses’ ethical problems (in order of influence): cognition of social stigmatization, level of agreement with infection control measures, and perceived risk.
Through this study, we obtained information on emergency nurses’ ethical problems during the Middle East respiratory syndrome–coronavirus outbreak and identified the factors that influence them. As found in this study, nurses’ ethical problems were influenced most by cognitions of social stigmatization. Accordingly, to support nurses confidently care for people during future health disasters, it is most urgent to promote appropriate public consciousness that encourages healthcare workers.
During their education process, nursing undergraduates experience ethical conflicts and dilemmas that can lead to moral distress. Moral distress can deprive the undergraduates of their working potential and may cause physical and mental health problems.
We investigated the experiences of the undergraduates in order to identify the existence of moral distress caused by ethical conflict and dilemmas experienced during their nursing education.
This study was designed according to the principles of research with human beings and was approved by the Human Research Ethics Committee.
A qualitative multiple-case study. Two federal higher education institutions were surveyed, from which 58 undergraduates in nursing participated in the study. The undergraduates were undergoing their professional training. The data were collected through focus groups and were submitted to thematic content analysis, with the resources of the ATLAS TI 7.0 software.
Moral distress in undergraduates is a reality and was identified in three axes of analysis: (1) moral distress is experienced by undergraduates in the reality of healthcare services, (2) the teacher as a source of moral distress, and (3) moral distress as a positive experience.
The undergraduates in nursing manifest moral distress in different stages of their education, particularly during their professional training. The academic community should reflect and seek solutions for the reality of moral distress in undergraduates.
Nurses’ ethical competence has been identified as a significant factor governing high quality of care. However, nurses lack support in dealing with ethical problems, and therefore managerial support for nurses’ ethical competence is needed.
This study aimed to analyse, from the perspective of nurse and nurse leaders, the level of nurses’ and nurse leaders’ ethical competence, perceptions of support for nurses’ ethical competence at the organisational and individual levels and background factors associated with this support.
A descriptive, cross-sectional study design was employed. The Ethical Competence and Ethical Competence Support questionnaires were used to measure the main components. Descriptive statistics and multifactor analysis of variance were used for data analysis.
The participants were 298 nurses and 193 nurse leaders working in specialised (48%/52%), primary (43%/36%) or private healthcare (5%/7%) in Finland.
Ethical approval was obtained from the university ethics committee. Results: Nurses estimated their own ethical competence to be at an average level, whereas nurse leaders estimated their own competence at a high level. Nurses’ and nurse leaders’ perceptions of provided support for nurses’ ethical competence was not at a high level. The positive agreement percentage related to organisational support was 44% among nurses and 51% among nurse leaders. The positive agreement percentage related to individual support was lower, that is, 38% among nurses and 61% among nurse leaders. University education had a positive association with some items of individual support.
Despite the findings that ethical competence was estimated at a high level among nurse leaders, perceptions of support for nurses’ ethical competence were not at a satisfactory level. At the organisational level, nurse leaders need to inform of ethical procedures and practices in orientation; encourage multidisciplinary ethics discussions and collaboration; and support nurses at an individual level to participate in ethics education, multidisciplinary ethics discussions and in solving ethical problems.
This article will explore a clinical case study of a home visit carried out by the case manager nurse. In this case, we will discuss the dilemma of finding the balance between autonomy and beneficence from the perspective of principlist ethics, virtue ethics and the ‘ethics of care’. The main conflict in this case study deals with all proposals are unsuitable and it is not necessary for a nurse to pay him a home visit, whereas for the healthcare system it is considered necessary. We could conclude that, during the home visit, the case manager aspires to achieve excellence, and throughout his clinical relationship with Francesc, searches for a series of virtues, respecting certain fundamental principles. In this way, the case managers ensure that Jaume’s care is more humanised. The case has been anonymised and confidentiality maintained.
Despite the significant role of nurses in end-of-life care, their attitudes towards euthanasia are under-represented both in the current literature and the controversial debate that is ongoing in several countries.
What are the attitudes towards euthanasia among Finnish nurses? Which characteristics are associated with those attitudes?
Cross-sectional web-based survey.
A total of 1003 nurses recruited via the members’ bulletin of the Finnish Nurses Association and social media.
Ethical approval was obtained from the Committee on Research Ethics of the university to which the authors were affiliated.
The majority (74.3%) of the participants would accept euthanasia as part of Finnish healthcare, and 61.8% considered that Finland would benefit from a law permitting euthanasia. Most of the nurses (89.9%) thought that a person must have the right to decide on his or her own death; 77.4% of them considered it likely that they would themselves make a request for euthanasia in certain situations.
The value of self-determination and the ability to choose the moment and manner of one’s death are emphasized in the nurses’ attitudes towards euthanasia.
A continuous dialogue about euthanasia and nurses’ shared values is crucial due to the conflict between nurses’ attitudes and current ethical guidelines on nursing.
A key message in the World Health Organization’s report on dementia emphasizes the need to improve public and professional attitudes to dementia and its understanding, while acknowledging the fact that the workforce in dementia care is becoming increasingly diverse culturally.
To explore possible differences among formal caretakers from varied cultural background in their attitudes toward the autonomy and human dignity of patients with dementia.
Semi-structured interviews and content analysis, utilizing two fictional vignettes for eliciting caretakers’ attitudes toward dignity and autonomy of their patients.
A total of 20 formal caretakers of patients with dementia from three different cultural groups in Israel ("Sabras," "Arabs," and "Russians"), working in nursing homes and a hospital.
Approvals of relevant research ethics committees were obtained and followed.
In comparison with the other groups, most Arab caretakers offer markedly richer perceptions of human dignity and autonomy. Their human dignity’s conceptualization emphasizes "person-centered approach," and their perception of patients’ autonomy includes provision of explanations and preservation and encouragement of independence.
The differences found in the attitudes toward the meaning of autonomy and human dignity between the Arab caretakers and the other caretakers stand in contrast to previous studies regarding human dignity, emphasizing the common nature of these attitudes. Offering a linkage (theoretical and empirical) between the Arab perceptions of dignity and autonomy, the study strengthen and further the importance attributed in existing literature to person-centered care in enhancing the quality of care for patients with dementia.
The conceptualization of human dignity may vary among different cultural groups. It may also influence the extent to which the caretaker holds a full-fledged perception of the patients’ autonomy.
The acquisition of experience is a major concern for nurses in intensive care units. Although the emotional component of the clinical practice of these nurses has been widely studied, greater examination is required to determine how this component influences their learning and practical experience.
To discover the relationships between emotion, memory and learning and the impacts on nursing clinical practice.
This is a qualitative phenomenological study. The data were collected from open, in-depth interviews. A total of 22 intensive care unit nurses participated in this research between January 2012 and December 2014.
The School of Nursing Ethics Committee approved the study, which complied with ethical principles and required informed consent.
We found a clear relationship between emotion, memory and the acquisition of experience. This relationship grouped three dimensions: (1) satisfaction, to relieve the patient’s pain or discomfort, give confidence and a sense of security to the patient, enable the presence of family members into the intensive care unit and provide family members with a realistic view of the patient’s situation; (2) error experience, which nurses feel when a patient dies, when they fail to accompany a patient in his or her decision to abandon the struggle to live or when they fail to lend support to the patient’s family; and (3) the feel bad–feel good paradox, which occurs when a mistake in the patient’s care or handling of his or her family is repaired.
Emotion is a capacity that impacts on nurses’ experience and influences improvements in clinical practice. Recalling stories of satisfaction helps to reinforce good practice, while recalling stories of errors helps to identify difficulties in the profession and recognise new forms of action. The articulation of emotional competencies may support the development of nursing ethics in the intensive care unit to protect and defend their patients and improve their relationships with families in order to maximise the potential for patient care.
Moral courage is one of the most fundamental virtues in nursing profession; however, little attention has been paid to it; as a result, no exact and clear definition of moral courage has ever been accessible.
This study is carried out for the purposes of defining and clarifying its concept in nursing profession.
This study used a hybrid model of concept analysis comprising three phases, namely, a theoretical phase, field work phase, and a final analysis phase. To find relevant literature, electronic search of valid databases was utilized using keywords related to the concept of courage. Field work data were collected over an 11 months’ time period from 2013 to 2014. In the field work phase, in-depth interviews were performed with 10 nurses. The conventional content analysis was used in two theoretical and field work phases using Graneheim and Lundman stages, and the results were combined in the final analysis phase.
Permission for this study was obtained from the ethics committee of Tehran University of Medical Sciences. Oral and written informed consent was received from the participants.
From the sum of 750 gained titles in theoretical phase, 26 texts were analyzed. The analysis resulted in 494 codes in text analysis and 226 codes in interview analysis. The literature review in the theoretical phase revealed two features of inherent–transcendental characteristics, two of which possessed a difficult nature. Working in the field phase added moral self-actualization characteristic, rationalism, spiritual beliefs, and scientific–professional qualifications to the feature of the concept.
Moral courage is a pure and prominent characteristic of human beings. The antecedents of moral courage include model orientation, model acceptance, rationalism, individual excellence, acquiring academic and professional qualification, spiritual beliefs, organizational support, organizational repression, and internal and external personal barriers. Professional excellence resulting from moral courage can be crystallized in the form of provision of professional care, creating peace of mind, and the nurse’s decision making and proper functioning.
Prisons are contexts where nurses are required to have specific skills to ensure that, in a setting designed for the expiation of crime, prisoners receive the same type of care as anyone else. But this is not always the case, giving rise to ethical issues.
‘How do correctional nurses describe their working experience in prisons? What issues emerged?’
This is a qualitative descriptive study. Following purposive sampling, we conducted five focus groups. Thematic analysis was used to analyse the data.
Our sample included 31 correctional nurses in seven prisons in Northern Italy.
The scientific merit of this study was recognized by the Academic Board of the University of Genoa. Approval to conduct the study was obtained from the Liguria Regional Government that funded this study and from the Local Health Authority that was the prison nurses’ employer. Formal consent was obtained from all the nurses who volunteered to participate in this study.
Five themes emerged from the focus groups: (1) prisoners’ healthcare needs, (2) negotiation between custody and care, (3) satisfaction of working in prisons, (4) obstacles to quality care and (5) safety. ‘Manipulation’ was a transversal theme that emerged from all the focus groups.
The problems generated by the clash between prison security and nursing care priorities did not enable nurses to practice autonomously and provide the best possible to care prisoners, giving rise to ethical issues and moral distress. This in turn causes high nursing turnover rates that negatively impact continuum of care.
In Italy, correctional nurses urgently require specific education interventions with the participation of all those who work in prisons. Interventions based on the post-modern concept of restorative nursing could offer prison nurses the opportunity to both resolve ethical issues and reduce moral distress.
Developing professional values among nursing students is important because values are a significant predictor of the quality care that will be provided, the clients’ recognition, and consequently the nurses’ job satisfaction. The literature analysis showed that there is only one validated tool available in Turkish that examines both the personal and the professional values of nursing students.
The aim of this study was to assess the reliability and validity of the Salford-Scott Nursing Values Questionnaire in Turkish.
This study was a Turkish linguistic and cultural adaptation of a research tool.
The sample of this study consisted of 627 undergraduate nursing students from different geographical areas of Turkey.
a socio-demographic form and the Salford-Scott Nursing Values Questionnaire. For the Salford-Scott Nursing Values Questionnaire, construct validity was examined using factor analyses.
The study was approved by the Cumhuriyet University Faculty of Medicine Research Ethics Board. Students were informed that participation in the study was entirely voluntary and anonymous.
Item content validity index ranged from 0.66 to 1.0, and the total content validity index was 0.94. The Kaiser–Meyer–Olkin measure of sampling was 0.870, and Bartlett’s test of sphericity was statistically significant (x2 = 3108.714, p < 0.001). Construct validity was examined using factor analyses and the six factors were identified. Cronbach’s alpha was used to assess the internal consistency reliability and the value of 0.834 was obtained.
Our analyses showed that the Turkish version of Salford-Scott Nursing Values Questionnaire has high validity and reliability.
Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the Dutch Care and Coercion bill, regular restraints of freedom, such as restrictions on choice of food or whom to visit, should be discouraged. Such restraints are only allowed if there is the threat of serious harm for the clients or their surroundings.
What do support staff consider as restraints on freedom and how do they justify these restraints?
In this study, data were collected by semi-structured interviews.
Fifteen support staff working with clients with moderate intellectual disabilities were interviewed. All participants work within the same organisation for people with intellectual disabilities in the Eastern part of the Netherlands.
The study was conducted according to good scientific inquiry guidelines and ethical approval was obtained from a university ethics committee.
Most restraints of freedom were found to be centred around the basic elements in the life of the client, such as eating, drinking and sleeping. In justifying these restraints, support staff said that it was necessary to give clarity in what clients are supposed to do, to structure their life and to keep them from danger.
In the justification of restraints of freedom two ethical viewpoints, a principle-guided approach and an ethics of care approach, are opposing one other. Here, the self-determination theory can be helpful, while it combines the autonomy of the client, relatedness to others and the client’s competence.
Despite the reasonable grounds support staff gave for restraining, it raises the question whether restraints of freedom are always in the interest of the client.
Nurses and surgeons may experience intra-team conflict during decision making about the use of postoperative life-sustaining treatment in the intensive care unit due to their perceptions of professional roles and responsibilities. Nurses have a sense of advocacy—a responsibility to support the patient’s best interest; surgeons have a sense of agency—a responsibility to keep the patient alive.
The objectives were to (1) describe the discourse surrounding the responsibilities of nurses and surgeons, as "advocates" and "agents," and (2) apply these findings to determine how differences in role responsibilities could foster conflict during decision making about postoperative life-sustaining treatment in the intensive care unit.
Articles, books, and professional documents were explored to obtain descriptions of nurses’ and surgeons’ responsibilities to their patients. Using discourse analysis, responsibilities were grouped into themes and then compared for potential for conflict.
No data were collected from human participants and ethical review was not required. The texts were analyzed by a surgeon and a nurse to minimize profession-centric biases.
Four themes in nursing discourse were identified: responsibility to support patient autonomy regarding treatment decisions, responsibility to protect the patient from the physician, responsibility to act as an intermediary between the physician and the patient, and the responsibility to support the well-being of the patient.
Three themes in surgery discourse were identified personal responsibility for the patient’s outcome, commitment to patient survival, and the responsibility to prevent harm to the patient from surgery.
These responsibilities may contribute to conflict because each profession is working toward different goals and each believes they know what is best for the patient. It is not clear from the existing literature that either profession understands each other’s responsibilities.
Interventions that improve understanding of each profession’s responsibilities may be helpful to reduce intra-team conflict in the intensive care unit.
Humanistic nursing practice which is dominated by technological advancement, outcome measurement, reduced resources, and staff shortages is challenging in the present work environment.
To examine the main concern in humanistic nursing area and how the way it is solved and resolved by Iranian nurses in acute care setting.
Data were collected from interviews and observations in 2009–2011 and analyzed using classic grounded theory. Memos were written during the analysis, and they were sorted once theoretical saturation occurred.
In total, 22 nurses, 18 patients, and 12 families from two teaching hospitals in Tehran were selected by purposeful and theoretical sampling.
The research was approved by the Ethics Committee of the university and hospitals.
The main concern for the nurses is the violation of their rights. They overcome this concern when there is a synergy of situation–education/learning, that is, a positive interaction between education and learning of values and sensitivity of the situation or existence of care promotion elements. They turn to professional values and seeking and meeting others’ needs, resulting in "success and accomplishment" of nurse/nursing manager and patient/family.
This theory shows that professional values, elements of care promotion, and sensitivity of the situation have a key role in activation of humanistic approach in nursing. Violation of the nurses’ professional rights often leads to a decrease in care, but these factors make the nurses practice in an unsparing response approach. It is necessary to focus on development of professional values and provide essential elements of care promotion as changeable factors for realization of humanistic nursing although there is a context in which the nurses’ rights are violated.
Despite the growing body of knowledge about surrogate decision making, we know very little about the use of ethical frameworks (including ethical theories, principles, and concepts) to understand surrogates’ day-to-day experiences in end-of-life care planning for incapacitated adults.
This qualitative systematic review was conducted to identify the types of ethical frameworks used to address surrogates’ experiences in end-of-life care planning for incapacitated adults as well as the most common themes or patterns found in surrogate decision-making research.
Seven research papers explicitly identified ethical theories, principles, or concepts, such as autonomy, substituted judgment, and best interest standards as guidelines for the research. Surrogate decision making themes included the responsibilities and goals of being a surrogate, factors influencing surrogates’ decision making, outcomes for surrogates, and an overarching theme of "wanting to do the right thing" for their loved one and/or themselves.
Understanding the complexity of surrogates’ experiences of end-of-life care planning is beyond the scope of conventional ethical frameworks.
Ethical frameworks that address individuality and contextual variations related to decision making may more appropriately guide surrogate decision-making research that explores surrogates’ end-of-life care planning experiences.
Nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one’s moral values. Nurses need moral courage in all areas and at all levels of nursing. Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Nevertheless, what the concept of moral courage means in nursing contexts remains ambiguous.
This article is an analysis of the concept of moral courage in nursing.
Rodgers’ evolutionary method of concept analysis provided the framework to conduct the analysis.
The literature search was carried out in September 2015 in six databases: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and The Philosopher’s Index. The following key words were used: "moral" OR "ethical" AND "courage" OR "strength" AND "nurs*" with no time limit. After applying inclusion and exclusion criteria, 31 studies were included in the final analysis.
This study was conducted according to good scientific guidelines.
Seven core attributes of moral courage were identified: true presence, moral integrity, responsibility, honesty, advocacy, commitment and perseverance, and personal risk. Antecedents were ethical sensitivity, conscience, and experience. Consequences included personal and professional development and empowerment.
This preliminary clarification warrants further exploring through theoretical and philosophical literature, expert opinions, and empirical research to gain validity and reliability for its application in nursing practice.
Paediatric nurses often face complex situations requiring decisions that sometimes clash with their own values and beliefs, or with the needs of the children they care for and their families. Paediatric nurses often use new technology that changes the way they provide care, but also reduces their direct interaction with the child. This may generate ethical issues, which nurses should be able to address in the full respect of the child.
The purpose of this review is to describe the main ethical dimensions of paediatric nursing. Our research question was, ‘What are the most common ethical dimensions and competences related to paediatric nursing?’
A rapid evidence assessment.
According to the principles of the rapid evidence assessment, we searched the PubMed, SCOPUS and CINAHL databases for papers published between January 2001 and March 2015. These papers were then independently read by two researchers and analysed according to the inclusion criteria.
Since this was a rapid evidence assessment, no approval from the ethics committee was required.
Ten papers met our inclusion criteria. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process.
Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses’ perceptions and experiences. Paediatric nurses require specific educational interventions to help them resolve ethical issues, contribute to the decision-making process and fulfil their role as advocates of a vulnerable population (i.e. sick children and their families). Further research is needed to investigate how paediatric nurses can improve the involvement of children and their families in decision-making processes related to their care plan.
Despite their negative consequences, evidence shows that futile medical treatments are still being provided, particularly to terminally ill patients. Uncovering the reasons behind providing such treatments in different religious and sociocultural contexts can create a better understanding of medical futility and help manage it effectively.
This study was undertaken to explore Iranian nurses’ and physicians’ perceptions of the reasons behind providing futile medical treatments.
This was a qualitative exploratory study. Study data were gathered through conducting in-depth semi-structured personal interviews and analyzed using the conventional content analysis method.
Twenty-one nurses and nine medical specialists were recruited purposively from four teaching hospitals affiliated to Tehran University of Medical Sciences.
This study was approved by the Nursing and Midwifery Research Center and the Research Ethics Committee of Tehran University of Medical Sciences. All participants gave informed consent for the research and that their anonymity was preserved.
The main theme of the study was "having an obligation to provide medical treatments despite knowing their futility." This theme consisted of three main categories including patients’ and family members’ request for continuing life-sustaining treatments, healthcare professionals’ personal motives, and organizational atmosphere and structure.
Different personal and organizational factors contribute to providing futile medical treatments. Promoting the structure and the function of hospital ethics committees, establishing and developing home care facilities, increasing the number of palliative care centers and hospices, and educating healthcare professionals, patients, and family members about the services and the benefits of such centers can facilitate making wise decisions about continuing or discontinuing treatments which have been labeled as futile.
The performance of nurses has become vital in hospitals. Some studies have suggested that nurses’ perceptions of the ethical climate in their hospitals are related to higher job satisfaction and organizational commitment and in turn lessen the issue of nursing shortage.
(1) The ethical climate types "caring," "independent," "law and code," and "rules" have a significant positive impact on overall job satisfaction. (2) The ethical climate types and overall job satisfaction have significant positive influences on normative and affective and significant negative influences on continuance commitment.
The study uses path analysis to understand which types of ethical climate impact overall job satisfaction. It also tries to find the effect of different types of ethical climate and overall job satisfaction on the components of organizational commitment. The relationships between variables were evaluated using factor analysis, reliability, descriptive statistics, correlations, and regression in this study.
A total of 171 useful questionnaires were collected from nurses working in public and private hospitals in Bosnia and Herzegovina.
Formal research approval was obtained from the administration of each study hospital. Questionnaires with a cover letter were mailed to the hospitals that agreed to participate in the study. In the cover letter, the researchers explained the study purpose, encouraged nurses’ voluntary participation, and guaranteed the anonymity of participants.
In the first path analyses, "rules" and "caring" climates significantly and positively affected overall job satisfaction. In the second one, while overall job satisfaction and "rules" climate significantly influenced normative commitment, "caring" climate and overall job satisfaction significantly affected affective commitment.
The findings of the study have been convenient with the literature.
Public and private hospitals can enhance overall job satisfaction and organizational commitment by altering the ethical climate of organizations. Hospital administrations should nurture caring and rule types of ethical climate which influence overall satisfaction. By this way, they could reduce nursing shortage.
To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature.
A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included.
The review is conducted according to the Vancouver Protocol.
There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion.
There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress.
The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought.
This study explored nurses’ care practices at the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity.
Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated.
Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals.
A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting.
Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members.
Despite the avoidance of death talk and nurses’ lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.
Spiritual development is one of the most important aspects of socialization that has attracted the attention of researchers. It is needed to train nursing student and novice nurses to provide high-quality care for patients. There is ambiguity in the definition of spiritual development and its relations, especially in the eastern countries.
To explore the concept of spiritual development in Iranian nurses.
Qualitative content analysis approach. Data were gathered from semi-structured interviews. Participants and research context: The participants were 17 Iranian Muslim nurses selected using a purposeful sampling. The place of interviews was on their choice.
Based on the principles of the Helsinki declaration, the focus was on preserving the participants’ autonomy, confidentiality, and anonymity. The participants were told the study purposes and trends, and their rights were emphasized; they were then asked to sign written consent forms. Formal research approval was obtained from Kerman University of Medical Sciences. Ethical approval was granted by the University Ethics Committee before the study was conducted (K/92 etc).
Three themes for spiritual development were defined: obligation to religion, commitment to ethics, and commitment to law. From the results, factors such as connection to the limitless divine power, personal and society-oriented ethical codes, and commitment to the law are proposed.
There are some differences between these findings and previous study, especially in the relation of the spirituality, religion, and law. Some studies, mostly Iranian, support these findings partially.
The results suggest that it is better to teach nursing education based on humanistic principles, ethics, and law to the new generation of nurses to improve community health and development. More studies are needed to examine the relation between these themes.
Physical impairment and dependency on others may be a threat to dignity.
The purpose of this study was to explore dignity as a core concept in caring, and how healthcare personnel focus on and foster dignity in nursing home residents.
This study has a hermeneutic design.
In all, 40 healthcare personnel from six nursing homes in Scandinavia participated in focus group interviews in this study.
This study has been evaluated and approved by the Regional Ethical Committees and the Social Science Data Services in the respective Scandinavian countries.
Two main themes emerged: dignity as distinction (I), and dignity as influence and participation (II).
A common understanding was that stress and business was a daily challenge.
Therefore, and according to the health personnel, maintaining human dignity requires slow caring in nursing homes, as an essential approach.
This is a case study of an ethical dilemma concerning the appropriateness of encouraging care-staff, working within a dementia care home, to either wear a clinical uniform or not to wear a clinical uniform in practice. It is proposed that people living with dementia may sustain higher levels of wellbeing if care-staff wear clothes that are more akin to their care home environment, for example, wearing similar clothes to the residents or even wearing pyjamas and nightwear during a night shift. The counter argument is that the practice may lead to greater levels of distress due to disorientation, increased potential for infection and inability to identify nurses when needed.
Some developed countries have recently changed their role in the context of international recruitment, becoming donors due to socio-economical and political factors such as recessions. This is also the case in Italy, where there has been a flow of immigrant nurses out of the country that has been documented over the past several years. In a short time, it has become a donor country to other developed European countries, such as the United Kingdom.
To advance knowledge in the context of human rights conflicts and ethical implications of the decision-making process of nurses who migrate between developed countries, such as from Italy to the United Kingdom, during times of recession.
A case study based on the descriptive phenomenological approach was undertaken in 2014.
A total of 26 Italian newly graduated nurses finding a job in the United Kingdom were interviewed via Skype and telephone.
The Internal Review Board of the University approved the project.
In accordance with the descriptive phenomenological approach undertaken, three main themes emerged: (1) escaping from the feeling of being refused/rejected in order to be desired, (2) perceiving themselves respected, as a person and as a nurse, in a growth project and (3) returning if the country changes its strategy regarding nurses.
Ethical implications in the context of human rights, such as autonomy of the decision, social justice and reciprocal obligation, non-maleficence and double effect, have been discussed.
The call for investing in nurses and nurses’ care in developed countries facing recession is urgent. Investing in nurses means respecting individuals and citizens who are at risk of developing health problems during the recession.
Today’s healthcare environment is often characterized by an ethically demanding work situation, and nursing students need to prepare to meet ethical challenges in their future role. Moral sensitivity is an important aspect of the ethical decision-making process, but little is known regarding nursing students’ moral sensitivity and its possible development during nursing education.
The aims of this study were to investigate moral sensitivity among nursing students, differences in moral sensitivity according to sample sub-group, and the relation between demographic characteristics of nursing students and moral sensitivity.
A convenience sample of 299 nursing students from one university completed a questionnaire comprising questions about demographic information and the revised Moral Sensitivity Questionnaire. With the use of SPSS, non-parametric statistics, including logistic regression models, were used to investigate the relationship between demographic characteristics and moral sensitivity.
The study followed the regulations according to the Swedish Ethical Review Act and was reviewed by the Ethics Committee of South-East Sweden.
The findings showed that mean scores of nursing students’ moral sensitivity were found in the middle to upper segment of the rating scale. Multivariate analysis showed that gender (odds ratio = 3.32), age (odds ratio = 2.09; 1.73), and parental status (odds ratio = 0.31) were of relevance to nursing students’ moral sensitivity. Academic year was found to be unrelated to moral sensitivity.
These demographic aspects should be considered when designing ethics education for nursing students. Future studies should continue to investigate moral sensitivity in nursing students, such as if and how various pedagogical strategies in ethics may contribute to moral sensitivity in nursing students.
Decisions regarding whether or not to institute mechanical ventilation during the later stages of chronic obstructive pulmonary disease is challenging both ethically, emotionally and medically. Caring for these patients is a multifaceted process where nurses play a crucial role.
We have investigated how nurses experienced their own role in decision-making processes regarding mechanical ventilation in later stages of chronic obstructive pulmonary disease and how they consider the patients’ role in these processes. We applied a qualitative approach, with six focus-group interviews of nurses (n = 26).
The Regional Committees for Medical and Health Research Ethics approved the study. Voluntary informed consent was obtained.
The nurses found themselves operating within a cure-directed treatment culture wherein they were unable to stand up for the caring values. They perceived their roles and responsibilities in decision-making processes regarding mechanical ventilation to patients as unclear and unsatisfactory. They also experienced inadequate interdisciplinary cooperation.
Lack of communication skills, the traditional hierarchical hospital culture together with operating in a medical-orientated treatment culture where caring values is rated as less important might explain the nurses’ absence in participation in the decision about mechanical ventilation.
To be able to advocate for the patients’ and their own right to be included in decision-making processes, nurses need an awareness of their own responsibilities. This requires personal courage, leadership who are capable of organising common interpersonal meetings and willingness on the part of the physicians to include and value the nurses’ participation in decision-making processes.
Through education, individuals acquire knowledge, skill and attitudes that facilitate professional socialization; it involves intellectual, emotional and psychomotor skill development. Teachers are role models for behaviour modification and value development.
To examine students’ perceptions of faculty members’ ethical and unethical attitudes during interactions in undergraduate nursing.
This descriptive study consisted of two phases. In Phase I, we developed an instrument, which was administered to nursing students to assess validity and reliability. Exploratory factor analysis yielded 32 items. Cronbach’s α was 0.83, and test–retest reliability was good. In Phase II, a 32-item version of the instrument was administered to nursing students from another university.
Participants included 219 nursing students from one university in Phase I and 196 from another university in Phase II. The study was conducted at the universities attended by the participants.
Ethical approval was granted by the institutions involved, and all participants provided informed consent.
In Phase I, the instrument demonstrated good psychometric properties for measuring nursing students’ perceptions of faculty members’ ethical and unethical behaviours. In Phase II, students considered certain professional and personal qualities, including respecting confidentiality and students’ private lives and assuming an impartial stance during interactions in the classroom, examinations, or clinical practice, ethical. They considered using obscene examples or unprofessional speech during teaching, selling textbooks in class, using university facilities for personal interests, engaging in romantic relationships with students, and humiliating students in front of patients or staff in clinical settings unethical.
Results of this study suggest that nurse educators should be aware of their critical role in the teaching–learning process, and they must scrutinize their attitudes towards students from an ethical point of view.
Patients’ rights are universal values that must be respected; however, it is not easy to put such values and principles into effect as approaches and attitudes differ from individual to individual, from society to society, and from country to country. If we want to reach a general conclusion about the status of patient rights in the world as whole, we should examine the situation in individual countries.
To study the effect of training sessions for nurses about patients’ rights on the perceptions of nurses and patients in two Egyptian hospitals.
Quasi-experimental with pre- and posttest design was used in this study. Two groups of participants were included in the study: the first with 97 nurses and the second with 135 patients. A questionnaire sheet was used for nurses and patients to assess their perceptions about patients’ rights before starting sessions. The training sessions were developed based on the baseline information gathered in the assessment phase and related literature. After the implementation of the sessions, a posttest was immediately conducted for nurses, while for patients the posttest was conducted 1 month after implementation to evaluate the effect of the nurses’ training sessions on the patients’ perceptions. The same tools were used in pretest and posttest.
Written approval was sought and obtained from the administrators of the studied hospitals prior to conducting the study. Oral consent was obtained from nurses and patients willing to participate. Confidentiality and anonymity of the participants were strictly maintained through code numbers on the questionnaires.
The improvement in nurses’ knowledge and perceptions about patients’ rights after implementation of the training sessions was remarkable. Moreover, an improvement in patients’ perceptions regarding their rights was reported.
Repetition of the training sessions is suggested to achieve continuous improvement. Provision of posters and booklets about a bill of patient rights within the hospitals and conduction of further study to examine nurses’ performance and patients’ satisfaction based on code of ethics are recommended.
Values are ideals and beliefs that individuals and groups uphold and lie at the core of the diverse world of human behaviour and are expressed in every human decision and action, both consciously and unconsciously. They represent basic beliefs of what is right, good or desirable and motivate both personal and professional behaviour. In the context of nursing profession, values are essential in order to maintain high standards of the nursing care.
This study was planned to examine changes in nursing students’ personal and professional values between entering and graduating from an undergraduate nursing programme.
Measures to protect participants included obtaining Deaconship of Nursing Faculty approval, obtaining signed informed consent and maintaining confidentiality.
This study was designed as longitudinal quality. The research population included 143 students registered at a first grade of a nursing faculty for the 2009–2010 academic year. Data were collected with a Questionnaire Form, the Value Preferences Scale, the Professional Values Precedence Scale and the Nursing Professional Values Scale.
According to the results, social values have statistical differences in 4-year nursing education. Nursing students in second class have higher score in terms of social values than those in third class. Also, majority of students ranked human dignity as first and justice as second and third from first to fourth classes, and they have very high scores on Nursing Professional Values Scale and its subscales and stated that all items of Nursing Professional Values Scale are very important.
As a result, nursing education has vital role in acquiring and maintaining professional values.
A slow but steady trend to decline routine immunization has evolved over the past few decades, despite its pivotal role in staving off life-threatening communicable diseases. Religious beliefs are among the reasons given for exemptions. In the context of an overview of various religious approaches to this issue, this article addresses the Jewish religious obligation to immunize. The latter is nested in the more general obligation to take responsibility for one’s health as it is essential to living a morally productive life. Furthermore, the individual’s responsibility extends to supporting communal health by contributing to herd immunity. Judaism embraces evidence-based information regarding immunization safety and efficacy and holds the resulting professional guidelines to be religiously binding. From a Jewish perspective, government bodies need to weigh respect for individual autonomy to refrain from immunization against preserving public safety, such that waiving autonomy should be reserved for immediately life-threatening situations. Nurses’ knowledge and understanding of the Jewish legal approach as explicated in this article and those of other religions in which similar principles apply (such as Islam and Christianity) can enrich their awareness of how revering God can go hand in hand with an obligation to prevent illness for the self and the community by immunizing.
The Taiwan Nursing Accreditation Council has proposed eight core professional nursing qualities including ethical literacy. Consequently, nursing ethics education is a required course for student nurses. These courses are intended to improve the ethical literacy. Moral sensitivity is the cornerstone of ethical literacy, and learning moral sensitivity is the initial step towards developing ethical literacy.
To explore the effect of nursing ethics educational interventions based on multiple teaching strategies on student nurses moral sensitivity. Based on the visual, auditory and kinaesthetic model, three strategies were developed for determining the programme components and corresponding learning styles.
This was a quasi-experimental study.
A total of 234 junior-college student nurses participated in this study. All participants were aged 18–19 years.
The study protocol was approved by the institutional review boards of Kaohsiung Veterans General Hospital. Only the participants who signed an informed consent form took part in the study. The participants were permitted to withdraw from the study at any point if they wished to do so without affecting their academic score.
The scores of Modified Moral Sensitivity Questionnaire for Student Nurses were significantly improved after the intervention of integrating multiple teaching strategies (p = .042). Significant relationships were observed between the satisfaction scores of two teaching strategies and moral sensitivity. The results indicated that using multiple teaching strategies is effective for promoting nursing ethics learning.
This strategy was consistent with the student nurses’ preferred learning style and was used to correct their erroneous ethical conceptions, assisting in developing their ethical knowledge.
The ability to save the life of an extremely premature baby has increased substantially over the last decade. This survival, however, can be associated with unfavourable outcomes for both baby and family. Questions are now being asked about quality of life for survivors of extreme prematurity. Quality of life is rightly deemed to be an important consideration in high technology neonatal care; yet, it is notoriously difficult to determine or predict. How does one define and operationalise what is considered to be in the best interest of a surviving extremely premature baby, especially when the full extent of the outcomes might not be known for several years?
The research investigates the caregiving dilemmas often faced by neonatal nurses when caring for extremely premature babies. This article explores the issues arising for neonatal nurses when they considered the philosophical and ethical questions about quality of life in babies ≤24 weeks gestation.
Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia.
Ethical processes and procedures have been adhered to by the researchers.
A qualitative approach was used to analyse the data. The theme ‘difficult choices’ was generated which comprised three sub-themes: ‘damaged through survival’, ‘the importance of the brain’ and ‘families are important’. The results show that neonatal nurses believed that quality of life was an important consideration; yet they experienced significant inner conflict and uncertainty when asked to define or suggest specific elements of quality of life, or to suggest how it might be determined. It was even more difficult for the nurses to say when an extremely premature baby’s life possessed quality. Their previous clinical and personal experiences led the nurses to believe that the quality of the family’s life was important, and possibly more so than the quality of life of the surviving baby. This finding contrasts markedly with much of the existing literature in this field.
Quality of life for extremely premature babies was an important consideration for neonatal nurses; however, they experienced difficulty deciding how to operationalise such considerations in their everyday clinical practice.
Nursing workforce in Western European health institutions has become more diverse because of immigration and recruitment from Asian, African, and East-European countries. Minority healthcare providers may experience communication problems in interaction with patients and coworkers, and they are likely to experience conflict or uncertainty when confronted with different cultural traditions and values. Persons with dementia are a vulnerable group, and the consequences of their illness challenge the ability to understand and express oneself verbally. The large number of minority healthcare providers in nursing homes underlines the importance to obtain better knowledge about this group’s experiences with the care challenges in dementia care units.
Can you tell about any challenges in the experiences in the encounter with persons suffering from dementia?
Five minority healthcare providers in a nursing home, in a dementia unit. All guidelines for research ethic were followed.
The participants were informed that participation was voluntary, and they were guarantied anonymity.
We used a qualitative method, conducting individual interviews, using a narrative approach. In the analysis, we applied a phenomenological–hermeneutical method, developed for researching life experiences.
One theme and four subthemes: striving to understand the quality of care for persons with dementia. The subthemes: sensitivity to understand the patients’ verbal and nonverbal expressions. To understand gratefulness, understand the patient as an adult and autonomous person, and understand the patient as a patient in a nursing home. Challenges comprise both ethical and cultural striving to understand persons with dementia.
To care for persons with dementia in an unfamiliar context may be understood as a striving for acting ethically, when at the same time striving to adapt and acculturate to new cultural norms, in order to practice good dementia care.
The concept of dignity is recognised as a fundamental right in many countries. It is embedded into law, human rights legislation and is often visible in organisations’ philosophy of care, particularly in aged care. Yet, many authors describe difficulties in defining dignity and how it can be preserved for people living in long term care.
In this article, Nordenfelt’s ‘four notions of dignity’ are considered, drawing on research literature addressing the different perspectives of those who receive, observe or deliver care in the context of the long-term care environment.
A review of the literature was undertaken using the terms ‘nursing homes’, ‘residential care’ or ‘long-term care’. The terms were combined and the term ‘human dignity’ was added. A total of 29 articles met the inclusion criteria from the United Kingdom (14), United States (2), Australia (1), Sweden (3), Hong Kong (2), Norway (3), Nordic (1), Taiwan (1), Netherlands (1).
Every effort has been made to ensure an unbiased search of the literature with the intention of an accurate interpretation of findings.
The four notions of dignity outlined by Nordenfelt provide a comprehensive description of the concept of dignity which can be linked to the experiences of people living in long-term care today and provide a useful means of contextualising the experiences of older people, their families and significant others and also of staff in long-term care facilities. Of particular interest are the similarities of perspectives of dignity between these groups. The preservation of dignity implies that dignity is a quality inherent in us all. This links directly to the exploration and conclusions drawn from the literature review. Conversely, promoting dignity implies that dignity is something that can be influenced by others and external factors. Hence, there are a number of implications for practice.
We suggest that two of Nordenfelt’s notions, ‘dignity of identity’ and ‘dignity of Menschenwüde’, are a common thread for residents, family members and staff when conceptualising dignity within long-term care environments.
Ethical studies in nursing are very important topics, and it is particularly crucial with vulnerable populations such as new graduated nurses. Neglecting ethical principles and violence toward graduates can lead to their occupational burnout, job dissatisfaction, and leaving the nursing profession.
This study was designed with the aim of understanding the experience of Iranian experienced nurses’ use of lateral and horizontal violence against new graduated nurses.
This qualitative study used a conventional content analysis approach; it was conducted with 18 experienced nurses. Data were collected through unstructured and semi-structured interviews of various general hospital departments in northwest of Iran and analyzed using methods as described by Graneheim and Lundman.
This study was approved by the Regional Committee of Medical Research Ethics. The ethical principles of voluntary participation, anonymity, and confidentiality were considered.
"Psychological violence," "Verbal violence," "Physical violence," and "Source of violence" were four categories extracted through data analysis.
Violence behaviors are instances of workplace maltreatment that damage individual nurses, quality of care, and the ethical climate of the healthcare settings. The lateral and hierarchical violence in nursing were explained by oppressed group model.
This study provided the context for identifying details of various types of workplace violence against new graduated nurses. It should be approached as a health system priority that requires specific multi-dimensional methods to manage consisting of identification, strategic planning, policymaking, prevention, education, and research.
In previous issues of this journal, Carol Gilligan’s original concept of mature care has been conceptualized by several (especially Norwegian) contributors. This has resulted in a dichotomous view of self and other, and of self-care and altruism, in which any form of self-sacrifice is rejected. Although this interpretation of Gilligan seems to be quite persistent in care-ethical theory, it does not seem to do justice to either Gilligan’s original work or the tensions experienced in contemporary nursing practice.
A close reading of Gilligan’s concept of mature care leads to a view that differs radically from any dichotomy of self-care and altruism. Instead of a dichotomous view, a dialectical view on self and other is proposed that builds upon connectedness and might support a care-ethical view of nursing that is more consistent with Gilligan’s own critical insights such as relationality and a practice-based ethics. A concrete case taken from nursing practice shows the interconnectedness of professional and personal responsibility. This underpins a multilayered, complex view of self-realization that encompasses sacrifices as well.
When mature care is characterized as a practice of a multilayered connectedness, caregivers can be acknowledged for their relational identity and nursing practices can be recognized as multilayered and interconnected. This view is better able to capture the tensions that are related to today’s nursing as a practice, which inevitably includes sacrifices of self. In conclusion, a further discussion on normative conceptualizations of care is proposed that starts with a non-normative scrutiny of caring practices.
Hospitals are experiencing an estimated 16.5% turnover rate of registered nurses costing from $44,380 - $63,400 per nurse—an estimated $4.21 to $6.02 million financial loss annually for hospitals in the United States of America. Attrition of all nurses is costly. Most past research has focused on the new graduate nurse with little focus on the mid-career nurse. Attrition of mid-career nurses is a loss for the profession now and into the future.
The purpose of the study was to explore relationships of professional values orientation, career development, job satisfaction, and intent to stay in recently hired mid-career and early-career nurses in a large hospital system.
A descriptive correlational study of personal and professional factors on job satisfaction and retention was conducted.
A convenience sample of nurses from a mid-sized hospital in a metropolitan area in the Southwestern United States was recruited via in-house email. Sixty-seven nurses met the eligibility criteria and completed survey documents.
Institutional Review Board approval was obtained from both the university and hospital system.
Findings indicated a strong correlation between professional values and career development and that both job satisfaction and career development correlated positively with retention.
Newly hired mid-career nurses scored higher on job satisfaction and planned to remain in their jobs. This is important because their expertise and leadership are necessary to sustain the profession into the future.
Nurse managers should be aware that when nurses perceive value conflicts, retention might be adversely affected. The practice environment stimulates nurses to consider whether to remain on the job or look for other opportunities.
The relationship between the nurse and the patient is understood as fundamental in nursing care. However, numerous challenges can be related to the provision of relationship-based nursing care. Challenges exist when nurses do not respond adequately to the patient’s appeal for help. Moreover, challenges arising in the nurse–patient relationship can be understood as more destructive demands from the patient to the nurse, thus begging inquiry into such a relationship.
The overall aim is to explore and argue the relevance of problematizing destructive demands evident within relationship-based nursing care.
This theoretical article explores destructive demands based on the phenomenological philosophy of the Danish theologian and philosopher Knud E. Løgstrup and provides examples of nurses’ experiences in everyday nursing care. The examples are drawn from a Norwegian empirical study based on a hermeneutical research design.
Data consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses with varying work experience within the primary and secondary somatic and psychiatric health service, from inside as well as outside institutions.
The original empirical study was approved by the Norwegian Social Science Data Services. Information was given and consent was obtained from the participants.
Two themes are described: strong impressions formed in meetings with patients and persistent concern over the burden of work and ability to endure.
Destructive demands related to relationship-based nursing care are discussed along two lines, first, by further elucidating nurses’ everyday experiences connected to destructive demands and, second, by highlighting the significance of including destructive demands within the relationship-based nursing care.
Including destructive demands related to relationship-based nursing care is of particular significance in enabling the proposition that radical, one-sided demands are based on relationality, reciprocity and thereby expectations of life. In short, both the nurse and the patient are human beings in need of love and goodness.
While nursing ethics education is commonly provided for undergraduate nursing students in most nursing colleges, consensus on the content and teaching modules for these ethics courses have still not been established.
This study aimed to examine the effects of nursing ethics education on the moral sensitivity and critical thinking disposition of nursing students in Korea.
A one-group pre- and post-test design was used. Moral sensitivity was measured using the Korean version of the Moral Sensitivity Questionnaire. Critical thinking disposition was measured using the Critical Thinking Disposition Questionnaire.
Participants were 70 undergraduate nursing students who were attending a university located in Seoul, Korea. The nursing ethics education was provided 7 times, from September to December 2010, and comprised 90-min sessions each week.
This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines.
After the education, the levels for the patient-oriented care, a sub-domain of moral sensitivity, and inquisitiveness, a sub-domain of critical thinking disposition, significantly improved. There were no changes in overall scores for moral sensitivity and critical thinking disposition. There were significant positive correlations between moral sensitivity and critical thinking disposition both pre- and post-intervention.
These results reflect the need for ongoing efforts to develop innovative content, structure, and instructional methods for undergraduate nursing ethics education programs.
With increased attention to patient privacy and autonomy, privacy protection and information provision for patients are becoming increasingly important.
The aim of this study was to identify and analyse nurses’ and patients’ perceptions of the importance and performance of protecting patients’ privacy and providing them with relevant information.
This study is a descriptive cross-sectional investigation. Participants and research context: Participants were 168 patients hospitalised in medical and surgical wards and 176 nurses who cared for them.
This study was approved by the Chung-Ang University Bioethics Committee, and informed written consent was collected from all participants.
Nurses’ recognition of the importance of protecting patients’ privacy and providing adequate information was higher compared to their actual performance, and the nurses’ level of performance was higher in comparison with the patients’ recognition of its importance.
Although a holistic approach to patient privacy protection and information provision is needed, the medical field has not embraced this model of care.
These findings provide empirical data to create an ethical environment for the future, as considerable attention has been devoted to patients’ rights and medical institutions’ liability for providing explanations to patients.
Care ethical theories provide an excellent opening for evaluation of healthcare practices since searching for (moments of) good care from a moral perspective is central to care ethics. However, a fruitful way to translate care ethical insights into measurable criteria and how to measure these criteria has as yet been unexplored: this study describes one of the first attempts.
To investigate whether the emotional touchpoint method is suitable for evaluating care from a care ethical perspective.
An adapted version of the emotional touchpoint interview method was used. Touchpoints represent the key moments to the experience of receiving care, where the patient recalls being touched emotionally or cognitively.
Interviews were conducted at three different care settings: a hospital, mental healthcare institution and care facility for older people. A total of 31 participants (29 patients and 2 relatives) took part in the study.
The research was found not to be subject to the (Dutch) Medical Research Involving Human Subjects Act.
A three-step care ethical evaluation model was developed and described using two touchpoints as examples. A focus group meeting showed that the method was considered of great value for partaking institutions in comparison with existing methods.
Considering existing methods to evaluate quality of care, the touchpoint method belongs to the category of instruments which evaluate the patient experience. The touchpoint method distinguishes itself because no pre-defined categories are used but the values of patients are followed, which is an essential issue from a care ethical perspective. The method portrays the insider perspective of patients and thereby contributes to humanizing care.
The touchpoint method is a valuable instrument for evaluating care; it generates evaluation data about the core care ethical principle of responsiveness.
The professional values presented in ethical guidelines of the Norwegian Nurses Organisation and International Council of Nurses describe nurses’ professional ethics and the obligations that pertain to good nursing practice. The foundation of all nursing shall be respect for life and the inherent dignity of the individual. Research proposes that nurses lack insight in ethical competence and that ethical issues are rarely discussed on the wards. Furthermore, research has for some time confirmed that nurses experience moral distress in their daily work and that this has become a major problem for the nursing profession.
The purpose of this article is to obtain a deeper understanding of the ethical challenges that nurses face in daily practice. The chosen research questions are "What ethical challenges do nurses experience in their daily practice?"
We conducted a qualitative interview study using a hermeneutical approach to analyzing data describing nurses’ experiences.
The Norwegian Social Science Data services approved the study. Furthermore, the head of the hospital gave permission to conduct the investigation. The requirement of anonymity and proper data storage in accordance with the World Medical Association Declaration of Helsinki was met.
The context for the study comprised three different clinical wards at a university hospital in Norway. Nine qualified nurses were interviewed. The results were obtained through a systematic development beginning with the discovery of busyness as a painful phenomenon that can lead to conflicts in terms of ethical values. Furthermore, the consequences compromising professional principles in nursing care emerged and ended in moral blindness and emotional immunization of the healthcare providers. Emotional immunization occurred as a new dimension involving moral blindness and immunity in relation to being emotionally touched.
Maintaining dignity is important for successful aging, but there is lack of validated research instruments in the nursing literature to investigate dignity as perceived by the old people.
This is a methodological study aiming to investigate the psychometric properties of the Greek version of Jacelon Attributed Dignity Scale as translated in the Greek language.
A methodological approach consisting of translation, adaptation, and cross-cultural validation. A sample of 188 Greek-speaking old Cypriot persons drawn from the Hospital outpatient departments was asked to complete the Greek versions of Jacelon Attributed Dignity Scale and the Instrumental Activities of Daily Living. Data analyses included internal consistency reliability (Cronbach’s alpha coefficient), item analysis, and exploratory factor analysis using principal component method with orthogonal varimax rotation.
The study protocol was approved by the National Bioethics committee according to the national legislation. Permission to use the research instrument was granted from the author. Information about the aim and the benefits of the study was included in the information letter.
Cronbach’s alpha for Greek version of Jacelon Attributed Dignity Scale was 0.90. Four factors emerged explaining 65.28% of the total variance, and item to total correlation values ranged from 0.25 to 0.74 indicating high internal consistency and homogeneity. Mean item score in Instrumental Activities of Daily Living was 5.6 (standard deviation = 1.7) for men and 6.7 (standard deviation = 1.7) for women, and the correlations between demographics, Instrumental Activities of Daily Living, and the four factors of the Greek version of Jacelon Attributed Dignity Scale were low; also in multiple linear regression, the values of R2 are presented low.
Demographic characteristics and degree of functionality seem to be associated with some of the dimensions of dignity but with low correlations; therefore, they cannot predict attributed dignity.
The Greek version of Jacelon Attributed Dignity Scale is a valid and reliable tool to measure attributed dignity in Greek-speaking older adults, but further testing of the psychometric properties and other potential factors that may affect the attributed dignity is needed.
Nursing students, during their study, experience significant changes on their journey to become nurses. A major change that they experience is the development of their moral competency.
The purpose of this study is to explore the process of moral development in Iranian nursing students.
A constructivist grounded theory method was adopted. Twenty-five in-depth, semi-structured, face-to-face intensive interviews with 22 participants were conducted from September 2013 to October 2014. All interviews were audio-taped, transcribed, and analyzed using writing memos and the constant comparative method.
The setting was three major nursing schools within Tehran, the capital of Iran. Nineteen nursing students and three lecturers participated in the study.
The study was approved by the Tehran University of Medical Sciences Committee for Medical Research Ethics (92/D/130/1781). It was explained to all participants that their responses would be treated with confidentiality and that they would not be identified in any way in the research and any publication ensuing from the research. All participants agreed to be interviewed and signed written consent forms agreeing to the recording and analyses of the interview data gathered.
Findings indicated three levels of moral development along with the formation of professional identity. The three levels of moral development, getting to know the identity of nursing (moral transition), accepting nursing identity (moral reconstruction), and professional identity internalization (professional morality), were connected to the levels of professional identity formation.
The proposed model added a new insight to professionalism in nursing.
From the findings, it was concluded that to enhance higher moral practice, nursing instructors should promote the professional identity of nursing students. Reinforcement of moral characteristics and professional identity within registered nurses occurs over a series of phases and, once fully integrated into the identity of nursing students, the moral characteristics that they acquire become part of their both professional and personal identities.
Nurses’ collegiality is topical because patient care is complicated, requiring shared knowledge and working methods. Nurses’ collaboration has been supported by a number of different working models, but there has been less focus on ethics.
This study aimed to develop nurses’ collegiality guidelines using the Delphi method.
Two online panels of Finnish experts, with 35 and 40 members, used the four-step Delphi method in December 2013 and January 2014. They reformulated the items of nurses’ collegiality identified by the literature and rated based on validity and importance. Content analysis and descriptive statistical methods were used to analyze the data, and the nurses’ collegiality guidelines were formulated.
Organizational approval was received, and an informed consent was obtained from all participants. Information about the voluntary nature of participation was provided.
During the first Delphi panel round, a number of items were reformulated and added, resulting in 32 reformulated items. As a result of the second round, 8 of the 32 items scored an agreement rate of more than 75%, with the most rated item being collegiality means that professionals respect each other. The item with second highest rating was collegiality has a common objective: what is best for patients, followed by the third highest which was professional ethics is the basis of collegiality.
Nurses’ collegiality and its content are well recognized in clinical practice but seldom studied. Collegiality can be supported by guidelines, and nurses working in clinical practice, together with teachers and managers, have shared responsibilities to support and develop it. More research in different nursing environments is needed to improve understanding of the content and practice of nursing collegiality.
Cone Beam Computed Tomography (CBCT), the focus of a number of radiotherapy fundraising campaigns in the mid-2000s, was introduced accompanied by a fanfare of newness and discourses of ‘hope’, ‘inspiring clinical confidence’ and ‘accuracy’. The CBCT system, used in the delivery of Radiotherapy treatment, was incorporated into strategic planning priorities across the United Kingdom based on a rationale of self-evidence. During this time, the way in which the new system was discussed with patients was variable.
The purpose of this study was to uncover how experimental practices were embedded and enacted during the use of a new technological system, specifically relating to how patients were enrolled during introductory phases of technology adoption.
Drawing on ethnographic work and interviews with staff members in one hospital, the study examines staff discussions prior to the introduction of the Cone-Beam CT imaging system in radiotherapy. It considers how staff views were at odds with practices that occurred during the ‘experimental’ stages of use and how these were shared with patients.
Approval was obtained from the Local National Health Service Research Ethics Committee and National Health Service Main Research Ethics Committee (REC 07/Q1308/16) for the interview and ethnographic stages, respectively. All names have been changed and participants signed a consent form.
Staff reported a lack of evidence, absence of proof and perturbing doubts with the X-ray volumetric imaging. Both patients’ and practitioners’ partial understanding about the risks and benefits of the system created incommensurable ideas regarding its use and what the patients’ role was during these introductory stages.
Maintaining partial truth telling renders patients’ experiences of new treatment at odds with ‘experimental’ practice. This has wide-reaching implications for practice.
"At-own-risk discharges" or "self-discharges" evidences an irretrievable breakdown in the patient–clinician relationship when patients leave care facilities before completion of medical treatment and against medical advice. Dissolution of the therapeutic relationship terminates the physician’s duty of care and professional liability with respect to care of the patient. Acquiescence of an at-own-risk discharge by the clinician is seen as respecting patient autonomy. The validity of such requests pivot on the assumptions that the patient is fully informed and competent to invoke an at-own-risk discharge and that care up to the point of the at-own-risk discharge meets prevailing clinical standards. Palliative care’s use of a multidisciplinary team approach challenges both these assumptions. First by establishing multiple independent therapeutic relations between professionals in the multidisciplinary team and the patient who persists despite an at-own-risk discharge. These enduring therapeutic relationships negate the suggestion that no duty of care is owed the patient. Second, the continued employ of collusion, familial determinations, and the circumnavigation of direct patient involvement in family-centric societies compromises the patient’s decision-making capacity and raises questions as to the patient’s decision-making capacity and their ability to assume responsibility for the repercussions of invoking an at-own-risk discharge. With the validity of at-own-risk discharge request in question and the welfare and patient interest at stake, an alternative approach to assessing at-own-risk discharge requests are called for. The welfare model circumnavigates these concerns and preserves the patient’s welfare through the employ of a multidisciplinary team guided holistic appraisal of the patient’s specific situation that is informed by clinical and institutional standards and evidenced-based practice. The welfare model provides a robust decision-making framework for assessing the validity of at-own-risk discharge requests on a case-by-case basis.
Uncivil behavior is a serious issue in nursing education around the world, and is frequently faced by instructors and students. There is no study in relation to explain the concept and dimensions of uncivil behavior in nursing education of Iran.
The aim of this study was to determine the perception of nursing educators about student incivility behavior.
This was a qualitative study. Data from 11 semi-structured interviews were analyzed using conventional content analysis.
In all, 11 nursing educators of 5 various nursing schools in Tehran, capital of Iran, participated.
Organizational approval by the Universities, and informed consent were ensured before conducting the research. The principles of voluntariness, confidentiality, and anonymity were respected during the research process.
Three themes were found: disruptive behavior affecting communication climate, disruptive behavior affecting ethical climate, and disruptive behavior affecting learning climate.
The results of this study demonstrated that uncivil behavior affects every ethical, communicational, and learning climate and threaten peace of the instructors, students, and the academic community. With the consideration of mutuality in incivility behaviors, the authors propose to examine students’ perceptions and identify dimensions of uncivil behavior of instructors for formulating strategies to minimize such behaviors in nursing educational society.
Much attention has been paid to the role of the nurse in recognizing and addressing ethical dilemmas. There has been less emphasis, however, on the issue of whether or not nurses understand the ethical nature of everyday practice. Awareness of the inherently ethical nature of practice is a component of nurse ethical sensitivity, which has been identified as a component of ethical decision-making. Ethical sensitivity is generally accepted as a necessary precursor to moral agency, in that recognition of the ethical content of practice is necessary before consistent action on behalf of patient interests can take place. This awareness is also compulsory in ensuring patient good by recognizing the unique interests and wishes of individuals, in line with an ethic of care. Scholarly and research literature are used to argue that bolstering ethical awareness and ensuring that nurses understand the ethical nature of the role are an obligation of the profession. Based on this line of reasoning, recommendations for education and practice, along with directions for future research, are suggested.
The relationship between healthcare professionals and patients in the Spanish health sector has undergone dramatic change. One aspect of this is that the use of informed consent has become a key factor in the delivery of adequate healthcare. But although a certain period of time has already passed since informed consent started to be used, in Spain there is still doubt about how adequately informed consent is being used.
(a) To look at how patients understand the notion and purpose of informed consent, and (b) how the informed consent is applied – the way patients receive such information affects their level of participation and decision making during the time they receive medical care.
We use interpretative description of interviews with patients. We developed guiding questions for the interviews with patients in two preliminary and exploratory focus groups. Then, we carried out 20 personal open-ended interviews with 20 purposive selected patients with illnesses that had a serious impact on their lives.
Permission from ethical committees and institutions involved in the study, and consent and confidentiality were ensured before conducting the research.
The findings show that while patients agreed that their consent should be necessary for health professionals to be able to intervene, they had serious difficulty obtaining and then understanding information offered to them at the moment when they were being asked to sign informed consent documents. The participants were critical of the consent documents, which they considered were treated as merely a formality and even some of them had felt coerced to sign.
Participants confirmed that the informed consent documents that they signed did not meet their ethical objectives. Their perception of the purpose of consent indicates that informed consent document may still be largely understood as a formality rather an ethical obligation.
It is of importance to understand and communicate caring ethics as a ground for qualitative caring environments. Research is needed on nursing attributes that are visible in nursing leadership since it may give bases for reflections related to the patterns of specific contexts.
The aim of this study was to illuminate the meaning of crucial attributes in nursing leadership toward an ethical care of patients in psychiatric in-patient settings.
The design of the study was descriptive and qualitative with a phenomenological hermeneutical approach.
The study comprised focus group interviews with nurses working in indoor psychiatric care who participated after giving informed consent.
Since the topic and informants are not labeled as sensitive and subject to ethical approval, it is not covered by the ethics committee’s aim and purpose according to Swedish law. However, careful procedures have been followed according to ethics expressed in the Declaration of Helsinki.
When identifying the thematic structures, analysis resulted in three major themes: To supply, including the following aspects: to supply evidence, to supply common space, and to supply good structures; To support, including the following aspects: to be a role model, to show appreciation and care, and to harbor; To shield, including the following aspects: to advocate, to emit non-tolerance of unethical behavior, and to reprove.
Leadership is challenging for nurses and plays an important role in ethical qualitative care. These findings should not be understood as a description about nurse manager’s role, which probably has different attributes and more focus on an organizational level.
Making the understanding about crucial attributes explicit, the nurse may receive confirmation and recognition of crucial attributes for ethical care in order to move toward an ethical care.
The authors examine the nursing practice of disposing unaltered controlled substances into public water systems as an issue for nurses concerned with the environmental harm it can cause. A summary of the history of controlled substance management reveals inconsistencies in the interpretation of current regulations that have led to disposal policies that vary by institution, according to a benchmarking survey of regional hospitals. Much attention has been given to the phenomenon of conscientious objection in the context of patient care that conflicts with a nurse’s moral integrity. Nurses who are compelled to dispose narcotics down drains may also face this struggle. The authors submit that this disposal method is based on a type of double effect logic where preventing diversion is viewed as a good effect of flushing unused controlled substances that outweighs any harm it may cause, though there is little evidence to support this conclusion. Consequently, the topic deserves further study so that nurse managers and administrators can support and offer alternatives to nurses who object to flushing drugs down the drain.
The Nursing and Midwifery Council, the United Kingdom regulator of nursing and midwifery has recently revised its professional code of practice. This article begins by arguing that a professional code must be capable of sustaining close reading and of action guidance. Using four exemplar clauses, it is argued that the new revised code does not meet this purpose. First, I show that in setting out requirements for consent and documentation, the meaning of the relevant clause has changed significantly during the editing process so that a literal reading of the final document bears little relation to established professional practice. Second, I argue that the clause concerning the nature of professional relationships has also been altered during the editing process so that it is inconsistent with other professional groups and established accounts of the professional nurse–patient relationship. Third, I argue that the clause concerning disclosure of confidential information, which survived revision and editing with its meaning intact, is nevertheless factually incorrect and inconsistent with UK law and authoritative guidance. Finally, fourth, I argue that use of the word ‘inappropriate’ is inappropriate as it amounts to meaningless circularity, discussed in relation to a clause on expressing personal beliefs. Taken together, these examples demonstrate that the Code is seriously flawed and does not fulfil its purpose. One way that simple prescriptive clauses in the Code can be usefully understood is through the provision of detailed guidance. I argue that the Nursing and Midwifery Council has changed its position on its view of the value of guidance and has significantly reduced the amount of written guidance and advice it provides. The article concludes by arguing that in order to meet its action directing function, further clarifying revision and the provision of detailed guidance is required.
Professional values improve the quality of nurses’ professional lives, reduce emotional exhaustion and depersonalization, increase personal success, and help to make collaborations with the members of the healthcare team more frequent.
The purpose of this study was to describe the professional values of Turkish nurses and to explore the relationships between nurses’ characteristics.
This was a descriptive study of a convenience sample consisting of 269 clinical nurses. A questionnaire was used to identify socio-demographic characteristics, and the Nurses’ Professional Values Scale was applied.
Permission to conduct the study was received from the hospital and the Institutional Review Boards of the Süleyman Demirel University ethic committee.
The mean scale score of the participant nurses was 165.41 ± 20.79. The results of this study revealed that human dignity was the most important professional value for nurses, and the importance attached to these values showed statistically significant differences by age, length of service, educational level, marital status, position at work, and receiving relevant in-service training.
Nurses’ Professional Values Scale scores showed that nurses give above average and attached importance to professional values.
Dignity has been highlighted in previous research as one of the most important ethical concerns in nursing care. According to Eriksson, dignified caring is related to treating the patient as a unique human being and respecting human value. Intensive care unit patients are vulnerable to threatened dignity, and maintaining dignity may be challenging as a consequence of critical illness.
The aim is to highlight how nurses in an intensive care setting understand patient dignity, what threatens patient dignity and how nurses can safeguard patient dignity.
Data materials were collected through a survey questionnaire which contained open questions about patient dignity, and the text was analysed using hermeneutic reading and text interpretation. Totally, 25 nurses employed in an intensive care unit in Finland participated in the study.
The study follows the guidelines for good scientific practice by the Finnish Advisory Board on Research Integrity and the ethical principles according to the Declaration of Helsinki.
Findings revealed that nurses recognize the patients’ absolute dignity by regarding them as unique human beings. The nurses also recognize the importance of shared humanity in preserving patient dignity. Intensive care patients’ dignity is threatened by negative attitudes and when their integrity is not being protected. Dignity is also threatened when patients and nurses are not part of the patients’ care and patient care decisions, when patients receive care against their will and because of the acute nature of intensive care.
Moral sensitivity is the foremost prerequisite to ethical performance; a review of literature shows that nurses are sometimes not sensitive enough for a variety of reasons. Moral distress is a frequent phenomenon in nursing, which may result in paradoxes in care, dealing with patients and rendering high-quality care. This may, in turn, hinder the meeting of care objectives, thus affecting social healthcare standards.
The present research was conducted to determine the relationship between moral sensitivity and moral distress of nurses in intensive care units.
This study is a descriptive-correlation research. Lutzen’s moral sensitivity questionnaire and Corley Moral Distress Questionnaire were used to gather data.
A total of 153 qualified nurses working in the hospitals affiliated to Shahid Beheshti University of Medical Sciences were selected for this study. Subjects were selected by census method.
After explaining the objectives of the study, all the participants completed and signed the written consent form. To conduct the study, permission was obtained from the selected hospitals.
Nurses’ average moral sensitivity grade was 68.6 ± 7.8, which shows a moderate level of moral sensitivity. On the other hand, nurses also experienced a moderate level of moral distress (44.8 ± 16.6). Moreover, there was no meaningful statistical relationship between moral sensitivity and moral distress (p = 0.26).
Although the nurses’ moral sensitivity and moral distress were expected to be high in the intensive care units, it was moderate. This finding is consistent with the results of some studies and contradicts with others.
As moral sensitivity is a crucial factor in care, it is suggested that necessary training be provided to develop moral sensitivity in nurses in education and practical environments. Furthermore, removing factors that contribute to moral distress may help decrease it in nurses.
Nurses, social workers, and medical residents are ethically mandated to engage in policy advocacy to promote the health and well-being of patients and increase access to care. Yet, no instrument exists to measure their level of engagement in policy advocacy.
To describe the development and validation of the Policy Advocacy Engagement Scale, designed to measure frontline healthcare professionals’ engagement in policy advocacy with respect to a broad range of issues, including patients’ ethical rights, quality of care, culturally competent care, preventive care, affordability/accessibility of care, mental healthcare, and community-based care.
Cross-sectional data were gathered to estimate the content and construct validity, internal consistency, and test–retest reliability of the Policy Advocacy Engagement Scale.
In all, 97 nurses, 94 social workers, and 104 medical residents (N = 295) were recruited from eight acute-care hospitals in Los Angeles County.
Informed consent was obtained via Qualtrics and covered purposes, risks and benefits; voluntary participation; confidentiality; and compensation. Institutional Review Board approval was obtained from the University of Southern California and all hospitals.
Results supported the validity of the concept and the instrument. In confirmatory factor analysis, seven items loaded onto one component with indices indicating adequate model fit. A Pearson correlation coefficient of .36 supported the scale’s test–retest stability. Cronbach’s α of .93 indicated strong internal consistency.
The Policy Advocacy Engagement Scale demonstrated satisfactory psychometric properties in this initial test. Findings should be considered within the context of the study’s limitations, which include a low response rate and limited geographic scope.
The Policy Advocacy Engagement Scale appears to be the first validated scale to measure frontline healthcare professionals’ engagement in policy advocacy. With it, researchers can analyze variations in professionals’ levels of policy advocacy engagement, understand what factors are associated with it, and remedy barriers that might exist to their provision of it.
Respecting dignity is having a profound effect on the clinical relationship and the care framework for terminally ill patients in palliative care units, hospices and their own homes, with particular consequences for the emergency department. However, dignity is a vague and multifaceted concept that is difficult to measure.
The aim of this study is to define the attributes of dignity in end-of-life care in the emergency department, based on the opinions of physicians and nurses.
A hermeneutic phenomenological approach utilising Gadamer's philosophical underpinnings guided the study.
This research was conducted in Spain in 2013–2014. Participants included 10 physicians and 16 nurses with experience working in the emergency department. Two focus groups and 12 in-depth interviews were carried out.
The study was approved by the Research Centre Ethical Committee (Andalusian Health Service, Spain).
The results point to the person's inherent value, socio-environmental conditions and conscious actions/attitudes as attributes of dignity when caring for a dying patient in the emergency department.
Dying with dignity is a basic objective in end-of-life care and is an ambiguous but relevant concept for physicians and nurses. In line with our theoretical framework, our results highlight care environment, professional actions and socio-family context as attributes of dignity.
Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses.
Conscience is an important concept in ethics, having various meanings in different cultures. Because a growing number of healthcare professionals are of immigrant background, particularly within the care of older people, demanding multiple ethical positions, it is important to explore the meaning of conscience among care providers within different cultural contexts.
The study aimed to illuminate the meaning of conscience by enrolled nurses with an Iranian background working in residential care for Persian-speaking people with dementia.
A phenomenological hermeneutical method guided the study.
A total of 10 enrolled nurses with Iranian background, aged 33–46 years, participated in the study. All worked full time in residential care settings for Persian-speaking people with dementia in a large city, in Sweden.
The study was approved by the Regional Ethical Review Board for ethical vetting of research involving humans. Participants were given verbal and written study information and assured that their participation was voluntary and confidential.
Three themes were constructed including perception of conscience, clear conscience grounded in relations and striving to keep a clear conscience. The conscience was perceived as an inner guide grounded in feelings, which is dynamic and subject to changes throughout life. Having a clear conscience meant being able to form a bond with others, to respect them and to get their confirmation that one does well. To have a clear conscience demanded listening to the voice of the conscience. The enrolled nurses strived to keep their conscience clear by being generous in helping others, accomplishing daily tasks well and behaving nicely in the hope of being treated the same way one day.
Cultural frameworks and the context of practice needed to be considered in interpreting the meaning of conscience and clear conscience.
Indonesia is recognized as a nurse exporting country, with policies that encourage nursing professionals to emigrate abroad. This includes the country’s adoption of international principles attempting to protect Indonesian nurses that emigrate as well as the country’s own participation in a bilateral trade and investment agreement, known as the Indonesia–Japan Economic Partnership Agreement that facilitates Indonesian nurse migration to Japan. Despite the potential trade and employment benefits from sending nurses abroad under the Indonesia–Japan Economic Partnership Agreement, Indonesia itself is suffering from a crisis in nursing capacity and ensuring adequate healthcare access for its own populations. This represents a distinct challenge for Indonesia in appropriately balancing domestic health workforce needs, employment, and training opportunities for Indonesian nurses, and the need to acknowledge the rights of nurses to freely migrate abroad. Hence, this article reviews the complex operational and ethical issues associated with Indonesian health worker migration under the Indonesia–Japan Economic Partnership Agreement. It also introduces a policy proposal to improve performance of the Indonesia–Japan Economic Partnership Agreement and better align it with international principles focused on equitable health worker migration.
On a day to day basis, nurses are facing more ethical dilemmas during end-of-life care resulting in not being able to actualize a good death for patients.
The purpose of this study was to explore how experienced hospice nurses resolve day to day ethical dilemmas during end-of-life care.
The study used a qualitative narrative approach.
Through purposeful sampling, a total of six experienced hospice nurse participated.
Approval from the researcher’s university Institutional Review Board for ethical review was obtained.
Using core story creation, several different ethical dilemmas were identified divulging struggles with key stakeholders including family members and providers. Thematic analysis generated three main themes: Ethics within Practice, Ethical Knowledge, and Ethical Solutions.
The participants told their stories depicting a keen awareness of ethical conflicts situated by contextual factors including social, political, and personal issues. The nurses’ deliberations were informed through formal, experiential, and intuitive knowledge. Ethical predicaments were resolved by either following rules or choosing acts of resistance.
A better understanding was obtained on how experienced hospice nurses successfully resolve ethical dilemmas culminating in better deaths for patients.
With the number of young people with medical complexity increasing, an increasing number must navigate the transition to adulthood. This transition, in part, involves a situational transition in which young people and their families must access new services in the adult system.
To explore how societal ideologies, communities, and organizations represent the foundation of barriers to access to services.
The discussion in this paper, framed within a social justice perspective, outlines barriers to access to services at the societal and community levels including societal ideologies, differences in philosophies of care in pediatric and adult care, physical environments, and availability of services.
Since this is an exploratory discussion paper, no ethical approval was required.
Based on analysis of the literature from a social justice perspective, it is suggested that the adult health care and social service systems do not provide the supports and services necessary to empower young people and their families to achieve their goals and maintain their health and quality of life. It is, thus, an ethical issue that the transfer from pediatric to adult services is occurring in the absence of appropriate services. Recommendations at the individual, community and policy levels highlight how nurses can address this ethical issue to promote more equitable access to services.
Mobbing and burnout can cause serious consequences, especially for health workers and managers. Level of burnout and exposure to mobbing may trigger each other. There is a need to conduct additional and specific studies on the topic to develop some strategies.
The purpose of this study is to determine the relationship between level of burnout and exposure to mobbing of the managers (head physician, assistant head physician, head nurse, assistant head nurse, administrator, assistant administrator) at the Ministry of Health hospitals.
The "Leymann Inventory of Psychological Terrorization" scale was used to measure the level of exposure to mobbing and the "Maslach Burnout Inventory" scale was used to measure the level of burnout of hospital managers. The relationship between level of burnout and exposure to mobbing was analyzed by Pearson’s Correlation Analysis.
The population of this study included managers (454 managers) at the Ministry of Health hospitals in the metropolitan area of Ankara between September 2010 and May 2011. All the managers were tried to conduct, but some managers did not want to reply to the questionnaire and some managers were not found at their workplace. Consequently, using a convenience sampling, 54% of the managers replied to the questionnaire (244 managers).
The approval of the study was granted by the Ministry of Health in Turkey. Furthermore, the study was evaluated and accepted by the Education, Planning and Coordination Council of one of the education and research hospitals in the study.
Positive relationships were found among each subdimension of the mobbing and emotional exhaustion and depersonalization. A negative relationship was found between each subdimension of the mobbing and personal accomplishment.
In hospitals, by detecting mobbing actions, burnout may be prevented.
Exposure to mobbing and burnout could be a serious problem for head nurses who are responsible for both the performance of the nurses and organization. Additionally, head nurses who are faced with mobbing and burnout are more likely to provide suboptimal services which could potentially result in negative outcomes. Therefore, this study draws attention to the importance of preventing these attitudes in the organization.
The role of nurses as patient advocates is one which is well recognised, supported and the subject of a broad body of literature. One of the key impediments to the role of the nurse as patient advocate is the lack of support and legislative frameworks. Within a broad range of activities constituting advocacy, whistleblowing is currently the subject of much discussion in the light of the Mid Staffordshire inquiry in the United Kingdom (UK) and other instances of patient mistreatment. As a result steps to amend existing whistleblowing legislation where it exists or introduce it where it does not are underway.
This paper traces the development of legislation for advocacy.
The authors argue that while any legislation supporting advocacy is welcome, legislation on its own will not encourage or enable nurses to whistleblow.
Ethics consultation is the traditional way of resolving challenging ethical questions raised about patient care in the United States. Little research has been published on the resolution process used during ethics consultations and on how this experience affects healthcare professionals who participate in them.
The purpose of this qualitative research was to uncover the basic process that occurs in consultation services through study of the perceptions of healthcare professionals.
The researchers in this study used a constructivist grounded theory approach that represents how one group of professionals experienced ethics consultations in their hospital in the United States.
The results were sufficient to develop an initial theory that has been named after the core concept: Moving It Along. Three process stages emerged from data interpretation: moral questioning, seeing the big picture, and coming together. It is hoped that this initial work stimulates additional research in describing and understanding the complex social process that occurs for healthcare professionals as they address the difficult moral issues that arise in clinical practice.
The holistic approach views the human as a bio-psycho-socio-spiritual being. Evidence suggests that among these dimensions, the spiritual one is largely ignored in healthcare settings.
This study aimed to evaluate Iranian nurses’ perceived professional competence in spiritual care, the relationship between perceived competence and nurses’ personal characteristics, and barriers to provide spiritual care.
A cross-sectional study was conducted in the year 2014.
The study population consisted of nurses working in teaching hospitals in Kashan city. Using a stratified, systematic random method, 250 samples were selected from a total of 1400 nurses. An indigenous instrument was used to assess the nurses’ competencies in spiritual care.
A research ethics committee approved the study. All the participants were briefed on the study aims, were assured of the confidentiality of their personal information, and signed a written informed consent.
Among a total of 250 nurses, 239 answered the questionnaire completely, and in total, 23%, 51%, and 26% had poor, moderate, and favorable competence in spiritual care, respectively. No significant differences were found between the mean competence scores of spiritual care in terms of gender, marital status, employment status, and level of qualification. Significant difference was found between nurses’ overall score of competence in spiritual care and receiving training on spiritual care, nurses’ position, and the ward they worked in.
Confirming the findings of the international literature, this study puts light on the situation of nurses’ perceived competence and barriers to providing spiritual care in Iran as an eastern and Islamic context.
Three-quarters of the nurses had moderate or unfavorable competence in spiritual care. Due to the crucial role of spiritual care in quality of care and patient satisfaction, nurses should be trained and supported to provide spiritual care.
Palliative carers constantly face ethical problems. There is lack of organised support for the carers to handle these ethical problems in a consistent way. Within organisational ethics, we find models for moral deliberation and for developing organisational culture; however, they are not combined in a structured way to support carers’ everyday work.
The aim of this study was to describe ethical problems faced by palliative carers and develop an adapted organisational set of values to support the handling of these problems.
Ethical problems were mapped out using focus groups and content analysis. The organisational culture were developed using normative analysis and focus group methodology within a participatory action research approach.
A total of 15 registered nurses and 10 assistant nurses at a palliative unit (with 19 patient beds) at a major University Hospital in Sweden.
The study followed standard ethics guidelines concerning informed consent and confidentiality.
We found six categories of ethical problems (with the main focus on problems relating to the patient’s loved ones) and five categories of organisational obstacles. Based on these findings, we developed a set of values in three levels: a general level, an explanatory level and a level of action strategies.
The ethical problems found corresponded to problems in other studies with a notable exception, the large focus on patient loved ones. The three-level set of values is a way to handle risks of formulating abstract values not providing guidance in concrete care voiced in other studies.
Developing a three-level set of values adapted to the specific ethical problems in a concrete care setting is a first step towards a better handling of ethical problems.
Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation.
To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care.
The study had a qualitative approach.
Data were collected by Flanagan’s critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis.
The study followed the ethical principles in accordance with the Declaration of Helsinki.
The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient’s world and make professional decisions. The ambulance nurse respects the patient’s will and protects the patient’s body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient.
It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human.
Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students’ ethical obligation results in the courage to see when a patient’s dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.
Healthcare organizations are now challenged to retain nurses’ generation and understand why they are leaving their nursing career prematurely. Acquiring knowledge about the effect of ethical work climate and level of perceived organizational support can help organizational leaders to deal effectively with dysfunctional behaviors and make a difference in enhancing nurses’ dedication, commitment, satisfaction, and loyalty to their organization.
This study aims to determine the relationship between ethical work climate, and perceived organizational support and nurses’ organizational commitment, job satisfaction, and turnover intention.
A descriptive correlational research design was conducted in all inpatient care units at three major hospitals affiliated to different health sectors at Alexandria governorate. All nurses working in these previous hospitals were included in the study (N = 500). Ethical Climate Questionnaire, Survey of Perceived Organizational Support, Organizational Commitment Questionnaire, Index of Job Satisfaction, and Intention to Turnover scale were used to measure study variables.
Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University. Privacy and confidentiality of data were maintained and assured by obtaining subjects’ informed consent to participate in the research before data collection.
The result revealed positive significant correlations between nurses’ perception of overall ethical work climate and each of perceived organizational support, commitment, as well as their job satisfaction. However, negative significant correlations were found between nurses’ turnover intention and each of these variables. Also, approximately 33% of the explained variance of turnover intention is accounted by ethical work climate, organizational support, organizational commitment, and job satisfaction, and these variables independently contributed significantly in the prediction of turnover intention.
Strategies to foster and enhance ethical and supportive work climates as well as job-related benefits are considered significant factors in increasing nurses’ commitment and satisfaction and decreasing their turnover intention.
The opinions of students regarding the attributes of a good nurse can make a major contribution to the planning and the conducting of professional education. There are few studies which aim at identifying the qualifications of a good nurse from the perspectives of nursing students.
To determine the opinions of first- and fourth-year nursing students concerning the ‘attributes of a good nurse’, and whether and how their views change depending on their year of study.
Descriptive research.
This study was conducted in the nursing department of a vocational school of health in the 2010/2011 academic year. The study participants consisted of first-year and intern students. A survey form was used to identify characteristics of participants, and students were asked the following open-ended question about their opinions related to the attributes of a good nurse.
The permission was taken from the school administration. Informed consent was obtained, and anonymity was ensured for participating students.
A total of 120 students participated in this study. Most frequently expressed attributes were ‘professional competence’ in first-year and ‘responsibility’ in fourth-year students. While first-year students placed a greater emphasis on the attributes of ‘geniality’, ‘patience’, ‘calmness’, ‘love of nursing’, ‘loyalty to nursing’ and ‘not attaching importance to material values’, fourth-year students emphasized the attributes of ‘empathy’, ‘honesty’, ‘responsibility’ and ‘scientific curiosity’ significantly more.
Fourth-year students placed a greater emphasis on the attributes which the students are expected to acquire through a nursing program and clinical experience. However, they mentioned the attributes related to a good nurse–patient relationship and communication significantly less. Appropriate ethical training methods and good role models can help students acquire attributes that are important for the nursing profession and combine them with the attributes they already have.
The advances in science and technology increasingly lead to the appearance of ethical issues and to the complexity of care. Therefore, it is important to define the ethics position of students studying in health departments so that high quality patient care can be achieved.
The aim of this study was to examine the ethics position of the students at Shool of Health of an University in western Turkey.
The study design was descriptive and cross-sectional. The study population included 540 first, second, third, and fourth year students from the Departments of Nursing, Midwifery, and Rescue and Disaster Management in the 2013–2014 academic year. Data were collected with a Personal Identification Form and The Ethics Position Questionnaire. Obtained data were analyzed with Chi-square test, Confirmatory Factor Analysis, and Nested Analysis of Variance.
Before conducting the research, approval was obtained from Ege University Clinical Research Ethics Committee in Izmir and written informed consent was taken from all the participants.
There was no significant difference in the mean scores for the Ethics Position Questionnaire between the students in terms of years and fields of study. Although the mean scores for the subscale idealism did not differ between fields of study, the mean scores significantly differed between years of study. However, the mean scores for the subscale relativism did not differ in terms of years and fields of study.
Whether students are idealistic or relativistic in terms of ethical judgment will be effective in ethical decision-making skills during patient care. Therefore, we need to define the factors that influence students’ ethics position in the future.
It is suggested that the courses and practices that teach students to be aware of their ethics position to create an ethical outlook can be placed in the curriculum in health schools.
The tension between care-based and technology-based rationalities motivates studies concerning how technology can be used in the care sector to support the relational foundation of care.
This study interprets values related to care and technologies connected to the practice of good care.
This research study was part of a development project aimed at developing innovative work practices through information and communication technology.
All staff (n = 18) working at two wards in a care facility for older people were asked to participate in interviews, and 12 accepted. We analysed the data using latent content analysis in combination with normative analysis.
The caregivers were informed that participation was voluntary and that they could drop out at any time without providing any explanation.
Four values were identified: ‘presence’, ‘appreciation’, ‘competence’ and ‘trust’. Caregivers wanted to focus on care receivers as unique persons, a view that they thought was compromised by time-consuming and beeping electronic devices. Appraising from next-of-kin and been seen as someone who can contribute together with knowledge to handle different situations were other desires. The caregivers also desired positive feedback from next-of-kin, as they wanted to be seen as professionals who have the knowledge and skills to handle difficult situations. In addition, the caregivers wanted their employer to trust them, and they wanted to work in a calm environment.
Caregivers’ desire for disturbance-free interactions, being valued for their skills and working in a trustful working environment were interpreted as their base for providing good care. The caregivers’ arguments are based on caring rationality, and sometimes they felt the technological rationality interfered with their main mission, providing quality care.
Introducing new technology in caring should support the caring relationship. Although society’s overall technology-based approach may have gained popularity as a problem solver, technology-based rationality may compromise a care-based rationality. A shift in attitudes towards care as a concept on all societal levels is needed.
Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess moral distress suffered by nurses nor a study conducted on the issue.
The study aims to (a) validate the Turkish version of the Moral Distress Scale–Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses’ moral distress level.
The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale–Revised.
The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality.
In parallel with the original scale, Turkish version of Moral Distress Scale–Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively.
Turkish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care.
Conducting video-research in birth settings raises challenges for ethics review boards to view birthing women and research-midwives as capable, autonomous decision-makers.
This study aimed to gain an understanding of how the ethical approval process was experienced and to chronicle the perceived risks and benefits.
The Birth Unit Design project was a 2012 Australian ethnographic study that used video recording to investigate the physical design features in the hospital birthing space that might influence both verbal and non-verbal communication and the experiences of childbearing women, midwives and supporters.
Six women, 11 midwives and 11 childbirth supporters were filmed during the women’s labours in hospital birth units and interviewed 6 weeks later.
The study was approved by an Australian Health Research Ethics Committee after a protracted process of negotiation.
The ethics committee was influenced by a traditional view of research as based on scientific experiments resulting in a poor understanding of video-ethnographic research, a paradigmatic view of the politics and practicalities of modern childbirth processes, a desire to protect institutions from litigation, and what we perceived as a paternalistic approach towards protecting participants, one that was at odds with our aim to facilitate situations in which women could make flexible, autonomous decisions about how they might engage with the research process.
The perceived need for protection was overly burdensome and against the wishes of the participants themselves; ultimately, this limited the capacity of the study to improve care for women and babies.
Recommendations are offered for those involved in ethical approval processes for qualitative research in childbirth settings. The complexity of issues within childbirth settings, as in most modern healthcare settings, should be analysed using a variety of research approaches, beyond efficacy-style randomised controlled trials, to expand and improve practice-based results.
Increasing attention to patients’ rights and their ability to choose their healthcare provider have changed the way patients can respond to untoward, disempowering and abusive healthcare encounters. These responses are often seen as crucial for quality improvement, yet they are little explored and conceptualized.
To explore patients’ potential responses to untoward healthcare encounters and looking at their possible consequences for care quality improvement as well as for the individual patient.
The article is structured looking at two primary strategies: patient exit (leaving a healthcare provider) and patient voice (expressing grievances), derived from Hirschman (1970). These strategies were explored by the use of theoretical and empirical literature and applied to an individual patient case. The case functions as a pedagogical tool to illustrate and problematize what exit and voice strategies can mean for a single patient.
The patient case is my version of a generalized scenario that is described elsewhere. It does not represent an individual patient’s story, but aims to be realistic and recognizable.
Based on the existing literature, it is hypothesized that, in their current form, exit and voice strategies have a limited effect on care quality and can come at a price for patients. However, both strategies may be of value to patients and providers. Therefore, the healthcare system could empower patients to engage in action and could further develop ways for providers to effectively use patients’ responses to improve practice and find ways to prevent patients from untoward experiences in healthcare.
This study is the result of findings from a previous dissertation conducted by this author on Student Nurses’ Unethical Behavior, Boundaries, and Social Media. The use of social media can be detrimental to the nurse–patient relationship if used in an unethical manner.
A mixed method, using a quantitative approach based on research questions that explored differences in student nurses’ unethical behavior by age (millennial vs nonmillennial) and clinical cohort, the relationship of unethical behavior to the utilization of social media, and analysis on year of birth and unethical behavior. A qualitative approach was used based on a guided faculty interview and common themes of student nurses’ unethical behavior.
In total, 55 Associate Degree nursing students participated in the study; the research was conducted at Central Texas College. There were eight faculty-guided interviews.
The main research instrument was an anonymous survey. All participants were assured of their right to an informed consent. All participants were informed of the right to withdraw from the study at any time.
Findings indicate a significant correlation between student nurses’ unethical behavior and use of social media (p = 0.036) and a significant difference between student unethical conduct by generation (millennials vs nonmillennials (p = 0.033)) and by clinical cohort (p = 0.045). Further findings from the follow-up study on year of birth and student unethical behavior reveal a correlation coefficient of 0.384 with a significance level of 0.003.
Surprisingly, the study found that second-semester students had less unethical behavior than first-, third-, and fourth-semester students. The follow-up study found that this is because second-semester students were the oldest cohort.
Implications for positive social change for nursing students include improved ethics education that may motivate ethical conduct throughout students’ careers nationally and globally for better understanding and promotion of ethics and behavior.
In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions.
We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these decisions ought to be made.
This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made.
We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders.
The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient.
As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress.
We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethical treatment of the patients for whom they care.
One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients.
How well ethical concerns are handled in healthcare is influenced by the ethical climate of the workplace, which in this study is described as workplace factors that contribute to healthcare professionals’ ability to identify and deal with ethical issues in order to provide the patient with ethically good care.
The overall aim of the study was to describe perceptions of the paediatric hospital ethical climate among healthcare professionals who treat/care for children with cancer.
Data were collected using the Hospital Ethical Climate Survey developed by Olsson as a separate section in a questionnaire. Descriptive statistics were used to analyse perceptions of the ethical climate.
Physicians, nurses and nurse-aides (n = 89) from three paediatric units participated in this study: haematology/oncology, chronic diseases and neurology.
The study was approved by the regional ethical review board.
Different perceptions of the ethical climate were rated as positive or negative/neutral. Nurses’ ratings were less positive than physicians on all items. One-third of the participants perceived that they were able to practice ethically good care as they believed it should be practised.
Differences in professional roles, involving more or less power and influence, might explain why physicians and nurses rated items differently. A positive perception of the possibility to practice ethically good care seems to be related to inter-professional trust and listening to guardians/parents. A negative/neutral perception of the possibility to practice ethically good care appears to be influenced by experiences of ethical conflicts as well as a lack of ethical support, for example, time for reflection and discussion.
The two-thirds of participants who had a negative/neutral perception of the possibility to practice ethically good care are at risk of developing moral stress. Clinical ethics support needs to be implemented in care where important values are at stake.
In their daily practice, Brazilian nurses have been met with complaints from co-workers and patients, as well as bioethical dilemmas intrinsic to the profession, particularly in the context of care delivery. Complaints against nursing professionals have been in the media spotlight.
To examine complaints filed with the Regional Board of Nursing of Mato Grosso do Sul (COREN-MS) in Midwest Brazil.
Retrospective, analytical desk research of 111 complaints received by COREN-MS in 2003–2013 was carried out. Characterizations of complainant, professionals investigated, and complaints were the variables investigated.
The project was approved by the Research Ethics Committee of the Federal University of Mato Grosso do Sul. To ensure confidentiality and anonymity, all documents retrieved were examined in situ and subjects were assigned numbered codes.
Most complainants were nursing professionals (40). Most causes of complaint originated in the hospital setting (65). Most allegations were made against nursing technicians and licensed practical nurses (82). Complaints involving interprofessional relationships (85), iatrogenic events (36), and professional liability (20) predominated.
Bioethical principles were breached, translating to poor-quality nursing care, detrimental to the professional image of nurses among users and nursing professionals alike.
The findings can serve as input to guide nursing schools and boards of nursing in developing policies to raise awareness among nursing professionals, sensitizing them to the responsible provision of care in the light of bioethical and legal principles.
In this paper we outline the possibilities of an ethic of care based on our self-affection and subjectivity in the ethical spaces between-two. In this we first refer to three Irigarayan concepts – breath, silence and listening from the third phase of her philosophy, and discuss them within the methodological framework of an ethics of intersubjectivity and interiority. Together with attentiveness, we analyse them as four categories of our ethical becoming. Furthermore, we argue that self-affection is based on our inchoate receptivity for the needs of the other(s) and is thus dialectical in its character. In this we critically confront some epistemological views of our ethical becoming. We wind up this paper with a proposal for an ethics towards two autonomous subjects, based on care and our shared ethical becoming – both as signs of our deepest hospitality towards the other.
Observance of the patients’ bill of rights is one of the main features of moral codes in hospitals. In this regard, nurses bear great responsibility because they spend a long time with patients. Therefore, the continuous evaluation of the nurses’ performance and assessing their knowledge about the patients’ bill of rights are a need.
We aimed to determine the nurses’ awareness of the patients’ rights and measure their performance in this regard.
This cross-sectional study was carried out in 2013. To measure the nurses’ knowledge and performance, 250 nurses and 300 patients were surveyed. The participants were selected randomly from five teaching hospitals in Tehran, Iran. Two questionnaires, one for nurses (17 questions) and the other for patients (11 questions), were applied. The data were analyzed in SPSS software using descriptive and inferential statistics.
The research protocol was submitted and approved by the research and ethics committees of the participating hospitals. Additionally, the consents of all of the participants were obtained before the study.
The mean score of the nurses’ knowledge regarding the patients’ rights was acceptable (69.85 ± 11.7 of 85). Furthermore, the mean score of nurses’ performance in observing the patients’ rights was relatively acceptable (11.2 ± 4.6 of 22). More experienced and educated nurses had higher knowledge regarding the patients’ rights, and patients with higher education level or experience of being hospitalized were less satisfied with the nurses’ performance.
Nurses’ knowledge of the patients’ bill of rights was acceptable; however, observance of the patients’ rights was not. It seems that notification of the patients’ bill of rights has increased the nurses’ awareness of the patients’ rights, although improvement of the nurses’ performance needs more extensive measures.
Nurse managers are responsible for solving work-related ethical problems to promote a positive ethical culture in healthcare organizations.
The aim of this study was to describe the activities that nurse managers use to solve work-related ethical problems. The ultimate aim was to enhance the ethical awareness of all nurse managers.
The data for this descriptive cross-sectional survey were analyzed through inductive content analysis and quantification.
The data were collected in 2011 using a questionnaire that included an open-ended question and background factors. Participants were nurse managers working in Finnish healthcare organizations (n = 122).
Permission for the study was given by the Finnish Association of Academic Managers and Experts of Health Sciences.
Nurse managers identified a variety of activities they use to solve work-related ethical problems: discussion (30%), cooperation (25%), work organization (17%), intervention (10%), personal values (9%), operational models (4%), statistics and feedback (4%), and personal examples (1%). However, these activities did not follow any common or systematic model.
In the future, nurse managers need a more systematic approach to solve ethical problems. It is important to establish new kinds of ethics structures in organizations, such as a common, systematic ethical decision-making model and an ethics club for nurse manager problems, to support nurse managers in solving work-related ethical problems.
To describe the professional values of the nurse lectures according to 241 nursing students, who participated voluntarily, in three different universities of Bogotá.
This is a quantitative, descriptive cross-sectional study that applied the Nurses Professional Values Scale—permission secured—Spanish; three dimensions of values were applied: ethics, commitment, and professional knowledge.
Project had ethical review and approval from an ethics committee and participants were given information sheets to read before they agreed to participate in the project.
It was concluded that nursing students, in general, do perceive these values in their professors, and they give priority to the dimension of ethics, followed by the knowledge dimension, and finally, commitment.
It is evident that professional values are transmitted by professors and students place importance to such values. Values related to the other’s care are paramount in nursing training in Colombia as well as in other countries.
It was found that participating students observed professors directly in relation to values focused on direct patient care, respect for privacy, respect for life, while matters related to professional improvement, participation in unions were not actually analyzed may be due to poor promotion activities and unions during undergraduate studies. The results obtained are primary approach to the study of values related to nursing, a topic which needs to be researched, something vital to all the country offering nursing training programs.
Little is known about case managers’ ethical issues and professional values.
This article presents an overview of ethical issues in case managers’ current practice. Findings are examined in the light of nursing ethics, social work ethics and principle-based biomedical ethics.
A systematic literature review was performed to identify and analyse empirical studies concerning ethical issues in case management programmes. It was completed by systematic content analysis of case managers’ national codes of ethics.
Only nine empirical studies were identified, eight of them from North America. The main dilemmas were how to balance system goals against the client’s interest and client protection against autonomy. Professional codes of ethics shared important similarities, but offered different responses to these two dilemmas.
We discuss the respective roles of professional and organizational ethics. Further lines of research are suggested.
Informed consent goes beyond signing a form; it is a process of providing necessary information, helping patients make an informed decision, and actively participate in their treatment.
This study aimed to assess the quality of obtaining surgical informed consent in hospitals affiliated with Tehran University of Medical Sciences.
In a cross-sectional, descriptive-analytical study, 300 patients were chosen through stratified sampling from seven hospitals affiliated with Tehran University of Medical Sciences. Data were collected using a questionnaire developed by the researchers and analyzed using descriptive and analytical statistics on SPSS software.
Ethical approval of this study was granted by Tehran University of Medical Sciences research ethics committee. Written informed consent for participation was obtained. The participants were reassured that their information will be used anonymously and their answers will not affect their treatment and care.
The mean score of quality of acquisition of informed consent was 17.13 out of 35, indicating that the quality falls in the inappropriate category. The results indicate that 48% of the signatories do not even read the form before signing it. Among the 52% who did read the consent form, 61.3% mentioned varying degrees of incomprehensibility of the consent form and 94.2% mentioned the presence of incomprehensible technical, medical and legal vocabulary. Only 12% and 18% of respondents reported that they were not in hurry and they had no fear or anxiety, respectively, when signing the form. The quality of obtaining informed consent was higher in women, younger patients, patients with higher education, and those who had special surgeries.
This study shows a poor practice in obtaining surgical informed consent in Iran. It seems necessary to consider fundamental changes in the process of acquiring consent based on the temporal and local conditions of the patients.
Ethical leadership is important for developing ethical healthcare practice. However, there is little research-based knowledge on how to stimulate and educate for ethical leadership.
The aim was to develop and investigate the feasibility of a 6-week web-based, ethical leadership educational programme and learn from participants’ experience.
A training programme was developed consisting of (1) a practice part, where the participating middle managers developed and ran an ethics project in their own departments aiming at enhancing the ethical mindfulness of the organizational culture, and (2) a web-based reflection part, including online reflections and coaching while executing the ethics project. Focus group interviews were used to explore the participants’ experiences with and the feasibility of the training.
Nine middle managers were recruited from a part-time master’s programme in leadership in Oslo, Norway. The research context was the participating leaders’ work situation during the 6 weeks of training.
Participation was voluntary, data anonymized and the confidentiality of the participating leaders/students and their institutions maintained. No patient or medical information was involved.
Eight of the nine recruited leaders completed the programme. They evaluated the training programme as efficient and supportive, with the written, situational feedback/coaching as the most important element, enhancing reflection and motivation, counteracting a feeling of loneliness and promoting the execution of change.
The findings seem consistent with the basic assumptions behind the educational design, based partly on e-health research, feedback studies and organizational ethics methodology, partly on theories on workplace learning, reflection, recognition and motivation.
The training programme seems feasible. It should be adjusted according to participants’ proposals and tested further in a large-scale study.
Ethical codes are guidelines that orient nurses and ensure that their decisions are in accordance with the values of the professional system. These codes show that there is a connection among values, patients’ rights, and nurses’ duties.
This study aimed to compare the viewpoints of patients, nurses, and nurse managers regarding the extent to which clinical ethical codes are observed.
In this descriptive–comparative study, data were collected using three questionnaires based on Iranian nurses’ ethical codes with a focus on clinical care. The reliability of the questionnaire was verified by test–retest method (r = 0.9). The patients were interviewed by the researcher, but nurses and managers completed the questionnaires themselves. After all, the data were analyzed using the SPSS statistical software (v 15).
In all, 100 patients, 100 nurses, and 30 managers from internal and surgical wards of two major hospitals in Shiraz, Iran, participated in 2014.
This research was approved by the Ethics Committee of Shiraz University of Medical Sciences. All the participants signed written informed consents.
According to the results, 70% of the patients, 86% of the nurses, and 53.3% of the nurse managers rated nurses’ adherence to ethical codes as satisfactory. The mean scores (standard deviation) of the level of adherence to ethical codes were 38.44 (6.91) in the patients, 41.08 (4.82) in the nurses, and 37.83 (6.98) in the nurse managers. The results of analysis of variance revealed a significant difference between the attitudes of the nurses and the other two groups (p = 0.001).
Nurses’ adherence to ethical codes was satisfactory in all three groups. Accordingly, our findings agree with the results of some national and international studies, although there are still controversies in this regard.
Although the nurses rated their performance in certain fields more satisfactory compared to the patients and managers, all the three groups agreed that clinical ethical codes were properly observed in the internal and surgical wards. Nurses can improve the quality of care by considering the viewpoints of patients and managers about their ethical performance.
Patients in clinical settings are not lonely islands; they have relatives who play a more or less active role in their lives.
The purpose of this article is to elucidate the ethical challenges nursing staff encounter with patients’ next of kin and to discuss how these challenges affect clinical practice.
The study is based on data collected from ethical group discussions among nursing staff in a nursing home. The discussions took place in 2011 and 2012. The data were analysed and interpreted by using hermeneutic methodology.
All the data have been anonymised and handled with confidentiality. Written informed consent was obtained from all participants.
Ethical challenges relating to patients’ next of kin were found to be an issue frequently discussed in the groups. Our findings indicate that next of kin have different characteristics, categorised as ‘the professionals’ and ‘the shadows’. In this article, we will describe the next of kin’s characteristics and the ethical challenges and practical implications that nursing staff experience in this connection.
We will discuss the findings in the light of the four basic principles of medical ethics and propose interventions to help nurses manage ethical challenges related to next of kin.
The study reveals the need to enhance nursing staffs’ communicative and ethical skills on an individual level, but most importantly, to establish routines in clinical settings for informing and following up next of kin in a systematic and structured way.
Academic dishonesty has become a serious problem at institutions of higher learning.
What is the frequency of academic dishonesty and what factors affect the tendency of dishonesty among Turkish health science school students?
This descriptive and cross-sectional study aims to evaluate academic dishonesty among university nursing, midwifery, and dietetic students.
The study sample consisted of 499 health science students in Turkey. The tendency toward academic dishonesty was investigated using the Academic Dishonesty Tendency Scale.
Institutional review board approved the study. Written permission was obtained from the researcher to use Turkish version of the Academic Dishonesty Tendency Scale.
Of all the students, 80.0% claimed to refer to Internet during homework preparation and 49.1% of students reported to cite the references at the end of article on some instances. Of the students, 56.1% claimed never to have cheated in the exams. It was found that academic dishonesty was partly low (1.80–2.59) in students. For students using a library while doing their homework, mean scores were significantly lower (p < 0.05). There were also statistically significant difference between mean scores and student’s year in school, student’s perception of school success, and frequency of Internet use while doing homework (p < 0.05).
The tendency of academic dishonesty was lower among students who use Internet and library more frequently. These findings are consistent with previous studies.
Measurements to take against academic dishonesty should be directed toward not only students but institutions and instructors as well.
Ethical issues pose challenges for nurses who are increasingly caring for patients in complicated situations. Ethical sensitivity is a prerequisite for nurses to make decisions in the best interest of their patients in daily practice. Currently, there is no tool for assessing ethical sensitivity in Chinese language, and no empirical studies of ethical sensitivity among Chinese nurses.
The study was conducted to translate the Moral Sensitivity Questionnaire–Revised Version (MSQ-R) into Chinese and establish the psychometric properties of the Moral Sensitivity Questionnaire–Revised Version into Chinese (MSQ-R-CV).
This research was a methodological and descriptive study.
MSQ-R was translated into Chinese using Brislin’s model, and the Translation Validity Index was evaluated. MSQ-R-CV was then distributed along with a demographic questionnaire to 360 nurses working at tertiary and municipal hospitals in Changsha, China.
This study was approved by the Institutional Review Boards of Yale University and Central South University.
MSQ-R-CV achieved Cronbach’s alpha 0.82, Spearman-Brown coefficient 0.75, significant item discrimination (p < 0.001), and item-total correlation values ranging from 0.524 to 0.717. A two-factor structure was illustrated by exploratory factor analysis, and further confirmed by confirmatory factor analysis. Chinese nurses had a mean total score of 40.22 ± 7.08 on the MSQ-R-CV, and sub-scores of 23.85 ± 4.4 for moral responsibility and strength and 16.37 ± 3.75 for sense of moral burden.
The findings of this study were compared with studies from other countries to examine the structure and meaningful implications of ethical sensitivity in Chinese nurses.
The two-factor MSQ-R-CV (moral responsibility and strength, and sense of moral burden) is a linguistically and culturally appropriate instrument for assessing ethical sensitivity among Chinese nurses.
Organ availability for transplantation has become an increasingly complex and difficult question in health economics and ethical practice. Advances in technology have seen prolonged life expectancy, and the global push for organs creates an ever-expanding gap between supply and demand, and a significant cost in bridging that gap. This article will examine the ethical implications for the nursing profession in regard to the procurement of organs from an impoverished seller’s market, also known as ‘Transplant Tourism’. This ethical dilemma concerns itself with resource allocation, informed consent and the concepts of egalitarianism and libertarianism. Transplant Tourism is an unacceptable trespass against human dignity and rights from both a nursing and collective viewpoint. Currently, the Australian Nursing and Midwifery Council, the Royal college of Nursing Australia, The Royal College of Nursing (UK) and the American Nurses Association do not have position statements on transplant tourism, and this diminishes us as a force for change. It diminishes our role as advocates for the most marginalised in our world to have access to care and to choice and excludes us from a very contemporary real debate about the mismatch of organ demand and supply in our own communities. As a profession, we must have a voice in health policy and human rights, and according to our Code of Ethics in Australia and around the world, act to promote and protect the fundamental human right to healthcare and dignity.
Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss.
To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation.
A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis.
An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation.
Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient’s/next-of-kin’s emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient’s autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have.
The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders.
MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.
Admission to a nursing home does not necessarily diminish an older person’s desire for sexual expression and fulfillment. Given that nursing staff directly and indirectly influence the range of acceptable sexual expressions of nursing home residents, their knowledge and attitudes toward aged sexuality can have far-reaching effects on both the quality of care they provide to residents and the self-image and well-being of these residents.
To investigate nursing staff’s knowledge and attitudes toward aged sexuality, to determine whether certain sociodemographic factors of the nursing staff relate to their knowledge and attitudes toward later-life sexuality, and to examine the relationship between knowledge and attitudes.
Descriptive cross-sectional survey study.
The administered questionnaire collected sociodemographic data and data from an adapted, Dutch version of the Aging Sexual Knowledge and Attitudes Scale. Data were collected from November 2011 through April 2012. A total of 43 geographically dispersed nursing homes in Flanders, Belgium, participated. Out of a potential research sample of 2228 nursing staff respondents, 1166 participated.
The study protocol was approved by the Ethics Committee of the Faculty of Medicine of the KU Leuven.
Nursing staff appeared to be moderately knowledgeable about aged sexuality and displayed a rather positive attitude toward sexuality in older people. Significant relationships between various variables were found both at univariable and multivariable levels. Knowledge and attitudes proved to be positively related, indicating that a higher level of knowledge of aged sexuality is associated with a more positive attitude toward sexuality in later life.
Research findings are discussed within a broader international context.
There is room for improvement for both nursing staff’s knowledge and attitudes toward aged sexuality. This might be aided by appropriate educational interventions. Our results identified different target groups of nursing home staff for these interventions.
Nurses and student nurses in Malawi often encounter challenges in taking a moral course of action. Several studies have demonstrated a need for increased awareness of ethical issues in the nursing education.
To explore the challenges experienced by nurse teachers in Malawi in their efforts to enhance students’ moral competence in clinical practice.
A qualitative hermeneutic approach was employed to interpret the teachers’ experiences.
Individual interviews (N = 8) and a focus group interview with teachers (N = 9) from different nursing colleges were conducted.
Ethical approval was granted and all participants signed their informed consent.
Two overall themes emerged: (1) authoritarian learning climate, with three subthemes: (a) fear of making critical comments about clinical practice, (b) fear of disclosing mistakes and lack of knowledge and (c) lack of a culture of critical discussion and reflection that promotes moral competence; and (2) discrepancy between expectations on learning outcome from nursing college and the learning opportunities in practice comprising three subthemes: (a) gap between the theory taught in class and learning opportunities in clinical practice, (b) lack of good role models and (c) lack of resources.
Our findings indicated that showing respect was a central objective when the students were assessed in practice. A number of previous studies have enlightened the need for critical reflection in nursing education. Few studies have linked this to challenges experienced by teachers for development of moral competence in practice. This is one of the first such studies done in an African setting.
There is a clear relationship between the two themes. A less authoritarian learning climate may enhance critical reflection and discussion between students, teachers and nurses. This can narrow the gap between the theory taught in college and what is demonstrated in clinical practice. Moral competence must be enhanced in order to ensure patients’ rights and safety.
Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives.
We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a person or an action that overcomes fears or other challenges to achieve something of great moral worth.
The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable.
A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency.
The study was approved by the Internal Review Board of the authors’ university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary.
Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person’s dying and death, and the challenge of adequately conveying the advance directive’s meaning and accurately recording a homeless person’s end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants reported having encountered those obstacles. So, while participants required moral courage to assist homeless persons with advance directives, they required greater moral courage as they anticipated their meetings than during those meetings.
Our study breaks new ground at the intersection of nursing, moral courage, and advance directives. It might also have important implications for how to improve the training that US nursing students receive before they provide this service.
Our results cannot be generalized, but portions of our approach are likely to be transferable to similar social contexts. For example, because homeless persons are misunderstood and marginalized throughout the United States, our design for training nursing students to provide this service is also likely to be useful across the United States. Internationally, however, it is not yet known whether our participants’ fears and the challenge they faced are also experienced by those who assist homeless persons or members of other vulnerable populations in documenting healthcare wishes.
To meet and take care of people with dementia implicate professional and moral challenges for caregivers. Using force happens daily. However, staff also encounter challenges with the management in the units. Managing the caretaking function is also significant in how caretakers experience working in dementia care.
The purpose of this study is to explore the caregiver’s experiences with ethical challenges in dementia care settings and the significance of professional leadership in this context.
The design is qualitative, and data appear through narrative interviews. A total of 23 caretakers participated in the study. The transcribed interviews were subjected to a phenomenological-hermeneutical interpretation.
The respondents signed an informed consent for participation prior to the interviews. They were assured anonymity and confidentiality in the publication of the data. Ricoeur’s method for interpretation ensures anonymity as the researcher relates to the data as one collective text. The study is part of a larger research project in ethics, in its entirety approved in line with the Helsinki Convention.
The findings show that the caretakers experienced inadequacy. Some of them described a negative work atmosphere where they experienced that their leaders did not take them seriously. Because of this, informal negative sub-groups functioned as an exclusive debriefing arena. Some of the informants described the opposite experience where the leaders actively supported them.
The analyses of the findings are discussed in light of the concepts of trust and mistrust in leadership.
There is a correlation between the leadership and the caregivers’ experience of being in difficult situations.
Persons with dementia are at risk of malnutrition and thus in need of assistance during mealtimes. Research suggest interventions for caregivers to learn how to facilitate mealtimes and eating, while other suggest a working environment enabling the encounter needed to provide high-quality care. However, the phenomenon of caring for this unique population needs to be elucidated from several perspectives before suggesting suitable implications that ensure their optimal health.
To illustrate the meanings within caregivers’ experiences of caring for persons with dementia during mealtime situations. We also measured weight and food intake among individuals with dementia to explain better the phenomenon of caring for them during mealtimes.
Mixed method including focus group interviews with seven caregivers analyzed using phenomenological hermeneutics. In addition, for nine persons with dementia, weight and food intake were collected and descriptive statistics were calculated.
Ethical review was obtained from an ethics committee, and all caregivers signed a consent form after being informed on the issue of research ethics. Relatives for persons with dementia were informed and signed the consent. In addition, throughout the study, the persons’ expressions were observed aiming to respect their vulnerability, integrity, and dignity.
One theme emerged from interviews (struggling between having the knowledge and not the opportunity), which was built upon three subthemes (being engaged and trying; feeling abandoned and insufficient; being concerned and feeling guilty). Seven of nine persons with dementia lost a minimum of 1.3 kg of weight and ate a maximum of 49.7% of the food served.
Caregivers struggle because they have knowledge about how to provide high-quality care but are unable to provide this care due to organizational structures. The weight loss and insufficient eating among the persons with dementia may support this conclusion. Sufficient time for adequate care should be provided.
Clinical group supervision has existed for over 20 years in nursing. However, there is a lack of studies about the role of supervision in nursing students’ education and especially the focus on ethical reasoning.
The aim of this study was to explore and describe nursing students’ ethical reasoning and their supervisors’ experiences related to participation in clinical group supervision.
The study is a qualitative interview study with interpretative description as an analysis approach.
A total of 17 interviews were conducted with nursing students (n = 12) who had participated in clinical group supervision in their first year of nursing education, and with their supervisors (n = 5).
The study was based on the ethical principles outlined in the Declaration of Helsinki, and permission was obtained from the Regional Ethical Review Board in Sweden.
The analysis revealed that both the form and content of clinical group supervision stimulated reflection and discussion of handling of situations with ethical aspects. Unethical situations were identified, and the process uncovered underlying caring actions.
Clinical group supervision is a model that can be used in nursing education to train ethical reflection and to develop an ethical competence among nursing students. Outcomes from the model could also improve nursing education itself, as well as healthcare organizations, in terms of reducing moral blindness and unethical nursing practice.
Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses’ follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party – the child – have attracted limited attention.
The study explores challenges of confidentiality linked to a third party in nurse–patient relationships in a rural Tanzanian HIV/AIDS context.
The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%.
Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes.
Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway.
The material indicates a delicate balance between the nurses’ attempt to secure the HIV-free survival of the babies and the mothers’ desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient’s restricted disclosure came to light during follow-up of the HIV-positive women and the third party – the child who is at risk of HIV infection through mother’s milk. World Health Organization’s substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion.
Healthcare professionals encounter ethical dilemmas and concerns in their practice. More research is needed to understand these ethical problems and to know how to educate professionals to respond to them.
To describe ethical dilemmas and concerns at work from the perspectives of Finnish and Dutch healthcare professionals studying at the master’s level.
Exploratory, qualitative study that used the text of student online discussions of ethical dilemmas at work as data.
Participants’ online discussions were analyzed using inductive content analysis.
The sample consisted of 49 students at master’s level enrolled in professional ethics courses at universities in Finland and the Netherlands.
Permission for conducting the study was granted from both universities of applied sciences. All students provided their informed consent for the use of their assignments as research data.
Participants described 51 problematic work situations. Among these, 16 were found to be ethical dilemmas, and the remaining were work issues with an ethical concern and did not meet criteria of a dilemma. The most common problems resulted from concerns about quality care, safety of healthcare professionals, patients’ rights, and working with too few staff and inadequate resources.
The results indicated that participants were concerned about providing quality of care and raised numerous questions about how to provide it in challenging situations. The results show that it was difficult for students to differentiate ethical dilemmas from other ethical work concerns.
Online discussions among healthcare providers give them an opportunity to relate ethical principles to real ethical dilemmas and problems in their work as well as to critically analyze ethical issues. We found that discussions with descriptions of ethical dilemmas and concerns by health professionals provide important information and recommendations not only for education and practice but also for health policy.
Ethics is a founding component of the nursing profession; however, nurses sometimes find it difficult to constantly adhere to the required ethical standards. There is limited knowledge about the factors that cause a committed nurse to violate standards; moral disengagement, originally developed by Bandura, is an essential variable to consider.
This study aimed at developing and validating a nursing moral disengagement scale and investigated how moral disengagement is associated with counterproductive and citizenship behaviour at work.
The research comprised a qualitative study and a quantitative study, combining a cross-validation approach and a structural equation model.
A total of 60 Italian nurses (63% female) involved in clinical work and enrolled as students in a postgraduate master’s programme took part in the qualitative study. In 2012, the researchers recruited 434 nurses (76% female) from different Italian hospitals using a convenience sampling method to take part in the quantitative study.
All the organisations involved and the university gave ethical approval; all respondents participated on a voluntary basis and did not receive any form of compensation.
The nursing moral disengagement scale comprised a total of 22 items. Results attested the mono-dimensionality of the scale and its good psychometric properties. In addition, results highlighted a significant association between moral disengagement and both counterproductive and citizenship behaviours.
Results showed that nurses sometimes resort to moral disengagement in their daily practice, bypassing moral and ethical codes that would normally prevent them from enacting behaviours that violate their norms and protocols.
The nursing moral disengagement scale can complement personnel monitoring and assessment procedures already in place and provide additional information to nursing management for designing interventions aimed at increasing compliance with ethical codes by improving the quality of the nurses’ work environment.
In order to protect the autonomy of human subjects, we need to take their culture into account when we are obtaining informed consent.
This study describes the cultural aspects related to informed consent in health research and is based on electronic searches that were conducted using the Scopus, PubMed, CINAHL, and Cochrane databases published between 2000 and 2013. A total of 25 articles were selected.
Our findings indicate that cultural perspectives relating to the informed consent process are essential during the whole research process and particularly crucial in the planning phase of a study. Our study indicates that appropriate communication between different stakeholders plays a vital role in cultural understanding.
The researchers’ awareness of cultural differences and their ability to work in a culturally sensitive way are key factors in improving study participation and retention in a multicultural context. Taking cultural aspects into account during the whole research process improves the quality of research.
Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety.
The purpose of this review was to describe how dilemmas and environmental, relational, and organizational factors contribute to moral distress in undergraduate student nurses during their clinical experience and professional education.
The research design was a systematic literature review.
The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check.
Since this was a systematic review, no ethical approval was required.
From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses.
Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students.
Nurse managers have responsibilities relating to the quality of care, the welfare of the staff and running of the organization. Ethics plays significant role in these responsibilities. Ethical problems are part of daily management, but research in this area is limited.
The aim of this study was to identify and describe ethical problems nurse managers encounter in their work to get more detailed and extensive view of these problems.
The data consisted of nine interviews with nurse managers at different management levels in primary healthcare and specialized healthcare organizations, and it was analysed by inductive content analysis.
Permission to conduct the interviews including ethical approval was given at all participating organizations according to national standards. The respondents were informed about the aim of the study, and voluntary participation, anonymous response and confidentiality were explained to them.
Four main categories were found: conflicts in practical situations, lack of appreciation, disregard of problems and experienced inadequacy. Problems could also be divided to patient-related, staff-related, organization-related and other problems.
The findings correspond with results from earlier studies but add knowledge of the nature and details of nurse managers’ ethical problems. New information is produced related to the ethical problems with nurse managers’ own courage, motivation and values.
Nurse managers identified a variety of different ethical problems in their work. This information is useful in the development of ethics in nursing management. Further research about the frequency and intensity of nurse managers’ ethical problems is needed as well as possible differences in different levels of management.
The perceptions of core professional nursing values of men in baccalaureate nursing programs are poorly understood.
The study purpose was to understand and interpret the meaning of core professional nursing values to male baccalaureate nursing students.
One-to-one interviews were conducted with male nursing students from a public university in the Midwest, following interpretive phenomenology.
Measures to protect participants included obtaining Institutional Review Board approval, obtaining signed informed consent, and maintaining confidentiality.
The study revealed five themes and several subthemes under an overarching finding of caring. Acquisition of professional nursing values began prior to the nursing program and continued to varying degrees throughout the program.
Several implications are offered for nursing education, nursing practice, research, and public policy. These include identification of common values, teaching-learning strategies, inclusive environments, teamwork, and conflict resolution.
Caring was revealed using a metaphor of a puzzle.
A predictive genetic test for Huntington’s disease can be used before any symptoms are apparent, but there is only sparse knowledge about the long-term consequences of a positive test result. Such knowledge is important in order to gain a deeper understanding of families’ experiences.
The aim of the study was to describe a young couple’s long-term experiences and the consequences of a predictive test for Huntington’s disease.
A descriptive case study design was used with a longitudinal narrative life history approach.
The study was based on 18 interviews with a young couple, covering a period of 2.5 years; starting 6 months after the disclosure of the test results showing the woman to be a carrier of the gene causing Huntington’s disease.
Even though the study was extremely sensitive, where potential harm constantly had to be balanced against the benefits, the couple had a strong wish to contribute to increased knowledge about people in their situation. The study was approved by the ethics committee.
The results show that the long-term consequences were devastating for the family. This 3-year period was characterized by anxiety, repeated suicide attempts, financial difficulties and eventually divorce.
By offering a predictive test, the healthcare system has an ethical and moral responsibility. Once the test result is disclosed, the individual and the family cannot live without the knowledge it brings. Support is needed in a long-term perspective and should involve counselling concerning the families’ everyday life involving important decision-making, reorientation towards a new outlook of the future and the meaning of life.
As health professionals, our ethical and moral responsibility thus embraces not only the phase in direct connection to the actual genetic test but also a commitment to provide support to help the family deal with the long-term consequences of the test.
Chief nurses are most likely to take the lead in discussing and working to resolve ethical dilemmas, creating an ethical culture within their organization that results in effective ethics training. As the first step in this process, there is a need to define the kinds of ethical dilemmas that chief nurses grapple with on a regular basis as a target for future study.
Anonymous written questionnaires and semi-structured interviews.
All research procedures were approved by the Chubu University Ethics Review Board, the research institution to which the authors belong (authorization no. 250016).
Responses from four chief nurses indicated that ethical dilemmas could be categorized as either those related to patient dignity or those related to management (unique to their roles as administrators). It was also learned that chief nurses struggle with the fact that although they consult with their superiors and others, these efforts do not lead to resolution. The expectation is that going forward, chief nurses will play a central role in acting as coordinators with physicians to promote better communication as well as lead group discussions aimed at providing care that respects patient dignity.
Ethical issues are increasingly being reported by care-providers; however, little is known about the nature of these issues within the nursing home. Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress.
The purpose of this review was to identify prior research which focuses on ethical issues in the nursing home and to explore staffs’ experiences of ethical issues.
Using a systematic approach based on Aveyard (2014), a literature review was conducted which focused on ethical and moral issues, nurses and nursing assistants, and the nursing home.
The most salient themes identified in the review included clashing ethical principles, issues related to communication, lack of resources and quality of care provision. The review also identified solutions for overcoming the ethical issues that were identified and revealed the definitional challenges that permeate this area of work.
The review highlighted a need for improved ethics education for care-providers.
Privacy has been recognized as a basic human right and a part of quality of care. However, little is known about the privacy of Somali asylum seekers in healthcare, even though they are one of the largest asylum seeker groups in the world.
The aim of the study was to describe the content and importance of privacy and its importance in healthcare from the perspective of Somali asylum seekers.
The data of this explorative qualitative study were collected by four focus group interviews with 18 Somali asylum seekers with the help of an interpreter. The data were analysed by inductive content analysis.
Research permissions were obtained from the director of the reception centre and from the Department of Social Services. Ethical approval was obtained from the Ethics Committee of Turku University.
The content of privacy includes visual privacy, physical privacy and informational privacy. All contents can be shared with healthcare professionals. The importance of privacy includes respect, dignity and freedom.
Privacy is strongly connected to the collectivism of Somali culture and religion. Unlike the Western cultures, privacy is not important only for the individual; most of all, it is seen to support collectivism.
Even though all contents of privacy can be shared with healthcare professionals, it is important to recognize the cultural aspect of privacy especially when using interpreters with Somali background.
An overview of ethical sensitivity among Chinese registered nurses is needed to develop and optimize the education programs and interventions to cultivate and improve ethical sensitivity.
The study was conducted to explore the barriers to and facilitators of ethical sensitivity among Chinese registered nurses working in hospital settings.
A convergent parallel mixed-methods research design was adopted.
In the cross-sectional quantitative study, the Chinese Moral Sensitivity Questionnaire–revised version was used to assess the levels of ethical sensitivity among registered nurses, and the scores were correlated with key demographics, training experiences in ethics, and workplace cultural environments (n = 306). In the qualitative study, semi-structured interviews were used to elicit the nurses’ perceptions of the barriers and facilitators in nurturing ethical sensitivity (n = 15). The data were collected from February to June 2014.
This study was approved by the Institutional Review Boards of Yale University and Central South University.
Despite moderately high overall Chinese Moral Sensitivity Questionnaire–revised version scores, the ethical sensitivity among Chinese nurses lags in practice. Barriers to ethical sensitivity include the lack of knowledge related to ethics, lack of working experience as a nurse, the hierarchical organizational climate, and the conformist working attitude. The positive workplace cultural environments and application of ethical knowledge in practice were considered potential facilitators of ethical sensitivity.
The findings of this study were compared with studies from other countries to examine the barriers and facilitators of ethical sensitivity in Chinese nurses.
This mixed-methods study showed that even though the Chinese nurses have moderately high sensitivity to the ethical issues encountered in hospitals, there is still room for improvement. The barriers to and facilitators of ethical sensitivity identified here offer new and important strategies to support and enhance the nurses’ sensitivity to ethical issues.
Equity as a basic human right builds the foundation of all areas of primary healthcare, especially prenatal care. However, it is unclear how pregnant women and their care providers perceive the equitable prenatal care.
This study aimed to explore Iranian women’s and care providers’ perceptions of equitable prenatal care.
In this study, a qualitative approach was used. Individual in-depth unstructured interviews were conducted with a purposeful sample of pregnant women and their care providers. Data were analyzed using inductive content analysis method.
A total of 10 pregnant women and 10 prenatal care providers recruited from six urban health centers across Ahvaz, a south western city in Iran, were participated in the study.
The study was approved by the Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences. The ethical principles of voluntary participation, confidentiality, and anonymity were considered.
Analysis of participants’ interviews resulted in seven themes: guideline-based care, time-saving care, nondiscriminatory care, privacy-respecting care, affordable comprehensive care, effective client–provider relationships, and caregivers’ competency.
The findings explain the broader and less discussed dimensions of equitable care that are valuable information for the realization of equity in care. Understanding and focusing on these dimensions will help health policy-makers in designing more equitable healthcare services for pregnant women.
Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child’s growing autonomy are known ethical concerns that involve the whole professional team around the child’s care.
The purpose of this study was to explore healthcare professionals’ experiences of participating in ethics case reflection sessions in childhood cancer care.
Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology.
Healthcare professionals working at a publicly funded children’s hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on.
The children’s and their parents’ integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board.
Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants’ articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions.
The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care.
Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child. A consolidated care approach would be valuable for both the child and the healthcare professionals because of the common care goals.
Nurses require specific knowledge, skills and attitudes to participate competently in various forms of ethics meetings. The literature does not state the contents of the knowledge, skills and attitudes nurses need for ethics meetings. Without such a competency profile, it cannot be assessed in how far nurses actually possess these qualities for ethics meetings.
Corroborating an existing profile of the requisite knowledge, skills and attitudes in the form of a questionnaire contributes to the development of a tool to determine the competence nurses need for ethics meetings.
In how far can this profile be confirmed by a quantitative follow-up in a random sample?
A questionnaire was developed to determine in how far nurses with prior involvement in ethics meetings recognise the earlier competency profile as important and comprehensive.
It was made available to subscribers of the digital newsletter of three widely read nursing journals in the Netherlands. Data collection and analysis took place in the spring of 2013.
Care was taken to state explicitly in the questionnaire that participation in the survey was completely voluntary and anonymous.
To a high degree, nurses with involvement in ethics meetings recognise the knowledge, skills and attitudes from the earlier interviews when presented as a survey.
Although the sample was small, the respondents and the results reflect known characteristics of nurses serving on ethics meeting.
This may be helpful to recruit and prepare nurses for professional ethics in nursing care, and to develop a tool to assess to what extent nurses actually possess competence for ethics meetings.
Exploring the concept of ethical competence in the context of healthcare is essential as it pertains to better quality of care. The concept still lacks a comprehensive definition covering the aspects of ethical expertise, ethical knowledge and action of a health professional.
This article aims to report an analysis of the concept of ethical competence.
A modified strategy suggested by Walker and Avant was used to analyse the concept.
As a result, the concept of ethical competence can be defined in terms of character strength, ethical awareness, moral judgement skills and willingness to do good. Virtuous professional, experience of a professional, human communication, ethical knowledge and supporting surroundings in the organisation can be seen as prerequisites for ethical competence. Ethical competence results in the best possible solutions for the patient, reduced moral distress at work and development and democratisation of society.
The results of the analysis establish a basis for an instrument to evaluate health professionals’ ethical competence. It will guide educators, as well as managers in healthcare, to support the development of ethical conduct in healthcare.
This study examines nurses’ perceptions of dignity in themselves and their work. Nurses commonly assert concern for human dignity as a component of the patients’ experience rather than as necessary in the nurses’ own lives or in the lives of others in the workplace. This study is exploratory and generates potential relationships for further study and theory generation in nursing.
What is the relationship between the construct nurses’ sense of dignity and global self-esteem, work satisfaction, and identified personal traits?
This cross-sectional correlation study used a stratified random sample of nurses which was obtained from a US University alumni list from 1965 to 2009 (N = 133).
University Institutional Review Board approval was achieved prior to mailing research questionnaire packets to participants. Participation was optional and numerical codes preserved confidentiality.
Statistical results indicated a moderately strong association between the nurse’s sense of personal dignity and self-esteem (rx = .62, p = .000) with areas of difference clarified and discussed. A positive but moderate association between nurses’ personal dignity and nurses’ work satisfaction (rx = .37, p = .000) and a similar association between self-esteem and nurses’ work satisfaction (rs = .29, p = .001) were found. A statistically significant difference was found (F = 3.49 (df = 4), p = .01) for dignity and categories of spiritual commitment and for nurses’ personal dignity when ratings of health status were compared (F = 21.24 (df = 4), p = .000).
Personal sense of dignity is discussed in relation to conceptual understandings of dignity (such as professional dignity) and suggests continued research in multiple cultural contexts.
The relationships measured show that nurses’ sense of dignity has commonalities with self-esteem, workplace satisfaction, spiritual commitment, and health status; the meaning of the findings has ramifications for the welfare of nurses internationally.
The increase in medical ethical regulations and bureaucracy handled by institutional review boards and healthcare institutions puts the researchers using qualitative methods in a challenging position.
Based on three different cases from three different research studies, the article explores and discusses research ethical dilemmas.
First, and especially, the article addresses the challenges for gatekeepers who influence the informant’s decisions to participate in research. Second, the article addresses the challenges in following research ethical guidelines related to informed consent and doing no harm. Third, the article argues for the importance of having research ethical guidelines and review boards to question and discuss the possible ethical dilemmas that occur in qualitative research.
Research ethics must be understood in qualitative research as relational, situational, and emerging. That is, that focus on ethical issues and dilemmas has to be paid attention on the spot and not only at the desktop.
This article presents key ethical challenges that were encountered when conducting a participatory qualitative research project with a very specific, small group of nurses, in this case with practice development nurses in Malta.
With the small number of nurses employed in practice development roles in Malta, there are numerous difficulties of maintaining confidentiality. Poorly constructed interventions by the researcher could have resulted in detrimental effects to research participants and the overall trustworthiness of the research. Generally, ethical guidelines for research exist to reinforce validity of research; however, there is not an established consensus on how these strategies can be utilised in some types of qualitative field work.
The researcher used an exploratory case study methodology. The sample consisted of 10 participants who were interviewed twice using face-to-face interviews, over a period of 2 months.
The study was ethically reviewed by the University Research Ethics Committee and the Faculty Research Ethics Committee, University of Malta. The participants referred to in this article have been given adequate information about the study and their consent has been obtained.
Numerous strategies for ensuring confidentiality during recruitment of the participants, during data collection, during transcription and data analysis and during dissemination of research results assisted the researcher in responding to potential and actual ethical issues.
This article emphasises the main strategies that can be used to respond to ethical challenges when researching with a small easily identifiable group. The learning discussed here may be relevant to or even transferable to other similar research studies or research contexts. These methods fostered a greater credibility throughout the research process and predisposed the participants to greater trust, and thus, they disclosed their experiences and speak more freely, thus enhancing the quality of the study.
Vulnerability is an important concept in nursing and nursing ethics. Vulnerability and ageing have generally been associated with frailty, which gives a limited view of both vulnerability and ageing.
The aim of this study was to illuminate the meaning of vulnerability to older persons themselves.
A qualitative design based on interpretive description was adopted. The data were collected by interviews that were analysed by qualitative content analysis as interplay between analysis, interpretation and meaning construction.
In total, 14 older persons aged 70–96 years were interviewed, 2 men and 12 women. Some of the participants lived in their own homes, some in service houses and some in nursing homes.
The ethical principles of informed consent, confidentiality and non-identification were respected.
The core meaning was a deeper sense of vulnerability as you grow old. This was expressed in six themes: Being easily harmed, Becoming an old person, Being an old person in society, Reactions when being violated and hurt, Protection and Vulnerability as strength.
The themes include frailty and threats to the dignity of older persons and also capacity to feel and develop. The results showed that although the frailty perspective dominated, vulnerability also had positive meanings for the older persons.
Health institutions can be considered as complex organizations because they need to be prepared to receive and satisfy patients. This clientele differs from other organizations because the use of hospital services is not a matter of choice. Another motive for this difference is that, most often, the patients do not determine what services and products they will use during their stay. Although they are the clients, usually, health professionals decide which service or product they will consume. Hence, nursing care delivery based on competence, efficiency and ethics represents a challenge.
This critical reflection is meant to draw attention to the relevance of the ethical aspects of nurses’ actions involving patients’ satisfaction with nursing care.
This paper highlights the responsibility of nurses to develop ethical actions in their commitment to manage and provide care with quality, commitment and efficiency. Findings and discussion: Possibilities of actions needed emerged from this discussion, such as the provision of reliable and updated information to clients, respect for standards, routines of care, exams and others, as well as clients’ education, in order to further their involvement and participation in decisions concerning the care planned for them.
The adoption of this paradigm entails a change in the performance of nurses’ management and care roles, which may have to observe attitudes previously disregarded in most services provided.
The aim of this study is to find and compare the current situation between common people and healthcare providers’ preferences for a good death in the context of Chinese culture.
A cross-sectional anonymous questionnaire survey covering 190 ordinary Chinese people and 323 healthcare providers was conducted. An inventory of the good death was translated and the subjects were surveyed about their attitude toward it.
Permission to conduct the study was granted by department chiefs, nurse managers and the participants themselves. The participants were informed that they took part on a voluntary and anonymous basis, that they could withdraw at any time, that they had the right to ignore questions they did not wish to answer, and that whatever they chose to do would not jeopardize their employment conditions.
The attributes that were perceived as important by major respondents for a good death were maintaining hope and pleasure, good relationship with medical staff, good relationship with family, independence, environment comfort, being respected as an individual, preparation for death, physical and psychological comfort, dying in a favorite place, and not being a burden to others. And some relatively less important characteristics were life completion, receiving enough treatment, natural death, controlling over the future, unawareness of death, pride and beauty, feeling that one’s life is worth living, and religious and spiritual comfort. We also found that healthcare providers were more likely than general out-patients to perceive "physical and psychological comfort," "dying in a favorite place," "good relationship with medical staff," and "natural death" as important for a good death.
This study offers healthcare providers in China a fundamental understanding of the normal expectations of the general public for a good death. It is believed that these findings in our study are valuable to improve palliative care in China. We compared the attitudes of Chinese and Westerners and found some differences, which suggested that cultural difference should be an important consideration to achieve a good death in China. We also found that healthcare providers see good death differently from general public, indicating that the criteria for good death warrant further study.
Growing evidence suggests that collaborative practice improves healthcare outcomes, but the precursors to collaborative behavior between nurses and physicians have not been fully explored.
The purpose of this descriptive correlational study was to describe the professional values held by nurses and their attitudes toward physician–nurse collaboration and to explore the relationships between nurses’ characteristics (e.g. education, type of work) and professional values and their attitudes toward nurse–physician collaboration.
This descriptive correlational study examines the relationship between nurses’ professional values (Nurses Professional Values Scale–Revised) and their attitudes toward nurse–physician collaboration (Jefferson Scale of Attitudes toward Physician–Nurse Collaboration).
Permission to conduct the study was received from the hospital, and the Institutional Review Boards of the healthcare system and the participating university.
A convenience sample of 231 registered nurses from a tertiary hospital in the United States was surveyed.
A significant positive relationship was found between nurses’ professional values and better attitudes toward collaboration with physicians (r = .26, p < .01). Attitude toward collaboration with physicians was also positively associated with master’s or higher levels of education (F(3, 224) = 4.379, p = .005).
The results of this study can be helpful to nurse administrators who are responsible for developing highly collaborative healthcare teams and for nurse educators who are focused on developing professional values in future nurses.
In Southeast Asia, the process of obtaining informed consent is influenced by both culture and policy at the hospital and national level. Both physicians and nurses play vital roles in this process, but physicians influence the roles of nurses.
Since the physicians and nurses often have different perspectives, it is important to investigate their views about the informed consent process and nurses’ roles therein and whether there is a difference between ideal and experienced practice (reality), and whether this differs across hospitals.
A questionnaire was developed and a survey was conducted among physicians and nurses. Using exploratory factor analysis a three factor structure was determined: ‘nurses’ roles’, ‘barriers in informed consent’, and ‘adequacy of information’. Non-parametric tests were applied to compare nurses and physicians, and hospital setting.
Responses were obtained from 129 physicians and 616 nurses from two Indonesian hospitals. Those hospitals differ in ownership, location, and size.
The study was reviewed by the hospital ethical committee. Participation was voluntary and confidentiality was ensured by keeping the responses anonymous.
Physicians and nurses differ significantly on all three factors. The scores reflecting disparity between ideal and reality regarding nurses’ roles varied across professions, while barriers in informed consent differed between hospitals.
The differences between ideal and reality indicated that improvement in the informed consent process and nurses’ roles therein is called for. Varying views between physicians and nurses on nurses’ roles may hinder collaboration. The differences between hospital settings showed interventions may have to be customized for different settings.
Views on nurses’ roles vary across professions. Views on barriers in informed consent vary across hospitals. Therefore interprofessional education is needed to promote interprofessional collaboration and intervention to improve informed consent practice should be tailored to the hospital context.
Organ donation and transplantation have made it possible to both save life and to improve the quality of life for a large number of patients. In the last years there has been an increasing gap between the number of patients who need organs and organs available for transplantation, and the focus worldwide has been on how to meet the organ shortage. This also rises some ethical challenges.
The objective of this study was to explore healthcare professionals’ experience of ethics related to care and interaction with critically ill patients with severe brain injuries and their families.
A hermeneutic phenomenological approach was used to explore the participants’ experiences. Methods for collecting data were a combination of participant observations and in-depth interviews.
Two ICUs in a Norwegian university hospital were recruited for data collection. A total of 12 cases were observed, and 32 of the healthcare professionals involved were interviewed.
The study was approved by the Regional Committee for Research Ethics. Permission to the study in the ICUs was obtained from the Chief Physician in the two ICUs respectively. The right of the participants was ensured by written, voluntary, and informed consent.
From the thematic analysis, a structure of the participants’ experiences emerged as a process. While the patients’ condition was clarified through phases of prognostic ambiguity, gradual clarification and prognostic certainty, interaction with the families was characterized by ambiguity that involved withholding. The prognostic process had a great impact on how the healthcare professionals interacted with the family. The interaction challenged the participants’ caring values in various ways and captured an important structure in their experiences of the ethical interaction with the patients’ families. These challenges distinguish caring for families in donation situations from caring for relatives of critically ill patients in general.
In the discussion we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act.
Ethical questions should be discussed more both in educations of healthcare professionals and in clinical practice.
Ethical reflections over care practices are important. In order to be able to perform such reflections, healthcare professionals must learn to think critically about their care practice.
The aim of this study was to evaluate whether an introduction to and practice in ethical reflections in community healthcare have consequences for the healthcare personnel’s practice.
A mixed-methods design was adopted with five focus group interviews and an electronic questionnaire based on results from the interviews.
A total of 29 community healthcare personnel with experience in ethical reflections participated in the interviews. The electronic questionnaire was sent via email to 2382 employees in community healthcare services in 13 municipalities in southern part of Norway.
The study was guided by the intentions of the Declaration of Helsinki and ethical standard principles and approved by the Norwegian Social Science Data Services.
An introduction to and practice in performing ethical reflections brought about an ethical awareness with understanding and respect for both colleagues and patients. The leader had a key role. Lack of time was a hindrance for ethical reflections. Three factors could predict meaningful ethical reflections: higher age of personnel, higher percentage of employment and longer experience with ethical reflections.
According to other studies, ethical reflections may enhance moral development of colleagues and their actions as advocates for the patients. A deepened ethical awareness, professional competency and sufficient time resources will guarantee proper caregiving.
A supportive environment that prioritizes participation in reflection meetings is decisive. To practice ethical reflections will provide better care for patients. A challenge for the community healthcare system is to offer adequate positions that provide the personnel an opportunity to be involved as caregivers and to participate in ethical reflections.
There are important ethical issues to be examined before launching any public health intervention, particularly when targeting vulnerable groups. The aim of this article is to identify and discuss ethical concerns that may arise when intervening for health behavior change among adolescents identified as overweight. These concerns originate from an intervention designed to capacitate adolescents to increase self-determined physical activity. Utilizing an ethical framework for prevention of overweight and obesity, we identified three ethical aspects as particularly significant: the attribution of responsibility for health behavior, liberty to choose, and the effect on the participants' psychosocial well-being. It is discussed whether and how measures can be taken to deal with these aspects. It seems evident that the ethical aspects are mainly concerned with the vulnerability of adolescents identified as overweight. However, we claim that when individual feedback and counseling is provided, tailored interventions have a unique potential to empower adolescents to make ethically anchored decisions about their own health behavior.
To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature.
A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants.
A regional, tertiary academic referral hospital in Ontario offering a perinatal program.
A total of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants.
Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress experienced by nurses regarding resuscitation of extremely premature infants.
Ethical approval was obtained from the research ethics review board for both the initial study and this secondary data analysis.
Five themes, uncertainty, questioning of informed consent, differing perspectives, perceptions of harm and suffering, and being with the family, contribute to the moral distress felt by nurses when exposed to neonatal resuscitation of extremely premature infants. An interesting finding was the nurses’ perceived lack of power and influence in the neonatal resuscitation decision-making process.
Moral distress continues to be a significant issue for nursing practice, particularly among neonatal nurses. Strategies are needed to help mediate the moral distress experienced by nurses, such as debriefing sessions, effective communication, role clarification, and interprofessional education and collaboration.
The demand for autonomy in medical decision making is increasing among Korean people, but it is not well known why some people prefer autonomy in decision making but others do not.
The aim of this study was to determine the extent to which Korean adults wished to exercise autonomy in the process of decision making regarding end-of-life treatment and to determine whether economic issues and family functioning, in particular, were associated with preferences for participation in decision making in Korean people.
This study was a cross-sectional correlational study using a survey.
Data were collected using structured questionnaires from 354 patients or their families who visited ambulatory departments at two general hospitals in South Korea, recruited by the proportionate quota sampling method. Data analysis was performed using multinomial logistic regression analyses.
The study was approved by the hospitals’ directors and the ethics committee of Kyungpook National University Hospital. Written informed consent was given by all participants.
A majority of Korean people wanted to make autonomous decisions regarding treatment at the end of life. Preferences for autonomous decision making regarding end-of-life treatment, rather than relying on family, showed a significant increase in association with poor family functioning and low income.
Results of this study suggested the necessity for development of alternatives to a dominant traditional "family-centered" approach in Korean people, in order to enhance end-of-life decision making for people who wish to take an active role in the decision-making process.
Healthcare providers need to examine not only patients’ preferred decision-making style but also any reasons for their choice, in particular, family conflict and financial burden.
To review the literature on perceptions of nursing students and/or educators on the contribution of ethics education to ethical competence in nursing students.
Nurses do not always demonstrate the competencies necessary to engage in ethical practice. Educators continue to debate about the best ways to teach ethics to nurses so that they can develop ethical competencies.
MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science.
A total of 15 articles with a quantitative, qualitative, or mixed-methods design published between January 1992 and March 2012 were analyzed.
According to students and educators, ethics education increases ethical perception of nursing students and the development of reflective and analytical skills. However, its contribution to the development of ethical behavior was barely mentioned. The accounts of students and educators revealed essential features of effective ethics education: active involvement of students in case study discussions and use of ethical frameworks. The use of activating educational strategies requires a safe learning environment where students can openly reflect on values at stake in their care practice.
A better understanding of how students learn to develop ethical skills and of influencing factors can guide educators to develop ethics courses for nursing curriculum. Future research needs to focus on the methodological accuracy of sampling and measuring instruments.
The concept of work engagement has existed in business and psychology literature for some time. There is a significant body of research that positively correlates work engagement with organizational outcomes. To date, the interest in the work engagement of nurses has primarily been related to these organizational outcomes. However, the value of work engagement in nursing practice is not only an issue of organizational interest, but of ethical interest. The dialogue on work engagement in nursing must expand to include the ethical importance of engagement. The relational nature of work engagement and the multiple levels of influence on nurses’ work engagement make a relational ethics approach to work engagement in nursing appropriate and necessary. Within a relational ethics perspective, it is evident that work engagement enables nurses to have meaningful relationships in their work and subsequently deliver ethical care. In this article, I argue that work engagement is essential for ethical nursing practice. If engagement is essential for ethical nursing practice, the environmental and organizational factors that influence work engagement must be closely examined to pursue the creation of moral communities within healthcare environments.
Although human dignity is an unconditional value of every human being, it can be shattered by extrinsic factors. It is necessary to discover the authentic meaning of patients’ dignity preservation from different religious perspectives to provide professional cross-cultural care in a diverse setting.
This article identifies common experiences of Iranian Muslim and Armenian Christian patients regarding dignified care at the bedside.
This is a qualitative study of participants’ experiences of dignified care elicited by individual in-depth semi-structured interviews.
A purposeful sample of 10 participants (five Iranian Muslims and five Iranian Armenians) from various private and governmental hospital settings was chosen.
This study was approved by the ethics committee of Tehran University of Medical Sciences. All the participants were provided with information about the purpose and the nature of the study, the voluntary condition of their participation in this study, and the anonymous reporting of recorded interviews.
The common experiences of Christian and Muslim patients regarding dignity preservation emerged as "exigency of respecting human nobility" and "providing person-centered care."
It is essential to recognize the humanness and individuality of each patient to preserve and promote human dignity in diverse cross-cultural settings. The findings support and expand current understanding about the objective and subjective nature of dignity preservation in cross-cultural nursing.
Background: Attention to patients’ spirituality, as a moral obligation of care, is now widely accepted in nursing practice. However, until recently, many nursing programs have paid little attention to spirituality. Objective: The objective of this study was to identify the impact of two different curricula, used to teach undergraduate nursing students, on increasing nursing student awareness of spirituality in the care of patients. Research design: A quasi-experimental post-intervention two-group design was conducted in 2009–2010 and 2010–2011 academic years. Participants and research context: The study included a total of 130 volunteer senior-year students. The students were assigned as "the intervention group/integrated system" that were informed about spirituality or as "the control group/traditional system" that received no information on spirituality. Data were collected via a personal information form and the Spirituality and Spiritual Care Rating Scale was used to assess responses. The study was conducted at the Department of Nursing of the Faculty of Health Sciences, Cumhuriyet University, in Central Anatolia/Turkey. Ethical considerations: Permission to conduct the study at the nursing school was obtained from the schools’ management teams. The rights of the participants were protected in this study by obtaining informed consent. Findings: The results revealed that the intervention group had a higher mean score on the Spirituality and Spiritual Care Rating Scale than did the control group. The students in the intervention group defined the terms of spirituality and spiritual care more accurately than did the control group students. Discussion: Nurses are professionally and ethically responsible for providing spiritual care. Nurses’ competence in meeting the spiritual needs of their patients should be improved by undergraduate education on spiritual care. Nursing scholars reported a significant difference in the knowledge and attitudes toward spirituality of nursing students as a result of the integration of spirituality into the undergraduate nursing curriculum. Conclusion: Spirituality should be more widely included in nursing education.
Background: Intravenous fluids and/or antibiotics are applied to only a limited extent in Norwegian nursing homes, and the patients are often sent to hospital in these situations. A transfer and a stay in hospital may be unnecessary strains for frail older patients. Given this background, a collaborative research project was initiated in a Norwegian county in 2009. A teaching programme was developed, which aimed to strengthen the awareness of ethics, assessments and practical procedures related to intravenous fluid and/or antibiotics among healthcare professionals. Objectives: This qualitative study aimed to increase our knowledge of the ethical problems experienced by nursing home nurses in situations related to the administration of intravenous fluids and/or antibiotics. Research design: An exploratory design was used, and five focus group interviews were conducted with 26 registered nurses. A hermeneutic analytic approach was applied. Ethical considerations: This study was reported to the Norwegian Social Science Data Services in May 2010. The Regional Committee for Medical and Health Research Ethics approved the collaborative research project. Findings: The analysis showed that the nurses experienced difficult decision-making situations, which were interpreted as external pressure and internal pressure. External pressure emerged in interactions with patients and relatives. Organizational factors were also interpreted as external pressure. Internal pressure was interpreted as the nurses’ experience of feeling inadequate in situations where it was difficult to protect the dignity of patients. Discussion: These findings correspond with international studies, which show that ethical problems often arise during decision-making situations. Conclusion: In agreement with the definition of an ethical problem, we found that the nurses experienced uncertainty and disagreements about how situations should be managed. External and internal pressures related to intravenous fluids and/or antibiotics in nursing homes have not been reported in previous studies. Thus, these findings merit further exploration.
Theoretical debates about the nature of grief and bereavement draw attention to the sensitivity of carrying out research with bereaved people, the possible threats that this may pose and the ethical considerations required to ameliorate potentially damaging outcomes. The authors of this article present a framework for ethical decision-making that has been successfully developed in the context of research with bereaved families. The discussion focuses on application and evaluation of the framework during research with family members who were approached about the donation of a deceased relative’s organs and/or tissues for transplantation. Practical strategies of relevance to the processes of participant recruitment, the interview encounter and follow-up care in the post-interview period are identified and discussed. Concerns about the possible impact of bereavement research are balanced with the views of family members who gave credence to the therapeutic and cathartic benefits of participating in sensitive, death-related research.
Introduction: We discuss Carol Gilligan's original concept of mature care in the light of the altruistic approach to caring and good clinical judgment. Discussion: In particular, we highlight how the concept of mature care can capture important challenges in today's nursing. Further, we illuminate how mature care might differ normatively from an altruistic approach to caring and the traditional prudential virtues in nursing. We also discuss similarities between mature care and virtue ethics. Conclusion: For nursing and nurses' identity, in today's health care system that is increasingly pressured to ‘produce' health, we believe it is important to both developing further theories on mature care and having normative discussions about care.
Background: Nursing continues to gain legitimation epistemologically and ontologically as a scientific discipline throughout the world. If a profession gains respect as a true autonomous scientific profession, then this recognition has to be put in practice in all environments and geographical areas. Nursing professional dignity, as a self-regarding concept, does not have a clear definition in the literature, and it has only begun to be analyzed in the last 10 years.
Objectives: The purpose of this meta-synthesis was to determine the various factors that constitute the notion of nursing professional dignity. The target was to create a tentative model of the concept.
Research design: The research design was a meta-synthesis (N = 15 original articles) of nursing professional dignity described in the literature, based on the guidelines by Noblit and Hare.
Method and findings: Original studies were sought out from electronic databases and manual searches. The selection of literature was conducted on stages based on titles (n = 2595), abstracts (n = 70), and full-texts (n = 15) according to the inclusion and exclusion criteria. From this analysis, a clear definition of nursing professional dignity emerged that underscored two main macro-dimensions constituting this intertwined, multidimensional, and complex notion: characteristics of the human beings and workplace elements.
Conclusion: The recognition of nursing professional dignity could have a positive impact on patients because the results clearly showed that nurses are more prone to foster patients’ dignity, patients’ safety, and a better quality of care if their own dignity is respected. If nurses are uncomfortable, humiliated, or not seen in their professional role, it is difficult to give to others good care, good support, or good relationships.
Background: Practical wisdom, understood as knowing how to be or act in any present situation with clients, is believed to be an essential part of the knowledge needed to be a professional mental health worker. Exploring processes of adapting, extending knowledge and refining tacit knowledge grounded in mental health workers’ experiences with being in practice may bring awareness of how mental health workers reflect, learn and practice professional ‘artistry’.
Research question: The aim of the article was to explore mental health workers’ processes of development and learning as they appeared in focus groups intended to develop practical wisdom. The main research question was ‘How might the processes of development and learning contribute to developing practical wisdom in the individual as well as in the practice culture?’
Research design: The design was multi-stage focus groups, and the same participants met four times. A phenomenological hermeneutical method for researching lived experience guided the analysis.
Participants and context: Eight experienced mental health workers representing four Norwegian municipalities participated. The research context was community-based mental health services.
Ethical considerations: The study was reported to Norwegian Social Data Services, and procedures for informed consent were followed.
Findings: Two examples of processes of re-evaluation of experience (Association, Integration, Validation, Appropriation and Outcomes and action) were explored. The health workers had developed knowledge in previous encounters with clients. In sharing practice experiences, this knowledge was expressed and developed, and also tested and validated against the aims of practice. Discussions led to adapted and extended knowledge, and as tacit knowledge was expressed it could be used actively.
Discussion: Learning to reflect, being ready to be provoked and learning to endure indecisiveness may be foundational in developing practical wisdom. Openness is demanding, and changing habits of mind is difficult.
Conclusion: Reflection on, and confrontation with, set practices are essential to building practice cultures in line with the aims of mental health services.
The use of doll therapy for people with dementia has been emerging in recent years. Providing a doll to someone with dementia has been associated with a number of benefits which include a reduction in episodes of distress, an increase in general well-being, improved dietary intake and higher levels of engagement with others. It could be argued that doll therapy fulfils the concepts of beneficence (facilitates the promotion of well-being) and respect for autonomy (the person with dementia can exercise their right to engage with dolls if they wish). However, some may believe that doll therapy is inappropriate when applied to the concepts of dignity (people with dementia are encouraged to interact with dolls) and non-maleficence (potential distress this therapy could cause for family members). The absence of rigorous empirical evidence and legislative guidelines render this a therapy that must be approached cautiously owing to the varied subjective interpretations of Kitwood’s ‘malignant social psychology’ and bioethics. This article suggests that by applying a ‘rights-based approach’, healthcare professionals might be better empowered to resolve any ethical tensions they may have when using doll therapy for people with dementia. In this perspective, the internationally agreed upon principles of the United Nations Convention on the Rights of Persons with Disabilities provide a legal framework that considers the person with dementia as a ‘rights holder’ and places them at the centre of any ethical dilemma. In addition, those with responsibility towards caring for people with dementia have their capacity built to respect, protect and fulfil dementia patient’s rights and needs.
People in extraordinary situations are vulnerable. As research participants, they are additionally threatened by abuse or exploitation and the possibility of harm through research. To protect people against these threats, informed consent as an instrument of self-determination has been introduced. Self-determination requires autonomous persons, who voluntarily make decisions based on their values and morals. However, in nursing research, this requirement cannot always be met. Advanced age, chronic illness, co-morbidity and frailty are reasons for dependencies. These in turn lead to limited abilities or opportunities for decision-making and self-determination. Exclusion of vulnerable people from research projects would disadvantage them by not covering their needs, which would violate the ethical principles of justice and beneficence. Commonly, vulnerability is attributed to social groups. The consequence for individuals, attributed as belonging to such a vulnerable group, is that the principles of respect for autonomy, justice and beneficence are subordinated to the principle of non-maleficence, understood as avoiding the risk to cause more harm than good. In addition, group-specific attribution could lead to stigmatizing because labelling a person as deviation from a norm violates integrity. For clinical nursing research, the question arises how the protection of vulnerable people could be granted without compromising ethical principles. The concept of relational ethics provides a possible approach. It defines vulnerability as the relation between a person’s health status and the extent to which this person is dependent on the researcher and the research context. Vulnerability is not attributed solely to a person but to a situation, meaning the person is viewed in context. By combining vulnerability as a context-related and situational concept with existing approaches of informed consent, the different ethical principles can be balanced and preserved at every step of the research process.
Background: The interest in the children’s role in pediatric care is connected to children’s health-related autonomy and informed consent in care. Despite the strong history of children’s rights, nurses’ role in the everyday nursing phenomenon, that is, restraint in somatic pediatric care, is still relatively seldom reported.
Aim: The aim of this study is to describe nurses’ perceptions of the use of restraint in somatic pediatric care. The ultimate aim is to deepen the understanding of the phenomenon of restraint, whose previous study has been fragmented.
Methods: Qualitative approach was selected because of the lack of previous information. Due to the sensitivity of the research question, individual interviewees were selected among voluntary nurses (n = 8). All participants were registered nurses with general work experience as nurses of 5–16 years on average and specifically 1.5–10 years in pediatric nursing. Inductive content analysis was used for aiming to produce a synthesis of the research phenomenon.
Ethical considerations: The research received organizational approval by the university hospital, and informed consent and confidentiality were ensured.
Results: Restraint in pediatric nursing was process-like, but occurred without advanced planning. The restraint-related process included five categories: (a) identification of the situations where restraint may occur, (b) finding preventive methods, (c) identification of different forms of restraint, (d) rationing the use of restraint, and (e) post-restraint acts. Restraint was seen as a part of pediatric nursing which occurred daily and involved several professionals. According to the nurses’ illustrations, restraint means doing things even when a child is not agreeable.
Conclusion: Restraint is part of somatic pediatric nursing, described as the last, but in some cases, the only resort for carrying out care or treatment. Restraint is not a goal in itself, but an instrumental tool and procedure in carrying out care. In the future, more information about nurses’ role and the use of restraint in pediatric nursing is still needed.
Background: The developments in technology and communication channels, increasing workload, and carelessness cause problems regarding patient privacy and confidentiality in nursing services.
Research objectives: The study was conducted to develop a patient privacy scale to identify whether nurses observe or violate patient privacy at workplace.
Research design: This research was a methodological and descriptive study.
Participants and research context: Participants were 354 nurses working at private hospitals and hospitals affiliated with the Ministry of Health in Istanbul/Turkey. Data were collected with a questionnaire about the demographic characteristics of nurses and their opinions about patient privacy and with patient privacy scale.
Ethical considerations: After getting permission from the top management of hospitals, information about the study was given to nurses. Those willing to participate were informed that participation was voluntary and invited to give written consent before data collection.
Findings: The content validity index of scale was 0.91, Cronbach’s alpha was 0.93, Spearman–Brown and Guttman coefficients were 0.85, the upper and lower 27% test was -29.65, and item-total correlation values ranged from 0.47 to 0.71. The scale had five subscales. In addition, 49% of the nurses stated that patient privacy was always observed in their services/units. They appraised with a mean score of 4.51 ± 0.49 for the total scale, 4.39 ± 0.61 for confidentiality of personal information and private life, 4.39 ± 0.70 for sexual privacy, 4.56 ± 0.57 for the privacy of those unable to protect themselves, 4.60 ± 0.59 for physical privacy, and 4.60 ± 0.52 for ensuring a favorable environment.
Discussion: The findings of this study were in contrast with the results of some international studies which determined the violation of the patient privacy.
Conclusion: The patient privacy scale is a valid and reliable tool to collect data on whether nurses observe or violate patient privacy, and the nurses generally reported observing or paying attention to patient privacy in all hospitals and especially private hospitals.
Background: Nursing practice is complex, as nurses are challenged by increasingly intricate moral and ethical judgments. Inadequately studied in underrepresented groups in nursing, moral distress is a serious problem internationally for healthcare professionals with deleterious effects to patients, nurses, and organizations. Moral distress among nurses has been shown to contribute to decreased job satisfaction and increased turnover, withdrawal from patients, physical and psychological symptoms, and intent to leave current position or to leave the profession altogether.
Research question: Do significant gender differences exist in the moral distress scores of critical care nurses?
Research design: This study utilized a quantitative, descriptive methodology to explore moral distress levels in a sample of critical care nurses to determine whether gender differences exist in their mean moral distress scores.
Participants and research context: Participants (n = 31) were critical care nurses from an American Internet nursing community who completed the Moral Distress Scale–Revised online over a 5-day period in July 2013.
Ethical considerations: Institutional review board review approved the study, and accessing and completing the survey implied informed consent.
Findings: The results revealed a statistically significant gender difference in the mean moral distress scores of participants. Females reported statistically significantly higher moral distress scores than did males. Overall, the moral distress scores for both groups were relatively low.
Discussion: The findings of a gender difference have not previously been reported in the literature. However, other findings are consistent with previous studies on moral distress.
Conclusion: Although the results of this study are not generalizable, they do suggest the need for continuing research on moral distress in underrepresented groups in nursing, including cultural and ethnic groups.
Background: At a time when British nursing has been under scrutiny for an apparent lack of compassion in education and practice, this paper based offers a perspective on the notions of vocation and altruism in nursing.
Objectives: To understand the vocational and altruistic motivations of nurses through the application of Pierre Bourdieu's concepts of ‘symbolic capital’, ‘field’ and ‘habitus’ through a long interview with nurse respondents.
Research design: A reflexive qualitative study was undertaken using the long interview. A thematic analysis of the data, using a qualitative data software package for analysis, was undertaken. The ideas of Pierre Bourdieu (Habitus, Capital and Field) were used to analyse and explain the content of community nurses' ‘talk’.
Participants: Twelve Community Nurses working in a variety of local primary care settings volunteered to participate in the study. It was a self-selecting convenience sample of nurses responding to an invitation to be interviewed.
Research context: A study in support of a doctoral thesis conducted within NHS primary care settings with registered nurses.
Ethical considerations: The key considerations for this study were to be mindful of the possibility of emotional harm or distress being caused to the respondents during the retelling of their experiences. It was also essential to ensure that the locations or names of patients or staff (if discussed) were anonymised. Ethical approval was sought and granted by both the Local NHS Primary Care and the University Ethics committees before the study commenced.
Findings: The nurse respondents had highly individual and at times contradictory views on their motivations to nurse including their views on vocation and altruism in nursing careers.
Discussion: Bourdieu's ideas apply well to the nursing context and provided a useful theoretical framework to explore the social and cultural influences on nursing careers. Gender is important consideration in all aspects of nursing but class and educational experience is an important dimension in the stories nurses tell.
Conclusion: The culturally determined experiences of these nurses in practice offer an authentic and realistic insight into the complex motives and predispositions of community nurses. This paper argues that nurse motivations whether vocational or altruistic, are better understood as culturally, rather than spiritually, driven.
Background: Nurse managers are placed in a unique position within the healthcare system where they greatly impact upon the nursing work environment. Ethical dilemmas and moral distress have been reported for staff nurses but not for nurse middle managers.
Objective: To describe ethical dilemmas and moral distress among nurse middle managers arising from situations of ethical conflict.
Methods: The Ethical Dilemmas in Nursing–Middle Manager Questionnaire and a personal characteristics questionnaire were administered to a convenience sample of middle managers from four hospitals in Israel.
Results: Middle managers report low to moderate levels of frequency and intensity of ethical dilemmas and moral distress. Highest scores were for administrative dilemmas.
Conclusion: Middle managers experience lower levels of ethical dilemmas and moral distress than staff nurses, which are irrespective of their personal characteristics. Interventions should be developed, studied, and then incorporated into institutional frameworks in order to improve this situation.
Background: A limited number of studies have shown that patient advocacy can be influenced by both facilitators and barriers which can encourage and discourage nurses to act as patient advocates.
Objective: This study’s aim was to describe Swedish nurses’ perceptions of influencers on patient advocacy.
Research design and context: Interviews with 18 registered nurses from different Swedish clinical contexts were analysed using the phenomenographic method.
Ethical considerations: Ethical revisions were made in accordance with national legislation and guidelines by committees for research ethics at Karlstad University.
Findings: Three levels of hierarchically related influencers on patient advocacy were found in the descriptive categories. The fundamental influencer, the nurse’s character traits, was described in the perceptions that advocacy is influenced by nurse’s having a moral compass, having control over the care situation, being protective and feeling secure as a nurse. The second most vital influencer, the nurse’s bond with the patient, was expressed in the perceptions of knowing the patient and feeling empathy for the patient. The third level of influencers, the organisational conditions, was described in the perceptions that the organisational structures and organisational culture influence patient advocacy.
Discussion: The results correspond with findings from earlier research but add an understanding that influencers on patient advocacy exist at three hierarchically related levels.
Conclusion: The nurse’s character traits are the fundamental influencer to patient advocacy, but in order to be comfortable and secure when advocating for patients, nurses also need to be familiar with both the patient and the situation. A supposition could be that all influencers interact, which needs to be further addressed in future studies.
Background: Currently preterm births are the leading causes of newborn deaths and newborn mortality in developed countries. Infants born prematurely remain vulnerable to many acute complications and long-term disabilities. There is a growing concern surrounding the moral and ethical implications of the complex and technological care being provided to extremely low birth weight infants in neonatal intensive care units in the developed nations.
Research purpose: The purpose of this study was to describe the ethical and moral issues that neonatal intensive care nurses experience when caring for low birth weight preterm infants and their families.
Research design: A phenomenological method design was used to describe the lived experiences of nurses with ethical and moral issues encountered in the neonatal intensive care unit. One-on-one, semi-structured interviews using open-ended questions were used to gather data from the participants.
Research participants: The setting for this study was a 97-bed neonatal intensive care. A total of 16 female nurses were interviewed.
Ethical considerations: Approval to conduct the research study was obtained from the institutional review board of the hospital where the study was conducted. Formal signed consent was obtained from each participant. To ensure confidentiality, each participant was asked to choose a confederate name to be used in the interview and the transcriptions.
Findings: The thematic analysis identified five recurring themes: (a) at the edge of viability, (b) infant pain and discomfort, (c) crucial decisions, (d) communicating with parents, and (e) letting go.
Conclusion: Neonatal intensive care unit nurses indicated that they often had challenges to their own sense of morality as they struggled to protect the infant from pain and unnecessary discomfort, provide care to an infant and their family whom they thought was faced with a lifetime of challenges and poor health, accepting decisions made by parents, and feeling as if parents were not adequately informed about outcomes.
Background:The complexity and variety of ethical issues in nursing is always increasing, and those issues lead to special concerns for nurses because they have critical impacts on nursing practice.
Research objectives: The purpose of this study was to gather comprehensive information about ethical issues in nursing practice, comparing the issues in different types of nursing units including general units, oncology units, intensive care units, operating rooms, and outpatient departments.
Research design: The study used a descriptive research design. Ethics/human rights issues encountered by nurses in their daily nursing practice were identified by using the Ethical Issues Scale.
Participants: The study sample included 993 staff nurses working in a university hospital in South Korea.
Ethical considerations: This study was approved by the University Institutional Review Board. Completed questionnaires were returned sealed with signed informed consent.
Findings: The most frequently and disturbingly encountered issues across nursing units were "conflicts in the nurse–physician relationship," "providing care with a possible risk to your health," and "staffing patterns that limit patient access to nursing care." The findings of this study showed that nurses from different nursing units experienced differences in the types or frequency of ethical issues. In particular, intensive care units had the greatest means of all the units in all three component scales including end-of-life treatment issues, patient care issues, and human rights issues.
Discussion: Nurses experienced various ethical challenges in their daily practice. Of the ethical issues, some were distinctively and frequently experienced by nurses in a specific unit.
Conclusion: This study suggested that identifying and understanding specific ethical issues faced by nurses in their own areas may be an effective educational approach to motivate nurses and to facilitate nurses’ reflection on their experiences.
Background: Attention to ethical leadership in nursing has diminished over the past several decades. Objectives: The aim of our study was to investigate how frontline nurses and formal nurse leaders envision ethical nursing leadership. Research design: Meta-ethnography was used to guide our analysis and synthesis of four studies that explored the notion of ethical nursing leadership. Participants and research context: These four original studies were conducted from 1999-2008 in Canada with 601 participants. Ethical considerations: Ethical approval from the original studies covered future analysis. Findings: Using the analytic strategy of lines-of-argument, we found that 1) ethical nursing leadership must be responsive to practitioners and to the contextual system in which they and formal nurse leaders work, and 2) ethical nursing leadership requires receiving and providing support to increase the capacity to practice and discuss ethics in the day-to-day. Discussion and conclusion: Formal nurse leaders play a critical, yet often neglected role, in providing ethical leadership and supporting ethical nursing practice at the point of patient care.
Background: As part of an ongoing Scandinavian project on the dignity of care for older people, this study is based on ‘clinical caring science’ as a scientific discipline. Clinical caring science examines how ground concepts, axioms and theories are expressed in different clinical contexts. Central notions are caring culture, dignity, at-home-ness, the little extra, non-caring cultures versus caring cultures and ethical context – and climate.
Aim and assumptions: This study investigates the individual variations of caring cultures in relation to dignity and how it is expressed in caring acts and ethical contexts. Three assumptions are formulated: (1) the caring culture of nursing homes influences whether dignified care is provided, (2) an ethos that is reflected on and appropriated by the caregiver mirrors itself in ethical caring acts and as artful caring in an ethical context and (3) caring culture is assumed to be a more ontological or universal concept than, for example, an ethical context or ethical person-to-person acts.
Research design: The methodological approach is hermeneutic. The data consist of 28 interviews with relatives of older persons from Norway, Denmark and Sweden.
Ethical considerations: The principles of voluntariness, confidentiality and anonymity were respected during the whole research process.
Findings: Three patterns were revealed: dignity as at-home-ness, dignity as the little extra and non-dignifying ethical context.
Discussion: Caring communion, invitation, at-home-ness and ‘the little extra’ are expressions of ethical contexts and caring acts in a caring culture. A non-caring culture may not consider the dignity of its residents and may be represented by routinized care that values organizational efficiency and instrumentalism rather than an individual’s dignity and self-worth.
Conclusion: An ethos must be integrated in both the organization and in the individual caregiver in order to be expressed in caring acts and in an ethical context that supports these caring acts.
Objective: To explore nurses’ experiences and perceptions about prioritizations, omissions, and rationing of bedside nursing care.
Methods: A total of 23 nurses participated in four focus groups. The interviews were based on a semi-structured interview guide; data were analyzed using a thematic analysis approach.
Findings: Four themes were developed based on the data: (a) priorities in the delivery of care; (b) professional roles, responsibilities, and role conflicts; (c) environmental factors influencing care omissions; and (d) perceived outcomes of rationing.
Discussion: The delivery of nursing care is framed by the biomedical ethos and inter-professional role conflict while the standards of basic care are jeopardized. Organizational and environmental factors appear to exert significant influence on prioritization. Failure to carry out necessary nursing tasks may lead to adverse patient outcomes, role conflict, and an ethical burden on nurses.
Conclusion: There is a need for further exploration and possible redesign of the nursing role, scope, and responsibilities, as well as addressing the arising ethical issues of rationing in nursing care.
Customarily patient advocacy is argued to be an essential part of nursing, and this is reinforced in contemporary nursing codes of conduct, as well as codes of ethics and competency standards governing practice. However, the role of the nurse as an advocate is not clearly understood. Autonomy is a key concept in understanding advocacy, but traditional views of individual autonomy can be argued as being outdated and misguided in nursing. Instead, the feminist perspective of relational autonomy is arguably more relevant within the context of advocacy and nurses’ work in clinical healthcare settings. This article serves to highlight and problematise some of the assumptions and influences around the perceived role of the nurse as an advocate for patients in contemporary Western healthcare systems by focusing on key assumptions concerning autonomy inherent in the role of the advocate.
Background: Hematopoietic stem cell transplantation is a potential cure for a range of life-threatening diseases, but is also associated with a high mortality rate. Nurses encounter a variety of situations wherein they are faced with discussing bad news with hematopoietic stem cell transplantation patients.
Research objective: The aim of this study was to explore the experiences and strategies used by Iranian nurses related to truth-telling and communicating bad news to hematopoietic stem cell transplantation patients.
Research design: A qualitative approach using content analysis of interview data was conducted.
Participants and research context: A total of 18 nurses from the main hematopoietic stem cell transplantation center in Iran participated in semi-structured interviews.
Ethical considerations: The Institutional Review Board of the Tabriz University of Medical Sciences and the Hematology-Oncology and Stem Cell Transplantation Research Center affiliated with the Tehran University of Medical Sciences approved the study.
Findings: In the first main category, not talking about the disease and potential negative outcomes, the nurses described the strategies of not naming the disease, talking about the truth in indirect ways and telling gradually. In the second main category, not disclosing the sad truth, the nurses described the strategies of protecting patients from upsetting information, secrecy, denying the truth and minimizing the importance of the problem. The nurses used these strategies to minimize psychological harm, avoid patient demoralization, and improve the patient’s likelihood of a fast and full recovery.
Discussion: The priority for Iranian hematopoietic stem cell transplantation nurses is to first do no harm and to help patients maintain hope. This reflects the Iranian healthcare environment wherein communicating the truth to hematopoietic stem cell transplantation patients is commonly considered inappropriate and avoided.
Conclusion: Iranian nurses require education and support to engage in therapeutic, culturally appropriate communication that emphasizes effective techniques for telling the truth and breaking bad news, thereby potentially improving patient outcomes and protecting patient rights.
Background: Clinical education is an essential part of the Bachelor’s program in Nursing and a keystone of professional nursing education. Through clinical experiences, the student nurses acquire nursing knowledge and essential skills for professional practice. The preceptor plays a vital role in the development of student nurses becoming professional nurses.
Aim: The aim of this Nordic qualitative study was to explore the experiences of good preceptorship in relation to undergraduate student nurses in clinical education from the perspective of the preceptors themselves.
Method: Data were collected by narrative interviews with 27 preceptors in Finland and Sweden and analyzed using a hermeneutical approach.
Findings: A caring relationship, based on caring ethics, is seen as the foundation for learning and development. Moreover, a mutual respect is a prerequisite for fellowship and a good atmosphere. As such, encounters are characterized by reciprocity and mutuality. The preceptors have a deep sense of responsibility toward the students and the profession. Furthermore, the preceptors have an inner responsibility to guide the students into working life and to share their knowledge by acting as role models.
Conclusion: The findings suggest that preceptorship should be examined through new lenses. Moreover, preceptorship is an ethical issue that should be recognized by all stakeholders.
Background: Ethical issues associated with nurses’ interactions with industry have implications for the safety, quality, and cost of healthcare. To date, little work has explored nurse–industry interactions and their associated ethical issues empirically.
Design and participants: A phenomenological study was conducted to explore registered nurses’ interactions with industry in clinical practice. Five registered nurses working in direct patient care were recruited and individual, in-depth interviews were conducted. The University’s Committee on Human Research approved the study.
Findings: Nurses frequently interacted with industry in their practice and felt ambivalent about these interactions. Nurses described systemic cuts to multiple "goods" central to nursing practice, including patient support, but paradoxically relied on industry resources to deliver these "goods." They relied on a particular conception of trust to navigate these interactions but were left to do so individually on the basis of their experience. Conflicts of interest arose as a result of multiple competing interests, and were frequently mediated through nurses’ superiors.
Conclusion: Nursing as a profession requires a guiding narrative to aid nurses in interpreting and navigating interactions with industry. A conception of trust that incorporates both the work of caring and attention to social justice could form the basis of these interactions, but would require that nursing take a much more critical stance toward marketing interactions.
Prehospital emergency medicine is a specific field of emergency medicine. The basic approach of prehospital emergency medicine is to provide patients with medical intervention at the scene of the incident. This special environment causes health professionals to encounter various problems. One of the most important problems in this field is ethics, in particular questions involving refusal of treatment and the processes associated with it.
The objective of this study is to identify emergency health professionals’ views regarding refusal of treatment.
This study was conducted with 356 health professionals who were on active duty in prehospital emergency health services. The data were collected through a form which included 10 statements. The participants were asked to indicate their level of agreement with the statements given by rating them between 0 and 10.
Before conducting the research, permission was received from the local ethics committee. Participants were given written information about the purpose of the study. Participants were assured that their participation was voluntary.
The healthcare professionals with fewer years of experience in the profession and female participants adopted an attitude of giving priority to providing care. Young participants, in general, respected patient autonomy. However, paradoxically, when it comes to emergency medical cases, they expressed an opinion closer to paternalism.
This study has found that prehospital emergency health professionals generally respect the patient’s right to refuse treatment; however, they do not prioritize this right when there is a life-threatening situation or when the person does not have decision-making capacity. In these cases, prehospital emergency health professionals tended to adopt a more paternalistic approach.
Moral distress has been characterised in the nursing literature as a major problem affecting nurses in all healthcare systems. It has been portrayed as threatening the integrity of nurses and ultimately the quality of patient care. However, nursing discourse on moral distress is not without controversy. The notion itself is conceptually flawed and suffers from both theoretical and practical difficulties. Nursing research investigating moral distress is also problematic on account of being methodologically weak and disparate. Moreover, the ultimate purpose and significance of the research is unclear. In light of these considerations, it is contended that the notion of moral distress ought to be abandoned and that concerted attention be given to advancing inquiries that are more conducive to improving the quality and safety of moral decision-making, moral conduct and moral outcomes in nursing and healthcare domains.
Involving patients in decisions on primary prevention can be questioned from an ethical perspective, due to a tension between health promotion activities and patient autonomy. A nurse-led intervention for prevention of cardiovascular diseases, including counselling (risk communication, and elements of shared decision-making and motivational interviewing) and supportive tools such as a decision aid, was implemented in primary care. The aim of this study was to evaluate the nurse-led intervention from an ethical perspective by exploring in detail the experiences of patients with the intervention, and their views on the role of both the nurse and patient. The study had a qualitative design. 18 patients who had received the intervention participated. Data were gathered by in-depth interviews. The interviews were analysed using directed content analysis. The findings revealed that patients perceived the consultations not as an infringement on their autonomy, but as supportive to risk reduction efforts they tried but found hard to realise. They specifically emphasised the role of the nurse, and appreciated the nurse's realistic advice, encouragement, and help in understanding. Patients' views on and experiences with risk management are in line with notions of relational autonomy, caring cooperation and communicative action found in the literature. We conclude that patients define the relationship with the nurse as shared work in the process of developing a healthier lifestyle.
This article aims to initiate a discussion on the demarcation of the ethics of care. This discussion is necessary because the ethics of care evolves by making use of insights from varying disciplines. As this involves the risk of contamination of the care ethical discipline, the challenge for care ethical scholars is to ensure to retain a distinct care ethical perspective. This may be supported by an open and critical debate on the criteria and boundaries of the ethics of care. As a contribution, this article proposes a tentative outline of the care ethical discipline. What is characteristic of this outline is the emphasis on relational programming, situation-specific and context-bound judgments, a political–ethical perspective, and empirical groundedness. It is argued that the ethics of care is best developed further by means of an intradisciplinary approach. Two intradisciplinary examples show how within the frame of one discipline, other disciplines are absorbed, both with their body of knowledge and their research methodology.
Background: Ethics-of-care theories contain important notions regarding the quality of care; however, until now, concrete translations of the insights into instruments are lacking. This may be a result of the completely different type of epistemology, theories and concepts used in the field of quality of care research. Objectives: Both the fields of ‘ethics of care’ and ‘quality of care’ aim for improvement of care; therefore; insights could possibly meet by focusing on the following question: How could ethics-of-care theories contribute to better quality in care at a measurement level? This study reviews existing instruments with the aim of bridging this gap and examines the evidence of their psychometric properties, feasibility and responsiveness. Research design: A systematic search of the literature was undertaken using multiple electronic databases covering January 1990 through May 2012. Method and findings: Of the 3427 unique references identified, 55 studies describing 40 instruments were selected. Using a conceptual framework, an attempt was made to distinguish between related concepts and to group available instruments measuring different types of concepts. A total of 13 instruments that reflect essential aspects of ethics-of-care theory were studied in greater detail, and a quality assessment was conducted. Conclusion: Three promising qualitative instruments were found, which follow the logic of the patient and take their specific context into account.
Nurses are frequently confronted with ethical dilemmas in their nursing practice. As a consequence, nurses report experiencing moral distress. The aim of this review was to synthesize the available quantitative evidence in the literature on moral distress experienced by nurses. We appraised 19 articles published between January 1984 and December 2011. This review revealed that many nurses experience moral distress associated with difficult care situations and feel burnout, which can have an impact on their professional position. Further research is required to examine worksite strategies to support nurses in these situations and to develop coping strategies for dealing with moral distress.
In this article, an intervention aimed at improving quality of care to prevent seclusion in psychiatry by focusing on the first five minutes at admission is analyzed from a care ethics perspective. Two cases are presented from an evaluation study in a psychiatric hospital. In both cases, the nurses follow the intervention protocol, but the outcome is different. In the first case, the patient ends up in the seclusion room. In the second case, this does not happen. Analyzing the cases from a care ethics perspective, we conclude that applying the intervention in the right way implies more than following the steps laid down in the protocol. It requires a new way of thinking and acting, resulting in new relationships between nurses and patients. Care ethics theory can help clarify what good care is actually about and keep in mind what is needed to apply the intervention. Thus, care ethics theory can be highly practical and helpful in changing and improving healthcare practice.
Patient dignity in involuntary psychiatric hospital care is a complex yet central phenomenon. Research is needed on the concept of dignity’s specific contextual attributes since nurses are responsible for providing dignified care in psychiatric care. The aim was to describe nurses’ experiences of violation of patient dignity in clinical caring situations in involuntary psychiatric hospital care. A qualitative design with a hermeneutic approach was used to analyze and interpret data collected from group interviews. Findings reveal seven tentative themes of nurses’ experiences of violations of patient dignity: patients not taken seriously, patients ignored, patients uncovered and exposed, patients physically violated, patients becoming the victims of others’ superiority, patients being betrayed, and patients being predefined. Understanding the contextual experiences of nurses can shed light on the care of patients in involuntary psychiatric hospital care.
The aim of this article was to critically analyse the concept of person-centred participation in healthcare from patients’ perspectives through a review of qualitative research findings. In accordance with the integrative review method of Broom, data were retrieved from databases, but 60 studies were finally included in the study. The diverse attributes of person-centred participation in healthcare were identified and contrasted with participation that was not person-centred and analysed through framework analysis. Person-centred participation in healthcare was found to be based on patients’ experiences, values, preferences and needs in which respect and equality were central. It manifested itself via three intertwined phases: the human-connection phase, the phase of information processing and the action phase. The results challenge in many aspects earlier concept analyses of patient participation in addition to illuminating patient participation that is not positively valued by patients.
This study presents findings from an ontological and contextual determination of the concept of dignity. The study had a caritative and caring science perspective and a hermeneutical design. The aim of this study was to increase caring science knowledge of dignity and to gain a determination of dignity as a concept. Eriksson’s model for conceptual determination is made up of five part-studies. The ontological and contextual determination indicates that dignity can be understood as absolute dignity, the spiritual dimension characterized by responsibility, freedom, duty, and service, and relative dignity, characterized by the bodily, external aesthetic dimension and the psychical, inner ethical dimension. Dignity exists in human beings both as absolute and relative dignity.
Patient requests for a healthcare provider of a particular race or sexual orientation create a conflict of obligations. On the one hand, providers have a duty to deliver clinically indicated care consistent with patient preferences. On the other hand, providers have legal, professional, and organizational assurances that they should not suffer workplace discrimination. Protecting healthcare providers from harm while maintaining obligations to patients requires unambiguous messaging to both parties. Providers need to be clear that their organization will not be complicit in discrimination against them, instead supporting their needs and preferences for management of the situation. In a context of patient-centered care, harm principle-based boundaries of respect for autonomy must be defined. A Caregiver preference guideline developed and used at University Health Network, Toronto provides a standardized way for the organization to decide when it will honor patient requests for providers of a particular background. This process stresses dialogue, assessment of clinical feasibility, and empowerment and support for affected care providers.
The aim of this study was to explore the experience of nursing personnel with respect to patient participation in special care units for persons with dementia in nursing homes, with focus on everyday life. The study has an explorative grounded theory design. Eleven nursing personnel were interviewed twice. Patient participation is regarded as being grounded in the idea that being master of one’s own life is essential to the dignity and self-esteem of all people. Patient participation was described at different levels as letting the resident make their own decisions, adjusting the choices, making decisions on behalf of the residents and forcing the residents. The educational level and commitment of the nursing personnel and how often they were on duty impacted the level that each person applied, as did the ability of the residents to make decisions, and organizational conditions, such as care culture, leadership and number of personnel.
We examined nurses’ perceptions of the ethical climate of their workplace and the relationships among the perceptions, medical error experience and intent to leave through a cross-sectional survey of 1826 nurses in 33 Korean public hospitals. Ethical climate was measured using the Hospital Ethical Climate Survey. Although the sampled nurses perceived their workplace ethical climate positively, 19% reported making at least one medical error during the previous year, and 25% intended to leave their jobs in the near future. Controlling for individual and organizational characteristics, we found that nurses with a more positive perception of the ‘patient’ dimension of ethical climate were less likely to have made medical errors. Nurses with a more positive perception of the ‘patient’, ‘manager’, ‘hospital’ and ‘physician’ dimensions of ethical climate were less likely to leave their current job. Enhancing workplace ethical climate could reduce medical errors and improve nurses’ retention in public hospitals.
Research ethics is always important. However, it is especially crucial with sensitive research topics such as family violence. The aim of this article is to describe and discuss some crucial issues regarding intimate partner violence and child maltreatment, based on the authors’ own research experiences. We focus on and discuss examples concerning the definition of family violence, research design, ethical approval, participant recruitment and safety and data collection and processing. During the research process, the significance of teamwork is emphasized. Support provided by the participants to each other and support given by experienced researchers within the team is very important for high ethical standards.
Nurse researchers engaged in qualitative interviews with patients and spouses in healthcare may often experience being in unforeseen ethical dilemmas. Researchers are guided by the bioethical principles of justice, beneficence, non-maleficence, respect for human rights and respect for autonomy through the entire research process. However, these principles are not sufficient to prepare researchers for unanticipated ethical dilemmas related to qualitative research interviews. We describe and discuss ethically challenging and difficult moments embedded in two cases from our own phenomenological interview studies. We argue that qualitative interviews involve navigation between being guided by bioethics as a researcher, being a therapist/nurse and being a fellow human being or even a friend. The researchers’ premises to react to unexpected situations and act in a sound ethical manner must be enhanced, and there is a need for an increased focus on the researchers’ ethical preparation and to continually address and discuss cases from their own interviews.
The very term `professional ethics' is puzzling with respect to what both `professional' and `ethics' might mean. I argue (1) that professionalism is ambiguous as to whether or not it is implicitly committed to ethical practice; (2) that to be `professionally' ethical is at best ambiguous, if not in fact bizarre; and (3) that, taken together, these considerations suggest that professional ethics is something to be avoided rather than lauded.
Successful clinical research outcomes are essential for improving patient care. Achieving this goal, however, implies an effective informed consent process for potential research participants. This article traces the development of ethical and legal requirements of informed consent and examines the effectiveness of past and current practice. The authors propose the use of innovative monitoring methodologies to improve outcomes while safeguarding consent relationships and activities. Additional rigorous research will help direct policy efforts at standardizing quality improvement processes.
Research indicates the essentiality of dignity as a vital component for quality of life, reconfirming the emphasis on dignity preservation in the international code of nursing ethics. Applying Noblit and Hare’s meta-ethnography, the aim of the study was to develop a theory model by synthesizing 10 qualitative articles from various cultural contexts, exploring nurse and allied healthcare professional perception/practice concerning dignity-preserving dementia care. "Advocating the person’s autonomy and integrity," which involves "having compassion for the person," "confirming the person’s worthiness and sense of self," and "creating a humane and purposeful environment," was identified as a primary foundation for dignity-preserving dementia care. "Balancing individual choices among persons no longer able to make sound decisions, against the duty of making choices on behalf of the person," which involves "persuasion" and/or "mild restraint," was considered a crucial aspect in certain situations. "Sheltering human worth—remembering those who forget" was identified as a comprehensive motive and core value within dignity-preserving dementia care.
The aim of this observational longitudinal cohort study was to describe relationships over time between degrees of stress of conscience, perceptions of conscience, burnout scores and assessments of person-centred climate and social support among healthcare personnel working in municipal care of older people. This study was performed among registered nurses and nurse assistants (n = 488). Data were collected on two occasions. Results show that perceiving one’s conscience as a burden, having feelings of emotional exhaustion and depersonalization and noticing disturbing conflicts between co-workers were positively associated with stress of conscience. No significant changes were observed during the year under study, but degrees of stress of conscience and burnout scores were higher than in previous studies, suggesting that downsizing and increased workloads can negatively affect healthcare personnel. Following and expressing one’s conscience in one’s work, and perceiving social support from superiors are of importance in buffering the effects of stress of conscience.
The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account.
Globalization is a part of modern life. Sharing a common set of professional nursing values is critical in this global environment. The purpose of this research was to examine the professional values of nursing students from two distinct cultural perspectives. Nurse educators in Taiwan partnered with nurse educators in the United States to compare professional values of their respective graduating nursing students. The American Nurses Association Code of Ethics served as the philosophical framework for this examination. The convenience sample comprised 94 Taiwanese students and 168 US students. Both groups reported high scores on an overall measure of values. They did differ substantially on the relative importance of individual items related to advocacy, competence, education, self-evaluation, professional advancement, and professional associations. Global implications for the collaborative practice of nurses from different cultures working together can be improved by first recognizing and then attending to these differences in value priorities.
The aim of this article is to investigate how life in Norwegian nursing homes may affect experiences of dignity among persons with dementia. The study had a qualitative design and used a phenomenological and hermeneutic approach. Participant observation in two nursing home units was combined with qualitative interviews with five residents living in these units. The study took place between March and December 2010. The residents feel that their freedom is restricted, and they describe feelings of homesickness. They also experience that they are not being seen and heard as individual autonomous persons. This lack of freedom, experiences of homesickness and feelings of not being confirmed and respected as individual autonomous persons may be a threat to their personal dignity. In order to protect and enforce the dignity of persons with dementia living in nursing home, we should confirm them as whole and as individual persons, and we should try to make the nursing homes less institutional and more home like.
In the issue of futile treatments, patients and healthcare professionals tend to disagree. We conducted an Internet questionnaire survey and explored the Japanese nurses’ attitude toward this topic, comparing with that of laypeople. In total, 522 nurses and 1134 laypeople completed the questionnaire. Nurse respondents were significantly less in favor of providing potentially futile treatments in hypothetical vignettes and stressed quality of life of the patient for judging the futility of a certain treatment. Of them, 85.4% reported having experienced providing such treatments. Reasons for providing them included factors related to not only patients but also healthcare teams. Our results indicate that attitudes among Japanese nurses toward the issue of futile treatments are different from patients and that their actual practice is influenced by several situational factors.
To effectively train ethical decision-making of nursing students, a case-based computer program was developed using Flash animation. Seven ethical cases collected from practicing registered nurses’ actual clinical experiences and a six-step Integrated Ethical Decision-Making Model developed by the author were employed in the program. In total, 251 undergraduate students from three nursing schools used the program in their nursing ethics course. The usability of the program and its usefulness in improving 11 abilities needed in ethical decision-making were measured; it scored higher than 4 on a 5-point scale. Of the students, 82% recommended the program as a valuable complementary tool in the teaching of a nursing ethics course. A variety of encouraging and positive experiences were reported by the students. The computer program is likely to be usefully practical in the training of abstract skills to nursing students, though certain challenges remain, such as the precise understanding of cognitive or affective responses to ethical issues.
The purpose of this article is to discuss the ethical issues impacting the phenomenon of patient safety and to present implications for nursing management. Previous knowledge of this perspective is fragmented. In this discussion, the main drivers are identified and formulated in ‘the ethical imperative’ of patient safety. Underlying values and principles are considered, with the aim of increasing their visibility for nurse managers’ decision-making. The contradictory nature of individual and utilitarian safety is identified as a challenge in nurse management practice, together with the context of shared responsibility and identification of future challenges. As a conclusion, nurse managers play a strategic role in patient safety. Their role is to incorporate ethical values of patient safety into decision-making at all levels in an organization, and also to encourage clinical nurses to consider values in the provision of care to patients. Patient safety that is sensitive to ethics provides sustainable practice where the humanity and dignity of all stakeholders are respected.
Ethical care is beginning to be recognised as care that accounts for the views of those at the receiving end of care. However, in the context of palliative and supportive district nursing care, the patients’ and their carers’ views are seldom heard. This qualitative research study explores these views. Data were collected through semi-structured interviews with 26 patients with palliative and supportive care needs receiving district nursing care, and 13 of their carers. Participants were recruited via community nurses and hospices between September 2010 and October 2011. Post-structural discourse analysis is used to examine how discourses operate on a moral level. One discourse, ‘busyness’, is argued to preclude a moral form of nursing care. The discourse of friendship is presented to contrast this. Discussion explores Gallagher’s ‘slow ethics’ and challenges the currently accepted ways of measuring to improve quality of care concluding that quality cannot be measured.
Recruitment of nurses by industrialized nations from developing countries has been common practice for decades. Globalization, a crucial trend of the 21st century, raises the world’s awareness of the economic and social disparities between nations. The direct impact on nurse emigration emphasizes the ethical, economic, and social inequalities between source and destination countries. It is often more cost-effective for industrialized countries to recruit from developing countries; however, the depletion of source country resources has created a global healthcare crisis. Destination countries are being challenged on the ethical implications of aggressive recruitment and their lack of developing a sustainable self-sufficient domestic workforce. Similarly, source countries are confronting the same challenges as they struggle to fund and educate adequate numbers of nurses for domestic needs and emigrant replacement. This article will review the ethical, economic, and social impacts of continued unrestricted international recruitment of nurses and present a proposal for development of an international treaty addressing global sustainability.
Our objective was to better understand the values and ethical dilemmas surrounding advance care planning through stories told by registered nurses and licensed social workers, who were employed as care managers within Area Agencies on Aging. We conducted eight focus groups in which care managers were invited to tell their stories and answer open-ended questions focusing on their interactions with consumers receiving home-based long-term care. Using narrative analysis to understand how our participants thought through particular experiences and what they valued, we identified seven themes representative of their work with consumers and families: humility, respect, responsibilities, boundaries, empowerment, courage, and veracity.
This article reports findings of a hermeneutic phenomenological study that explored the clinical learning experience for Malawian undergraduate student nurses. The study revealed issues that touch on both nursing education and practice, but the article mainly reports the practice issues. The findings reveal the emotions that healthcare workers in Malawi encounter as a consequence of practising in resource-poor settings. Furthermore, there is severe nursing shortage in most clinical settings in Malawi, and this adversely affects the performance of nurses because of the excess workload it imposes on them. The results of the study also illustrate loss of professional pride among some of the nurses, and the article argues that such a demeanour is a consequence of burnout. However, despite these problems, the study also reveals that there are some nurses who have maintained their passion to care.
The aim of this study was to identify key aspects in the exchange of information and to determine how nurses communicate news to hospitalised children. For this study, we applied the critical incident technique with 30 children aged between 8 and 14 years. Data were collected in paediatric units in a hospital in Alicante (Spain) using participant observation and semi-structured interviews. The analysis yielded three main categories: the children’s reaction to the information, nursing staff behaviour as a key aspect in the exchange of information and communication of news as well as children’s experience. This article emphasises the need to promote children’s consent and participation in nursing interventions. An analysis of these aspects will verify whether children’s rights are being respected and taken into account in order to promote children’s well-being and adaptation to hospitalisation.
The aim of this study was to illuminate the meaning of receiving help from home nursing care for the chronically ill, elderly persons living in their homes. The study was carried out in Norway. Data were collected by narrative interviews and analysed by phenomenological hermeneutic interpretations. Receiving help from home nursing care sometimes meant ‘Being ill and dependent on help’. Other times it meant ‘Being at the mercy of help’. It could also mean ‘Feeling inferior as a human being’. Sometimes help was given by nurses who were respectful and proficient at caring for an elderly person, while at other times nurses seemed to be incompetent and worked with a paternalistic attitude without respect for privacy. Receiving help also meant elderly persons wanted to be regarded and approached as equal human beings, supported in the courage to meet challenges in life.
Intentional rounding, a process involving the performance of regular checks on all patients following a standardised protocol, is being introduced widely in the United Kingdom. The process has been promoted by the Prime Minister and publicised by the Chief Nursing Officer at the Department of Health as well as by influential think tanks and individual National Health Service organisations. An evidence base is offered in justification. This article subjects the evidence base to critical scrutiny concluding that it consists of poor quality studies and serial misreporting of findings and a failure to consider wider concerns, including transference of evidence to differing health-care systems, and the conflation of perception and quality of care. Political promotion and wide implementation of intentional rounding despite the flimsy and questionable evidence base raise questions about the use of evidence in ethical nursing practice and the status of nursing as an autonomous profession.
Student nurses’ professional development arises through socialisation in nursing knowledge, values and behaviours. Students are expected to demonstrate compassion; however, compassion is a complex concept, one that creates emotional challenges. A grounded theory study was undertaken to explore student nurse socialisation in compassionate practice. In-depth interviews were undertaken with 19 students in the north of England during 2009–2010, and their concerns and concern management emerged. Students expressed several concerns, one being their emotional vulnerability and uncertainty of the emotional requirements for compassionate practice. A core category of ‘balancing future intentions’ was identified: that students managed feelings of vulnerability and uncertainty through balancing their intentions towards and away from engagement in compassionate practice, depending upon perceived impact on their emotional well-being. The findings are discussed in relation to emotional labour and moral distress, and courage, resilience and self-compassion are explored as a means to enable sustainable compassionate practice.
This integrative review aims to provide a synthesis of research findings of health-care professionals’ knowledge, attitudes and behaviours relating to patient capacity to consent to or refuse treatment within the general hospital setting. Search strategies included relevant health databases, hand searching of key journals, ‘snowballing’ and expert recommendations. The review identified various knowledge gaps and attitudinal dispositions of health-care professionals, which influence their behaviours and decision-making in relation to capacity to consent processes. The findings suggest that there is tension between legal, ethical and professional standards relating to the assessment of capacity and consent within health care. Legislation and policy guidance concerning capacity assessment processes are lacking, and this may contribute to inconsistencies in practice.
It is important to define and practice ethical rules and codes for professionalisation. Several national and international associations have determined midwifery ethical codes. In Turkey, ethical rules and codes that would facilitate midwifery becoming professionalised have not yet been determined. This study was planned to contribute to the professionalisation of midwifery by determining national ethical values and codes. A total of 1067 Turkish midwives completed the survey. The most prevalent values of Turkish midwives were care for mother–child health, responsibility and professional adequacy. The preferred professional codes chosen by Turkish midwives were absence of conflicts of interest, respect for privacy, avoidance of deception, reporting of faulty practices, consideration of mothers and newborns as separate beings and prevention of harm. In conclusion, cultural values, beliefs and expectations of society cannot be underestimated, although the international professional values and codes of ethics contribute significantly to professionalisation of the midwifery profession.
A relatively small but intellectually robust strand in the Christian religion is the Reformed tradition. Especially, its Calvinist sensibilities inform this Protestant stance towards human culture in general and vocations in particular. Correspondingly, there are some small but robust contributions to academic discourse in nursing ethics. So far there has been no attempt to bring those together as a distinct approach. This article suggests such a Reformed Christian, especially Calvinist, account of nursing ethics. Central to the Reformed perspective is the notion that God is sovereign over all of creation and culture and hence that there can be no religiously or morally neutral area in human life. Consequently, nursing is not seen as professional to the extent it is based on research evidence or theoretical models, but to the extent it serves the ultimate purpose of the practice of care. In the Reformed view, this purpose is fostering the well-being of human beings in need as intrinsically valuable. Nurses are professionals who accept this responsibility, that is, the whole of expectations holding for personal qualities, conduct and outcomes, required to serve the purpose of care. As this is a moral purpose, succeeding or failing to live up to these expectations is the source of moral issues in nursing.
The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life.
The ageing and frail migrants who are at the end of life are an increasing share of migrants living in Australia. However, within such populations, information about end-of-life experiences is limited, particularly among Africans. This article provides some insights into the sociocultural end-of-life experiences of Africans in Australia and their interaction with the health services in general and end-of-life care in particular. It provides points for discussion to consider an ethical framework that include Afro-communitarian ethical principles to enhance the capacity of current health services to provide culturally appropriate and ethical care. This article contributes to our knowledge regarding the provision of culturally appropriate and ethical care to African patients and their families by enabling the learning of health service providers to improve the competence of palliative care systems and professionals in Australia. Additionally, it initiates the discussion to highlight the importance of paying sufficient attention to a diverse range of factors including the migration history when providing palliative and hospice care for patients from African migrant populations.
Nurses working in a newborn intensive care unit report that treatment decision disagreements for infants in their care may lead to ethical dilemmas involving all health-care providers. Applying Rest’s Four-Component Model of Moral Action as the theoretical framework, this study examined the responses of 224 newborn intensive care unit nurses to the Nurses Ethical Involvement Survey. The three most frequent actions selected were as follows: talking with other nurses, talking with doctors, and requesting a team meeting. The multiple regression analysis indicates that newborn intensive care unit nurses with greater concern for the ethical aspects of clinical practice (p = .001) and an increased perception of their ability to influence ethical decision making (p = .018) were more likely to display Nurse Activism. Future research is necessary to identify other factors leading to and inhibiting Nurse Activism as these findings explained just 8.5% of the variance.
Several important ethical dilemmas emerge when nurses join a public-sector strike. Such industrial action is commonplace in South Africa and was most notably illustrated by a national wage negotiation in 2010. Media coverage of the proceedings suggested unethical behaviour on the part of nurses, and further exploration is merited. Laws, policies and provisional codes are meant to guide nurses’ behaviour during industrial action, while ethical theories can be used to further illuminate the role of nurses in industrial action. There are, however, important aspects to consider before judging whether nurses act unethically when striking. Following Loewy’s suggestion that the nature of the work, the proceeding commitment of the nurse to the patient, the prevailing situation when the strike is planned and the person(s) who stand(s) to benefit from the strike be considered, coupled with a consideration of the South African historical socio-political context, important aspects of the ethics of nurses’ behaviour in industrial action transpire.
How ethical praxis is shaped by different contexts and situations has not been widely studied. We performed a follow-up study on stroke team members’ experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. A number of ways for handling ethical problems emerged, which we have now explored further. Data were collected through a three-part form used as base for individual interviews with 15 stroke team members and analyzed using both quantitative and qualitative content analysis. In the analysis, the approaches in the form were condensed into strategies, and the two different ways those strategies were preferred and used by the team members were shown. Hindrances perceived by the team members to impede them from working the preferred way were also revealed and grouped into eight categories.
The concept of suffering is discussed among those who are cognitively aware and verbally capable to express their suffering. Due to immaturity, preterm infants’ abilities to express suffering are limited. Relieving suffering is an ethical and juridical demand of good nursing care. The purpose of this study is to describe nurses’ perceptions of the suffering of preterm infants. A descriptive qualitative approach was selected. Data were collected from essays written by nurses (n = 19) working in the neonatal intensive care unit. Inductive content analysis guided by the research question was performed. The nurses described individually determined suffering of the preterm infants according to four categories: suffering ruled by maturation, existence of suffering, individual threshold of suffering and interpreting the cues of suffering. Suffering of preterm infants is manifested by population-specific features, emphasising the need to develop sensitive interventions for relieving their suffering.
In many Western countries, studies have demonstrated extensive use of coercion in nursing homes, especially towards patients suffering from dementia. This article examines what kinds of strategies or alternative interventions nursing staff in Norway used when patients resist care and treatment and what conditions the staff considered as necessary to succeed in avoiding the use of coercion. The data are based on interdisciplinary focus group interviews with nursing home staff. The study revealed that the nursing home staff usually spent a lot of time trying a wide range of approaches to avoid the use of coercion. The most common strategies were deflecting and persuasive strategies, limiting choices by conscious use of language, different kinds of flexibility and one-to-one care. According to the staff, their opportunities to use alternative strategies effectively are greatly affected by the nursing home’s resources, by the organization of care and by the staff’s competence.
Deliberative ways of dealing with ethical issues in health care are expanding. Moral case deliberation is an example, providing group-wise, structured reflection on dilemmas from practice. Although moral case deliberation is well described in literature, aims and results of moral case deliberation sessions are unknown. This research shows (a) why managers introduce moral case deliberation and (b) what moral case deliberation participants experience as moral case deliberation results. A responsive evaluation was conducted, explicating moral case deliberation experiences by analysing aims (N = 78) and harvest (N = 255). A naturalistic data collection included interviews with managers and evaluation questionnaires of moral case deliberation participants (nurses). From the analysis, moral case deliberation appeals for cooperation, team bonding, critical attitude towards routines and nurses’ empowerment. Differences are that managers aim to foster identity of the nursing profession, whereas nurses emphasize learning processes and understanding perspectives. We conclude that moral case deliberation influences team cooperation that cannot be controlled with traditional management tools, but requires time and dialogue. Exchanging aims and harvest between manager and team could result in co-creating (moral) practice in which improvements for daily cooperation result from bringing together perspectives of managers and team members.
Questions of social justice and health-care costs are some of the concerns of society. The cost caused by cardiovascular diseases can have an enormous impact, and it is important to know what patients think about illness costs when they are hospitalized. Two interviews were realized in a longitudinal study, in a sample of 106 patients submitted to expensive techniques in Cardiology (Portugal), to understand the patients’ perception about the health costs and behavior changes based on awareness. We can conclude that cardiovascular diseases are a global phenomenon that generally affects all social groups. From those interviewed, 83% of the patients agree about getting information concerning the treatments and intervention costs during hospitalization because the information about costs can bring the necessary tools for improvement in patients and health resources; 70.8% of the patients say that this information could bring awareness to the patient’s life, enhancing responsibility and personal autonomy.
The purpose of this study was to determine the opinions and expectations of patients and nurses about privacy during a hospital admission for surgery. The study explored what enables and maintains privacy from the perspective of Turkish surgical patients and nurses. The study included 102 adult patients having surgery and 47 nurses caring for them. Data were collected via semistructured questionnaire by face-to-face interviews. The results showed that patients were mostly satisfied by the respect shown to their privacy by the nurses but were less confident of the confidentiality of their personal data. It was found that patients have expectations regarding nursing approaches and attitudes about acknowledging and respecting patient autonomy and confidentiality. It is remarkable that while nurses focused on the physical dimension of privacy, patients focused on informational and psychosocial dimensions of privacy, as well as its physical dimension.
The practice of respecting patients’ autonomy is rooted in the healthcare professionals’ empathy for patients’ situations, without which appropriate supports to the patients during the informed consent process may be remarkably moderated. The purpose of this study was to explore elective surgery patients’ experiences during their decision-making process. This research was conducted using a phenomenological approach, and the data analysis was guided by Colaizzi’s method. A total of 17 participants were recruited from a hospital in southern Taiwan. Two major themes emerged from the analyses: (a) a voluntary yet necessary alternative—to undergo a surgery and (b) alternatives compelled by the unalterable decision—the surgery. It was concluded that unless healthcare professionals can empathize with the distressed situation of their patients who are facing elective surgery, the practice of informed consent may become merely a routine. Nurses can be the best advocates for patients and facilitators to enhance communication between patients and healthcare personnel.