Educating Nurses for Ethical Practice in Contemporary Health Care Environments

Relationship between moral resilience and secondary traumatic stress among ICU nurses: A cross-sectional study

BACKGROUND

Since the outbreak of COVID-19, researchers worldwide have focused more on the issue of secondary traumatic stress (STS) experienced by nurses. This stress has an adverse effect on the health of nurses and the quality of nursing care, potentially undermining the stability of the nursing team and hindering the ability to meet the growing demand for nursing services. The impact of the COVID-19 pandemic, and the rise in global demand for ICU nursing, has placed a significant strain on ICU nurses, severely damaging their mental and physical health. Notably, ICU nurses also face high levels of moral distress, and moral resilience can effectively alleviate this distress and improve the quality of care.

AIMS

This study aimed to examine the levels of moral resilience and STS among ICU nurses, to explore their relationship and identify the factors influencing STS.

STUDY DESIGN

This cross-sectional study involved 229 ICU nurses from two tertiary hospitals in Xi'an, China, who participated between November and December 2023. The data were collected through email using anonymous electronic questionnaires, encompassing a self-designed demographic- and work-life-related characteristic questionnaire; the Rushton Moral Resilience Scale; and the Secondary Traumatic Stress Scale. Descriptive statistics, t-tests, analysis of variance and hierarchical regression analysis were performed to analyse the data.

RESULTS

The findings of the study indicated that ICU nurses' moral resilience and STS scores were at an intermediate level. Hierarchical regression analysis indicated that STS was negatively correlated with the subscales of the Rushton Moral Resilience Scale, specifically moral adversity coping (β, -0.156; 95% CI, -1.241 to -0.039) and relational integrity (β, -0.245; 95% CI, -1.453 to -0.388), which are significant predictors of STS. Additionally, good sleep quality (β, -.396; 95% CI, -14.948 to -7.117) and seeking psychological counselling because of work difficulties (β, .107; 95% CI, 0.237-9.624) emerged as significant predictors of STS among ICU nurses, with the model's explanation of the variance in STS increasing to 45.5%, △R2 = .167, F = 16.482 (p < .001).

CONCLUSION

This study found that ICU nurses have moderate levels of moral resilience and STS, which are negatively correlated. This suggests that improving the moral resilience of ICU nurses may help reduce their STS levels.

RELEVANCE TO CLINICAL PRACTICE

The study revealed that ICU nurses' moral resilience and secondary traumatic stress levels were at a moderate level, indicative of the need to take measures to enhance their moral resilience and reduce their secondary traumatic stress, as their presence not only affects the health of ICU nurses but also diminishes the quality of care and increases turnover rates.

Educational approach for public health ethics in nursing: Focusing on COVID-19

Background: With the increasing ethical challenges and dilemmas faced by nurses due to various disasters such as COVID-19 worldwide, there is a need for a new public health ethics education curriculum to strengthen competencies for ethical responses in the nursing field. Objectives: This study was aimed to identify the impact of a teaching method utilizing news articles and panel discussion material in the public health ethics education program on nursing students' thinking regarding ethical issues. Design: This was an exploratory study to identify the thinking styles inherent in ethical reflection by analyzing the reflection contents written by nursing students using text mining techniques. Participants: 73 among the students taking a nursing ethics course at a university in Seoul, South Korea, voluntarily participated in this study after providing informed consent. Methods: The public health ethics program was conducted with sessions held once a week for a total of 7 weeks, and reflections written by nursing students were collected as text files during session 5 to 7. In this study, data preprocessing process, keyword analysis, and LDA topic modeling were sequentially conducted utilizing the R program according to the data analysis procedure of text mining techniques. Ethical considerations: This study was conducted under ethics approval from the institution where participants were recruited. Findings and discussion: The results of this study show that the teaching method utilizing news articles enhanced rational ethical deliberation from the cognitive aspect, whereas the teaching method utilizing panel discussion material strengthened the response to emotions on a more internal level. Conclusions: The teaching method utilizing news articles and panel discussion materials in public health ethics education is expected to be mutually complementary and effective, so further studies are recommended.

Competency frameworks, nursing perspectives, and interdisciplinary collaborations for good patient care: Delineating boundaries

To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. These are some of the reasons behind current movements to develop competency frameworks that can enhance cross-disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care.

Development and application of an online learning platform for nursing ethics: A teaching practice research

BACKGROUND

It is crucial to diversify the methods for clinical nurses to continue learning nursing ethics in that ethical decision-making ability in nursing is regarded as one of the core competencies in nursing practice.

OBJECTIVE

In response to nurses' learning needs for nursing ethics, this study built an online learning platform for the pertinent topic, and tested its effect on improving nurses' ethical decision-making ability and critical thinking ability.

DESIGN

A qualitative method was adopted to develop interventions, which were designed as a teaching practice research consisting of a study group and a control group.

PARTICIPANTS

A total of 93 nurses, including 20 interviewees and 30 in the study group and 43 in the control group.

METHOD

Qualitative methods were employed to understand the learning needs of nurses. The judgment about nursing decisions and the critical thinking disposition inventory, learning effectiveness questionnaire and learning software quality evaluation scale were used as research tools in this teaching practice research. The SPSS 25.0 was adopted to analyze data by paired sample t-test and independent sample t-test.

RESULTS

In the measurement of the judgment about nursing decisions scale, the study group scored higher than the control group. The critical thinking disposition inventory scale identified a similar result in the total score incorporating the four dimensions, including analyticity, systematicity, critical thinking self-confidence, inquisitiveness. There is a correlation between learning software quality and learning effect, with a correlation coefficient of 0.640.

CONCLUSION

The online learning platform of nursing ethics built in this study has positive learning effects, and it demonstrates effectiveness to improve nurses' abilities in nursing ethics, decision-making and critical thinking. It is expected to be a viable way to improve the continuity of nurses' study of ethics.

Ethics Education for Nurses: Foundations for an Integrated Curriculum

BACKGROUND

Complexity in health care environments causes practice problems. Nurses bear responsibility for recognizing, addressing, and preventing ethical problems. Inadequacies in ethics education are partly to blame and contribute to nurse moral distress, attrition, and suboptimal care. Foundational curricula structures adequate for developing nurse moral agency are needed.

METHOD

The state of the science of ethics education in nursing was explored in-depth by a subcommittee of the American Nurses Association Ethics Advisory Board. A framework based in nursing goals was designed by nurse ethics experts to address ethics education across levels of curricula and practice. Rest's four-component model of moral behavior structures guidelines.

RESULTS

The model captures three facets of nurse moral agency: necessary characteristics, knowledge and skills, and motivation. A case is provided to illustrate its utility.

CONCLUSION

This framework provides the means to meet the profession's goal of preparing ethically competent nurses who will exercise moral agency. [J Nurs Educ. 2022;61(3):123-130.].

Moral Resilience in Nursing Education: Exploring Undergraduate Nursing Students Perceptions of Resilience in Relation to Ethical Ideology

Introduction

Moral resilience has recently been proposed as one strategy to address moral distress in nurses and nursing students. Central to nursing students’ capacity for moral resilience is how they understood and enact resilience with an element of realism, suggesting an ethical, ideological influence. Resilience is shown to differ significantly across students, and possibly because of a disconnect between a students’ perceived resilience and their ethical ideology. Yet, resilience seldom has been explored in relation to ethical ideology.

Objective

This study aims to explore self-reported resilience in relation to ethical ideology in undergraduate nursing students, compare differences in scores, and explore relationships between study variables and selected demographic characteristics.

Methods

A descriptive cross-sectional research design was followed. An online encrypted survey was conducted among a convenient sample of nursing undergraduates who met the eligibility criteria and provided implied informed consent. This study complied with ethical principles outlined in the Canadian Tri-Council Policy Statement for research with human subjects. Ethical approval was secured from the University’s Research Ethics Board. Data were analyzed using mean scores, standard deviations, independent sample t-test, variance analysis with post hoc–testing, and Pearson correlation to explore differences in perceptions and associations between study and selected demographic variables.

Results

Undergraduate students have a high level of self-reported resilience. Statistically significant differences in self-reported resilience across selected demographic variables were observed. The association between resilience and ethical ideology was not significant. Ethical relativism was significantly correlated with age and year of study.

Conclusion

Findings suggest that faculty cultivating resilience in nursing students pays attention to gender’s influence discourses in students’ perceptions of resilience and ethical ideology and provides students with opportunities for ethical self-reflection and dialogue to critically examine their ethical ideological perspectives and the influence these may have on moral resilience development. Implications for future research are discussed.

Moral Resilience for Critical Care Nurses

Ethically challenging situations are an increasing phenomenon in the nurse's environment, and literature on the subject is growing. Morally challenging experiences common in the critical care environment include end-of-life situations, barriers to providing the best care possible, and lack of organizational resources. These experiences can lead to moral distress and subsequent negative impacts on the clinician. Emerging in the literature are strategies to address the impact of moral distress through the development of moral resilience. Moral resilience is gained through personal commitment and organizational support.

A Case-Centered Approach to Nursing Ethics Education: A Qualitative Study

Nurses deal with ethical decisions as they protect patients’ rights, but a consensus on effective approaches to nursing ethics education is lacking. The “four topics” method can facilitate decision-making when nurses experience ethical dilemmas in practice. This study aimed to describe nursing students’ perspectives on and experiences of a case-centered approach to nursing ethics education using the four topics method. This qualitative study consisted of two phases. First, we delivered case-centered nursing ethics education sessions to nursing students using the four topics method. Then, we conducted two focus group discussions that explored students’ perspectives on and experiences of nursing ethics education. Data were analyzed using conventional content analysis. Four themes were identified: the importance of ethics education as perceived by nursing students, problems in current nursing ethics education, the experience of case-centered nursing ethics education using the four topics approach, and suggestions for improving nursing ethics education. The case-centered approach using the four topics method is effective in enhancing nursing students’ nursing ethics ability. It is crucial to understand that nursing students would like to set up their own ethical standards and philosophy. Continuous efforts to encourage students’ participation and to provide ethical reflection opportunities during clinical practice are needed to better connect theory with clinical practice.

Time use of advanced practice nurses in hospitals: A cross-sectional study

AIMS

To examine the use of time by advanced practice nurses and time use differences according to type of healthcare organization, work experience, and supervisor.

DESIGN

A cross-sectional, observational study.

METHODS

Non-participant observations were executed in Belgium (October 2015-January 2016). Time use was categorized in domains (patient/family, team, healthcare organization) and roles (clinical expert, educator/coach, change agent/innovator, researcher, leader, collaborator, and ethical decision-making facilitator). Proportional working time in domains and roles was calculated. Chi-squared tests identified differences in time use according to type of healthcare organization, number of years of work experience, and type of hierarchical/functional supervisor.

RESULTS

Participants mainly devoted time to the patient/family domain (30.78%) and the clinical expert role (34.19%). The role of leader and ethical decision-making facilitator covered, respectively, 4.84% and 0.07% of participants' time. Time distribution in domains and roles differed between participants in university and peripheral hospitals.

CONCLUSION

Activities were executed in all domains and roles, except for the ethical decision-making facilitator role. Further research could uncover barriers and facilitators for role execution, especially about leadership and ethical decision-making.

IMPACT

Advanced practice nurses, supervisors and policymakers could act to optimize advanced practice nurses' scope of practice.

Decision Making: Approaches and Tools to Respond to Ethical Issues in Genetic and Genomic Nursing

Competent genetic and genomic nursing practice requires the incorporation of various ethical approaches, or tools, into patient decision making. Using different decision-making approaches, which converge to answer an ethical issue, nurses can be confident that their judgment is justified. A lack of convergence can signal a need to reexamine the nurse's ethical decision-making skills. This article describes four approaches that nurses can use to facilitate ethical decision making, which is a skill that must be learned and practiced; these will then be applied to a genomic case study.