Concept Development of "Nursing Presence": Application of Schwartz-Barcott and Kim's Hybrid Model

[Collaboration between care teams and care experts in home care nursing: A qualitative case study]

Collaboration between care teams and care experts in home care nursing: A qualitative case study Abstract: Background: As a result of demographic change and the associated ageing population, the number of people affected by multimorbidity is increasing, and with it the complexity of home care nursing. In a home care nursing service (Spitex), care teams work with employees of different levels of competence. For support in complex situations, they can seek help from nursing experts (PEX). Aim: The aim was to investigate the collaboration between the care teams and the PEX of a regional Spitex organization and to work out measures for optimization. The research question was: "How do the care teams of a regional Spitex organization experience the collaboration with the nursing experts?" Methods: A qualitative case study design with four sub-cases was used to describe in detail how collaboration with PEX is experienced. Four Focus group interviews were evaluated using content analysis and cross-case analysis. Results: The Cross-Case analysis reveals the categories for optimal collaboration: present, professionally versatile, relieving in coordination tasks, supportive in complex situations. The following categories are categorized as disruptive factors in collaboration: varying levels of commitment, collaboration low priority and confusing. Conclusions: The PEX are to be made better known through targeted information dissemination. Implications for practice include the importance of presence and mutual understanding of roles so that collaboration is experienced as added value.

Exploring presence practices: a study of unit managers in a selected Provincial Hospital in Free State Province

BACKGROUND

Nursing presence depends on an individual's belief system, truths, sensory experience, professional skills, and active listening. Thus, one may assume that presence occurs when nurses care for patients in a kind and compassionate way. This study aimed to explore and describe presence practices amongst unit managers in a selected provincial hospital in Free State Province.

METHODS

A qualitative research approach with an exploratory descriptive contextual research design was employed in this study. A purposive nonprobability sampling technique was utilised to select participants. Data were collected through semi-structured interviews and analysed using the six steps of thematic qualitative data analysis. The study's trustworthiness was ensured through ascertaining credibility, dependability, confirmability, transferability, and authenticity. Approval to conduct the study was obtained from the North-West University Health Research Ethics Committee (NWU-HREC), DoH in the Free State Province, and the CEO (the gatekeeper) of the selected hospital.

RESULTS

Four themes were generated, namely, presence practices amongst unit managers in a selected provincial hospital in Free State, the impact of presence practices on hospital dynamics in a selected provincial hospital in Free State, unit managers' practices of relational care and human connectedness in the unit, and the perceptions of unit managers on barriers to presence practices in a selected provincial hospital in Free State. Each of these themes presents categories and sub-categories. Unit managers actively foster supportive work cultures, effective management, human connectedness and relational care, and effective communication to yield team cohesion and positive impacts on patient care. Unit managers also display resilience and highlight the need for ongoing support from colleagues and top management.

CONCLUSION

Unit managers exhibit diverse presence practices which emphasise their commitment through visibility and accessibility despite staff shortages and resource constraints.

Parental supporter in pediatric resuscitation: A mixed-method study with Delphi and analytic hierarchy process

INTRODUCTION

Providing support to parents is an evidence-based practice and a crucial part of family-centered nursing care. However, it is not clear who and how to provide the best support to parents during and after their child's resuscitation attempts.

PURPOSE

This study was conducted to explore the characteristics and roles of parental supporters responsible for caring for parents during and after their child's resuscitation.

METHODS

This is a mixed-method study combining the Delphi technique and the Analytic Hierarchy Process. A list of potentially important items describing the characteristics and roles of parental supporters caring for parents during and after pediatric resuscitation was developed through qualitative interviews with parents and members of the resuscitation team, and a thorough literature search. Then, the Delphi round was conducted with key experts. In the final step, the Analytic Hierarchy Process was used for ranking items in the order of their importance.

RESULTS

A list with 69 items describing the characteristics and roles of parental supporters was developed. 15 items (21.74%) were related to the "Characteristics of parental supporter" category; 8 items (11.59%) were related to the "Roles of a parental supporter during resuscitation" category; 13 items (18.84%) were related to the "Roles of a parental supporter after successful resuscitation" category; 23 items (33.34%) were related to the "Roles of a parental supporter after unsuccessful resuscitation" category; and 10 items (14.49%) were related to the "Roles of a parental supporter after unsuccessful resuscitation with help of other staff of the hospital" category.

CONCLUSION

The findings of this study can be used to develop guidelines that include parental supporter characteristics and roles to support parents during and after their child's resuscitation according to family-centered care practices in pediatric settings.

CLINICAL RELEVANCE

Study findings indicate the need for the presence of a parental supporter during and after pediatric resuscitation, whether witnessed by the parents or not. Knowledge regarding the characteristics and roles of parental supporters can be used in practice to uphold family-centered nursing care during critical situations.

Vicarious trauma in nursing: A hybrid concept analysis

BACKGROUND

Vicarious trauma can significantly affect the physical and mental health of nurses, as well as their ability to provide quality of care. However, the concept of vicarious trauma has received limited attention and remains controversial in the nursing context.

OBJECTIVE

The purpose of this study was to clarify and define the concept of vicarious trauma as it pertains to the nursing context.

METHODS

The Schwartz and Kim's three-stage hybrid concept analysis method was used to define the concept. In the theoretical phase, PubMed, CINAHL, OVID, Medline, Embase, Web of Science, Scopus, ProQuest, PsycINFO, CNKI database, VIP database and Wanfang database were used using keywords "nurs*"and "vicarious trauma*", resulting in a total of 25 papers. In the fieldwork phase, we conducted participatory observations in three hospitals and semi-structured in-depth interviews with 18 clinical nurses from seven cities. In the analysis phase, the results of the previous two phases were integrated to develop a comprehensive concept of vicarious trauma in nursing.

RESULTS

Based on the results of the theoretical and field phases, we propose the concept of vicarious trauma in nursing as follows: vicarious trauma is a psychological trauma impacting nurses' cognitive schema which they may experience in clinical settings or on social media, resulting from deeply empathize with the physical or emotional trauma of patients, family, or colleagues, such as patients' physical injuries or death, family's grieving feelings and colleagues' received threats and attacks. Positively, vicarious trauma can transform into vicarious post-trauma growth through repositioning and connection, nourishing nurses and promoting their personal and professional development.

CONCLUSION

The concept of vicarious trauma in nursing is multidimensional and holistic. This study clarifies the concept of vicarious trauma in nursing using the hybrid concept analysis, providing a framework for future research and practice on vicarious trauma in the nursing field.

PATIENT OR PUBLIC CONTRIBUTION

Nurses contributed to the conduct of the study by participating in the data collection via interviews.

Patients' experiences of patient-centred care in hospital setting: A systematic review of qualitative studies

BACKGROUND

Patient-centred care (PCC) has been proposed as an appropriate approach for addressing current shifts in healthcare needs. Although the importance of PCC is generally recognised, PCC is poorly understood by patients in the hospital settings.

OBJECTIVES

To identify patients' experiences of PCC in hospital settings.

METHODOLOGICAL DESIGN

This systematic review followed the Joanna Briggs Institute's (JBI) guidance for systematic reviews of qualitative evidence and the PRISMA checklist for reporting systematic reviews. The search strategy included peer-reviewed qualitative studies published after 2010 in English or Finnish. The databases searched were SCOPUS, MEDLINE, CINAHL and Medic. Unpublished studies and grey literature were searched in MedNar. Ten qualitative studies were included, and their quality was assessed by two independent reviewers using JBI quality assessment criteria. The data were analysed using thematic analysis.

SETTING AND PARTICIPANTS

Studies were included if they had explored adult patient experiences of PCC in hospital settings.

RESULTS

A thematic analysis produced 14 subthemes which were grouped into five analytical themes: the presence of the professional, patient involvement in care, receiving information, the patient-professional relationship and being seen as a person.

CONCLUSIONS AND IMPLICATIONS

This review suggests that the implementation and provision of PCC in hospitals is incomplete and patients' involvement in their own care should be in the focus of PCC. The majority of patients experienced receiving PCC, but others did not. The need for improvement of patient involvement was strongly emphasised. Patients highlighted the importance of professionals being present and spending time with patients. Patients felt well-informed about their care but expressed the need for better communication. Meaningful patient-professional relationships were brokered by professionals demonstrating genuine care and respecting the patient as an individual. To improve the implementation of PCC, patient experiences should be considered in the development of relevant hospital care strategies. In addition, more training in PCC and patient-professional communication should be provided to health care professionals.

Primary healthcare nurses' experiences of addressing intimate partner violence in supportive legal and health system contexts

AIM

To explore the experiences of primary healthcare (PHC) nurses caring for women experiencing intimate partner violence (IPV) in a context of institutional support for the management of this health issue.

DESIGN

Secondary qualitative analysis.

METHODS

A purposeful sample (n = 19) of registered nurses, working in a PHC setting, with experience providing care to women who had disclosed intimate partner violence completed an in-depth interview. Thematic analysis was used to code, categorize and synthesize the data.

RESULTS

Four themes were developed from the analysis of the interview transcripts. The first two themes address the characteristics of the type of violence most frequently encountered by participants, and how these characteristics shape the needs of women and the care nurses provide them. The third theme encompasses uncertainties and strategies developed to deal with the aggressor during the consultations as the woman's companion or as the patient himself. Finally, the fourth theme reflects the positive and negative consequences of caring for women exposed to intimate partner violence.

CONCLUSION

When there is a supportive legal framework and health system to address IPV, nurses are able to implement evidence-based best practices in caring for women experiencing intimate partner violence. The predominant type of violence experienced by women at the time they enter the healthcare system shapes their needs and the service/unit they reach. These varying needs should be considered in the development of training programmes for nurses and should be adapted for different healthcare services. Caring for women experiencing intimate partner violence implies an emotional burden even in an institutional supportive context. Therefore, actions to prevent nurses' burnout should be considered and implemented.

IMPACT

Lack of institutional support usually hinders the potential role nurses can play in the care provided to women who have experienced intimate partner violence. Findings from this study demonstrated that primary healthcare nurses are able to implement evidence-based best practices in the care for women experiencing intimate partner violence when there is a supportive legal framework and the health system context is openly favourable to addressing intimate partner violence. Findings from this study could inform the design and implementation of programmes and/or policies to improve nurses' responses to intimate partner violence in primary healthcare services.

The Effect of an Educational Intervention on Nurses' Knowledge, Perception, and Use of Nursing Presence in the Perioperative Setting

PURPOSE

Explore the effect of a nursing presence educational intervention on nurse circulators' perceptions, knowledge, and use of nursing presence with patients undergoing surgical procedures.

DESIGN

One group, pretest-posttest design.

METHODS

Nursing presence is an intentional-reflective way of being with patients that was operationalized using four domains (Attention-to-Environment, Interaction Quality, Focus-of-Energy, and Active Engagement). Data collection involved observations of participants in practice and completion of surveys to examine 34 randomly selected nurse circulators' knowledge, perception, and use of nursing presence before and after participating in a nursing presence educational intervention. Dependent t tests and McNemar tests were used to examine relationships between the independent and three dependent variables - knowledge, perceptions, and use of nursing presence.

FINDINGS

The educational intervention significantly enhanced participants' nursing presence knowledge, but not perceptions, which were very high at baseline. Participants' significantly increased their use of 3 of 4 nursing presence domains with the exception of the Attention-to-Environment domain, which is related to promoting a healing environment.

CONCLUSIONS

Lack of attention to promoting a healing environment by the surgical team created a barrier to circulators' ability to successfully use all four nursing presence domains. Embracing nursing presence as a practice framework involves cooperation from the surgical team and a shift in perioperative environment from a chaotic to healing one.

Family support person role during resuscitation: A qualitative exploration

AIMS AND OBJECTIVES

To provide guidance to nurses by examining how critical care nurses perceive and perform the family support person role during resuscitation.

BACKGROUND

Nurses can serve as family support person when families witness a loved one's resuscitation. However, few studies have examined the role of family support person to provide nurses with sufficient knowledge to enact the role.

DESIGN

An exploratory-descriptive qualitative design with individual, semi-structured interviews.

METHODS

Sixteen critical care nurses who had served as family support person completed interviews. The data were analysed by thematic analysis. COREQ guidelines were followed.

RESULTS

Six themes were identified: Hard but Rewarding Role, Be With, Assess, First Moments, Explain and Support. Findings explicated nurses' perceptions of the role and key role activities.

CONCLUSIONS

Nurses perceived the role as hard but rewarding. Role challenges included the need for quick, accurate assessments and interventions to keep family members safe, informed and supported, while allowing them to witness resuscitation. Key role activities included: being fully present and compassionately attentive to family, continuously assessing family members, coordinating the first moments when family presence during resuscitation commences, explaining in simple, tailored terms the resuscitation activities, and supporting the family emotionally and psychologically through a variety of strategies. Nurses noted the high variability in how families respond and the complexity of simultaneously performing the multi-faceted role activities.

RELEVANCE TO CLINICAL PRACTICE

To effectively support the growing global trend of family presence during resuscitation, nurses need the knowledge this study provides about how to fulfil the family support person role. Identifying the role activities may facilitate development of clinical guidelines and educational preparation for the role. Nurses can refine the many skills this role requires, building their competence and confidence, to increase opportunities for family members to experience family presence during resuscitation in a safe, and high-quality manner.

A concept analysis of facilitating presence through guided reflection for transformative learning in nursing education

AIM

The aim of the study was to report an analysis of the novel concept, facilitating presence through guided reflection for transformative learning.

DESIGN

A concept analysis.

METHODS

Search included keywords 'presence', 'reflective practices', 'nursing education' and 'concept analysis'. 65 peer-reviewed articles between 2000-2020 were included.

RESULTS

The final definition of the main concept is an interpersonal, co-constructed, intersubjective and intentional process to accompany nursing students in deep, constructive learning to discover new meanings and perspectives through self-inquiry and critical reflection on experiences. The nurse educator actively listens and intimately connect in the moment to create a safe environment. This leads to the nursing student's ability to learn to see what is important to the other and to respond by doing what can be done and/or by being who the other needs one to be.

PATIENT CONTRIBUTION

This concept will help to streamline the practice of presence ultimately enhancing the quality of patient care.

Developing and validating the nursing presence scale for hospitalized patients

Aim

We developed and psychometrically tested the Nursing Presence Scale.

Background

Nursing presence is a foundation for professional nursing practice; therefore, it is critical to measure this concept.

Introduction

This instrument development study was designed to generate an itemized scale and psychometric testing using a sample of Iranian patients.

Methods

Based on both a concept development and literature review, and finally face and content validity 44-item draft scale was generated. During November 2018–2019, 774 patients were surveyed. Exploratory and confirmatory factor analyses were used to evaluate the scale’s construct validity; concurrent and predictive reliability of the nursing presence scale were also evaluated. We also examine the weighting to scale items.

Results

The analyses yielded a 36-item, 4-factor scale that adequately fit the data. Cronbach’s alpha coefficient for the whole instrument was 0.94. The intra class correlation coefficient was 0.91. Nursing Presence Scale scores were positively correlated with Revised Humane Caring Scale and predicted 25% of missed nursing care.

Conclusion

This 36-item has good reliability and validity, making it useful for measuring the current condition of nursing presence.

Implications for Nursing and Health Policy

Measuring the frequency of nursing presence allows for data-driven planning and upgrading the inpatient care services.

Professional nurses' experience in providing nursing care to women experiencing gender-based violence: A caring presence study

Background

Women in a sub-district of one of the most rural provinces in South Africa are at a high risk of experiencing gender-based violence. Professional nurses are at the frontline of providing healthcare to these women. Caring presence is a valuable resource to professional nurses in these settings.

Aim

To explore and describe the experiences of professional nurses in providing nursing care to women experiencing gender-based violence.

Setting

A primary health clinic, community health centre, out-patient department and emergency department in the rural sub-district.

Methods

An interpretive phenomenological design was applied. Purposive sampling was used and semi-structured one-on-one interviews were held with professional nurses. Interpretive phenomenological analysis was done and data saturation was achieved (n = 15).

Results

Participants were willing to provide nursing care but worked in difficult environments, and their level of competence influenced how they engaged with these women. They realised that the lifeworld of the women made it difficult for them to disclose that they are experiencing gender-based violence. Participants emphasised the importance of multidisciplinary and multi-sectoral collaboration. A final theme, caring presence, also emerged.

Conclusion

Participants felt compassion and were willing to provide nursing care. However, they experienced reluctance due to hindrances that limited them in connecting with and attuning to the women. This left them feeling frustrated, and with a deepened sense of empathy, as they realised how deeply the women are suffering. Recommendations were formulated.

Contribution

This study revealed nurses’ need to be guided in providing relational care to women who are experiencing gender-based violence. Based on the findings, it is recommended that infrastructure should be updated to ensure private and safe spaces for women, debriefing and training should be provided and multidisciplinary collaboration should be strengthened. Policy for improved referral systems, the assessment and management of women experiencing gender-based violence and the wellness of professional nurses should be developed.

The obstacles to nurses being present with patients

AIM

The aim of the present research was to investigate the obstacles, which prevent nurses being present with patients.

BACKGROUND

It is vital for nurses to be able to spend time with patients for an accurate assessment of patients' needs to take place and to allow patients to express their concerns. The factors, which prevent nurses spending time with patients, are still unclear.

METHOD

Data were collected using semi-structured interviews with thirty-five participants, including the nurses and physicians from educational hospitals of Tehran. The analysis was performed through the conventional content analysis. To achieve accuracy and trustworthiness of the data, the Lincoln and Guba criteria were used.

RESULT

The results of the study can be summarized as: "conflict between human considerations and bureaucratic structure," "failure to meet basic needs," "the personal and interpersonal aspects of caring" and "safety in caring context."

CONCLUSION

To ensure high-quality care, it is important to understand more fully the factors that prevent nurses spending time with patients. Interventions are needed to allow nurses to spend more time with the patients.

IMPLICATION FOR NURSING MANAGEMENT

Health service managers should consider that the intrinsic motivation of nurses is to care for patients. They can increase the presence of nurses at patients' bedside and improve care quality by creating an attractive working environment, appreciating nurses' values, paying attention to their opinions and establishing professional communication based on mutual respect.

A framework for nurses working in partnership with substitute decision-makers for people living with advanced dementia: A discursive paper

AIM

To describe and discuss clinical strategies for nurses working in partnership with substitute decision-makers for people living with advanced dementia.

BACKGROUND

By providing person-centred care to patients living with advanced dementia, nurses are positioned to work in partnership with substitute decision-makers who make healthcare decisions related to advanced care. Because the experience of being substitute decision-makers is complex and stressful, nurses need skillsets for working in partnership with substitute decision-makers.

DESIGN

In this discursive paper, an innovative framework for working in partnership with substitute decision-makers is proposed.

METHOD

Evidence-based findings from a systematic review provided five domain foci for the partnership framework. In each domain, two clinical strategies were discursively proposed. Clinical strategies were hypothesised from research findings and insights from the authors' nursing experiences. Then, topical literature was searched, and findings were used to support the discursively argued strategies.

DISCUSSION

To deal with complexities and reduce stress for substitute decision-makers, an innovative Nurse-Substitute Decision-Maker Partnership Framework for use in the context of advanced dementia is proposed and discussed. The partnership framework consists of five domains: Building trust, Exploring emotions, Translating quality of life, Encouraging proactivity and Negotiating families. Within these domains, ten strategies to support the practices of clinical nurses to work in partnership with substitute decision-makers are discussed.

RELEVANCE TO CLINICAL PRACTICE

In the framework, the ten clinical nursing strategies are designed to provide targeted care to substitute decision-makers in areas that are known to cause complexity and stress to them. The Nurse-Substitute Decision-Maker Partnership Framework has been designed to improve nurse-substitute decision-maker partnerships and reduce the stress experienced by substitute decision-makers as they work through the complexities associated with advanced dementia.

Presence and Therapeutic Listening

Presence and therapeutic listening are complementary therapies that are incorporated into daily nursing practice. This article presents the nurse's role in facilitating complementary therapies of presence and therapeutic listening, barriers encountered, and the behaviors and techniques to be used. Also discussed is the impact that using presence and therapeutic listening has on patient outcomes. These interventions have the potential to significantly alter patients' perceptions of care and improve patient outcomes. Presence and therapeutic listening are vital to developing a therapeutic nurse-patient relationship. This relationship is what drives positive patient outcomes and increases overall satisfaction and quality of care.

Videoconferencing: Is It Satisfactory

Consideration of the impact of COVID-19 on conducting research studies is the subject of this column. First, it is argued that presence is critical to some qualitative methods and especially for those who use the Parse methods. Second, the use of e-mail, telephone, and videoconferencing is examined in terms of their advantages and disadvantages in relation to obtaining knowledge about a phenomenon of interest.

Here and now: Lived experiences of professional nurses practising caring presence in a rural public hospital in the North West Province, South Africa

BACKGROUND

Practising caring presence is recognised as an important nursing intervention indispensable to high-quality, patient-centred care. An awareness of the real world of professional nurses (PNs) practising caring presence will assist in expanding and supporting the existing literature on the same. A clear and rich description of what the concept of caring presence entails within the unique South African nursing context may guide nurses in the art of this nursing skill, enhance their professionalism and facilitate the formulation of recommendations on how to encourage nurses to implement the practice of caring presence within nursing.

AIM

This study explored and described the lived experiences of PNs practising caring presence in a rural public hospital.

SETTING

The study setting was a 120-bed, level-two district hospital in the North West Province of South Africa.

METHODS

A descriptive phenomenological method, specifically Husserl's approach, informed this study. Semi-structured interviews were conducted with a purposive sample of 10 PNs. Data were coded and analysed using Colaizzi's seven-step method.

RESULTS

Five themes emerged from the data analysis: professional caring presence, ethical caring presence, personal caring presence, healing caring presence and what caring presence is not.

CONCLUSION

Professional nurses experience practising caring presence as professionally and personally fulfilling, as an expression of their passion for the profession, as a way of portraying ethical care, as a willingness to be personally present and as a healing experience that involves commitment and taking care of patients holistically. Unprofessional, unethical behaviour and depersonalisation of patients were indicated as uncaring behaviour.

Exploring the Experiences of Oncology Nurses about the Factors Facilitating their Presence at the Bedside of Patients with Cancer: A Qualitative Study

BACKGROUND

The presence of nurses at patients' bedside is regarded as an indication of the quality of care. There is not enough evidence on facilitators of nurses' presence at cancer patients' bedside.

AIM

The present study aimed to investigate nurses' experiences of factors facilitating their presence at patients' bedside in oncology ward.

SUBJECTS AND METHODS

In this qualitative study, data were collected using purposeful sampling and semi-structured individual interviews with 25 oncology nurses from two teaching hospitals in Sari, Northern Iran, between 2016 and 2017. Interviews were digitally recorded, handwritten, coded, classified, and analyzed using conventional content analysis approach.

RESULTS

Data analysis led to the development of three main categories and seven subcategories. The first category, namely, "leverage spirituality" with two subcategories (motivational beliefs and religious motives). "Being with patient with compassion and commitment" is the second category with two subcategories (sense of altruism and compassionate care and adherence to the profession). The third category is "effective communication" with three subcategories (initial methods being patient, soothing communication, and intimate communication).

CONCLUSION

The results of this study showed that nurses' spiritual beliefs, kindness, and professional commitment and establishing human-friendly relationships with the patient and family would help the nurses of the oncology unit to have a more effective presence in the patients' bed. It seems that further studies are needed to examine the facilitators of the presence of oncology nurses on patients' bedside based on severity of illness.

Ethical conflict among nurses working in the intensive care units

BACKGROUND

Ethical conflict is a barrier to decision-making process and is a problem derived from ethical responsibilities that nurses assume with care. Intensive care unit nurses are potentially exposed to this phenomenon. A deep study of the phenomenon can help prevent and treat it.

OBJECTIVES

This study was aimed at determining the frequency, degree, level of exposure, and type of ethical conflict among nurses working in the intensive care units.

RESEARCH DESIGN

This was a descriptive cross-sectional research.

PARTICIPANTS AND RESEARCH CONTEXT

In total, 382 nurses working in the intensive care units in Iranian hospitals were selected using the random sampling method. Data were collected using the Ethical Conflict in Nursing Questionnaire-Critical Care Version (Persian version).

ETHICAL CONSIDERATIONS

This study was approved by the Medical Research Ethics Committee. Ethical considerations such as completing the informed consent form, ensuring confidentiality of information, and voluntary participation were observed.

FINDINGS

The results showed that the average level of exposure to ethical conflict was 164.39 ± 79.06. The most frequent conflict was related to "using resources despite believing in its futility," with the frequency of at least once a week or a month (68.6%, n = 262). The most conflictive situation was violation of privacy (76.9%, n = 294). However, the level of exposure to ethical conflict according to the theoretical model followed was the situation of "working with incompetent staff." The most frequently observed type of conflict was moral dilemma.

CONCLUSION

The moderate level of exposure to ethical conflict was consistent with the results of previous studies. However, the frequency, degree, and type of ethical conflict were different compared to the results of other studies. Recognizing ethical conflict among intensive care unit nurses can be useful as it allows to consolidate those measures that favor low levels of ethical conflict, design appropriate strategies to prevent ethical conflicts, and improve the nursing work environment.