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Zheng M, Zhao J, Zhang X. When You Think of and Identify Yourself as a Nurse, You Will Become More Deontological and Less Utilitarian. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:712. [PMID: 38928958 PMCID: PMC11203591 DOI: 10.3390/ijerph21060712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
This study aims to examine how the activation of the role of nursee and professional identification as a nurse can influence moral judgments in terms of deontological and utilitarian inclinations. In Study 1, a priming technique was used to assess the impact of activating the nursing concept on moral reasoning. Participants were randomly assigned to either a nursing prime or neutral prime condition. By using a scrambled-sentence task, participants were prompted to think about nursing-related or neutral thoughts. Following the priming task, participants were asked to respond to 20 moral dilemmas. The process dissociation approach was employed to measure the degree of deontological and utilitarian tendencies in their moral reasoning. In Study 2, participants completed the nursing profession identification scale and the moral orientation scale before engaging in moral judgments similar to those in Study 1. The findings revealed that priming the concept of being a nursee resulted in an increase in deontological clinical inclinations while having no significant effect on utilitarian inclinations. Additionally, a positive correlation was observed between identification with the nursing profession and deontological clinical inclinations, whereas a negative correlation was found with utilitarian inclinations. Deliberation orientation acted as a complete mediator in the relationship between nursing professional identification and deontological tendencies and as a partial mediator for utilitarian tendencies.
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Affiliation(s)
- Mufan Zheng
- Department of Psychology, Wuhan University, Wuhan 430072, China;
| | - Junhua Zhao
- Department of Psychology, Wuhan University, Wuhan 430072, China;
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Eklund Saksberg M, Bielsten T, Cahill S, Jaarsma T, Nedlund AC, Sandman L, Jaarsma P. Nurses' priority-setting for older nursing home residents during COVID-19. Nurs Ethics 2024:9697330241226597. [PMID: 38317371 DOI: 10.1177/09697330241226597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses' prioritizations in their work to achieve well-being and health for nursing home residents. AIM The aim of this study was to explore nursing home nurses' priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT We conducted a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis. ETHICAL CONSIDERATIONS Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649). FINDINGS We identified an overarching theme-nursing home nurses struggling on multiple fronts, "just do it"-and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives' expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing. CONCLUSIONS Nurses' priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses' priorities. Nursing home nurses need organizational and managerial support to prioritize.
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Expert nurses' coping strategies in ethically challenging situations: a qualitative study. BMC Nurs 2021; 20:183. [PMID: 34587956 PMCID: PMC8479722 DOI: 10.1186/s12912-021-00709-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nurses frequently encounter ethically challenging situations in everyday practice. In these situations, nurses often know an appropriate course of action to take but are unable to do so. Many studies have examined the ethically challenging situations faced by nurses, but how nurses cope with these situations is not well understood. Therefore, this study aims to explore the coping strategies used or adopted in ethically challenging situations by expert nurses in South Korea. METHODS Participants were recruited via purposive sampling. Small group interviews were conducted with 26 expert registered nurses in a general hospital in South Korea. The data were analyzed using Giorgi's descriptive phenomenological method. RESULTS The essential theme of nurses' experience of coping with ethically challenging situations was "being faithful to the nature of caring." This essential theme comprised three themes: self-monitoring of ethical insensitivity, maintaining honesty, and actively acting as an advocate. CONCLUSIONS The findings of this study suggest that the coping strategies of expert nurses are mostly consistent with the attributes of ethical competence as previously defined in healthcare, and expert nurses can address ethically challenging situations in an effective and ethical manner by faithfully adhering to the spirit of caring. System-wide early counseling and interventions should be considered for nurses who have experienced ethical difficulties.
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Donkers MA, Gilissen VJHS, Candel MJJM, van Dijk NM, Kling H, Heijnen-Panis R, Pragt E, van der Horst I, Pronk SA, van Mook WNKA. Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study. BMC Med Ethics 2021; 22:73. [PMID: 34139997 PMCID: PMC8211309 DOI: 10.1186/s12910-021-00641-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background The COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19. Methods An extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19.
Results Three hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior. Conclusion Levels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00641-3.
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Affiliation(s)
- Moniek A Donkers
- Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Vincent J H S Gilissen
- Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Math J J M Candel
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Nathalie M van Dijk
- Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Hans Kling
- Department of Spiritual Care Services, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ruth Heijnen-Panis
- Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Elien Pragt
- Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Iwan van der Horst
- Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Sebastiaan A Pronk
- Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Academy for Postgraduate Medical Training, Maastricht University Medical Center+, Maastricht, The Netherlands.,School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Čartolovni A, Stolt M, Scott PA, Suhonen R. Moral injury in healthcare professionals: A scoping review and discussion. Nurs Ethics 2021; 28:590-602. [PMID: 33427020 PMCID: PMC8366182 DOI: 10.1177/0969733020966776] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration.
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Affiliation(s)
- Anto Čartolovni
- 324714Catholic University of Croatia, Croatia; University of Hull, UK
| | | | - P Anne Scott
- 8799National University of Ireland Galway, Ireland
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De Brasi EL, Giannetta N, Ercolani S, Gandini ELM, Moranda D, Villa G, Manara DF. Nurses' moral distress in end-of-life care: A qualitative study. Nurs Ethics 2020; 28:614-627. [PMID: 33267730 DOI: 10.1177/0969733020964859] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff. RESEARCH QUESTION The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events. RESEARCH DESIGN A hermeneutic-phenomenological qualitative study was performed. PARTICIPANTS AND RESEARCH CONTEXT Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim. ETHICAL CONSIDERATIONS Ethical approval was obtained from the Institutional Review Hospital Board. FINDINGS Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured. DISCUSSION In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients' last requests. According to our findings, the concept of 'good' end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events. CONCLUSION Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.
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Affiliation(s)
| | - Noemi Giannetta
- 18985Vita-Salute San Raffaele University, Italy; Tor Vergata University of Rome, Italy
| | - Sara Ercolani
- 9338ASST Grande Ospedale Metropolitano Niguarda, Italy
| | | | | | - Giulia Villa
- 9372IRCCS San Raffaele Scientific Institute, Italy
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Maffoni M, Argentero P, Giorgi I, Giardini A. Healthcare professionals' perceptions about the Italian law on advance directives. Nurs Ethics 2019; 27:796-808. [PMID: 31631774 DOI: 10.1177/0969733019878831] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the variegated legislative framework on advance directives, the first specific regulation in Italy on this issue came into force only in 2018. RESEARCH OBJECTIVE This qualitative study aimed to investigate the implications of the new Italian law on advance directives in clinical practice from the perspective of those who deal with this delicate ethical issue on an everyday basis, that is, Italian healthcare professionals. RESEARCH DESIGN A qualitative research design using semi-structured audio-recorded interviews was adopted. The data collection and analysis were performed according to the Grounded Theory approach. PARTICIPANTS Nineteen healthcare professionals (16 nurses, 3 physicians) working in a palliative care unit of a research and clinical institute in Italy. ETHICAL CONSIDERATIONS The study is part of the WeDistress HELL Project (WEllness and DISTRESS in HEalth care professionals dealing with end of Life and bioethicaL issues) approved by the Ethical Committee of ICS Maugeri - Institute of Pavia (Italy). FINDINGS The authors identified a main overall category, 'Pros and Cons of the Italian law on advance directives', composed of six constituent categories: Positive welcome, Self-determination and protection, Prompts for future betterment, Uncertainties, Lack of knowledge, and Neutrality and no suggestions. DISCUSSION The Italian law n. 219/2017 on advance directives was seen as a legal instrument possessing both strengths and weaknesses, but able to guarantee the patient's self-determination and support healthcare professionals in providing care according to patients' wishes. CONCLUSION An understanding of the healthcare providers' perspective may support the discussion on advance directives and bridge the gaps that currently persist in handling ethical issues.
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Affiliation(s)
- Marina Maffoni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Ines Giorgi
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit - Institute of Pavia, Italy
| | - Anna Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit - Institute of Montescano, Italy
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Sánchez-Izquierdo M, Santacreu M, Olmos R, Fernández-Ballesteros R. A training intervention to reduce paternalistic care and promote autonomy: a preliminary study. Clin Interv Aging 2019; 14:1515-1525. [PMID: 31692560 PMCID: PMC6717153 DOI: 10.2147/cia.s213644] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/25/2019] [Indexed: 12/30/2022] Open
Abstract
Introduction Paternalism, assuming control of aged care, is a widespread orientation in older adults care. Paternalistic attitudes and practices are commonly understood as a threat to the freedom and autonomy of a person, making patients more dependent. Therefore, the reduction of these attitudes and behaviors is a primary goal for any older adult health and social care situation. The aim of this preliminary study is to develop a behavioral intervention to decrease paternalistic behaviors in formal caregivers and to increase those care behaviors which promote autonomy at post-intervention (1 week) and at follow-up (14 weeks). Methods A sample of 118 professional caregiver volunteers working in day care centers and nursing homes were assigned to quasi-experimental (N=47) and control (N=71) conditions. The intervention consisted of 3 weekly group sessions. Individual and contextual measures were collected: 1) the primary outcome variable was the type of care (paternalistic versus autonomist) measured through the self-report Paternalist/Autonomist Care Assessment (PACA); 2) A 10-item caregiver self-register of paternalistic behaviors was carried out, 3) Finally, in order to assess the potential effects on observed behavior both in caregiver and older adult functioning at a contextual level, the five institutions were assessed through the SERA-RS. Results Compared with the control group, caregivers in the behavioral intervention group displayed significantly lower paternalistic appraisals at posttest and follow-up. Regarding the intervention group, caregivers at posttest and follow-up showed significantly greater occurrence of autonomist behaviors being promoted and lower paternalistic appraisal. The results regarding the effect on the institutions showed better personnel performance and older adult functioning. Conclusion Caregivers who followed the intervention learned to better identify older adult needs; although we did not find significant differences in autonomy occurrence compared with the control group, a behavioral intervention may promote more autonomist environments and, therefore, better personnel and older adult functioning.
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Affiliation(s)
| | - Marta Santacreu
- Department of Psychology, National Distance Education University of Spain - UNED, Madrid 28670, Spain
| | - Ricardo Olmos
- Department of Methodology, Autonomous University of Madrid, Madrid 28049, Spain
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Fernández-Ballesteros R, Sánchez-Izquierdo M, Olmos R, Huici C, Ribera Casado JM, Cruz Jentoft A. Paternalism vs. Autonomy: Are They Alternative Types of Formal Care? Front Psychol 2019; 10:1460. [PMID: 31316428 PMCID: PMC6611139 DOI: 10.3389/fpsyg.2019.01460] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/07/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Ricardo Olmos
- Department of Methodology, Autonomous University of Madrid, Madrid, Spain
| | - Carmen Huici
- Department of Social Psychology and Organizations, National University of Distance Education, Madrid, Spain
| | | | - Alfonso Cruz Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
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Suhonen R, Stolt M, Habermann M, Hjaltadottir I, Vryonides S, Tonnessen S, Halvorsen K, Harvey C, Toffoli L, Scott PA. Ethical elements in priority setting in nursing care: A scoping review. Int J Nurs Stud 2018; 88:25-42. [PMID: 30179768 DOI: 10.1016/j.ijnurstu.2018.08.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/04/2018] [Accepted: 08/13/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses' professional and moral values. OBJECTIVE To explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses. DESIGN, DATA SOURCES AND METHODS A scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis. RESULTS Nurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients' daily care needs, prioritising work by essential tasks and participating in priority setting for patients' access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient's situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses' moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise. CONCLUSIONS Analysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.
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Affiliation(s)
- Riitta Suhonen
- University of Turku, Department of Nursing Science, Turku University Hospital, and City of Turku, Welfare Division, Turku, Finland.
| | - Minna Stolt
- University of Turku, Department of Nursing Science, Turku University Hospital, Turku, Finland.
| | | | - Ingibjörg Hjaltadottir
- University of Iceland, Clinical Nurse Specialist, University Hospital of Iceland, Iceland.
| | - Stavros Vryonides
- Cyprus University of Technology, School of Health Sciences, Department of Nursing, Limassol, Cyprus.
| | | | | | - Clare Harvey
- Central Queensland University Australia, School of Nursing, Midwifery and Social Sciences, Tertiary Education Division, Mackay, Australia.
| | - Luisa Toffoli
- School of Nursing and Midwifery, University of South Australia, Australia.
| | - P Anne Scott
- National University of Ireland Galway, Galway, Ireland.
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Bah HT, Sey-Sawo J. Teaching and practicing nursing code of ethics and values in the Gambia. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Young A, Froggatt K, Brearley SG. 'Powerlessness' or 'doing the right thing' - Moral distress among nursing home staff caring for residents at the end of life: An interpretive descriptive study. Palliat Med 2017; 31:853-860. [PMID: 28659023 DOI: 10.1177/0269216316682894] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Caring for dying people can contribute to moral distress experienced by healthcare professionals. Moral distress can occur when this caring is restricted by organisational processes, resources or the provision of futile care. These factors apply to end of life care in nursing homes but research is lacking. AIM To describe how nursing home staff experience moral distress when caring for residents during and at the end of life. METHODS An interpretive descriptive design, using the critical incident technique in semi-structured interviews to collect data from nursing home staff. Data were analysed using a thematic analysis approach. SETTING Four nursing homes in one large metropolitan area. PARTICIPANTS A total of 16 staff: 2 nurse managers, 4 nurses and 10 care assistants. FINDINGS Participants described holding 'good dying' values which influenced their practice. The four practice-orientated themes of advocating, caring, communicating and relating with residents were found to influence interactions with residents, relatives, general practitioners, and colleagues. These led staff to be able to 'do the right thing' or to experience 'powerlessness', which could in turn lead to staff perceiving a 'bad death' for residents. CONCLUSION When there are incongruent values concerning care between staff and others involved in the care of residents, staff feel powerless to 'do the right thing' and unable to influence care decisions in order to avoid a 'bad death'. This powerlessness is the nature of their moral distress.
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Affiliation(s)
| | - Katherine Froggatt
- 2 International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sarah G Brearley
- 2 International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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Exploring the Relationship Among Moral Distress, Coping, and the Practice Environment in Emergency Department Nurses. Adv Emerg Nurs J 2017; 38:133-46. [PMID: 27139135 DOI: 10.1097/tme.0000000000000100] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Emergency department (ED) nurses practice in environments that are highly charged and unpredictable in nature and can precipitate conflict between the necessary prescribed actions and the individual's sense of what is morally the right thing to do. As a consequence of multiple moral dilemmas, ED staff nurses are at risk for experiencing distress and how they cope with these challenges may impact their practice. To examine moral distress in ED nurses and its relationship to coping in that specialty group. Using survey methods approach. One hundred ninety-eight ED nurses completed a moral distress, coping, and demographic collection instruments. Advanced statistical analysis was completed to look at relationships between the variables. Data analysis did show that moral distress is present in ED nurses (M = 80.19, SD = 53.27), and when separated into age groups, the greater the age, the less the experience of moral distress. A positive relationship between moral distress and some coping mechanisms and the ED environment was also noted. This study's findings suggest that ED nurses experience moral distress and could receive some benefit from utilization of appropriate coping skills. This study also suggests that the environment in which ED nurses practice has a significant impact on the experience of moral distress. Because health care is continuing to evolve, it is critical that issues such as moral distress and coping be studied in ED nurses to help eliminate human suffering.
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Abstract
Background: 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. Objective: This integrative review intends to clarify this point in addition to better defining ethical competence in the context of nursing practice. Method: 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. Ethical consideration: We have respected the ethical requirements required regarding the sources and authorship. There is no conflict of interest in this literature review. Results: 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. Conclusion: 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.
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Schaefer R, Zoboli ELCP, Vieira M. Identification of risk factors for moral distress in nurses: basis for the development of a new assessment tool. Nurs Inq 2016; 23:346-357. [DOI: 10.1111/nin.12156] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Rafaela Schaefer
- Department of Nursing; The Institute of Health Sciences of the Catholic University of Portugal - Porto (UCP); Porto Portugal
- Centre of Interdisciplinary Investigation in Health (CIIS); Porto Portugal
| | | | - Margarida Vieira
- Department of Nursing; The Institute of Health Sciences of the Catholic University of Portugal - Porto (UCP); Porto Portugal
- Centre of Interdisciplinary Investigation in Health (CIIS); Porto Portugal
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Abstract
Background: 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. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: 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. Results: 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. Conclusion: 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.
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Abstract
BACKGROUND 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. RESEARCH OBJECTIVE The purpose of this study was to explore how experienced hospice nurses resolve day to day ethical dilemmas during end-of-life care. RESEARCH DESIGN The study used a qualitative narrative approach. PARTICIPANTS Through purposeful sampling, a total of six experienced hospice nurse participated. Ethical considerations: Approval from the researcher's university Institutional Review Board for ethical review was obtained. FINDINGS 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. DISCUSSION 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. CONCLUSION A better understanding was obtained on how experienced hospice nurses successfully resolve ethical dilemmas culminating in better deaths for patients.
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Coffey A, McCarthy G, Weathers E, Friedman MI, Gallo K, Ehrenfeld M, Chan S, Li WHC, Poletti P, Zanotti R, Molloy DW, McGlade C, Fitzpatrick JJ, Itzhaki M. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries. Int J Nurs Pract 2016; 22:247-57. [PMID: 26823112 PMCID: PMC5066738 DOI: 10.1111/ijn.12417] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 09/18/2015] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
Nurses' knowledge regarding advance directives may affect their administration and completion in end‐of‐life care. Confidence among nurses is a barrier to the provision of quality end‐of‐life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end‐of‐life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross‐sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end‐of‐life and more comfortable stopping preventive medications at end‐of‐life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end‐of‐life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end‐of‐life care.
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Affiliation(s)
- Alice Coffey
- Senior Lecturer /Director International Programmes, School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Geraldine McCarthy
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Elizabeth Weathers
- Research Assistant, Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - M Isabel Friedman
- Clinical Education Specialist, Center for Learning and Innovation, North Shore-LIJ Health System, Lake Success, New York, USA
| | - Katherine Gallo
- Senior Vice President, Chief Learning Officer, Center for Learning and Innovation, North Shore-LIJ Health System, Lake Success, New York, USA
| | - Mally Ehrenfeld
- Associate Professor, Head of School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sophia Chan
- Professor in Nursing and Director of Research, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - William H C Li
- Assistant Professor, Director of Master of Nursing Programme, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - Piera Poletti
- Director, CEREF Centre for Research & Continuing Education, Padova, Italy
| | - Renzo Zanotti
- Associate Professor and Dean, Master in Nursing Sciences, Padua University, Padua, Italy
| | - D William Molloy
- Consultant in Geriatric Medicine, Centre of Gerontology and Rehabilitation, St. Finbarr's Hospital, Cork, Ireland
| | - Ciara McGlade
- Research Fellow and Consultant in Geriatric Medicine, Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - Joyce J Fitzpatrick
- Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michal Itzhaki
- Lecturer, Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Dahlke S, Baumbusch J. Nursing teams caring for hospitalised older adults. J Clin Nurs 2015; 24:3177-85. [DOI: 10.1111/jocn.12961] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing; University of Alberta; Edmonton AB Canada
| | - Jennifer Baumbusch
- School of Nursing; University of British Columbia; Vancouver BC Canada
- Canadian Institute of Health Research; Canadian Gerontological Nurses Association; University of British Columbia; Vancouver BC Canada
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Dahlke SA, Phinney A, Hall WA, Rodney P, Baumbusch J. Orchestrating care: nursing practice with hospitalised older adults. Int J Older People Nurs 2014; 10:252-62. [DOI: 10.1111/opn.12075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 09/29/2014] [Indexed: 02/05/2023]
Affiliation(s)
| | - Alison Phinney
- Nursing; University of British Columbia; Vancouver British Columbia Canada
| | - Wendy Ann Hall
- School of Nursing; UBC; Vancouver British Columbia Canada
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Abstract
This manuscript proposes a proactive framework for preventing or mitigating disruptive ethical conflicts that often result from delayed or avoided conversations about the ethics of care. Four components of the framework are explained and illustrated with evidenced-based actions. Clinical implications of adopting a prevention-based, system-wide ethics framework are discussed. While some aspects of ethically-difficult situations are unique, system patterns allow some issues to occur repeatedly--often with lingering effects such as healthcare providers' disengagement and moral distress (McAndrew et al. Journal of Trauma Nursing 18(4):221-230, 2011), compromised inter-professional relationships (Rosenstein and O'Daniel American Journal of Nursing, 105(1):54-64, 2005), weakened ethical climates (Pauly et al. HEC Forum 24:1-11, 2012), and patient safety concerns (Cimiotti et al. American Journal of Infection Control 40:486-490, 2012). This work offers healthcare providers and clinical ethicists a framework for developing a comprehensive set of proactive, ethics-specific, and evidence-based strategies for mitigating ethical conflicts. Furthermore, the framework aims to encourage innovative research and novel ways of collaborating to reduce such conflicts and the moral distress that often results.
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Affiliation(s)
- Carol Pavlish
- University of California Los Angeles School of Nursing, 700 Tiverton Avenue, Factor 4-238, Los Angeles, CA, 90095, USA,
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22
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Abstract
Over the past 30 years, there has been a modest improvement in the survival rates of U.S. infants.The public health impact of associated economic and technological advances raises questions regarding neonatal care and end-of-life decisions for those caring for this population. Nurses have an obligation to remain abreast of neonatal ethical standards because they are intimately involved in caring for these patients. Therefore, the aim of this article is to (a) summarize the extant neonatal bioethical literature to appreciate the complex ethical issues that translate into practice challenges, (b) present a framework that guides the assessment of the benefits and burdens of neonatal intensive care in the clinical setting to solicit and provoke dialogue, and (c) provide examples that advocate for educational training for neonatal healthcare providers in support of ethically sound care to affected families and infants.
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Affiliation(s)
- Raquel Pasarón
- Department of Pediatric Surgery, Miami Children’s Hospital.
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23
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Abstract
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.
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Coffey A, McCarthy G, Weathers E, Friedman MI, Gallo K, Ehrenfeld M, Itzhaki M, Chan S, Li WHC, Poletti P, Zanotti R, Molloy DW, McGlade C, Fitzpatrick JJ. Nurses' preferred end-of-life treatment choices in five countries. Int Nurs Rev 2013; 60:313-9. [PMID: 23961792 DOI: 10.1111/inr.12024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous research has focused on physician's perspectives of end-of-life (EOL) decision making as well as patient and family EOL decision making. There is a lack of research pertaining to the EOL treatment preferences of nurses and especially nurses working in a variety of care settings. AIM The aim of this study was to compare nurses' EOL treatment preferences in Hong Kong, Ireland, Israel, Italy and the USA. METHODS A comparative descriptive design was used with a convenience sample of nurses (n = 1089). A survey questionnaire using EOL hypothetical clinical case scenarios was used to collect data between June 2011 and July 2012. RESULTS Nurses in every country consistently chose a more aggressive option for patients than for themselves or for a parent. The treatment preferences of nurses varied from country to country. Lack of knowledge of patients' wishes and duty of care were the main influencing factors on treatment preferences. STUDY LIMITATIONS The study was limited to the hypothetical nature of the scenarios; however, the study highlights numerous future research questions. CONCLUSIONS This study is the first to examine and compare nurses' preferred EOL treatment choices in five countries from three different continents. The findings of this study raise several important questions for healthcare researchers, for policy development, and highlight the need for further international collaboration.
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Affiliation(s)
- A Coffey
- Catherine McAuley School of Nursing and Midwifery, University College Cork.
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King G, Scudder JN. Reasons Registered Nurses Report Serious Wrongdoings in a Public Teaching Hospital. Psychol Rep 2013; 112:626-36. [DOI: 10.2466/21.13.pr0.112.2.626-636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined reasons a registered nurse would report a wrongdoing within a public teaching hospital. Of a group of 238 initial respondents, 30% reported they had observed a wrongdoing in the past year, with 68 nurses indicating they had reported a wrongdoing in the past year. The latter group was the focus of this study. They indicated through a self-report survey that incidents threatening the well-being of patients and their professional ethics were more likely to be reported within their organizations. Observer anonymity was perceived to have a small, but important effect on nurses reporting a wrongdoing in this sample. A manipulation check of the initial 238 respondents revealed a very strong tendency for nurses to overlook a serious mistake by a close peer who had a reputation of being a “competent” nurse.
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Abstract
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.
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Oncology Nurses’ Narratives About Ethical Dilemmas and Prognosis-Related Communication in Advanced Cancer Patients. Cancer Nurs 2013; 36:114-21. [DOI: 10.1097/ncc.0b013e31825f4dc8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sundin K, Fahlen U, Lundgren M, Jacobsson C. Registered Nurses’ Experiences of Priorities in Surgery Care. Clin Nurs Res 2013; 23:153-70. [DOI: 10.1177/1054773812474298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Priorities and allocation are complex tasks in health care. Unspoken and also often unconscious priorities frequently occur. Research concerning how registered nurses (RN) priorities are limited. The aim of this study was to illuminate the meanings of RNs’ lived experiences of priorities in surgery care. Narrative interviews were conducted with 10 RNs working in a department of surgery. The RNs interviewed had all worked for more than 5 years as RNs. A phenomenological-hermeneutic interpretation of the interviews was conducted. The findings revealed 3 themes: making a conscious allocation and priorities of care, doing unreflected good, and being qualified to determine. The RNs did not often comprehend their actions as prioritizing. They more often comprehended their nursing tasks as obvious and did not consider this as priorities. But in situations of ethical difficulty, the RNs reflected upon their priority and actions.
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Affiliation(s)
| | - Ulla Fahlen
- Sundsvall-Härnösand Hospital, Department of Surgical, Härnösand, Sweden
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Pavlish C, Brown-Saltzman K, Jakel P, Rounkle AM. Nurses' Responses to Ethical Challenges in Oncology Practice: An Ethnographic Study. Clin J Oncol Nurs 2012. [DOI: 10.1188/12.cjon.592-600] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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