‘Good ethics and moral standing ’: a qualitative study of aesthetic leadership in clinical nursing practice

Ethical decision-making: exploring the four main principles in nursing

Nurses are regularly confronted with moral questions and ethical dilemmas in their practice, for example where a patient's decisions about their treatment conflict with the nurse's own views. While the standards contained in the Nursing and Midwifery Council The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates provide nurses with an overarching framework to guide practice, it is important that nurses understand the four main principles that underpin ethical care - autonomy, beneficence, non-maleficence and justice. This article examines these four principles and how they relate to nurses' ethical decision-making. The author also explores how nurses' ethics were tested by the coronavirus disease 2019 (COVID-19) pandemic. Having an awareness of ethical decision-making can enhance nurses' practice by providing them with a theoretical framework for treating patients with dignity and respect.

Development and validation of the information security attitude questionnaire (ISA-Q) for nurses

AIM

The aim of the study was to understand nurses' information security attitudes towards patient information. This study developed the Information Security Attitude Questionnaire (ISA-Q) to measure the physical, technical and administrative aspects of information security for nurses and assessed its validity and reliability.

DESIGN

Cross-sectional study and scale development.

METHODS

Exploratory and confirmatory factor analyses and correlation analyses were performed to assess construct, discriminant and convergent validity; Cronbach's α and test-retest reliability were examined.

RESULTS

Exploratory and confirmatory factor analyses yielded a 6-factor, 30-item solution. Six factors accounted for 60.19% of the total variance. The confirmatory factor analysis was achieved through structural equation modelling. Discriminant and convergent validity were confirmed. The internal consistency of the ISA-Q was 0.94, and the test-retest reliability was 0.74. The ISA-Q is an appropriate questionnaire for identifying information security attitudes of nurses, making it useful for developing systematic performance methods to enhance nurses' information security levels.

How Community Nurses Manage Ethical Conflicts: A Grounded Theory Study

Research is limited on how nurses in community settings manage ethical conflicts. To address this gap, we conducted a study to uncover the process of behaviors enacted by community nurses when experiencing ethical conflicts. Guided by Glaserian grounded theory, we developed a theoretical model (Moral Compassing) that enables us to explain the process how 24 community nurses managed challenging ethical situations. We discovered that the main concern with which nurses wrestle is moral uncertainty ("Should I be addressing what I think is a moral problem?"). Moral Compassing comprises processes that resolve this main concern by providing community nurses with the means to attain the moral agency necessary to decide to act or to decide not to act. The processes are undergoing a visceral reaction, self-talk, seeking validation, and mobilizing support for action or inaction. We also discovered that community nurses may experience continuing distress that we labeled moral residue.

Health-promoting leadership: A qualitative study from experienced nurses' perspective

AIMS AND OBJECTIVES

To increase knowledge about experienced nurses' understanding of a health-promoting work environment, health-promoting leadership and its role in retention of staff in the nursing workplace.

BACKGROUND

The quality of leadership is imperative in creating supportive and health-promoting work environments to ensure workforce productivity and ethically sustainable caring cultures. More knowledge on how leaders can promote health and sustainable careers among nurses is needed. At a time of current and projected nursing shortage, it is important to understand the reasons why nurses intend to remain in their jobs.

DESIGN

Qualitative descriptive.

METHOD

Twelve experienced registered nurses participated in an individual, digitally recorded, semi-structured interview. Data were transcribed verbatim and subjected to qualitative content analysis of manifest and latent content.

RESULTS

A health-promoting work environment should provide autonomy, participation in decision-making, skills development and social support. Health-promoting leaders should be attentive and take action.

CONCLUSION

Health-promoting work environments enable nurses to flourish. Having ample autonomy is therefore important to nurses so that when they face new challenges, they see them as a way of using and developing their competencies. Although most nurses claim their own leaders are not health promoting, they have a clear understanding of how a health-promoting leader should act. The health-promoting leader should not only be attentive and promote skills development, but also cater for nurses' meaningfulness.

RELEVANCE TO CLINICAL PRACTICE

Nurses in primary health care understand a health-promoting work environment to be a workplace where they can develop, not only clinical skills, but also flourish as human beings. Further, nurses find it health promoting to have a meaningful job, using their competence to make a difference for patients and their families. Nurse Managers have an important role in facilitating meaningfulness in nurses' jobs to retain nurses as a valuable asset for the organisation.

Self-reported confidence in patient safety knowledge among Australian undergraduate nursing students: A multi-site cross-sectional survey study

BACKGROUND

Patient safety is critical to the provision of quality health care and thus is an essential component of nurse education.

OBJECTIVE

To describe first, second and third year Australian undergraduate nursing students' confidence in patient safety knowledge acquired in the classroom and clinical settings across the three years of the undergraduate nursing program.

DESIGN

A cross-sectional online survey conducted in 2015.

SETTING

Seven Australian universities with campuses across three states (Queensland, New South Wales, South Australia).

PARTICIPANTS

A total of 1319 Australian undergraduate nursing students.

METHODS

Participants were surveyed using the 31-item Health Professional Education in Patient Safety Survey (H-PEPSS). Descriptive statistics summarised the sample and survey responses. Paired t-tests, ANOVA and generalized-estimating-equations models were used to compare responses across learning settings (classroom and clinical), and year of nursing course.

RESULTS

Participants were most confident in their learning of clinical safety skills and least confident in learning about the sociocultural dimensions of working in teams with other health professionals, managing safety risks and understanding human and environmental factors. Only 59% of students felt confident they could approach someone engaging in unsafe practice, 75% of students agreed it was difficult to question the decisions or actions of those with more authority, and 78% were concerned they would face disciplinary action if they made a serious error. One patient safety subscale, Recognising and responding to remove immediate safety risks, was rated significantly higher by third year nursing students than by first and second year students. Two broader aspects of patient safety scales, Consistency in how patient safety issues are dealt with by different preceptors, and System aspects of patient safety are well covered in our program, were rated significantly higher by first year nursing students than by second and third year students. One scale, Understanding that reporting adverse events and close calls can lead to change and can reduce recurrence of events, was rated significantly higher by third year students than first and second year students.

CONCLUSIONS

In order are to achieve meaningful improvements in patient safety, and create harm free environments for patients, it is crucial that nursing students develop confidence communicating with others to improve patient safety, particularly in the areas of challenging poor practice, and recognising, responding to and disclosing adverse events, including errors and near misses.

Ethical leadership outcomes in nursing: A qualitative study

Background:

Leadership style adopted by nursing managers is a key element in progress and development of nursing and quality of healthcare services received by the patients. In this regard, the role of ethical leadership is of utmost importance.

Objectives:

The objective of the study was to elaborate on the ethical leadership and its role in professional progress and growth of nurses in the light of work condition in health providing institutes.

Methods:

The study was carried out as a qualitative study following conventional content analysis method. In total, 14 nursing faculty members and nursing managers at different levels were selected through purposive sampling method. Semi-structured interviews were used for data gathering. The data were analyzed using latent content analysis and constant comparison analysis.

Ethical considerations:

This study was conducted in accordance with ethical issues in research with human participants and national rules and regulations related to informed consent and confidentiality. The study was approved by the Committee of Ethics in Research at the Shahid Beheshti University of Medical Sciences in Tehran, Iran, under the code: sbmu.rec.1393.695 on 15 February 2015.

Findings:

Five subcategories were obtained based on the analysis, which constituted two main categories including “all-inclusive satisfaction” and “productivity.” Nursing leaders highlighted the point that their ethical behavior creates “inner satisfaction of the leader,” “employees’ job satisfaction,” and “patients’ satisfaction.” Improvement of productivity was another outcome of ethical behavior of the leaders. This kind of behavior resulted in “providing better services” and “inspiring ethical behavior in the employees.” It has great influence on progress and growth of the nursing profession.

Conclusion:

By creating an ethical climate, ethical leadership leads to positive and effective outcomes—for the patients as well as for the nurses and the leaders—and professional progress and development of the nursing profession. Therefore, an ethical work environment that supports nurses’ progress and development can be developed by paying more attention to moralities in recruitment, teaching ethical values to the leaders, and using a systematic and objective approach to assess morality in the environment.