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Kalantari S, Modanloo M, Ebadi A, Khoddam H. Concept analysis of conscience-based nursing care: a hybrid approach of Schwartz-Barcott and Kim's hybrid model. BMC Med Ethics 2024; 25:70. [PMID: 38890687 PMCID: PMC11184846 DOI: 10.1186/s12910-024-01070-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and elevates the level of patient care. However, a precise definition of conscience in the nursing field is lacking, making it challenging to measure. To address this issue, this study employed the hybrid approach of Schwartz Barcott and Kim to analyze the concept of conscience-based nursing care. METHODS This approach involves a three-phase process; theoretical, fieldwork, and analytical. A systematic literature review was conducted using electronic databases during the first phase to find relevant papers. The content of 42 articles that met the inclusion criteria was extracted to determine the attributes, antecedents, and consequences of consciousness care using thematic analysis. Based on the working definition as a product of this phase, the plan of doing the fieldwork phase was designed. During this phase, data were collected through interviews with nurses all of whom were responsible for patient care in hospitals. In this phase, 5 participants were chosen for in-depth interviewing by purposeful sampling. Data were analyzed using directed content analysis. The findings of the theoretical and fieldwork phases were integrated and the final definition was derived. RESULTS The integration of the theoretical and fieldwork phases resulted in identifying four key characteristics of conscience-based nursing care. Firstly, it involves providing professional care with a conscientious approach. Secondly, ethics is at the core of conscience-based care. Thirdly, external spirituality plays a significant role in shaping one's conscience in this context. Finally, conscience-based nursing care is both endogenous and exogenous, with professional commitment being the central focus of care. CONCLUSION Conscience-based nursing care is an essential component of ethical care, which elevates clinical practice to professional care. It requires the integration of individual and social values, influenced by personal beliefs and cultural backgrounds, and supported by professional competence, resources, and a conducive organizational atmosphere in the healthcare field. This approach leads to the provision of responsive care, moral integrity, and individual excellence, ultimately culminating in the development of professionalism in nursing.
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Affiliation(s)
- Soheyla Kalantari
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahnaz Modanloo
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abbas Ebadi
- Research Center for Life & Health Sciences & Biotechnology of the Police, Direction of Health, Rescue & Treatment , Police Headquarter, Tehran, Iran
| | - Homeira Khoddam
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
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Lennon C, Harvey D, Goldstein PA. Ethical considerations for theatre teams in organ donation after circulatory determination of death. Br J Anaesth 2023; 130:502-507. [PMID: 36801100 DOI: 10.1016/j.bja.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/20/2022] [Accepted: 01/15/2023] [Indexed: 02/18/2023] Open
Abstract
Transplant surgery is an area that gives rise to a number of ethical considerations. As medicine continues to expand the boundaries of what is technically possible, we must consider the ethical implications of our interventions, not solely on patients and society, but also on those asked to provide that care. Here, we consider physician participation in procedures required to provide patient care in the context of the ethical convictions held by the physician, with an emphasis on organ donation after circulatory determination of death. Strategies that can be used to mitigate any potential negative impact on the psychological well-being of members of the patient care team are considered.
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Affiliation(s)
| | - Dan Harvey
- National Health Service Blood & Transplant, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter A Goldstein
- Department of Anesthesiology, New York, NY, USA; Department of Medicine, New York, NY, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
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Karabulut SD, Gül Ş, Keleş Ş, Baykara ZG, Yalım NY. Nurses' attitudes toward, perceptions of, and experiences with conscientious objection. Nurs Ethics 2022; 29:1615-1633. [PMID: 35575202 DOI: 10.1177/09697330221085771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Conscientious objection is a person's refusal to fulfill a legal duty due to their ethical values, religious beliefs, or ideological affiliations. In nursing, it refers to a nurse's refusal to perform an action or participate in a particular situation based on their conscience. Conscientious objection has become a highly contested topic in recent years. RESEARCH OBJECTIVES This study had four objectives: (1) eliciting information on how Turkish nurses perceive conscientious objection, (2) revealing whether their moral beliefs affect the care they provide, (3) determining their experiences with conscientious objection, and (4) identifying existing or potential issues of conscientious objection. RESEARCH DESIGN This qualitative study collected data through semi-structured interviews. The data were analyzed using thematic content analysis. PARTICIPANTS The sample consisted of 21 nurses. ETHICAL CONSIDERATIONS The study was approved by an ethics committee. Confidentiality and anonymity were guaranteed. Participation was voluntary. FINDINGS The analysis revealed four themes: (1) universal values of nursing (professional values), (2) experiences with conscientious objection (refusing to provide care/not providing care), (3) possible effects of conscientious objection (positive and negative), and (4) scope of conscientious objection (grounded and groundless). CONCLUSION Participants did not want to provide care due to (1) patient characteristics or (2) their own religious and moral beliefs. Participants stated that conscientious objection should be limited in the case of moral dilemmas and accepted only if the healthcare team agreed on it. Further research is warranted to define conscientious objection and determine its possible effects, feasibility, and scope in Turkey.
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Affiliation(s)
- Seyhan Demir Karabulut
- Department of Medical History and Ethics, Faculty of Medicine, 63994Baskent University, Ankara, Turkey
| | - Şenay Gül
- Department of Fundamentals of Nursing, Faculty of Nursing, 37515Hacettepe University, Ankara, Turkey
| | - Şükrü Keleş
- Department of Medical History and Ethics, Faculty of Medicine, 64255Karadeniz Technical University, Trabzon, Turkey
| | - Zehra Göçmen Baykara
- Department of Fundamentals of Nursing, Faculty of Health Science, 369802Gazi University, Ankara, Turkey
| | - Neyyire Yasemin Yalım
- Department of Medical Ethics and History, Faculty of Medicine, Ankara University, Ankara, Turkey
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Brown J, Goodridge D, Thorpe L, Hodson A, Chipanshi M. Factors influencing practitioners' who do not participate in ethically complex, legally available care: scoping review. BMC Med Ethics 2021; 22:134. [PMID: 34583710 PMCID: PMC8479895 DOI: 10.1186/s12910-021-00703-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Evolving medical technology, advancing biomedical and drug research, and changing laws and legislation impact patients’ healthcare options and influence healthcare practitioners’ (HCPs’) practices. Conscientious objection policy confusion and variability can arise as it may occasionally be unclear what underpins non-participation. Our objective was to identify, analyze, and synthesize the factors that influenced HCPs who did not participate in ethically complex, legally available healthcare. Methods We used Arksey and O’Malley’s framework while considering Levac et al.’s enhancements, and qualitatively synthesized the evidence. We searched Medline, CINAHL, JSTOR, EMBASE, PsychINFO, Sociological Abstracts, and ProQuest Dissertations and Theses Global from January 1, 1998, to January 15, 2020, and reviewed the references of the final articles. We included articles written in English that discussed the factors that influenced physicians and registered nurses (RNs) who did not participate in end-of-life (EOL), reproductive technology and health, genetic testing, and organ or tissue donation healthcare areas. Using Covidence, we conducted title and abstract screening, followed by full-text screening against our eligibility criteria. We extracted the article’s data into a spreadsheet, analyzed the articles, and completed a qualitative content analysis using NVivo12. Results We identified 10,664 articles through the search, and after the screening, 16 articles were included. The articles sampled RNs (n = 5) and physicians (n = 11) and encompassed qualitative (n = 7), quantitative (n = 7), and mixed (n = 2) methodologies. The care areas included reproductive technology and health (n = 11), EOL (n = 3), organ procurement (n = 1), and genetic testing (n = 1). One article included two care areas; EOL and reproductive health. The themed factors that influenced HCPs who did not participate in healthcare were: (1) HCPs’ characteristics, (2) personal beliefs, (3) professional ethos, 4) emotional labour considerations, and (5) system and clinical practice considerations. Conclusion The factors that influenced HCPs’ who did not participate in ethically complex, legally available care are diverse. There is a need to recognize conscientious objection to healthcare as a separate construct from non-participation in healthcare for reasons other than conscience. Understanding these separate constructs will support HCPs’ specific to the underlying factors influencing their practice participation.
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Affiliation(s)
- Janine Brown
- Faculty of Nursing, University of Regina, 111-116 Research Drive, Saskatoon, SK, S7N 3R3, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, E1216, Health Sciences Building, 104 Clinic Place, Saskatoon, SK, S7N 5E5, Canada.
| | - Lilian Thorpe
- Departments of Community Health and Epidemiology and Psychiatry, University of Saskatchewan, E3218, Health Sciences Building, 104 Clinic Place, Saskatoon, SK, S7N 5E5, Canada
| | - Alexandra Hodson
- Faculty of Nursing, University of Regina, 111-116 Research Drive, Saskatoon, SK, S7N 3R3, Canada
| | - Mary Chipanshi
- Nursing Liaison Librarian, University of Regina Library, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
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Dicks SG, Burkolter N, Jackson LC, Northam HL, Boer DP, van Haren FM. Grief, Stress, Trauma, and Support During the Organ Donation Process. Transplant Direct 2020; 6:e512. [PMID: 32047840 PMCID: PMC6964929 DOI: 10.1097/txd.0000000000000957] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022] Open
Abstract
The organ donation process is complex and stressful for the family of the potential donor and members of the multidisciplinary team who may experience grief, ethical dilemmas, vicarious trauma, or compassion fatigue. Several studies each explore the role of a specific healthcare group and the impact of inhospital processes on group members. We conducted a systematic literature search to identify such studies and a qualitative synthesis to consolidate findings and highlight features of the interaction and relationships between role players. Our results suggest that, while healthcare professionals have different roles, attitudes, and views, the experience of stressors and interdisciplinary tension is common. Nevertheless, staff are united by the goal of caring for the patient and family. We therefore propose that, while focusing on bereavement care and other aspects of the family's experience, staff can find other shared goals and develop understanding, trust, empathy, and respect for each other's positions, thereby improving functioning in the complex adaptive system that forms at this time. Education and training can equip staff to facilitate anticipatory mourning, family-led activities, and a meaningful parting from their relative, assisting families with their grief and increasing staff members' efficacy, confidence, and interdisciplinary teamwork. Knowledge of systems thinking and opportunities to share ideas and experiences will enable staff to appreciate each other's roles, while supportive mentors, self-care strategies, and meaningful feedback between role players will foster healthy adjustment and shared learning. A focus on psychosocial outcomes such as family satisfaction with the process, collaboration within the multidisciplinary team, and reduction in the role stress of healthcare professionals will contribute to family well-being as well as personal and professional growth for staff.
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Affiliation(s)
- Sean G. Dicks
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
| | | | | | - Holly L. Northam
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Douglas P. Boer
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Frank M.P. van Haren
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
- School of Medicine, Australian National University, Canberra, ACT, Australia
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Dobrowolska B, McGonagle I, Pilewska-Kozak A, Kane R. Conscientious object in nursing: Regulations and practice in two European countries. Nurs Ethics 2019; 27:168-183. [PMID: 31113265 DOI: 10.1177/0969733019845136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery. AIM To present (a) the arguments for and against conscientious objection in nursing practice, (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice. DESIGN Discussion paper. ETHICAL CONSIDERATIONS Ethical guidelines has been followed at each stage of this study. FINDINGS Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient's rights. DISCUSSION AND CONCLUSION Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice.
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Kim JN, Jeong SH. [Types of Perception toward Ethical Issues in Perioperative Nurses: Q-Methodological Approach]. J Korean Acad Nurs 2019; 48:679-691. [PMID: 30613056 DOI: 10.4040/jkan.2018.48.6.679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was aimed at identifying the types of perceptions of ethical issues among perioperative nurses. METHODS Q-methodology focusing on individual subjectivity was used with data collected in November 2016. Thirty-four Q-statements were selected and scored by the 35 participants on a 9-point scale with normal distribution. Participants were perioperative nurses working in advanced general hospitals and general hospitals. The data were analyzed using the PC-QUANL program. RESULTS total of 35 perioperative nurses were classified into 4 factors based on the following viewpoints: self-centered (type 1), onlooking and avoiding (type 2), patient-centered (type 3), and problem-centered (type 4). The 4 factors accounted for 57.84% of the total variance. Individual contributions of factors 1, 2, 3, and 4 were 41.80%, 7.18%, 5.20%, and 3.66%, respectively. CONCLUSION The major contribution of this study is the clarification of perioperative nurses' subjective perceptions of ethical issues. These findings can be used in formulating effective strategies for nursing educators, professional nurses, and nursing administrators to improve ethical decision-making abilities and to perform ethical nursing care by the appropriate management of ethical issues in everyday nursing practice.
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Affiliation(s)
- Jin Nam Kim
- Department of Nursing, Chonbuk National University Hospital, Jeonju, Korea
| | - Seok Hee Jeong
- College of Nursing·Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea.
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