Fostering a Trusting Relationship With Family in Dementia Special Care Units: A Participatory Action Research Project

AIM

To explore experiences of nursing home staff in implementing self-designed interventions to foster trusting relationships with family in practice.

DESIGN

This qualitative study used a Participatory Action Research approach.

METHODS

Data collection included focus groups (n = 15), interviews (n = 28) and observations (n = 5). A holistic narrative approach was used for data analysis, resulting in co-constructed narratives representing experiences of nursing home staff in implementing four different interventions in five Dutch dementia special care units in nursing homes. The data collection period began in August 2021 and ended in April 2022.

RESULTS

Nursing home staff implemented self-designed interventions to foster trusting relationships with family, including initiating informal conversations, sharing residents' 'happy' moments, discussing mutual expectations, and being more aware of families' emotional burdens. Identified facilitators emphasise the importance of reciprocity, familiarity, transparency, realistic goal setting and empathy. Identified barriers are related to moral uncertainty in balancing competing demands, conflicting social norms, prioritising hands-on care tasks over family contact and lack of courage to act.

CONCLUSION

Nursing home staff conclude that their interventions contribute positively to building and maintaining a trusting relationship with families.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Sharing the narratives of nursing home staff with peers would support them in implementing interventions to foster trust. Regular Moral Case Deliberations can be used to address moral uncertainty. Collective dialogue among nursing home staff can be useful in establishing new social norms that prioritise family involvement. Conversation skills training can empower nursing home staff.

IMPACT

Trust between nursing home staff and families can be improved by implementing the conducted interventions.

REPORTING METHOD

This report adheres to the standards for reporting qualitative research (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Conceptual Foreknowings: Integrative Review on Having Courage

Having courage is a humanuniverse living experience that is common to all humans. Individuals experience courage in one way or another at different times. Hence, it is imperative to understand having courage from various standpoints. To explore the different perspectives on the phenomenon of courage, the scholar dwelled with printed material across the disciplines of theology, psychology, philosophy, sociology, social work, education, business, and nursing. Two themes were crafted from the literature as (a) courage is steadfastness in the midst of fear and (b) unfaltering commitment to the cherished.

How nursing care is expressed among nurse anaesthetists in the perioperative context: A meta-ethnographic synthesis

AIM

To develop a conceptual framework describing nursing care from the anaesthesia nurse's perspective in the perioperative context.

BACKGROUND

Surgical patients find themselves in a vulnerable situation in need of advanced treatment and care. Nurse anaesthetists have a central role in reducing harm and enhance patient safety, in which person-centred care has been identified as a key component. However, they are challenged by productivity and efficiency demands leading to a potential risk to patient safety.

DESIGN

Noblit and Hare's interpretative meta-ethnography, directed by the eMERGe reporting guidance.

METHODS

A comprehensive systematic search of nine databases without year limitation. Fifteen studies published between 2002 and 2021 were found eligible for inclusion. Quality appraisal was performed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.

RESULTS

Four themes were identified: being vigilant to keep safe from harm, strengthening patients' confidence, expressing courage to act and speak up, and endorsing team collaboration to achieve best practice. The themes were synthesised into the metaphor, 'Continuously assessing and acting according to the patients' needs in a holistic perspective'. A conceptual framework was developed, illustrating the interconnection between the different nursing expressions, as the nurse anaesthetists seek to care for the patient as a whole person.

CONCLUSIONS

Nurse anaesthetists aim to deliver holistic nursing care. Nursing care is expressed at two levels, foregrounding and backgrounding anaesthetic nursing, in line with the philosophy of person-centred care. Nursing care in anaesthesia is a matter of how and why it is performed, expressed in attitudes toward the recipients of care.

RELEVANCE TO CLINICAL PRACTICE

The framework may be used to inform educational programs and clinical practice in nurse anaesthesia and to promote person-centred care as a shared value across all levels involved in perioperative patient care.

NO PATIENT OR PUBLIC CONTRIBUTION

Data were retrieved from already published literature.

Career Calling, Courage, Flourishing and Satisfaction with Life in Italian University Students

Career calling is defined as a positive resource promoting vocational development and well-being. The present study focuses on the relationships between career calling, courage and two indicators of well-being, i.e., flourishing and satisfaction with life. The sample consisted of 306 Italian university students (118 males and 188 females) ranging from 18 to 30 years of age. A structural equation modeling (SEM) approach with latent variables was adopted. The results showed that courage plays a mediating role between career calling and well-being indicators. In light of these results, suggestions on the practical implications for career interventions to support university students are also addressed.

Heroism and paramedic practice: A constructivist metasynthesis of qualitative research

OBJECTIVES

We aimed to identify, appraise, and synthesise the qualitative literature to develop theory on heroism and paramedic practice.

HYPOTHESIS/RESEARCH QUESTION

What does published literature tell us about heroism and paramedic practice?

SETTING

Paramedics and other healthcare workers (HCWs) faced an outpouring of public support for them early in the COVID-19 pandemic which brought into focus the relationship between them and society, where they are portrayed as heroes.

PARTICIPANTS

We conducted a metasynthesis using Evolved Grounded Theory and procedural guidelines of Noblit and Hare to guide analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines were also applied.

RESULTS

151 papers were retrieved and eleven included in the final sample. Studies were moderate to very low quality, involving a wide range of methodologies and settings; none specifically explored heroism and paramedic practice. The following interrelated themes were constructed on heroism and paramedic practice: (a) Myth, Folk law, and storytelling in heroism and paramedic practice (b) The epic journey of heroism and paramedic practice (c) Heroes and Zeroes: The fluctuating Societal Value in heroism and paramedic practice (d) Politicisation, and objectification in Heroism and Paramedic practice.

CONCLUSION

Paramedics have long been characterised as heroes, but this may not reflect their everyday experiences. Heroism in paramedic practice can provide scripts for prosocial action, inspiring others, and leading to more social heroic actions. Paramedics may however be ambivalent to such heroism narratives, due to politicisation, and objectification in the media and society. This metasynthesis is only one of many possible constructions of heroism and paramedic practice and is the first point in making sense of and developing theory on heroism and paramedic practice.

STUDY REGISTRATION

PROSPERO: CRD42021234851.

The relationship between ethical leadership, conscientiousness, and moral courage from nurses' perspective

BACKGROUND

Nurses' conscientiousness and moral courage are essential to providing high quality care. Leadership is one of the factors that may be very effective in strengthening these characteristics in nurses. Among leadership styles, the ethical leadership has a special value. This study investigated the relationship between ethical leadership of nursing managers, conscientiousness, and moral courage from the nurses' perspective.

METHODS

In this cross-sectional descriptive study, 180 nurses working in hospitals of Yazd, central Iran, were selected through simple random sampling. Three questionnaires: the "Ethical Leadership", "Conscientiousness", and "Moral Courage" were used to collect data. Data were analyzed with SPSS20 using descriptive and analytical statistics.

RESULTS

There was a positive and significant relationship between conscientiousness and moral courage with ethical leadership from the nurses' perspective (P < 0.05). The relationship between conscientiousness and moral courage was also significant (P < 0.05). The regression analysis showed that ethical leadership can be considered as a predictor of conscientiousness and moral courage.

CONCLUSION

The relationship between ethical leadership and conscientiousness and moral courage suggests that nursing managers, by adopting such an approach in leadership, can increase conscientiousness and moral courage in nurses.

The Relationship between Subjective Risk Intelligence and Courage with Working Performance: The Potential Mediating Effect of Workplace Social Courage

Background: There is a growing attention toward the construct of courage from a psychological point of view; recently, courage has been related with numerous positive individual behaviors and outcomes, such as coping strategies and subjective wellbeing, and an increasing number of studies explore the role of courage in the working and organizational environments. The present study is aimed to analyze the effect that individual courage—together with risk intelligence—and workplace social courage have on working performance; Methods: The participants are 961 Italian workers, balanced by gender; the measures used are: Courage, Subjective Risk Intelligence Scale, Workplace Social Courage Scale, and Performance Scale. Data were analyzed using Structural Equation Models; Results: The results show the effect of subjective risk intelligence and courage on working performance, both directly and through the mediation of workplace social courage; Conclusions: Suggestions for further research and practical implications are discussed.

Iranian nurses' views on barriers to moral courage in practice: A qualitative descriptive study

Background

Nursing is a caring profession. Due to the nature of their work, nurses need to have the moral courage to deliver safe nursing care. Research results have reported a low level of moral courage in the majority of nurses. The current study aimed to identify the barriers to show moral courage in Iranian nurses.

Methods

This study was qualitative research that was conducted using conventional content analysis. Data was gathered using in-person, semi-structured, in-depth interviews. Interviews were conducted from March to September 2020. Purposeful sampling was used and sampling was continued until data saturation was reached. Participants were 19 nurses working in hospitals in Iran.

Results

According to data analysis, six categories and three themes were extracted. Themes are “organizational failure”, “deterrent personal identity” and “defeated professional identity”.

Conclusions

The results of this study revealed the barriers to show moral courage which were usually overlooked in previous quantitative studies. It appears that the elimination of these barriers is an effective step in the improvemalet of nurses’ competencies. The results of this study can be helpful in the developmalet of programs to address the factors affecting nurses’ moral courage.

Coronavirus: the 7th C affecting the 6Cs. A focus on compassion, care and touch

The C0VID-19 pandemic has challenged everyone in society, from children who are no longer able to attend school and nursery to adults trying to juggle working at home and vulnerable members of society who have needed to self-isolate. NHS staff and key workers also need to juggle their family situations and many will have to adapt their practice and ways of working to address the demands placed on the NHS during this time. The current pandemic has altered the nature of services being provided to patients, and staff are now wearing personal protective equipment, with many being redeployed to ward areas. This article considers the 6Cs of nursing and the challenges faced by staff during the COVID-19 pandemic, with a primary focus on care and compassion. The vital role that touch has in the care of the patient and family is also considered.

Measuring nurses' moral courage: an explorative study

BACKGROUND

The 21-item Nurses' Moral Courage Scale was developed and validated in 2018 in Finland with the purpose of measuring moral courage among nurses.

OBJECTIVES

The objective of this study was to make a Dutch translation of the Nurses' Moral Courage Scale to describe the level of nurses' self-assessed moral courage and associated socio-demographic factors in Flanders, Belgium.

RESEARCH DESIGN

A forward-backward translation method was applied to translate the English Nurses' Moral Courage Scale to Dutch, and a pilot study was conducted to improve readability and understandability. A non-experimental, descriptive cross-sectional exploratory design was used to conduct a survey. Descriptive analysis was used.

PARTICIPANTS

The data were collected from a convenience sample of 559 nurses from two hospitals in Flanders.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the university ethics committee, permission to conduct the study was obtained from the participating hospitals. Participants received a guide letter and gave their informed consent.

FINDINGS

The readability and understandability of the Dutch Nurses' Moral Courage Scale were positively evaluated, and the scale revealed a good level of internal consistency for the total scale (α = .914) and all subscales. Nurses' mean score of the 21-item Nurses' Moral Courage Scale was 3.77 (standard deviation = 0.537). The total Nurses' Moral Courage Scale score was associated with age (p < .001), experience (p < .001), professional function (p = .002), level of education (p = .002) and personal interest (p < .001).

DISCUSSION AND CONCLUSION

The Nurses' Moral Courage Scale was successfully translated to Dutch. The Flemish nurses perceived themselves as morally courageous, especially when they were in a direct interpersonal relationship with their patients. Acting courageously in ethical dilemmas that involved other actors or organizations appeared to be more challenging. The results strongly suggest the important role of education and ethical leadership in developing and supporting this essential virtue in nursing practice.

Moral courage and psychological empowerment among nurses

BACKGROUND

Moral courage is one of the fundamental values of nursing profession and a powerful method of coping with ethical problems. Psychological empowerment is a suitable method of enabling individuals to coping mental pressures of the work environment. This study determined the correlation between moral courage and psychological empowerment of nurses.

METHODS

This was a descriptive cross-sectional study. A total of 180 nurses employed in different wards were selected randomly. Data were collected by Demographics Questionnaire, Sekerka's Moral Courage Scale, and Spreitzer's psychological empowerment Scale and analyzed with SPSS16 using descriptive and inferential statistics.

FINDINGS

The results indicated that the mean score of moral courage was 21.11 ± 69.90 and the greatest amount of moral courage was in the dimension of "going beyond compliance". The mean score of "psychological empowerment" was 30.9 ± 73.58 and the greatest mean belonged to "competence". There was a positive significant correlation between "psychological empowerment" and "moral courage and its dimensions" (P < 0.05).

CONCLUSION

The findings suggested a correlation between moral courage and psychological empowerment. Thus, nurses' moral courage could be enhanced by reinforcing their psychological empowerment leading to increased patient satisfaction and quality care.

Development and validation of Nurses' Moral Courage Scale

BACKGROUND

Moral courage is required at all levels of nursing. However, there is a need for development of instruments to measure nurses' moral courage.

OBJECTIVES

The objective of this study is to develop a scale to measure nurses' self-assessed moral courage, to evaluate the scale's psychometric properties, and to briefly describe the current level of nurses' self-assessed moral courage and associated socio-demographic factors.

RESEARCH DESIGN

In this methodological study, non-experimental, cross-sectional exploratory design was applied. The data were collected using Nurses' Moral Courage Scale and analysed statistically.

PARTICIPANTS AND RESEARCH CONTEXT

The data were collected from a convenience sample of 482 nurses from four different clinical fields in a major university hospital in Finland for the final testing of the scale. The pilot comprised a convenience sample of 129 nurses.

ETHICAL CONSIDERATIONS

The study followed good scientific inquiry guidelines. Ethical approval was obtained from the university ethics committee and permission to conduct the study from the participating hospital.

FINDINGS

Psychometric evaluation showed that the 4-sub-scale, 21-item Nurses' Moral Courage Scale demonstrates good reliability and validity at its current state of development showing a good level of internal consistency for a new scale, the internal consistency values ranging from 0.73 to 0.82 for sub-scales and 0.93 for the total scale, thus well exceeding the recommended Cronbach's alpha value of >0.7. Principal component analysis and confirmatory factor analysis supported the theoretical construct of Nurses' Moral Courage Scale. Face validity and expert panel assessments markedly contributed to the relevance of items in establishing content validity.

DISCUSSION AND CONCLUSION

Nurses' Moral Courage Scale provides a new generic instrument intended for measuring nurses' self-assessed moral courage. Recognizing the importance of moral courage as a part of nurses' moral competence and its assessment offers possibilities to develop interventions and educational programs for enhancement of moral courage. Research should focus on further validation measures of Nurses' Moral Courage Scale in international contexts.

Heroism and nursing: A thematic review of the literature

OBJECTIVES

Nursing history is replete with examples of heroic individuals acting courageously to meet the needs of vulnerable patients and communities. Heroism exemplifies the pinnacle of self-actualised behaviour. It fuels the plots of countless human stories, and enthrals and inspires people. Yet, heroism may be seen as an extreme behaviour that only exceptional individuals are capable of enacting, and may thus be seen as out of reach for ordinary nurses, and something that could be risky to teach and disseminate. An alternative view is that altruistic professions such as nursing are often regarded as being heroic by nature, and that nurses therefore need to be encouraged to understand, deepen and exercise their potential through a recognition of acts of heroism in nursing - whether these can be classed as exceptional or everyday acts of nursing heroism. The purpose of this article is to provide a thematic review of the literature on heroism in nursing, in order to understand how recent research in heroism science is being, or could be, applied to the nursing discipline. Heroism science is an emerging research area that is of interest to nursing leaders, educators and all those seeking to advance the social change agenda in healthcare.

REVIEW METHODS

A literature review was undertaken in 2017 using CINAHL, PUBMED, Cochrane, Medline, and Google Scholar. The search was limited to papers that were peer reviewed, in English, and published in the last ten years.

RESULTS

Four books and 33 papers were identified.

CONCLUSION

Gaining a clear understanding of what constitutes a hero and heroism is essential to applying heroism to nursing and to education of students so they are inspired to act courageously.

Student courage: An essential for today's health education

AIM

The aim of this concept analysis is to propose the new concept of student courage as it operates within the context of healthcare professionals' education.

BACKGROUND

Nurses have a moral obligation that often requires courage. However, nursing students do not have the capacity to act with moral courage until they are close to licensure. Student courage is propositioned as a precursor to moral courage.

DESIGN

The Walker and Avant approach is used to examine the attributes, antecedents, consequences, and empiric referents of student courage. Cases are provided to represent how student courage can be operationalized and to distinguish student courage from moral courage.

RESULTS

The analysis demonstrates that the concept of student courage has four critical attributes: (a) persistence, (b) bravery, (c) overcoming fear, and (d) self-advocacy. Positive and negative consequences are associated with student courage and include: (a) moral distress, (b) criticism, (c) empowerment, and (d) self-knowledge.

CONCLUSIONS

This concept analysis helps fill the gap for nursing students transitioning into a professional role as well as clarifying a nursing student's role in patient care.

The moral courage of nursing students who complete advance directives with homeless persons

Background:

Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives.

Research hypothesis:

We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a person or an action that overcomes fears or other challenges to achieve something of great moral worth.

Research design:

The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable.

Participants and research context:

A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency.

Ethical considerations:

The study was approved by the Internal Review Board of the authors’ university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary.

Findings:

Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person’s dying and death, and the challenge of adequately conveying the advance directive’s meaning and accurately recording a homeless person’s end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants reported having encountered those obstacles. So, while participants required moral courage to assist homeless persons with advance directives, they required greater moral courage as they anticipated their meetings than during those meetings.

Discussion:

Our study breaks new ground at the intersection of nursing, moral courage, and advance directives. It might also have important implications for how to improve the training that US nursing students receive before they provide this service.

Conclusion:

Our results cannot be generalized, but portions of our approach are likely to be transferable to similar social contexts. For example, because homeless persons are misunderstood and marginalized throughout the United States, our design for training nursing students to provide this service is also likely to be useful across the United States. Internationally, however, it is not yet known whether our participants’ fears and the challenge they faced are also experienced by those who assist homeless persons or members of other vulnerable populations in documenting healthcare wishes.

Concept analysis of moral courage in nursing: A hybrid model

BACKGROUND

Moral courage is one of the most fundamental virtues in the nursing profession, however, little attention has been paid to it. As a result, no exact and clear definition of moral courage has ever been accessible.

OBJECTIVE

This study is carried out for the purposes of defining and clarifying its concept in the nursing profession.

METHODS

This study used a hybrid model of concept analysis comprising three phases, namely, a theoretical phase, field work phase, and a final analysis phase. To find relevant literature, electronic search of valid databases was utilized using keywords related to the concept of courage. Field work data were collected over an 11 months' time period from 2013 to 2014. In the field work phase, in-depth interviews were performed with 10 nurses. The conventional content analysis was used in two theoretical and field work phases using Graneheim and Lundman stages, and the results were combined in the final analysis phase. Ethical consideration: Permission for this study was obtained from the ethics committee of Tehran University of Medical Sciences. Oral and written informed consent was received from the participants.

RESULTS

From the sum of 750 gained titles in theoretical phase, 26 texts were analyzed. The analysis resulted in 494 codes in text analysis and 226 codes in interview analysis. The literature review in the theoretical phase revealed two features of inherent-transcendental characteristics, two of which possessed a difficult nature. Working in the field phase added moral self-actualization characteristic, rationalism, spiritual beliefs, and scientific-professional qualifications to the feature of the concept.

CONCLUSION

Moral courage is a pure and prominent characteristic of human beings. The antecedents of moral courage include model orientation, model acceptance, rationalism, individual excellence, acquiring academic and professional qualification, spiritual beliefs, organizational support, organizational repression, and internal and external personal barriers. Professional excellence resulting from moral courage can be crystallized in the form of provision of professional care, creating peace of mind, and the nurse's decision making and proper functioning.

The Evolution of Professional Nursing Culture in Italy: Metaphors and Paradoxes

We explored the perceptions of Italian nurses regarding their developing culture as a health profession. We sought to understand the ongoing evolution of the nursing profession and the changes that were central to it becoming an intellectual discipline on par with the other health professions in Italy. In 2010, the Regulatory Board of Nursing established a center of excellence to build evidence-based practice, advocate for interdisciplinary health care, and champion health profession reforms for nursing. In this study, focus groups—involving 66 nurse participants from various educational, clinical, and administrative backgrounds—were utilized to better ascertain how the profession has changed. Six themes, three of them metaphors—“vortex,” “leopard spots,” and “deductive jungle”—explain nurses’ experiences of professional change in Italy between 2001 and 2011 and the multiple dimensions that characterize their professional identity and autonomy.

The 2004 Indian Ocean tsunami catastrophe, its survivors, job and the universal features of suffering: a theoretical study

The purpose of this theoretical article is to discuss the existential and universal feature of suffering--as illustrated by Job's suffering in the Book of Job in the Bible and by the survivors of the 2004 Asian tsunami catastrophe--and to highlight its significance for health care. Further, the study is aiming at contributing to health professionals' understanding of patients' suffering. The sources are narratives, comprising Job's book, TV interviews 1 year after the tsunami catastrophe and the survivors' autobiographies. The methodological approach is a philosophical analysis. The existential, universal, ontological and epistemological aspects of suffering are carefully scrutinized to unveil the universal and existential versus culture-specific features of suffering. Based on the results, the authors' recommendations are (1) a holistic concept of the patient and health care has to seriously consider suffering in all its complexity because when a person is in pain, it is not his/her body but the whole person as a unity of body, psyche and spirit that suffers and (2) suffering should be seen as the most central concept of health care, which should provide treatment for physical pain and all dimensions of suffering: physical, social, mental and spiritual aspects.

Learning the requirements for compassionate practice

Student nurses’ professional development arises through socialisation in nursing knowledge, values and behaviours. Students are expected to demonstrate compassion; however, compassion is a complex concept, one that creates emotional challenges. A grounded theory study was undertaken to explore student nurse socialisation in compassionate practice. In-depth interviews were undertaken with 19 students in the north of England during 2009–2010, and their concerns and concern management emerged. Students expressed several concerns, one being their emotional vulnerability and uncertainty of the emotional requirements for compassionate practice. A core category of ‘balancing future intentions’ was identified: that students managed feelings of vulnerability and uncertainty through balancing their intentions towards and away from engagement in compassionate practice, depending upon perceived impact on their emotional well-being. The findings are discussed in relation to emotional labour and moral distress, and courage, resilience and self-compassion are explored as a means to enable sustainable compassionate practice.

Ethical concerns in the student/preceptor relationship: a need for change

Nursing schools are required to ensure that the clinical and academic milieu prepares nurses not only to recognize but also to act on various ethical issues. As a result of our years teaching nursing ethics to undergraduate nursing students we have come to believe there is a disconnect between classroom teaching and students' experiences in practice. How then can nurse educators help nursing students not only to see the ethical components of their work but also to take the necessary steps to solve ethical dilemmas and challenge unethical practice? One such strategy is the use of preceptorship. In this paper, we set out to learn about nursing students' ethical encounters in the clinical area, specifically those within the preceptor/student relationship. To this end we conducted an integrative review and are weaving in Gesler's (1992) concepts who argued that ethical issues play out in our physical and social environments. We identified nine articles that describe students' perceptions of ethical problems in their relationships with preceptors. However, it was rare for the authors of these articles to label these as 'ethical' issues. The integrative review revealed first, that students describe ethical issues in their narratives, and second, their most common response to these issues is silence. We continue to be concerned that nursing students' classroom learning of ethics is disconnected from their everyday nursing practice. Further research and education implications are discussed and explored in this paper.

Nursing's role in courage development in patients facing complications of diabetes

The purpose of this study was to explore the experience of nurses in relation to courage development in patients with disabling complications of diabetes. The phenomenon of courage has been explored in philosophy, theology, literature, and other fields of inquiry rooted in the humanities. Nursing inquiry has not often been directed toward an exploration of courage, although coping, compassion, caring, and other experiences integral to the nurse-patient relationship have been examined. The holistic view of the cascading effect of complications on the individual patient is often overlooked. This qualitative study used phenomenological inquiry and included face-to-face interviews of nurses to explore their experience in assisting patients in the development of courage. The experience of courage is investigated as it relates to a specific group of patients who have complications of diabetes. Four categories representing the unique opportunities for courage development by nurses were generated. These categories included education, advocacy, relationship building, and humanization. Each category described nursing intentions and actions and taken together formed an essential structure of courage development. Conclusions indicated that nurses recognize and are able to describe their role in courage development. Implications for improved health through deliberate caring nursing interventions, aimed at courage development, are presented.

Care of the old-A matter of ethics, organization and relationships

The world stands on the threshold of a demographic revolution called global ageing. According to the World Health Organization (WHO), the population aged 60 and over is expected to increase from today's 650 million to an estimated 2 billion by 2050. Alongside demographic changes, dramatic changes can also be observed in older people's services. The shift has resulted in reduced government spending on caring for ill and frail older people in health care. Today, many governments have developed strategies to keep older people living well in their private home for as long as possible and have replaced long-term care institutions with residential homes. The aim of this study was to illuminate the meaning of caring for older people as experienced by health care students and professionals working in this field. Interviews were carried out with 17 women and one man, aged 21–65 years; six were Registered Nurses (RN), six were Enrolled Nurses (EN) and six were nursing students. The interviews were analyzed with a phenomenological hermeneutical approach and provided three themes and eight sub-themes: Ethical moral self with sub-themes “meeting the needs of the old”, “pliability towards the old”, and “difficulties in meeting aggressiveness”; Organizational and co-workers ethical moral actions with sub-themes, “co-workers who are offensive”, and “supportive and non-supportive leaders”: The relation with the old persons and their relatives with sub-themes “fellowship and closeness in the relation”, “uncertainty and fear in the relation”, and, “demands from the older persons’ close relatives”.

Being altruistically egoistic-Nursing aides' experiences of caring for older persons with mental disorders

Older persons with mental disorders, excluding dementia disorders, constitute a vulnerable group of people. With the future international increase in the older population, mental disorders will increase as well, thus entailing new challenges for their caregivers. These older persons often remain in their own homes, and in Sweden they are cared for by nursing aides. With little previous research, an increased workload and facing new strenuous situations, it is important to make use of the knowledge the nursing aides possess and to deepen the understanding of their experiences. The study aimed at illuminating the meaning of caring for older persons with mental disorders as experienced by nursing aides in the municipal home help service. Interviews with nine female nursing aides were performed and analysed with a phenomenological hermeneutical research method inspired by the philosophy of Paul Ricoeur. Being altruistically egoistic emerged as a main theme in the nursing aides’ narratives. The nursing aides’ experiences could be interpreted as a movement between being altruistic and egoistic. The findings revealed a continuous distancing by the nursing aides and their struggle to redress the balance between their altruistic and egoistic actions. Caring for these older persons constitutes a complex situation where distancing functions as a recourse to prioritize oneself and to diminish the value of caring. The study suggests that an increased knowledge base on older persons with mental disorders, followed by continuous supervision, is necessary for the nursing aides to improve the quality of the care given.