Moral conflicts from the justice and care perspectives of japanese nurses: a qualitative content analysis

BACKGROUND

Healthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals' moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions.

METHOD

Semi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person's thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally's taxonomy.

RESULTS

Among 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The "rules" category of justice and the "welfare of others" category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective.

CONCLUSIONS

The nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider's responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended.

Emotional Responses of Neonatal Intensive Care Nurses to Neonatal Death

The study was planned as a descriptive qualitative study to determine the emotional responses of neonatal intensive care nurses to work in the neonatal unit and to neonatal deaths. The sample of the study consisted of 7 nurses who work at the neonatal intensive care unit since data saturation was achieved. The data were collected using the "Semi-Structured In-Depth Interview Guide for Nurses". The data were analyzed using the content analysis method. Following codes were reached as a result of the study: 'happiness-sadness', 'professional satisfaction-exhaustion', 'empathy', 'responsibility-guilt', 'hope-despair' under the theme of being a nurse at neonatal unit'; 'unforgettable first loss', 'professionalism in intervention-and then: sadness, 'mature-premature difference', 'difficulty in giving hurtful news-inability to associate with death' and 'attachment-burnout' under the theme of experiencing neonatal loss.It was seen that nurses' emotions about working at neonatal intensive care unit were generally positive; however, these emotions changed to negative after neonate's relapsing and death.

Parents of extremely and moderately preterm children reported long-lasting impressions of medical care and the hospital environment

AIM

Few studies have examined the parents of moderately preterm children. The aim of this study was to investigate the experiences of parents of both extremely and moderately preterm children.

METHODS

Qualitative telephone interviews were conducted in 2013-2014 with 13 mothers and 10 fathers of extremely preterm children and with 11 mothers and seven fathers of moderately preterm children. The children were born between 2000 and 2003. Data were analysed with a narrative approach.

RESULTS

Parents of extremely preterm children recounted dramatic birth stories that, for most, ended positively. Parents of moderately preterm children presented more neutral birth stories, and most recounted that their children did not receive attention for prematurity from medical staff. Parents from both groups described staff members' treatment in terms of long-lasting impressions, and they were deeply affected by the hospital environment and the other parents and children admitted. Parents whose children died or were disabled recounted dramatic stories and endless fights for support.

CONCLUSION

Parents from both groups reported long-lasting impressions of the medical staff and the hospital environment, which they found important to talk about, even a decade after the birth of their child/children.

Parents' Perspectives: An Expanded View of Occupational and Co-Occupational Performance in the Neonatal Intensive Care Unit

IMPORTANCE

One limitation of occupation-based neonatal practice is the lack of clarity surrounding what parent and infant occupations exist in the neonatal intensive care unit (NICU). Without clear definitions and examples of these constructs, occupational therapists may not recognize or value them as part of practice.

OBJECTIVE

To explore concepts of occupational and co-occupational performance in the NICU and provide richly expanded descriptions of parent and infant occupations in this setting.

DESIGN

Phenomenological study with convenience sampling. Participants engaged in semistructured interviews. Inductive content analysis, in vivo and process coding methods, and cross-case analysis were used. Member checking and expert review of emergent themes were used to ensure authenticity.

SETTING

A metropolitan 48-bed Level 3 NICU with single-family rooms in the midwestern United States.

PARTICIPANTS

Fourteen parents (mean age = 29.7 yr; range = 19-37 yr) volunteered for the study.

RESULTS

Five themes of active occupational engagement emerged: (1) perceiving "they" versus "I"; (2) maintaining proximity; (3) expressing emotions, values, and beliefs; (4) addressing health issues; and (5) analyzing. A matrix framework displayed emergent themes with definitions of parent occupations, infant occupations, and parent-infant co-occupations. Examples of both directly observable and hidden occupations were found at matrix intersections.

CONCLUSIONS AND RELEVANCE

Occupational performance prevalently reflected attempts to balance power differentials and pursue meaningful engagement through observable and hidden participation in caregiving. Findings suggest that beyond typical occupations (e.g., feeding, socializing), neonatal therapists can address the doing, being, and becoming occupations expressed by parents in this study.

WHAT THIS ARTICLE ADDS

Parents described five broad thematic categories of NICU-based occupation and co-occupation, which may be valuable to therapists seeking to strengthen the occupational focus of neonatal intervention. Neonatal therapists may need to advocate for service provision policy change to fully address the observable and nonobservable doing, being, and becoming occupational and co-occupational needs of parents and infants.

Relational Principles in the Care of Suicidal Inpatients: Experiences of Therapists and Mental Health Nurses

This study explored and compared therapists' and mental health nurses' experiences of caring for suicidal inpatients in light of ethics of care and ethics of justice. Analysis of interview data from eight therapists and eight mental health nurses indicates two approaches: "connection and care" and "duty and control," reflecting aspects of both ethical perspectives. There are some differences between the two professional groups, and sometimes there might be conflicts between the two approaches and ethical perspectives. Clinical practice is increasingly shaped by standardization and guidelines, and it is important to promote professionals' efforts to provide relational-emotional care for suicidal patients.

The way justice unleashes staff’s compassion toward hotel guests

Purpose

This paper aims to model staff reactions to a hotel based on the way they perceive hotel’s treatment of customers. It suggests that employees are not motivated to help abused customers in the form of customer-oriented behaviors (COBs) until employees also feel that they are victims of abuse by the hotel. Hence, effects of staff’s unfavorable justice perceptions for customers on employee COBs are expected to be negative until staff’s unfavorable justice perceptions for themselves, interacting in this relationship, turn it positive.

Design/methodology/approach

Drawing on social exchange and compassion theories, the argument is made that staff members who are also victims of abuse by the hotel can empathize more with guests, turning quid pro quo responses to abuse of customers into compassionate responses.

Findings

Regression results from a field study of 280 employees at ten hotels in the Canary Islands provide general support for our hypotheses.

Practical implications

By understanding when and why (un)fair treatment of guests and staff has consequences for the hotel in the form of COBs, hotel managers can favor a better staff response to hotels’ careful stewardship of the service encounter in terms of COBs. The reversal of the direction in the relationship suggests the unfolding of compassion within a justice framework, which challenges the long-lived perceived incompatibility between compassion and justice in the organizational literature.

Originality/value

The present study is the first one to study COBs stemming either from staff responses to hotels’ abuse of customers or COBs resulting from the interaction between perceived justice for customers and justice perceptions for themselves.

“I thought he was ugly”: Mothers of extremely premature children narrate their experiences as troubled subjects

This article explores the ways in which mothers of extremely premature children make sense of their negative feelings towards their newborn child and their strategies for performing “proper motherhood”. The analysis was guided by discursive psychology and the feminist debate on attachment, mother–infant bonding, and “good motherhood”. The empirical material was created within a sub-study that set out to explore mothers’ and fathers’ experiences of having a premature child and was part of a project investigating the need for support for premature children and their families. Parents were interviewed about the pregnancy, their experiences of the birth and hospital period, the process of going home, the experiences of pre-school and school, and thoughts about the future. The stories of four mothers, which dealt with negative feelings towards their child and the guilt and distress related to this, were selected for analysis. The mothers handled their troubled positions as subjects unable to feel “motherly love” by referring to notions of attachment and bonding, and good motherhood as being loving and caring. Yet, the mothers also talked about motherhood as being socially constructed, as duties that can be performed without the “right motherly feelings”, and as something that men could also perform.

Ethical challenges in neonatal intensive care nursing

BACKGROUND

Neonatal nurses report a great deal of ethical challenges in their everyday work. Seemingly trivial everyday choices nurses make are no more value-neutral than life-and-death choices. Everyday ethical challenges should also be recognized as ethical dilemmas in clinical practice.

RESEARCH OBJECTIVE

The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns.

RESEARCH DESIGN

Data were collected through semi-structured qualitative in-depth interviews. Phenomenological-hermeneutic analysis was applied to interpret the data.

PARTICIPANTS AND RESEARCH CONTEXT

Six nurses from neonatal intensive care units at two Norwegian hospitals were interviewed on-site.

ETHICAL CONSIDERATIONS

The study is designed to comply with Ethical Guidelines for Nursing Research in the Nordic Countries and the Helsinki declaration.

FINDINGS

Findings suggest that nurses experience a diverse range of everyday ethical challenges related to challenging interactions with parents and colleagues, emotional strain, protecting the vulnerable infant, finding the balance between sensitivity and authority, ensuring continuity of treatment, and miscommunication and professional disagreement.

DISCUSSION

A major finding in this study is how different agents involved in caring for the newborn experience their realities differently. When these realities collide, ethical challenges arise. Findings suggest that acting in the best interests of the child becomes more difficult in situations involving many agents with different perceptions of reality.

CONCLUSION

The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care.

Nurses’ perspectives on the suffering of preterm infants

The concept of suffering is discussed among those who are cognitively aware and verbally capable to express their suffering. Due to immaturity, preterm infants’ abilities to express suffering are limited. Relieving suffering is an ethical and juridical demand of good nursing care. The purpose of this study is to describe nurses’ perceptions of the suffering of preterm infants. A descriptive qualitative approach was selected. Data were collected from essays written by nurses (n = 19) working in the neonatal intensive care unit. Inductive content analysis guided by the research question was performed. The nurses described individually determined suffering of the preterm infants according to four categories: suffering ruled by maturation, existence of suffering, individual threshold of suffering and interpreting the cues of suffering. Suffering of preterm infants is manifested by population-specific features, emphasising the need to develop sensitive interventions for relieving their suffering.