Impact of moral resilience and interprofessional collaboration on nurses' ethical competence

BACKGROUND

Home care nurses are central in providing holistic and compassionate care to patients in home-based palliative care. Ethical caring competency is essential for home care to sustain nurses' integrity in the face of moral adversity. Interprofessional collaboration is vital for ensuring ethical decision-making and providing patient-centered care in home-based palliative care settings.

AIM

This study explored the predictive roles of interprofessional collaboration and moral resilience on ethical caring competency among home care nurses in home-based palliative care.

METHODS

A cross-sectional survey of 400 nurses was conducted from October to December 2023, utilizing standardized scales to measure interprofessional collaboration, moral resilience, and ethical caring competency. A convenience sample of 400 home care nurses was also included in this study. Correlation and linear regression analysis were used to clarify the associative and predictive findings.

ETHICAL CONSIDERATIONS

Ethical approval from the ethics committee, institutional permission, and informed consent from the participants were obtained for data collection.

RESULTS

Correlation analysis showed significant positive correlations between the ethical caring competency, interprofessional collaboration, and moral resilience constructs, with coefficients ranging from 0.482 to 0.967. Linear regression revealed that management of collaborative systems and total moral resilience significantly predict ethical caring competency, explaining 14.6% and 36.6% of its variance, respectively. Other variables, such as the effects of collaboration and communication, did not significantly influence ethical caring competency.

CONCLUSION

The study highlights the significant impact of interprofessional collaboration, particularly the management of collaborative systems and moral resilience, on enhancing ethical caring competency among nurses.

IMPLICATIONS

Enhancing interprofessional collaboration and moral resilience through targeted strategies in nursing practice and education can significantly improve ethical caring competencies. These efforts are essential for delivering high-quality, patient-centered care and for fostering a healthcare environment that respects the ethical principles guiding nursing practice.

"It Is Not About Us and Them": Nursing Students' Perception of Interdisciplinary Collaboration in Mental Health Clinical Studies

Through interdisciplinary collaboration, a synthesis can be made together across subject boundaries that basically separate the subjects. This means that in addition to their own expertise, the professions can create a new understanding, new attitudes and new knowledge. In other words, a shared additional knowledge. The purpose of this study was to explore and describe nursing students' experiences of interdisciplinary collaboration in clinical studies in mental health services. A qualitative, explorative study was performed based on three focus group interviews. A qualitative content analysis was conducted. The analysis resulted in the categories: 'Community'-The students experienced the interaction and the communication in different ways. 'Learning'-The students could gain both knowledge and understanding. In conclusion when the interdisciplinary collaboration was optimal, the students experienced it as enriching both in terms of interaction, communication, learning and understanding. Interdisciplinary collaboration can give students knowledge of cultural forms of expression so that they can better meet patients' needs. The students also gain an increased understanding related to care. Students can get good learning opportunities when different professions are taught together.

Virtue ethics in healthcare teams; its time has come: Review of the nursing virtue ethics literature

AIM

To summarize and evaluate the nursing virtue ethics literature, examine how virtue ethics has been applied to healthcare teams, offer a new framework to guide understanding and development of virtuous healthcare teams, and offer recommendations to nurse leaders.

BACKGROUND

With the unprecedented levels of incivility and turnover in the post- COVID-19 world, virtue ethics may provide an innovative approach for nursing leaders working to rebuild healthy practice environments.

EVALUATION

An integrative review yielded articles from eight databases using PRISMA guidelines. Level of evidence and quality were assessed using the Johns Hopkins tools.

KEY ISSUES

Virtue ethics has been of interest to the healthcare community predominantly as a concept. Most articles focused on debating whether virtue ethics belongs in nursing. Virtue ethics offers a creative strategy for leaders to attract and retain nurses.

CONCLUSION

There is a dearth of research on virtue ethics and nursing. One study empirically uncovered and validated a framework for virtue ethics in healthcare teams.

IMPLICATIONS FOR NURSING MANAGEMENT

To rebuild strong healthcare teams, nurse leaders can model virtue ethics using an empirically derived framework while coaching their teams to do the same. Doing so holds the promise of reengaging staff and rebuilding healthy practice environments.

Managing ongoing swallow safety through information-sharing: An ethnography of speech and language therapists and nurses at work on stroke units

BACKGROUND

Speech and language therapists and nurses need to work together to keep patients with swallowing difficulties safe throughout their acute stroke admission. Speech and language therapists make recommendations for safe swallowing following assessment and nurses put recommendations into practice and monitor how patients cope. There has been little research into the everyday realities of ongoing swallow safety management by these two disciplines. Patient safety research in other fields of healthcare indicates that safety can be enhanced through understanding the cultural context in which risk decisions are made.

AIMS

To generate new understanding for how speech and language therapists (SLTs) and nurses share information for ongoing management of swallows safety on stroke units.

METHODS & PROCEDURES

An ethnographic methodology involving 40 weeks of fieldwork on three stroke wards in England between 2015 and 2017. Fieldwork observation (357 h) and interviews with 43 members of SLT and nursing staff. Observational and interview data were analysed iteratively using techniques from the constant comparative method to create a thematically organized explanation.

OUTCOMES & RESULTS

An explanation for how disciplinary differences in time and space influenced how SLT and nursing staff shared information for ongoing management of swallow safety, based around three themes: (1) SLTs and nurses were aligned in concern for swallow safety across all information-sharing routes; however, (2) ambiguity was introduced by the need for the information contained in swallowing recommendations to travel across time, creating dilemmas for nurses. Patients could improve or deteriorate after recommendations were made and nurses had competing demands on their time. Ambiguity had consequences for (3) critical incident reporting and relationships. SLTs experienced dilemmas over how to act when recommendations were not followed.

CONCLUSIONS & IMPLICATIONS

This study provides new understanding for patient safety dilemmas associated with the enactment and oversight of swallowing recommendations in context, on stroke wards. Findings can support SLTs and nurses to explore together how information for ongoing dysphagia management can be safely implemented within ward realities and kept up to date. This could include considering nursing capacity to act when SLTs are not there, mealtime staffing and SLT 7-day working. Together they can review their understanding of risk and preferred local and formal routes for learning from it.

WHAT THIS PAPER ADDS

What is already known on the subject It is known that information to keep swallowing safe is shared through swallowing recommendations, which are understood to involve a balance of risks between optimizing the safety of the swallow mechanism and maintaining physiological and emotional health. There is increasing appreciation from patient safety research, of the importance of understanding the context in which hospital staff make decisions about risk and patient safety. What this paper adds to existing knowledge The paper provides new empirical understanding for the complexities of risk management associated with SLT and nursing interactions and roles with respect to ongoing swallow safety. What are the potential or actual clinical implications of this work? Findings can underpin SLT and nurse discussion about how swallow safety could be improved in their own settings.

Nurses’ Contributions in Rural Family Medicine Education: A Mixed-Method Approach

Family medicine residents frequently collaborate with nurses regarding clinical decisions and treatments, which contributes to their education. In rural areas, these residents experience a wider scope of practice by collaborating with nurses. However, nurses’ contributions to rural family medicine education have not been clarified. This study measured the contributions of 88 rural community hospital nurses to family medicine education using a quantitative questionnaire and interviews. The interviews were recorded, transcribed verbatim, and analyzed using the grounded theory approach. Nurses’ average clinical experience was 20.16 years. Nurses’ contributions to the roles of teacher and provider of emotional support were statistically lower among participants working in acute care wards than those working in chronic care wards (p = 0.024 and 0.047, respectively). The qualitative analysis indicated that rural nurses’ contributions to family medicine education focused on professionalism, interprofessional collaboration, and respect for nurses’ working culture and competence. Additionally, nurses struggled to educate medical residents amid their busy routine; this education should be supported by other professionals. Rural family medicine education should incorporate clinical nurses as educators for professionalism and interprofessional collaboration and as facilitators of residents’ transition to new workplaces. Subsequently, other professionals should be more actively involved in improving education quality.

Ethical issues identified in nurses´ interprofessional collaboration in clinical practice: a meta-synthesis

The aim of this study was to synthesize previous knowledge about ethics in nurses' interprofessional collaboration in clinical practice. Although healthcare professionals have common goals and shared values, ethical conflicts still arise during patient care. We carried out a meta-synthesis of peer-reviewed papers published in any language from 2013-2019, using both electronic searches, with the CINAHL, PubMed, Scopus, and SocINDEX databases, and manual searches. We identified 4,763 papers and selected six qualitative papers, and three theoretical papers, based on predetermined inclusion and exclusion criteria and quality appraisal. The studies came from the USA, Canada, Sweden, Australia, Botswana, and the Netherlands. We found that in ethics studies on nurses' interprofessional collaboration in clinical practice the focus has been on factors that affect how patients receive care. These factors were patients' wishes, whether they were told the truth about their condition, and how different professionals recognized and treated their pain. The focus in the papers we reviewed was on the roles of different professionals during the care process, including ethical conflicts with regard to their aims, commitment, and the balance of power among them and other professions. More research is needed to raise the visibility of how nurses and other professionals recognize, and evaluate, their professional and interprofessional ethics.

Iranian Physicians' Perspectives Regarding Nurse-Physician Professional Communication: Implications for Nurses

BACKGROUND AND PURPOSE

Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran.

METHODS

Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed.

RESULTS

Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication."

IMPLICATIONS FOR PRACTICE

Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.

How clinical nurses in South Korea perceive the status of the nursing profession: A Q-methodological approach

Professional self-image among nurses is shaped by subjective perceptions, feelings, and tacit views. A perceived positive status reflects and influences the nurse's self-esteem, professional empowerment, and nursing performance. The aim of this study was to examine the perceived status of the nursing profession among clinical nurses in South Korea. Q-methodology was used with data collected from September to December 2014. Forty-four Q statements were selected and scored by the 31 participants on a 9-point scale with normal distribution. The data were analyzed using the pc-QUANL program. Thirty-one nurses were classified into 3 factors based on the following viewpoints: as professional (I am proud of my nursing job), subprofessional (I am not proud of my nursing job), and developmental (advocating for change and improvement). The major finding of this study included clinical nurses' subjective perception toward the status of nursing profession. The results indicated that to raise the status of nursing profession, nurses need to understand the value of nursing and their contribution to patients and public.

Radiographers' perceptions of their professional rights in diagnostic radiography: a qualitative interview study

BACKGROUND

Considering the ethics of each profession is important as inter-professional collaboration increases. Professional ethics creates a basis for radiographers' work, as it includes values and principles, together with rights and duties that guide and support professionals. However, little is known about radiographers' rights when it comes to professional ethics.

THE AIM

The aim of this study was to describe radiographers' perceptions and experiences of their professional rights. The ultimate aim was to increase the understanding of professional ethics in this context and support radiographers' ethical pondering in diagnostic radiography.

METHODOLOGY

A qualitative method was used. Semistructured group interviews with 15 radiographers were conducted in spring 2013 at two publicly provided diagnostic imaging departments in Finland. Data were analysed by inductive content analysis. All the participants were women, and they had worked as radiographers for an average of 18 years.

FINDINGS

Based on our analysis, radiographers' professional rights consisted of rights related to their expertise in radiography and the rights related to working conditions that ensured their wellbeing. Expertise-based rights included rights to plan, conduct and assess radiological care with patient advocacy. Radiographers have the right to contribute to a culture of safe radiation in their organisation and to use their professional knowledge to achieve their main target, which is the safe imaging of patients. Radiographers also have right to work in conditions that support their well-being, including the legal rights stated in their employment contract, as well as their rights concerning resources at work.

CONCLUSIONS

Radiographers' professional rights are an elementary and multidimensional part of their clinical practice. In future, more theoretical and empirical research is needed to deepen the understanding of their rights in the clinical practice and support radiographers on issues related to this aspect of their work.

Refining a definition of reflection for the being as well as doing the work of a physician

BACKGROUND

Reflection is core to professional competency and supports the active, constructive process of professional identity formation.

AIMS

Medical educators thus grapple with operationalizing and effectively integrating reflection as a foundational construct within health care professions education and practice.

METHODS

Core elements of reflection including role of emotions and awareness of self, other and situation, do not appear within various working definitions of reflection.

RESULTS

This observation as well as noted recent shift in medical education toward emphasis on the "being" as well as "doing the work" of a physician led to the author's proposed refining of Sandars' reflection definition and expansion of Nguyen et al.'s reflection model.

CONCLUSIONS

A refined reflection definition is offered for a more inclusionary approach. A caveat regarding potential for expected reflective learning outcomes (given reflection as a process) is provided and the integral role of mentor-enhanced reflection is discussed. Reflection as a continuum is highlighted and exemplified within Wald et al.'s REFLECT rubric and Nguyen et al.'s reflection model.

The Mangle of Interprofessional Health Care Teams: A Performative Study Using Forum Theater

The aim of this study was to explore dimensions of relational work in interprofessional health care teams. Practitioners from a variety of disciplines came together to examine teamwork and cocreate knowledge about interprofessionalism using forum theater. Interviews held prior to the workshop to explore teamwork were foundational to structuring the workshop. The forum theater processes offered participants the opportunity to enact and challenge behaviors and attitudes they experienced in health care teams. Throughout the workshop, aspects of professional identity, power, trust, communication, system structures, and motivation were explored. The activities of the workshop were analyzed using Pickering’s theory, identifying three mangle strands found in being a team: organizational influences, accomplishing tasks, and an orientation to care. Performativity was identified as having a bearing on how teams perform and how teamwork is enacted. Practice components were seen as strands within a mangling of human and nonhuman forces that shape team performativity.

Nurses’ professional values and attitudes toward collaboration with physicians

Background:

Growing evidence suggests that collaborative practice improves healthcare outcomes, but the precursors to collaborative behavior between nurses and physicians have not been fully explored.

Research question:

The purpose of this descriptive correlational study was to describe the professional values held by nurses and their attitudes toward physician–nurse collaboration and to explore the relationships between nurses’ characteristics (e.g. education, type of work) and professional values and their attitudes toward nurse–physician collaboration.

Research design:

This descriptive correlational study examines the relationship between nurses’ professional values (Nurses Professional Values Scale–Revised) and their attitudes toward nurse–physician collaboration (Jefferson Scale of Attitudes toward Physician–Nurse Collaboration).

Ethical considerations:

Permission to conduct the study was received from the hospital, and the Institutional Review Boards of the healthcare system and the participating university.

Participants/context:

A convenience sample of 231 registered nurses from a tertiary hospital in the United States was surveyed.

Findings:

A significant positive relationship was found between nurses’ professional values and better attitudes toward collaboration with physicians ( r = .26, p < .01). Attitude toward collaboration with physicians was also positively associated with master’s or higher levels of education ( F(3, 224) = 4.379, p = .005).

Discussion:

The results of this study can be helpful to nurse administrators who are responsible for developing highly collaborative healthcare teams and for nurse educators who are focused on developing professional values in future nurses.