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Tarabeih M, Na’amnih W. Non-Maleficence toward Young Kidney Donors: A Call for Stronger Ethical Standards and Associated Factors in Multidisciplinary Nephrology Teams. NURSING REPORTS 2024; 14:1998-2013. [PMID: 39189279 PMCID: PMC11348254 DOI: 10.3390/nursrep14030149] [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: 06/12/2024] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The rising frequency of live kidney donations is accompanied by growing ethical concerns as to donor autonomy, the comprehensiveness of disclosure, and donors' understanding of long-term consequences. AIM To explore donors' satisfaction with the ethical competence of multi-professional nephrology teams regarding disclosure of donation consequences to live kidney donors. METHODS A cross-sectional study was performed among Israeli live kidney donors who had donated a kidney in two hospitals that belonged to the Ministry of Health's Transplantation Center one year after the donation, from December 2018 to December 2020. Data collection was conducted online and through face-to-face interviews with the donors in their native language (Hebrew or Arabic). RESULTS Overall, 91 live kidney donors aged 18-49 years were enrolled. Of those, 65.9% were males, and 54.9% were academic donors. Among the live kidney donors, 59.3% reported that the motivation behind the donation was a first-degree family member vs. 35.2% altruistic and 5.5% commercial. Only 13.2% reported that the provided disclosure adequately explained the possible consequences of living with a single kidney. Approximately 20% of the participants reported that the disclosure included information regarding their risk of developing ESRD, hypertension, and proteinuria. The donors reported a low mean of the index score that indicates a low follow-up by the physician after the donation (mean = 1.16, SD = 0.37). The mean GFR level was significantly lower in the post-donation period one year following a kidney donation (117.8 mL/min/1.73 m2) compared with the pre-donation period (84.0 mL/min/1.73 m2), p < 0.001. CONCLUSION Our findings display that donors' satisfaction with the ethical competence of multi-professional nephrology teams regarding the disclosure of donation consequences to live kidney donors is low. This study indicates that donors are at an increased risk of worsening kidney functions (creatinine and GFR), and BMI. Our findings underscore the imperative to advise donors that their condition may worsen over time and can result in complications; thus, they should be monitored during short and long-term follow-up periods. This study was not registered.
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Affiliation(s)
- Mahdi Tarabeih
- School of Nursing Sciences, The Academic College of Tel-Aviv-Yaffa, Tel Aviv 64044, Israel;
| | - Wasef Na’amnih
- School of Nursing Sciences, The Academic College of Tel-Aviv-Yaffa, Tel Aviv 64044, Israel;
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Vierula J. Applicants' success in the ethics entrance exam: A cross-sectional study. Nurs Ethics 2024; 31:818-832. [PMID: 37899712 PMCID: PMC11370179 DOI: 10.1177/09697330231204999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Student selection is the first step in recruiting future social and healthcare professionals. Ethically competent professionals are needed in social and healthcare. It is important to select applicants who have the best possible abilities to develop their ethical competence in the future. Values-based recruitment has been used to inform the recruitment and selection of higher education applicants. However, objective and valid tests in student selection are needed. AIM To assess social and healthcare applicants' success and related factors in the ethics section of the universities of applied sciences digital entrance examination (UAS Exam) to undergraduate degree programmes. RESEARCH DESIGN A cross-sectional design was used. PARTICIPANTS AND RESEARCH CONTEXT Social and healthcare applicants needed to identify ethical situations in the ethics section of a national digital entrance examination (UAS Exam) in autumn 2019 (between 29 October and 1 November) in 20 Finnish universities of applied sciences. ETHICAL CONSIDERATIONS The process for the responsible conduct of research was followed in the study. Ethics committee approval was obtained from the Human Sciences Ethics Committee in the Satakunta region (27 September 2019). Approval to undertake the study was obtained from the participating universities of applied sciences. Participation to the study was voluntary and based on informed consent. RESULTS The applicants' (n = 8971) mean scores were 7.1/20 (standard deviation 6.5), and 22.7% of the applicants failed the ethics section. Age, previous education, and place of birth (own/parent) explained the applicants' success in the ethics section (total score and failed exam results). CONCLUSION(S) Applicants' success in the ethics section varied indicating that future students may have a different basis to develop their ethical competence. This may impact on (new) students' learning, especially in practical studies.
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Dunn H. Ethical decision-making: exploring the four main principles in nursing. Nurs Stand 2024:e12346. [PMID: 39034737 DOI: 10.7748/ns.2024.e12346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 07/23/2024]
Abstract
Nurses are regularly confronted with moral questions and ethical dilemmas in their practice, for example where a patient's decisions about their treatment conflict with the nurse's own views. While the standards contained in the Nursing and Midwifery Council The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates provide nurses with an overarching framework to guide practice, it is important that nurses understand the four main principles that underpin ethical care - autonomy, beneficence, non-maleficence and justice. This article examines these four principles and how they relate to nurses' ethical decision-making. The author also explores how nurses' ethics were tested by the coronavirus disease 2019 (COVID-19) pandemic. Having an awareness of ethical decision-making can enhance nurses' practice by providing them with a theoretical framework for treating patients with dignity and respect.
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Affiliation(s)
- Hannah Dunn
- Lecturer and advanced nurse practitioner, Buckinghamshire New University, High Wycombe, England
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Meyer EC, Lamiani G, Uveges M, McLeod-Sordjan R, Mitchell C, Truog RD, Marron JM, Kennedy KO, Ritholz M, Teti SL, Milliken AB. Everyday Clinical Ethics: Essential Skills and Educational Case Scenarios. HEC Forum 2024:10.1007/s10730-024-09533-6. [PMID: 38980646 DOI: 10.1007/s10730-024-09533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 07/10/2024]
Abstract
Bioethics conjures images of dramatic healthcare challenges, yet everyday clinical ethics issues unfold regularly. Without sufficient ethical awareness and a relevant working skillset, clinicians can feel ill-equipped to respond to the ethical dimensions of everyday care. Bioethicists were interviewed to identify the essential skills associated with everyday clinical ethics and to identify educational case scenarios to illustrate everyday clinical ethics. Individual, semi-structured interviews were conducted with a convenience sample of bioethicists. Bioethicists were asked: (1) What are the essential skills required for everyday clinical ethics? And (2) What are potential educational case scenarios to illustrate and teach everyday clinical ethics? Participant interviews were analyzed using qualitative content analysis. Twenty-five (25) bioethicists completed interviews (64% female; mean 14.76 years bioethics experience; 80% white). Five categories of general skills and three categories of ethics-specific skills essential for everyday clinical ethics were identified. General skills included: (1) Awareness of Core Values and Self-Reflective Capacity; (2) Perspective-Taking and Empathic Presence; (3) Communication and Relational Skills; (4) Cultural Humility and Respect; and (5) Organizational Understanding and Know-How. Ethics-specific skills included: (1) Ethical Awareness; (2) Ethical Knowledge and Literacy; and (3) Ethical Analysis and Interaction. Collectively, these skills comprise a Toolbox of Everyday Clinical Ethics Skills. Educational case scenarios were identified to promote everyday ethics. Bioethicists identified skills essential to everyday clinical ethics. Educational case scenarios were identified for the purpose of promoting proficiency in this domain. Future research could explore the impact of integrating educational case scenarios on clinicians' ethical competencies.
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Affiliation(s)
- Elaine C Meyer
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
| | - Giulia Lamiani
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Melissa Uveges
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Renee McLeod-Sordjan
- Division of Medical Ethics, Department of Medicine, Northwell Health, Hofstra Northwell School of Nursing and Physician Assistant Studies and Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Christine Mitchell
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Robert D Truog
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Department of Anesthesiology, Critical Care and Pain, Boston Children's Hospital, Boston, MA, USA
| | - Jonathan M Marron
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Dana-Farber/Boston Children's Cancer Center and Blood Disorders Center, Boston, MA, USA
| | - Kerri O Kennedy
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Office of Ethics, Boston Children's Hospital, Boston, MA, USA
| | - Marilyn Ritholz
- Behavioral Medicine, Joslin Diabetes Center, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Aimee B Milliken
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
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Kolagari S, Moradi R, Milliken A, Khoddam H. Psychometric validation of the Persian version of the ethical awareness scale for nurses working in Iranian intensive care units. Nurs Open 2024; 11:e2168. [PMID: 38853447 PMCID: PMC11163024 DOI: 10.1002/nop2.2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/06/2024] [Accepted: 04/23/2024] [Indexed: 06/11/2024] Open
Abstract
AIM The purpose of this study was to translate and validate the ethical awareness scale for nurses working in Iranian intensive care units. DESIGN A cross-sectional psychometric study. METHODS The study was conducted in Oct 2020 to Sep 2021, involving the participation of 200 ICU nurses. The process included translation of the original version of the ethical awareness scale into Persian, following the World Health Organization guideline, for use in Iran. The translated version was then evaluated for reliability, face validity, content validity ratio, content validity index, convergent validity and construct validity. RESULTS The initial reliability of the scale was established. In qualitative face validity, a few items changed slightly and all items were retained in the quantitative face validity assessment. Based on Lawshe's values, three items were removed from the scale during CVR assessment. All items exhibited acceptable CVI scores. Convergent validity was established with an average variance extracted greater than 0.5. The fit indices, such as CFI = 0.94, GFI = 0.94, RMSEA = 0.01, AGFI = 0.97 and CMIN/DF = 2.99, supported the structural model of the scale. The fit indices for the structural model of the scale were all within acceptable ranges, suggesting that the model fit the data well. Its reliability was confirmed through the test-retest method, with Cronbach's alpha = 0.84 and McDonald's omega coefficient >0.8. CONCLUSION The findings of this study indicate the Persian version of the ethical awareness scale for Iran (EAS-IR) is comparable in content to the original version, demonstrating its validity and reliability for assessing ethical awareness among Iranian nurses in ICUs. The scale can be a valuable resource for measuring ethical awareness in the Iranian healthcare context and may contribute to improving ethical practices and decision-making in ICU settings. PATIENT OR PUBLIC CONTRIBUTION In this project, no patient or public contribution was necessary, because it was not applied to our work.
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Affiliation(s)
- Shohreh Kolagari
- Nursing Research CenterGolestan University of Medical SciencesGorganIran
| | - Reza Moradi
- School of Nursing and Midwifery SchoolGolestan University of Medical SciencesGorganIran
| | - Aimee Milliken
- Connell School of NursingBoston CollegeChestnut HillMassachusettsUSA
- Brigham and Women's HospitalBostonMassachusettsUSA
| | - Homeira Khoddam
- Nursing Research CenterGolestan University of Medical SciencesGorganIran
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Waterfield D, Barnason S. "It Kills Your Soul": A Mixed Methods Study of Ethical Sensitivity of Critical Care Nurses. West J Nurs Res 2024; 46:404-415. [PMID: 38676378 DOI: 10.1177/01939459241247690] [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: 04/28/2024]
Abstract
BACKGROUND Critically ill patients often experience distressful and impactful symptoms and conditions that include pain, agitation/sedation, delirium, immobility, and sleep disturbances (PADIS). The presence of PADIS can affect recovery and long-term patient outcomes. An integral part of critical care nursing is PADIS prevention, assessment, and management. Ethical sensitivity of everyday nursing practice related to PADIS is an imperative part of implementing evidence-based care for patients. OBJECTIVE The first 2 aims of this study were to determine the measured level of ethical awareness as an attribute of ethical sensitivity among the critical care nurse participants and to explore the ethical sensitivity of critical care nurses related to the implementation of PADIS care. The third aim was to examine how the measured level of ethical awareness and ethical sensitivity exploration results converge, diverge, and/or relate to each other to produce a more complete understanding of PADIS ethical sensitivity by critical care nurses. METHODS This was a convergent parallel mixed methods study (QUAL + quant). Ethical sensitivity was explored by conducting an ethnography of critical care nurses. The participants were 19 critical care nurses who were observed during patient care, interviewed individually, participated in a focus group (QUAL), and were administered the Ethical Awareness Scale (quant). FINDINGS Despite high levels of individual ethical awareness among nurses, themes of ambiguous beneficence, heedless autonomy, and moral distress were found to be related to PADIS care. CONCLUSIONS More effort is needed to establish moral community, ethical leadership, and individual ethical guidance for nurses to establish patient-centered decision-making and PADIS care.
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Affiliation(s)
- Denise Waterfield
- College of Nursing, University of Nebraska Medical Center, Kearney, NE, USA
| | - Susan Barnason
- College of Nursing, University of Nebraska Medical Center, Kearney, NE, USA
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Zheng H, Luo L, Tan X, Cen Y, Xing N, Huang H, Cai Y. Moral courage and its influencing factor among oncology specialist nurses: A multi-centre cross-sectional study. Nurs Open 2024; 11:e2096. [PMID: 38268282 PMCID: PMC10794856 DOI: 10.1002/nop2.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/25/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024] Open
Abstract
AIM Moral courage among healthcare workers has been extensively studied. However, few studies have been conducted on oncology specialist nurses, who frequently encounter complex moral situations. This study aimed to describe the current situation regarding moral courage and explored its influence on oncology specialist nurses in China. DESIGN This was an exploratory, descriptive study. METHODS A convenience sample of 390 nurses was conducted from 15 hospitals in Sichuan Province, China, between March and May 2023. Participants were assessed using the Moral Distress Scale-Revised, Nurses' Moral Courage Scale and the Moral Sensitivity Questionnaire. RESULTS The results demonstrated that moral courage was negatively associated with moral distress, and positively associated with moral sensitivity. Having a master's degree or above, an intermediate title or senior title, medical ethics training, moral distress or moral sensitivity contributed to explaining 54.1% of the variance in moral courage. CONCLUSIONS Moral courage was associated with several factors. Developing clinical intervention strategies and effective teaching methods will be critical for improving moral courage. No Patient or Public Contribution.
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Affiliation(s)
- Hongling Zheng
- Nursing DepartmentSichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Lei Luo
- Nursing DepartmentSichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Xiaohui Tan
- Nursing DepartmentSichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Yao Cen
- Nursing DepartmentSichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Naifang Xing
- Nursing DepartmentSichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Hui Huang
- School of NursingChengdu Medical CollegeChengduChina
| | - Yanling Cai
- School of NursingChengdu Medical CollegeChengduChina
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Grace PJ, Milliken A. A semantic exploration: Nurse ethicist, medical ethicist, or clinical ethicist: Do distinctions matter? Nurs Ethics 2023; 30:659-670. [PMID: 37946385 DOI: 10.1177/09697330221146251] [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: 11/12/2023]
Abstract
Since the 1960s, it has been recognized that "medical ethics," the area of inquiry about the obligations of practitioners of medicine, is inadequate for capturing and addressing the complexities associated with modern medicine, human health, and wellbeing. Subsequently, a new specialty emerged which involved scholars and professionals from a variety of disciplines who had an interest in healthcare ethics. The name adopted is variously biomedical ethics or bioethics. The practice of bioethics in clinical settings is clinical ethics and its primary aim is to resolve patient care issues and conflicts. Nurses are among these clinical ethicists. They are drawn to the study and practice of bioethics and its applications as way to address the problems encountered in practice. A significant number are among the ranks of clinical ethicists. However, in the role of bio- or clinical ethicist, some retained the title of their original profession, calling themselves nurse ethicists, and some did not. In this article, we explore under which conditions it is permissible or preferable that one retains one's prior profession's nomenclature as a prefix to "ethicist," under which conditions it is not, and why. We emphasize the need for transparency of purpose related to titles and their possible influence on individual and social good.
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Affiliation(s)
- Pamela J Grace
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Aimee Milliken
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
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Font Jiménez I, Ortega Sanz L, González Pascual JL, González Sanz P, Aguarón García MJ, Jiménez-Herrera MF. Reflective based learning for nursing ethical competency during clinical practices. Nurs Ethics 2023; 30:598-613. [PMID: 36919260 DOI: 10.1177/09697330221140513] [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: 03/16/2023]
Abstract
BACKGROUND A combination of theoretical and practical approaches is required to learn and acquire ethical competencies in caring. Occasionally, reflection on practical action differs from theoretical learning. In the context of reflective learning, issues such as ethical values can be discussed since they evoke conflict among nursing students. AIM To identify ethical conflicts encountered by nursing students during clinical placements and to determine their cooperation strategies. RESEARCH DESIGN Qualitative study with a content analysis according to Elo and Kinglas framework. PARTICIPANTS AND RESEARCH CONTEXT Students enrolled in a nursing program at a Spanish university aged between 22 and 35, mainly women. METHODOLOGY The study includes 134 ethical reflections from nursing students in the last year of the nursing program, written during their clinical practices in a variety of learning environments. The research team analyzed the reflections using an inductive content analysis method. ETHICAL CONSIDERATIONS Ethical permission was obtained by the management center according to Law 3/2028, and all the participants accepted to participate through the informed consent form. FINDINGS Three main categories emerged from the analysis of the ethical reflections: (1) evaluation of professional performance and patient care; (2) the student as the protagonist of the dilemma; (3) student coping. Student dilemmas and concerns are related to ignorance, student-patient communication, mistakes made and self-confidence. Some situations conflict with the autonomy of patients and their rights, and can contribute to stressful situations for patients. Stress factors include hospital routines, which the patient cannot modify, and asymmetric relationships with staff, which encourage passivity. CONCLUSION All ethical problems detected by the students begin with the professional-patient relationship, including issues related to bad news, errors or malpractice. Reflection on the ethical values of nursing, both in the classroom and in clinical practices, allows students to develop a greater ethical awareness of care, enhancing their decision-making skills in ethical dilemmas.
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Affiliation(s)
- Isabel Font Jiménez
- Faculty of Biomedical and Health Sciences, Department of Nursing and Nutrition, Universidad Europea de Madrid, Madrid, Spain
| | - Laura Ortega Sanz
- Departament d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain; Grup de Recerca GAP, CIBERSAM, Hospital Universitari Institut Pere Mata, Reus, Spain
| | - Juan Luis González Pascual
- Faculty of Biomedical and Health Sciences, Department of Nursing and Nutrition, Universidad Europea de Madrid, Madrid, Spain
| | - Pilar González Sanz
- Faculty of Biomedical and Health Sciences, Department of Nursing and Nutrition, Universidad Europea de Madrid, Madrid, Spain
| | - Maria Jesús Aguarón García
- Departament d'Infermeria, Gup de Recerca Avançada en Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
| | - María F Jiménez-Herrera
- Departament d'Infermeria, Gup de Recerca Avançada en Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
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Schulz I, O'Neill J, Gillam P, Gillam L. The scope of ethical dilemmas in paediatric nursing: a survey of nurses from a tertiary paediatric centre in Australia. Nurs Ethics 2023; 30:526-541. [PMID: 36877536 DOI: 10.1177/09697330231153916] [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: 03/07/2023]
Abstract
BACKGROUND No previous study has provided evidence for the scope and frequency of ethical dilemmas for paediatric nurses. It is essential to understand this to optimise patient care and tailor ethics support for nurses. RESEARCH AIM The aim of this study was to explore the scope of nurses' ethical dilemmas in a paediatric hospital and their engagement with the hospital clinical ethics service. RESEARCH DESIGN This study used a cross-sectional survey design. PARTICIPANTS AND RESEARCH CONTEXT Paediatric nursing staff in a tertiary paediatric centre in Australia completed an online survey asking about their exposure to a range of ethical dilemmas and their knowledge of the clinical ethics service. Analysis used descriptive and inferential statistics. ETHICAL CONSIDERATIONS Ethical approval was granted from the hospital research committee. The survey was anonymous, and no identifying details of participants were collected. RESULTS Paediatric nurses experienced a wide range of ethical dilemmas frequently, both in the intensive care and general areas. Knowledge and use of the clinical ethics service was poor and the most frequent challenge for nurses in managing dilemmas was feeling powerless. CONCLUSION There is a need to recognise the moral burden of ethical dilemmas for paediatric nurses in order to foster ethical sensitivity, and to provide adequate support to improve care and mitigate nursing moral distress.
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Affiliation(s)
- Ingrid Schulz
- The Victorian Paediatric Palliative Care Program, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Jenny O'Neill
- The Department of Nursing Research, The Royal Children's Hospital, Melbourne, VIC, Australia; Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; The Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter Gillam
- Department of Psychology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lynn Gillam
- The Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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Blomqvist H, Bergdahl E, Hemberg J. Ethical sensitivity and compassion in home care: Leaders' views. Nurs Ethics 2023; 30:180-196. [PMID: 36241186 PMCID: PMC10014894 DOI: 10.1177/09697330221122965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND With an increasing older population, the pressure on home care resources is growing, which makes it important to ensure the maintenance of quality care. It is known that compassion and ethical sensitivity can improve the quality of care, but little is known about care leaders' perceptions on ethical sensitivity and compassion in home care and how it is associated with staff competence and thus quality of care. AIM The aim of the study was to explore home care leaders' perceptions of ethical sensitivity and compassion associated with care quality in home care. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT A hermeneutical approach with a qualitative explorative design was used. The data consists of texts from 10 in-depth interviews with home care leaders. Content analysis was used as a method. ETHICAL CONSIDERATIONS The study was conducted following the ethical guidelines of the Declaration of Helsinki and the Finnish Advisory Board of Research Ethics. Research ethics permission was applied for from a Research Ethics Board. FINDINGS One overall theme and four subthemes were found. The overall theme was: "Compassion provides deeper meaning and ethical sensitivity provides means for knowing how to act". DISCUSSION If nurses fail to be sensitive and compassionate with patients, good and high qualitative home care cannot be achieved. Ethical sensitivity and compassion can be seen as resources in home care but the organization and the care leaders need to provide the support for these to develop. CONCLUSION This study provides an understanding of the meaning of ethical sensitivity and compassion as sources of strength and their link to quality of care in a home care context. Further studies could focus on how to build compassion and ethical sensitivity into home-based care and how to ensure adequate support for healthcare professionals' compassion and ethical sensitivity.
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Affiliation(s)
- Heidi Blomqvist
- Faculty of Education and Welfare Studies, Department of Caring Sciences, 1040Åbo Akademi University, Finland
| | | | - Jessica Hemberg
- Faculty of Education and Welfare Studies, Department of Caring Sciences, 1040Åbo Akademi University, Finland
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Frennert S. Moral distress and ethical decision-making of eldercare professionals involved in digital service transformation. Disabil Rehabil Assist Technol 2023; 18:156-165. [PMID: 33151763 DOI: 10.1080/17483107.2020.1839579] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM Technology affects almost all aspects of modern eldercare. Ensuring ethical decision-making is essential as eldercare becomes more digital; each decision affects a patient's life, self-esteem, health and wellness. METHODS We conducted a survey and interviews with eldercare professionals to better understand the behavioural ethics and decision making involved in the digital transition of eldercare. CONCLUSION Our qualitative analysis showed three recurrent roles among eldercare professionals in regard to digital service transformation; makers, implementers and maintainers. All three encountered challenging and stressful ethical dilemmas due to uncertainty and a lack of control. The matter of power relations, the attempts to standardize digital solutions and the conflict between cost efficiency and if digital care solutions add value for patients, all caused moral dilemmas for eldercare professionals. The findings suggest a need for organizational infrastructure that promotes ethical conduct and behaviour, ethics training and access to related resources.Implications for rehabilitationThe transition to digital care service is not neutral, but value-laden. Digital transformation affects ethical behaviour and decision-making.The decision as to which digital services should be developed and deployed must include eldercare professionals and not lay solely in the hands of managers, technologists and economists.We must move away from attempting to fit standardized solutions to a heterogenous group of older patients; accommodating the pluralism of patients' needs and wants protects their dignity, autonomy and independence.As digital care practices evolve, so too must organizational structures that promote ethical conduct.
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Affiliation(s)
- Susanne Frennert
- Department of Computer Science and Media Technology, Internet of Things and People Research Center, Malmö University, Malmo, Sweden
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Jakobsen L, Olsen RM, Brinchmann BS, Devik SA. Developing and Testing Digital Ethical Reflection in Long-Term Care: Nurses' Experiences. SAGE Open Nurs 2023; 9:23779608221150725. [PMID: 36654853 PMCID: PMC9841835 DOI: 10.1177/23779608221150725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/17/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Nurses working in municipal long-term care face ethical challenges that can lead to moral distress and discomfort for the nurse and affect the quality of patient care. Tools and methods that contribute to increased ethical awareness and support for nurses dealing with moral issues are lacking. Technological innovations may be suitable for ethics work, but little research has been conducted on how such solutions could be designed or their potential benefit. Therefore, this study contributes knowledge about the development and testing of a digital tool for ethics support among nurses. Objective To investigate how digital ethical reflection can support ethics work among nurses working in long-term care. Methods A digital ethical reflection tool was designed and tested in nursing homes and home nursing care in collaboration with two Norwegian municipalities. The study used sequential explanatory mixed-methods design. Over a 6-week period, at the end of each shift, nurses digitally reported the ethical challenges they had experienced. Their responses and experiences were described using descriptive statistics. Additionally, focus group interviews were conducted and analyzed using reflexive thematic analysis (TA). Results During the study period, 17 nurses reported a total of 223 registrations, with 24.8% stating that they had been in an ethically difficult situation. The digital reporting was perceived as practically applicable and helped to increase nurses' awareness of morally charged situations. The value of the registrations was found to depend on manager participation and the application of the obtained information. The participating nurses become aware that they lacked an arena for meaningful dialogue with and recognition from their manager. Conclusions Information obtained through digital reflection can form the basis for ethical reflections at the departmental level. Digital reflection has the potential to become a tool for managers in their support for employees facing ethical challenges when providing long-term care.
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Affiliation(s)
- Lena Jakobsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway,Lena Jakobsen, Faculty of Nursing and Health Sciences, Nord University, PO Box 1490, 8049 Bodø, Norway.
| | - Rose Mari Olsen
- Centre for Care Research Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
| | - Berit Støre Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, Norway and Nordland Regional University, Bodø, Norway
| | - Siri Andreassen Devik
- Centre for Care Research Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
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14
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Arakelian E, Rudolfsson G. Sharing the Same Reality, Healthy Relations Between Colleagues at Work: A Meta-Synthesis. SAGE Open Nurs 2023; 9:23779608231207239. [PMID: 37854790 PMCID: PMC10580729 DOI: 10.1177/23779608231207239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/11/2023] [Accepted: 09/23/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Good relations are important at work, leading to well-being among coworkers. Since the latest research in nursing is mostly about bullying, and lateral violence, it was important to study what healthy relations mean. Objectives The aim was to identify and synthesize qualitative studies that describe healthy relations, creating health and well-being between colleagues at work. Methods A meta-synthesis approach, inspired by Sherwood's steps of analysis, was chosen for this study. Ten articles from three continents, comprising 230 participants, were included. Results Two themes were identified as follows: (a) creating a mutual bond on a personal level and a permissive atmosphere through the human warmth; and (b) sharing togetherness in a greater whole, offering unconditional help and devoting themselves to taking care of each other. An overarching metaphor implicating the home/homeness was abstracted from the two themes: "Healthy relations between colleagues at work constitute the community as a common world, containing feelings of being at home, implying acting in an expression of the ethos and dignity, a culture created that makes the ideal form of healthy relations visible." Conclusion Nurses find their meaning when they work in a permissive environment, and when they are allowed to be themselves. Such meaning can be found through their engagement with one another, by offering each other unconditional help. Good relationships lead to a place they call their home, where there is trust and friendship.
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Affiliation(s)
- Erebouni Arakelian
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Gudrun Rudolfsson
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Division of Nursing, Department of Health Sciences, University West, Trollhättan, Sweden
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15
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Rahmani P, Behshid M, Seif‐Farshad M, Mousavi S, Molaei Tavani F. Moral awareness and its relationship with moral sensitivity among Iranian nursing students: A basis for nursing ethics education. Nurs Open 2022; 10:773-780. [PMID: 36125847 PMCID: PMC9834526 DOI: 10.1002/nop2.1344] [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: 01/02/2022] [Revised: 05/25/2022] [Accepted: 07/29/2022] [Indexed: 01/16/2023] Open
Abstract
AIM This descriptive-analytical correlational study was carried out to examine moral awareness and its relationship with moral sensitivity among Iranian nursing students. DESIGN A descriptive-analytical correlational study. METHODS The present descriptive-analytical study was performed among 140 Iranian nursing students. The data collection tool was a three-part questionnaire including (1) Demographic Information Questionnaire, (2) Nurses' Awareness about the Iranian Nursing Code of Ethics by Mohajjel Aghdam and (3) Moral Sensitivity Questionnaire (MSQ) by Kim Lutzen. The data collected from these questionnaires were analysed in SPSS-26 using descriptive and inferential statistics. RESULTS The mean moral awareness (29.42 ± 4.01) was good, and the mean moral sensitivity (135.05 ± 18.79) was moderate among the students. A significant positive correlation was observed between the total score of moral awareness and moral sensitivity (r = .22, p = .009) in the nursing students.
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Affiliation(s)
- Parvin Rahmani
- Student Research CommitteeDepartment of Medical‐Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical ScienceTabrizIran
| | - Mozhgan Behshid
- Student Research CommitteeDepartment of Medical‐Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical ScienceTabrizIran,Medical Education Research Center, Health Management and Safety Promotion Research Institute, Department of Medical‐Surgical Nursing, Faculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Mehran Seif‐Farshad
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Department of Medical‐Surgical Nursing, Faculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Saeid Mousavi
- Department of Statistics and Epidemiology, Faculty of HealthTabriz University of Medical SciencesTabrizIran
| | - Fatemeh Molaei Tavani
- Student Research CommitteeDepartment of Medical‐Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical ScienceTabrizIran
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16
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Zumstein-Shaha M, Grace PJ. Competency frameworks, nursing perspectives, and interdisciplinary collaborations for good patient care: Delineating boundaries. Nurs Philos 2022; 24:e12402. [PMID: 35761762 PMCID: PMC10078421 DOI: 10.1111/nup.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 04/29/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. These are some of the reasons behind current movements to develop competency frameworks that can enhance cross-disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care.
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Affiliation(s)
- Maya Zumstein-Shaha
- Department of Health, Master of Science in Nursing Program, Adjunct Head of Program, Bern University of Applied Sciences, Bern, Switzerland.,Department of Nursing, Faculty for Health, University of Witten/Herdecke, Witten, Germany
| | - Pamela J Grace
- Boston College, William F. Connell School of Nursing, Boston, Massachusetts, USA
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17
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Abstract
BACKGROUND Midwives frequently encounter ethical dilemmas in a critical unit such as a delivery room. Determining these ethical dilemmas is very important to prevent ethical problems and develop an ethical approach. AIM This study aims to identify the ethical dilemma experiences of midwives working in delivery rooms in Turkey. RESEARCH DESIGN This study follows a qualitative phenomenological research design. PARTICIPANTS AND RESEARCH CONTEXT The sample comprised 13 midwives with at least two years working experience in delivery rooms, having completed the midwifery program of Manisa Celal Bayar University Health Sciences Institute in the 2017-2018 academic year. Data were collected through audio-recorded semi-structured interviews to reveal their experiences. Content analysis was done using the Nvivo software package program. All interviews were digitally recorded, transcribed verbatim, and transferred into NVivo for analysis. ETHICAL CONSIDERATIONS Ethical approval was granted by Manisa Celal Bayar University University Health Sciences Ethics Committee (Date: 16.12.2016 No: 372). Participation in this study was voluntary. Written and verbal consent was gained. These consents include protecting midwives' privacy, keeping information confidential, and/or allowing the participant to remain anonymous. FINDINGS Four themes were identified: differences of approach to the birth process, hospital management, communication, and differences in ethical approach. Several factors explained these ethical dilemmas while the midwives adopted different approaches to ethical decision making. DISCUSSION These midwives experienced various dilemmas while working in the delivery room and are aware of most of them. They also took responsibility in the decision-making process and experienced many intense emotions that they had to cope with. CONCLUSION The ethical dilemmas faced by these midwives while working in delivery rooms were mainly caused by hierarchy. Future studies could investigate clarifying job descriptions of midwives, who are authorized to manage normal births under their own responsibility, within the hospital management and the health care team.
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Affiliation(s)
- Hazal Türken
- Izmir Private Ata Health Hospital, Maternity Department, Izmir, Turkey
| | - Selda İldan Çalım
- Department of Midwifery, Faculty of Health Sciences, 52953Manisa Celal Bayar University, Manisa, Turkey
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18
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Kalevor S, Uveges MK, Meyer EC. Using Everyday Ethics to Address Bias and Racism in Clinical Care. AACN Adv Crit Care 2022; 33:111-118. [PMID: 35259217 DOI: 10.4037/aacnacc2022566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Shika Kalevor
- Shika Kalevor is a Fellow at the Bioethics Center at Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108
| | - Melissa Kurtz Uveges
- Melissa Kurtz Uveges is Assistant Professor, Boston College William F. Connell School of Nursing, Boston, Massachusetts
| | - Elaine C Meyer
- Elaine C. Meyer is Senior Attending Psychologist, Boston Children's Hospital, and Associate Professor of Psychology, Harvard Medical School Center for Bioethics, Boston, Massachusetts
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19
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Robichaux C, Grace P, Bartlett J, Stokes F, Saulo Lewis M, Turner M. Ethics Education for Nurses: Foundations for an Integrated Curriculum. J Nurs Educ 2022; 61:123-130. [PMID: 35254162 DOI: 10.3928/01484834-20220109-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Complexity in health care environments causes practice problems. Nurses bear responsibility for recognizing, addressing, and preventing ethical problems. Inadequacies in ethics education are partly to blame and contribute to nurse moral distress, attrition, and suboptimal care. Foundational curricula structures adequate for developing nurse moral agency are needed. METHOD The state of the science of ethics education in nursing was explored in-depth by a subcommittee of the American Nurses Association Ethics Advisory Board. A framework based in nursing goals was designed by nurse ethics experts to address ethics education across levels of curricula and practice. Rest's four-component model of moral behavior structures guidelines. RESULTS The model captures three facets of nurse moral agency: necessary characteristics, knowledge and skills, and motivation. A case is provided to illustrate its utility. CONCLUSION This framework provides the means to meet the profession's goal of preparing ethically competent nurses who will exercise moral agency. [J Nurs Educ. 2022;61(3):123-130.].
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20
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Koskinen C, Kaldestad K, Rossavik BD, Ree Jensen A, Bjerga G. Multi-professional ethical competence in healthcare - an ethical practice model. Nurs Ethics 2022; 29:1003-1013. [PMID: 35212250 PMCID: PMC9289975 DOI: 10.1177/09697330211062986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction The starting point is that ethical competence is the basis for ethical healthcare practices and quality of care. Simultaneously, there is a need for research and development from a holistic multi-professional perspective. Aim The aim is to create a proposed model for multi-professional ethical competence grounded in clarified meanings and dimensions of ethical competence studied from a multi-professional healthcare perspective. The research questions are, what is ethical competence from a multi-professional healthcare perspective and what strengthens a multi-professional ethical healthcare practice? Research design The research has a qualitative approach and hermeneutic application research design. Two groups with six participants from clinical practice and two scientific researchers in each group met four times for dialogue. Thematic analysis was used as an analysis method. Ethical considerations The research is approved by the Declaration of Helsinki, the General Data Protection Regulations, and ethical permission was asked from the Norwegian Centre for Research Data (NSD). Results The proposed model for multi-professional ethical competence encompasses a three-dimensional ethical value base that is underpinned by: Ethical attitude – a personal desire to do good; Ethical basis – the best for the patient as a common goal and Ethical culture – common goals and values in the organization. Multi-professional ethical competence is strengthened by: Reflection – to see with new wondering eyes; Time for talk – interdisciplinary teamwork and Leadership – an ethical role model and support. Discussion Ethical competence has a strong link to the core of caring ethics and a deeper personal value base and attitude. Ethical competence involves the whole culture and is seen as a shared value base and a responsibility to do the best for the patient as a multi-professional team and organization. Ethical competence becomes active in healthcare practice by opening up for meaningful multi-professional talks and reflections.
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Affiliation(s)
- Camilla Koskinen
- Faculty of Health Sciences, Department of Caring and Ethics,56627University of Stavanger, Stavanger, Norway
| | - Kari Kaldestad
- Faculty of Health Sciences, Department of Caring and Ethics,56627University of Stavanger, Stavanger, Norway
| | | | - Anne Ree Jensen
- Department of Surgery,60496Stavanger University Hospital, Stavanger, Norway
| | - Grethe Bjerga
- Faculty of Health Sciences, Department of Caring and Ethics,56627University of Stavanger, Stavanger, Norway
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21
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Munkeby H, Moe A, Bratberg G, Devik SA. 'Ethics Between the Lines' - Nurses' Experiences of Ethical Challenges in Long-Term Care. Glob Qual Nurs Res 2022; 8:23333936211060036. [PMID: 35005098 PMCID: PMC8738871 DOI: 10.1177/23333936211060036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/01/2022] Open
Abstract
In long-term care, ethical challenges are becoming increasingly apparent as the number of older patients with complex care needs increases, in parallel with growing demands for more cost-efficient care. Scarce resources, cross-pressure and value conflicts are associated with missed care, moral stress and nurses wanting to leave the profession. Through five focus group interviews, this study aimed to explore how nurses working in nursing homes and homecare services perceive, experience and manage ethical challenges in everyday work. Content analysis revealed three main themes: striving to do good; failing and being let down and getting rid of frustrations and learning from experiences. The nurses’ morality was mainly expressed through emotions that arose in specific situations. Dedicated spaces for ethical reflection and leaders who recognize that organizational conditions affect the individual nurse-patient relationship are required. Facilitating ethical reflection is an important leadership responsibility, which may also require leaders to actually participate.
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Affiliation(s)
- Hilde Munkeby
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Aud Moe
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Grete Bratberg
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Siri A Devik
- Centre of Care Research, Steinkjer, Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
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22
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Koirala B, Davidson PM, Rushton CH. Ethics in nursing: Progress on National Nursing Ethics Summit. Nurs Outlook 2021; 70:154-165. [PMID: 34776256 DOI: 10.1016/j.outlook.2021.08.001] [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: 02/09/2021] [Revised: 07/31/2021] [Accepted: 08/23/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND In 2014 a National Nursing Ethics Summit was undertaken to chart a future for nursing ethics in the United States. PURPOSE The purpose of this study was to understand changes in the field over a 5-year period as a measure of longitudinal impact and identify recommendations for education, practice, research and scholarship, and policy. METHODS This cross-sectional study used a mixed method design. FINDINGS Nineteen participants from 15 institutions participated in the survey. The majority of respondents agreed or strongly agreed on their effort in promoting education (84%), contributing to scholarship (74%), creating a sustained environment for ethical practice (63%) and developing new initiatives (58%) in nursing ethics. DISCUSSION Further investment is needed to establish a more broadly funded research agenda for ethical issues in nursing, improvement in evidence-based practice, and development of policy initiatives to promote ethical practice and infrastructure for sustainability and responsiveness to contemporary challenges.
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Affiliation(s)
- Binu Koirala
- Johns Hopkins University School of Nursing, Baltimore, MD.
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23
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Bianchi M, Ghirotto L. Nurses' perspectives on workarounds in clinical practice: A phenomenological analysis. J Clin Nurs 2021; 31:2850-2859. [PMID: 34755404 PMCID: PMC9539462 DOI: 10.1111/jocn.16110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/28/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
Aims and objectives To explore the phenomenon of workarounds in clinical practice through the nurses’ perspective and identify which factors according to their experience contribute to activities carried forth non‐compliantly to procedures, protocols and rules defined by an Institution. Background A workaround in clinical practice is a non‐compliance and a violation of an organisation's defined procedures, regulations or rules that may prevent adverse events. Its increasing recurrence in the workplace calls for a deeper analysis of the phenomenon. Design A phenomenological descriptive design, following Colaizzi's analysis. Methods In‐depth interviews were conducted with 16 nurses about their experience of workarounds. The interviews were digitally audio‐recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed three phases: extracting significant statements, creating formulated meanings and aggregating them into themes. The process employed NVivo 12 software. COREQ checklist was used for reporting. Results Data analysis identified 17 sub‐themes falling into the four macro‐themes: (i) living the profession in saved times; (ii) Perceiving contingencies as a guide to action; (iii) sense of personal responsibility; and (iv) emotional aspects. Conclusions From a nurses’ perspective, a workaround is often triggered by the need to overcome problems interfering with efficient and timely patient care in everyday clinical practice. This will of undertaking responsibilities favouring gained efficiency is closely linked to their confidence acquired over years of experience in the field. Relevance to clinical practice The results of this study can help clinical leadership to acknowledge workaround, understand the underlying triggers and work towards reconciling official procedures with real‐world situations. They can help nurses working in clinical practice to reflect and understand how to reconcile the needs related to the demands of organisations with the need to live their profession, which is more patient‐oriented.
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Affiliation(s)
- Monica Bianchi
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Luca Ghirotto
- Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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24
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Zhou J, Zhang KF. Effect of ethical nurse leaders on subordinates during pandemics. Nurs Ethics 2021; 29:304-316. [PMID: 34749561 DOI: 10.1177/09697330211030673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As caring in times of pandemics becomes extremely stressful, the volume and intensity of nursing work witness significant increase. Ethical practices are therefore even more important for nurses and nurse leaders during this special period. RESEARCH AIM The aim was to explore the relationship between ethical nurse leaders and nurses' task mastery and ostracism, and to examine the mediating role of relational identification in this relationship during pandemics. RESEARCH DESIGN Based on social exchange theory, this study tests a theoretical model proposing that ethical nurse leaders can increase nurses' task mastery and reduce their ostracism by improving their relational identification with leaders during pandemics. PARTICIPANTS AND RESEARCH CONTEXT A multilevel and multi-wave field study using data from 172 nurses from 45 departments of two comprehensive hospitals was performed from April to August 2020 to test proposed hypotheses. ETHICAL CONSIDERATIONS We received formal approvals from the ethical committee of the hospital where we conducted this study before the data collection. RESULTS Ethical nurse leaders can indeed increase nurses' task mastery and reduce their ostracism during the pandemic period; furthermore, nurses' identification with their leaders mediates these relationships. We find that ethical leadership plays an even more important role in improving nurses' task mastery and reducing their ostracism that may be facilitated by pandemics this special time. Nurses will become more identified with their leaders when they are treated by ethical ways. DISCUSSION The study tries to advance our understanding of the important role of ethical leadership in nurse management literature and provide useful suggestions for healthcare institutions, nurse leaders, and nurses during pandemics. CONCLUSION Theoretical contributions and practical implications of our findings are discussed. Specifically, we suggest that healthcare institutions cultivate ethical nurse leaders to facilitate nurses' relational identification, which in turn will positively influence work outcomes.
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Affiliation(s)
- Jinyi Zhou
- University of Science and Technology Beijing, China
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25
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Delgado J. Vulnerability as a key concept in relational patient- centered professionalism. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:155-172. [PMID: 33423192 DOI: 10.1007/s11019-020-09995-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 05/21/2023]
Abstract
The goal of this paper is to propose a relational turn in healthcare professionalism, to improve the responsiveness of both healthcare professionals and organizations towards care of patients, but also professionals. To this end, it is important to stress the way in which difficult situations and vulnerability faced by professionals can have an impact on their performance of work. This article pursue two objectives. First, I focus on understanding and making visible shared vulnerability that arises in clinical settings from a triple perspective: patient and family, health professionals, and institutions. Second, to address this challenge for professionalism, in this paper I articulate the term "relational centered-patient professionalism", which has two main axes. The relational approach means taking into account how the relationships among professionals, patients and institutions determine the constitution and evolution of those professional values. The focus on patient centered care is indispensable, because it is the ultimate goal pursued by the development of these professional values, and must always be at the center.
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Affiliation(s)
- Janet Delgado
- University Institute of Women's Studies, University of La Laguna, La Laguna, Spain.
- University Hospital of the Canary Islands, La Laguna, Spain.
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26
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Meyer EC, Carnevale FA, Lillehei C, Uveges MK. Widening the Ethical Lens in Critical Care Settings. AACN Adv Crit Care 2021; 31:210-220. [PMID: 32526004 DOI: 10.4037/aacnacc2020265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Elaine C Meyer
- Elaine C. Meyer is Faculty Associate, Center for Bioethics, and Associate Professor of Psychology, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115
| | - Franco A Carnevale
- Franco A. Carnevale is Full Professor, Ingram School of Nursing; Associate Member, Faculty of Medicine (Pediatrics); Adjunct Professor, Counselling Psychology; and Affiliate Member, Biomedical Ethics Unit, McGill University, Montreal, Canada
| | - Craig Lillehei
- Craig Lillehei is Chair of Surgical Education, Boston Children's Hospital, Boston, Massachusetts
| | - Melissa Kurtz Uveges
- Melissa Kurtz Uveges is Postdoctoral Research Fellow, Center for Bioethics, Harvard Medical School, Boston, Massachusetts
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27
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Uncu F, Güneş D. The importance of moral sensitivity in nursing education: A comparative study. Nurs Forum 2021; 56:635-639. [PMID: 33896007 DOI: 10.1111/nuf.12584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIM This study aims to determine the importance of the "Ethics and Deontology in Nursing" course in nursing education for the purpose of revealing the level of moral sensitivity of nursing students. MATERIALS AND METHODS In our research, which is a descriptive study, data were collected from 461 nursing students who studied at the Faculty of Health Sciences. In the study, the Personal Information Form and Moral Sensitivity Questionnaire (MSQ) were used as data collection forms. The findings from the study were evaluated with SPSS 22.00 package software, and the level of significance in all analyses was accepted as p < 0.05. RESULTS The average age of the students participating in the study was 20.83 ± 1.55. Also, 51.8% of the students took the course "Ethics and Deontology in Nursing." The total mean score of the MSQ of students was determined as 83.32 ± 16.79. A statistically significant difference was found between the students' total scores of autonomy, benefit, holistic approach, conflict, practice, orientation, and moral sensitivity, depending on whether they took the course "Ethics and Deontology in Nursing." CONCLUSION It was concluded that moral sensitivity in nursing students was positively influenced by the ethical education they received.
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Affiliation(s)
- Fatoş Uncu
- Department of Public Health Nursing, Faculty of Health Sciences, Fırat University, Elazığ, Turkey
| | - Dilek Güneş
- Department of Surgical Nursing, Faculty of Health Sciences, Fırat University, Elazığ, Turkey
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28
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Delgado J, Siow S, de Groot J, McLane B, Hedlin M. Towards collective moral resilience: the potential of communities of practice during the COVID-19 pandemic and beyond. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106764. [PMID: 33762300 PMCID: PMC7992383 DOI: 10.1136/medethics-2020-106764] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 05/25/2023]
Abstract
This paper proposes communities of practice (CoP) as a process to build moral resilience in healthcare settings. We introduce the starting point of moral distress that arises from ethical challenges when actions of the healthcare professional are constrained. We examine how situations such as the current COVID-19 pandemic can exponentially increase moral distress in healthcare professionals. Then, we explore how moral resilience can help cope with moral distress. We propose the term collective moral resilience to capture the shared capacity arising from mutual engagement and dialogue in group settings, towards responding to individual moral distress and towards building an ethical practice environment. Finally, we look at CoPs in healthcare and explore how these group experiences can be used to build collective moral resilience.
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Affiliation(s)
- Janet Delgado
- NICU, University Hospital of the Canary Islands, La Laguna, La Laguna, Spain
- University Institute of Women's Studies, University of La Laguna, La Laguna, Spain
| | - Serena Siow
- Department of Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Janet de Groot
- Department of Psychiatry, Oncology and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Brienne McLane
- Department of Psychiatry, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Margot Hedlin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Spekkink A, Jacobs G. The development of moral sensitivity of nursing students: A scoping review. Nurs Ethics 2020; 28:791-808. [PMID: 33325340 DOI: 10.1177/0969733020972450] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Moral sensitivity is known to be the starting point for moral competence and even is a core concept in the curricula for bachelor's-level nursing students in the Netherlands. While the development of moral sensitivity in nursing is commonly agreed to be important, there is no clear understanding of how to develop moral sensitivity through nursing education and what components of nursing education contribute to moral sensitivity. Studies on educational interventions could build knowledge about what works in developing moral sensitivity and how to achieve this outcome. Therefore, the aim of this study is to explore if and how educational interventions contribute to the development of moral sensitivity in nursing students. A scoping review was conducted. Four electronic databases were searched: CINAHL, PubMed, MEDLINE and SpringerLink. Articles that were not about formal or initial nursing education and that had no link to moral development or moral sensitivity were excluded. After the final selection on educational interventions, 10 articles out of the initial 964 resources were included in the review. Three different but related dimensions of moral sensitivity emerged from the literature: (1) raising moral awareness, (2) providing the ability to frame and name ethical issues and (3) improving moral reasoning ability. Half of the studies used quantitative measures to evaluate the educational intervention, in particular the Moral Sensitivity Questionnaire; the other half used diverse qualitative evaluation methods. None of the studies presented teaching methods that included all three dimensions of moral sensitivity. Moral awareness of self appears to be more loosely connected to the other two dimensions, which raises the question of whether it can be seen as a prerequisite for them. To encompass all dimensions of moral sensitivity, a mix of quantitative and qualitative measures seems most appropriate to study that topic.
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Affiliation(s)
| | - Gaby Jacobs
- 36513University of Humanistic Studies, The Netherlands
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Kim Y, Lee E. The relationship between the perception of open disclosure of patient safety incidents, perception of patient safety culture, and ethical awareness in nurses. BMC Med Ethics 2020; 21:104. [PMID: 33109160 PMCID: PMC7590671 DOI: 10.1186/s12910-020-00546-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Scientific advances have resulted in more complex medical systems, which in turn have led to an increase in the number of patient safety incidents (PSIs). In this environment, the importance of honest disclosure of PSIs is rising, which highlight the need to settle a reliable system. This study aimed to investigate the effects of patient safety culture and ethical awareness on open disclosure of PSIs. Methods Data were collected from 389 nurses using self-reported perceptions of open disclosure of PSIs, perceptions of patient safety culture, and ethical awareness. Results Perception of open disclosure of PSIs was significantly correlated with ethical awareness and perception of patient safety culture. Ethical awareness had the greatest impact on perception of PSIs, and two components of the perception of patient safety culture, namely overall knowledge about patient safety and staffing, were found to have significant effects. Conclusions To enhance nurses’ perception of open disclosure of PSIs, educational curriculum and programs that teach and practice fundamental ethical values are needed. Furthermore, it also calls for effort on the part of healthcare institutions and the government, as well as people’s trust, to implement a legal safety net and foster patient safety culture to promote honest disclosure of PSIs to patients.
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Affiliation(s)
- Yujeong Kim
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, 680 Gukchabosangro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Eunmi Lee
- Department of Nursing, Research Institute for Basic Science, Hoseo University, 20, Hoseo-ro79beon-gil, Baebang-eup, Asan-si, Chungcheongnam-do, 31499, Republic of Korea.
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De Panfilis L, Tanzi S, Perin M, Turola E, Artioli G. "Teach for ethics in palliative care": a mixed-method evaluation of a medical ethics training programme. BMC Palliat Care 2020; 19:149. [PMID: 32977796 PMCID: PMC7519533 DOI: 10.1186/s12904-020-00653-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Training in medical ethics aims to educate health care professionals in dealing with daily care ethical issues. To guarantee quality of life and spiritual and emotional support, palliative care professionals have to develop ethical and relational skills. We propose the implementation and evaluation of a specialized training programme in medical ethics dedicated to a hospital-based Palliative Care Unit. METHODS This study is a mixed-method before-after evaluation with data triangulation. RESULTS The results highlight that participants developed their ethical knowledge, and a deeper ethical awareness. They also felt more confident and motivated to widely apply ethical reflections and reasonings in their daily practice. CONCLUSION The participants appreciated the innovative structure of the training, especially regarding the integration of the theoretical-interactive and practical parts. However, they recommended increasing the number of concrete occasions for ethical supervision and practical application of what they learned during the programme. The training programme also has some potential practical implications: the development of advanced ethical skills within a hospital-based PC team may improve the quality of life of the patients and their families. In addition, health care professionals with advanced ethical competencies are able to educate patients and their families towards more active participation in the decision-making process.
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Affiliation(s)
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marta Perin
- Unit of Bioethics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Turola
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanna Artioli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Gholamzadeh S, Shayestehfard M, Torabizadeh C, Ebadi A. Ethical Sensitivity in Nursing Students: Developing a Context–based Education. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sedgwick M, Yanicki S, Pijl EM. Analysis of Undergraduate Nursing Students' Sensitivity to Microethical Dilemmas During Simulation. J Nurs Educ 2020; 59:88-92. [DOI: 10.3928/01484834-20200122-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/07/2019] [Indexed: 11/20/2022]
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34
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Ethikkompetenzen vertiefen und verdichten – Welche Rolle kann die Ethik-Leitlinienentwicklung als exemplarische Methode der Ethikdidaktik in der hochschulischen Pflegeausbildung spielen? Ethik Med 2019. [DOI: 10.1007/s00481-019-00544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Milliken A, Ludlow L, Grace P. Ethical Awareness Scale: Replication Testing, Invariance Analysis, and Implications. AJOB Empir Bioeth 2019; 10:231-240. [PMID: 31580779 DOI: 10.1080/23294515.2019.1666176] [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] [Indexed: 12/31/2022]
Abstract
Background: Ethical awareness (EA) enables nurses to recognize the ethical implications of all practice actions and is an important component of safe and quality nursing care. Evidence suggests that nurses may sometimes feel underprepared to recognize and address ethical issues as they arise in practice. The Ethical Awareness Scale (EAS) presented strong evidence as a psychometrically sound measure of EA in critical care nurses in pilot testing. The present study extends earlier work by (a) expanding the sample, (b) replicating the psychometric analyses, (c) more deeply investigating data-to-model fit, and (d) providing guidelines for the interpretation of EAS scores and subsequent practice-focused and educational interventions. Methods: This study utilized two sets of cross-sectional EAS survey results with ICU nurse respondents from two hospitals in New England. Invariance testing using simple OLS regression was conducted between the item estimates of both samples. The final Rasch analysis utilized a rating scale model. Finally, a score interpretation framework was developed. Results: 240 participants were included in the combined analysis. Nurses were predominantly female (93.1%), aged 25-35 (39.9%), and Bachelor's degree prepared (73.4%). Mean levels of EA were in the low/moderate range (M = 36.2/54). Cronbach's alpha of 0.86 was achieved. The Rasch analysis demonstrated a variable map structure consistent with the hypothesized item order, scoring categories that were sufficiently used by respondents, and adequate model-data fit. Conclusions: This study demonstrates that the EAS is a psychometrically sound and meaningful measure of EA in critical care nurses with item difficulty estimates that are invariant across samples. A raw score on the EAS can be practically interpreted, given the theoretical description of what a nurse at each level of the scale's continuum may "look" like in terms of EA using the diagnostic interpretation table. These findings have implications for nursing education and practice.
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Affiliation(s)
- Aimee Milliken
- Wiese Postdoctoral Fellow in Bioethics, Brigham and Women's Hospital
| | - Larry Ludlow
- Measurement, Evaluation, Statistics, and Assessment, Lynch School of Education, Boston College
| | - Pamela Grace
- William F. Connell School of Nursing, Boston College, Associate Professor of Nursing and Ethics
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Riedel A, Giese C. Ethikkompetenzentwicklung in der (zukünftigen) pflegeberuflichen Qualifizierung – Konkretion und Stufung als Grundlegung für curriculare Entwicklungen. Ethik Med 2019. [DOI: 10.1007/s00481-018-00515-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Milliken A. Toward Everyday Ethics: Strategies for Shifting Perspectives. AACN Adv Crit Care 2018; 28:291-296. [PMID: 28847865 DOI: 10.4037/aacnacc2017406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Aimee Milliken
- Aimee Milliken, Boston College, Connell School of Nursing, Maloney Hall, 140 Commonwealth Ave, Chestnut Hill, MA 02467
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38
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Grace P, Milliken A. Educating Nurses for Ethical Practice in Contemporary Health Care Environments. Hastings Cent Rep 2018; 46 Suppl 1:S13-7. [PMID: 27649912 DOI: 10.1002/hast.625] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Because health care professions exist to provide a good for society, ethical questions are inherently part of them. Such professions and their members can be assessed based on how effective they are in developing knowledge and enacting practices that further the health and well-being of individuals and society. The complexity of contemporary health care environments makes it important to prepare clinicians who can anticipate, recognize, and address problems that arise in practice or that prevent a profession from fulfilling its service goals and obligations. Different health care professions have evolved distinct perspectives about appropriate goals for, and the purposes of, their clinicians, even when the goal of improving health and well-being for society is shared across professions. While medicine and nursing goals are shared in principle, they differ in the particulars. Given the centrality to nursing of ethical questions, the profession has a collective responsibility to help clinicians at all levels of practice become ethically savvy and to reinforce their moral agency as needed. Both knowledge of nursing ethics and knowledge of the interdisciplinary field of bioethics are critical to nursing work.
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Milliken A, Ludlow L, DeSanto-Madeya S, Grace P. The development and psychometric validation of the Ethical Awareness Scale. J Adv Nurs 2018; 74:2005-2016. [PMID: 29672907 DOI: 10.1111/jan.13688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 11/26/2022]
Abstract
AIM To develop and psychometrically assess the Ethical Awareness Scale using Rasch measurement principles and a Rasch item response theory model. BACKGROUND Critical care nurses must be equipped to provide good (ethical) patient care. This requires ethical awareness, which involves recognizing the ethical implications of all nursing actions. Ethical awareness is imperative in successfully addressing patient needs. Evidence suggests that the ethical import of everyday issues may often go unnoticed by nurses in practice. Assessing nurses' ethical awareness is a necessary first step in preparing nurses to identify and manage ethical issues in the highly dynamic critical care environment. DESIGN A cross-sectional design was used in two phases of instrument development. METHOD Using Rasch principles, an item bank representing nursing actions was developed (33 items). Content validity testing was performed. Eighteen items were selected for face validity testing. Two rounds of operational testing were performed with critical care nurses in Boston between February-April 2017. RESULTS A Rasch analysis suggests sufficient item invariance across samples and sufficient construct validity. The analysis further demonstrates a progression of items uniformly along a hierarchical continuum; items that match respondent ability levels; response categories that are sufficiently used; and adequate internal consistency. Mean ethical awareness scores were in the low/moderate range. CONCLUSION The results suggest the Ethical Awareness Scale is a psychometrically sound, reliable and valid measure of ethical awareness in critical care nurses.
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Affiliation(s)
- Aimee Milliken
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Larry Ludlow
- Lynch School of Education, Boston College, Chestnut Hill, Massachusetts, USA
| | | | - Pamela Grace
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
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Jurchak M, Grace PJ, Lee SM, Willis DG, Zollfrank AA, Robinson EM. Developing Abilities to Navigate Through the Grey Zones in Complex Environments: Nurses’ Reasons for Applying to a Clinical Ethics Residency for Nurses. J Nurs Scholarsh 2017; 49:445-455. [DOI: 10.1111/jnu.12297] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Martha Jurchak
- Executive Director, Ethics Service; Brigham and Women's Hospital; Boston MA USA
| | - Pamela J. Grace
- Alpha Chi , Associate Professor, Boston College; William F. Connell School of Nursing; Chestnut Hill MA USA
| | - Susan M. Lee
- Senior Nurse Scientist, Center for Nursing Excellence; Brigham and Women's Hospital; Boston MA USA
| | - Danny G. Willis
- Associate Professor & Department Chair; Boston College; William F. Connell School of Nursing; Chestnut Hill MA USA
| | - Angelika A. Zollfrank
- Coordinator of Pastoral Education, Department of Spiritual Care; Yale-New Haven Hospital; New Haven CT USA
| | - Ellen M. Robinson
- Alpha Chi , Nurse Ethicist, Patient Care Services Institute for Patient Care; Massachusetts General Hospital; Boston MA USA
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41
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Bartholdson C, Molewijk B, Lützén K, Blomgren K, Pergert P. Ethics case reflection sessions: Enablers and barriers. Nurs Ethics 2017. [PMID: 29529973 DOI: 10.1177/0969733017693471] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In previous research on ethics case reflection (ECR) sessions about specific cases, healthcare professionals in childhood cancer care were clarifying their perspectives on the ethical issue to resolve their main concern of consolidating care. When perspectives were clarified, consequences in the team included 'increased understanding', 'group strengthening' and 'decision grounding'. Additional analysis of the data was needed on conditions that could contribute to the quality of ECR sessions. OBJECTIVE The aim of this study was to explore conditions for clarifying perspectives during ECR sessions. RESEARCH DESIGN Data were collected from observations and interviews and the results emerged from an inductive analysis using grounded theory. Participants and research context: Six observations during ECR sessions and 10 interviews were performed with healthcare professionals working in childhood cancer care and advanced paediatric homecare. Ethical considerations: The study was approved by a regional ethical review board. Participants were informed about their voluntary involvement and that they could withdraw their participation without explaining why. FINDINGS Two categories emerged: organizational enablers and barriers and team-related enablers and barriers. Organizational enablers and barriers included the following sub-categories: the timing of the ECR session, the structure during the ECR session and the climate during the ECR session. Sub-categories to team-related enablers and barriers were identified as space for inter-professional perspectives, varying levels of ethical skills and space for the patient's and the family's perspectives. DISCUSSION Space for inter-professional perspectives included the dominance of a particular perspective that can result from hierarchical positions. The medical perspective is relevant for understanding the child's situation but should not dominate the ethical reflection. CONCLUSION Conditions for ECR sessions have been explored and the new knowledge can be used when training facilitators as well as for those who organize/implement ECR sessions. Awareness of space for different perspectives, including the possible medical advantage over the nursing perspective, could reduce the somewhat unilateral attention and contribute to an inter-professionally shared reflection.
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Affiliation(s)
- Cecilia Bartholdson
- Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden.,Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden
| | - Bert Molewijk
- VU University Medical Center Amsterdam, The Netherlands; University of Oslo, Norway.,Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden
| | - Kim Lützén
- Karolinska Institutet, Sweden.,Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden
| | - Klas Blomgren
- Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden
| | - Pernilla Pergert
- Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden
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Abstract
Background: Ethical sensitivity has been identified as a foundational component of ethical action. Diminished or absent ethical sensitivity can result in ethically incongruent care, which is inconsistent with the professional obligations of nursing. As such, assessing ethical sensitivity is imperative in order to design interventions to facilitate ethical practice and to ensure nurses recognize the nature and extent of professional ethical obligations. Aim: To review and critique the state of the science of nurse ethical sensitivity and to synthesize findings across studies. Research design: Whittemore and Knafl’s revised framework for integrative reviews guided the analysis. Research context and data sources: A comprehensive, computer-assisted search of literature published in Cumulative Index of Nursing and Allied Health Literature and PubMed was performed. A systematic approach was used to extract, reduce, and synthesize the data. Findings: Four major conceptualizations of ethical sensitivity emerged from the literature. A sample of 25 reports met inclusion criteria, including 17 empirical reports and 8 theoretical reports. Discussion: Despite the existence of a concept analysis and a validated tool, ethical sensitivity remains a highly theoretical concept with multiple, and at times competing, conceptualizations. Ethical sensitivity has been assessed extensively in the context of ethical dilemmas; however, little attention has been paid to the way the concept operates in day-to-day practice. Conclusion: Future research should focus on better ways to operationalize and assess the concept, with particular attention to nurse awareness of the ethical content of everyday practice.
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