Ready to Go Home? Nurses' Perspectives of Prolonged Admission for Patients Undergoing Video-Assisted Thoracic Surgery for Non-Small-Cell Lung Cancer in Denmark

Enhanced recovery after surgery programs with median postoperative hospitalization of 2 days improve outcomes after lung cancer surgery. This article explores nursing care practices for patients with lung cancer who remain hospitalized despite having recovered somatically. Qualitative focus group interviews were conducted with 16 nurses. Ricoeur's phenomenological hermeneutics underpins the methodology applied in this study, and we relied on Benner and Wrubel's theory. The nurses emphasized that the thoughts of patients with a recent lung cancer diagnosis revolve around more than the surgery. Nursing comprises not only practicalities but also attending to patients' stress and their coping with being struck with lung cancer and having undergone surgery. A counterculture emerged to counteract the logic of productivity, indicating that caring as a worthy end in itself may be underestimated in protocol-driven care. Prolonging hospitalization largely depends on clinical judgment. The nurses' aim is not to keep patients in the hospital but to avoid any needless suffering, allowing them to reclaim the primacy of caring.

The relationship professional commitment and ethics with patient rights: a cross-sectional descriptive study

BACKGROUND

Ethical behavior of health workers is an important part of health services. The aim of the present study was to determine the relationship between ethics and professional commitment and its relationship with the level of respect for patient rights in medical students.

MATERIAL & METHODS

A cross-sectional descriptive study was conducted with the participation of nursing, midwifery and emergency medicine students of Ilam University of Medical Sciences. Sampling was done by stratified random method. The data was collected using Demographic, Professional Commitment, Professional ethics and a researcher made questioner on compliance with patient rights questionnaires.

RESULTS

300 students were participated. The results showed that the average score of professional ethics in middle school students is high (64.07 ± 8.01), the average score of professional commitment is also high (64.07 ± 8.01) and the score of respect for patient rights is also high (10.74). ± 83.46) was obtained. The professional ethics score it showed a positive and statistically significant relationship with the patient's rights compliance score. only professional commitment is related to gender, but the average of all three variables in different age groups and the type of residence (dormitory, private home, etc.) have meaningful statistical difference.

CONCLUSION

The findings of the study show that the level of ethics and professional commitment and respect for patient rights among nursing, midwifery and emergency medicine students was good. It is hoped that the results of this research will provide a basis for better planning for the development of knowledge and respect for patient rights among students.

Paediatric nurses' perspectives on artificial intelligence applications: A cross-sectional study of concerns, literacy levels and attitudes

AIMS

This study aimed to explore the correlation between artificial intelligence (AI) literacy, AI anxiety and AI attitudes among paediatric nurses, as well as identify the influencing factors on paediatric nurses' AI attitudes.

DESIGN

A descriptive, correlational and cross-sectional research.

METHODS

This study was conducted between January and February 2024 with 170 nurses actively working in paediatric clinics in Turkey. The data collection tools included the Nurse Information Form, the General Attitudes Towards Artificial Intelligence Scale (GAAIS), the Artificial Intelligence Literacy Scale (AILS) and the Artificial Intelligence Anxiety Scale (AIAS). To determine the associations between the variables, the data was analysed using IBM SPSS 28, which included linear regression and Pearson correlation analysis.

RESULTS

The study indicated significant positive correlations between paediatric nurses' age and their AIAS scores (r = .226; p < .01) and significant negative correlations between paediatric nurses' age and their AILS (r = -.192; p < .05) and GAAIS scores (r = -.152; p < .05). The GAAIS was significantly predictive (p < .000) and accounted for 50% of the variation in AIAS and AILS scores.

CONCLUSION

Paediatric nurses' attitudes towards AI significantly predicted AI literacy and AI anxiety. The relationship between the age of the paediatric nurses and the anxiety, AI literacy and attitudes towards AI was demonstrated. Healthcare and educational institutions should create customized training programs and awareness-raising activities for older nurses, as there are noticeable variations in the attitudes of paediatric nurses towards AI based on their age.

IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE

Providing in-service AI training can help healthcare organizations improve paediatric nurses' attitudes towards AI, increase their AI literacy and reduce their anxiety. This training has the potential to impact their attitudes positively and reduce their anxiety.

REPORTING METHOD

The study results were critically reported using STROBE criteria.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Ethical Decision-Making Confidence and Professional Values Among Nurse Leaders

OBJECTIVES

The aims of this study were to describe differences in nurse leaders' ethical decision-making confidence and their professional values based on identified characteristics and to explore the relationship between ethical decision making and professional values.

BACKGROUND

Nurse leaders have multiple duties and obligations toward their patients, other staff, and the organizations where they work. However, ethical decisions can be complex, requiring the guidance of professional values and critical appraisal of the situation.

METHODS

This study was conducted using a correlational design. Convenience sampling was used, resulting in a sample of 56 nurse leaders in various positions.

RESULT

Ethical decision making and professional values were found to be strongly correlated.

CONCLUSION

Ethical decision making and professional values are highly correlated in this sample. Understanding the importance of the effects of certain factors on ethical decision making can assist in forming an environment supportive of ethical practices for nurses.

Moral Dilemmas Regarding Physical Restraints in Intensive Care Units: Understanding Autonomy, Beneficence, Non-Maleficence and Justice in the Use of Physical Restraints

In intensive care units, patients are often restrained to ensure their safety, with physical restraints being the most commonly used method. However, physical restraints compromises the patient's freedom, health and comfort, and nurses often face moral dilemmas when deciding whether to use physical restraints. This article examines physical restraints through the four universal principles of autonomy, beneficence, non-maleficence and justice. Through these principles, the authors will critically explore whether the physical restraints of patients by nurses is ethical in practice and what moral issues exist. This paper also explores conflicts and moral dilemmas for nurses in this context. Finally, suggestions are made on changes to education and clinical practice.

Trends and ethical issues in nursing during disasters: A systematic review

BACKGROUND

During a disaster, nurses face complex ethical challenges because of risky situations. It is necessary to identify trends and ethical issues of nurses in disasters to improve the quality of care and impact for nurses.

METHOD

This systematic review enrolled in the international registration with PROSPERO: CRD42022350765. We searched the following databases: PubMed, EBSCO MEDLINE, SCOPUS, ProQuest, ScienceDirect, and Sage Pub. The inclusion criteria were developed according to PICO and D; are Population (F): involving nurses; intervention/Exposure (I): disaster, Comparison (C): none; outcome (O): ethical practice. And Design (D): qualitative, quantitative, and mixed methods. Years of publication were 2012-2022, with full text in English. The quality of study assessment used was The Joanna Briggs Institute (JBI) Critical Appraisal tool and Mixed Methods Appraisal Tool (MMAT) version 2018. Analysis used PICO synthesis.

RESULTS

There were 15 studies reviewed from 2093 results, including cross-sectional (4/15, 26.6%), qualitative (9/15, 60%), and mixed methods (2/15, 13.3%) studies. The types of disasters were: COVID-19 (7/15, 46.6%), infectious (4/15, 26.6%), and all disaster events (4/15, 26.6%). The main themes were: (1) ethical issues in disasters have the potential to address ethical dilemmas, (2) factors applying nursing ethics to support ethical decision-making in disasters, (3) strategies for applying ethics and dealing with ethical issues in disasters, and (4) the impact of applying ethics in disasters.

CONCLUSION

Applying ethics nursing in a disaster is influenced by various factors. This framework for ethical nursing in disasters aims to help nurses, educational institutions, and policymakers develop schemes or scenarios to enhance responsible ethical decisions in disasters.

The relationship between the ethical attitudes and holistic competence levels of intensive care nurses: A cross-sectional study

BACKGROUND

Intensive care units are directly associated with the competency level of nurses and are units where ethical problems are frequently experienced. This research aims to determine the relationship between intensive care nurses' ethical attitudes and holistic competence levels.

METHODS

This study was conducted as a cross-sectional design using self-report questionnaires distributed to 131 intensive care nurses in Turkey. The data of the study were collected with the "Nurses Information Form," "Holistic Nursing Competence Scale" and "Ethical Attitude Scale for Nursing Care".

RESULTS

The total mean score of the Holistic Nursing Competence of the nurses was 6.89±0.95. Holistic Nursing Competence level was significantly lower for those who had experienced less than one year in the profession, and it was higher for those who worked in the emergency intensive care unit and the nurses whose clinics had 21 and above nurses. The total mean score of the nurses' ethics attitude toward nursing care was 59.36±29.09. Ethical Attitude for Nursing Care was significantly lower for those who had a master's degree, and the nurses whose clinics had 21 and above nurses scored higher. There was a weak and negative correlation between the nurses' Holistic Nursing Competence Scale and the total mean score of the Ethical Attitude Scale for Nursing Care. The ethical attitude was predicted in 13.2% of the Holistic Nursing Competence of nurses.

CONCLUSIONS

It was concluded that nurses' holistic competence levels were high, their ethical attitudes were negative, and there was a weak negative correlation between their holistic competence levels and their ethical attitudes toward care.

Clinical nurse adherence to professional ethics: A grounded theory

BACKGROUND

Professional ethics is the regulation and discipline of nurses' daily nursing work. Nurses often encounter various ethical challenges and problems in their clinical work, but there are few studies on nurses' adherence to professional ethics.

RESEARCH AIM

An analysis of nursing adherence to nursing ethics from the perspective of clinical nurses in the Chinese public health system.

RESEARCH DESIGN

This study adopts the grounded theory approach proposed by Strauss and Corbin.

PARTICIPANTS AND RESEARCH CONTEXT

Between July 2021 and January 2022, Clinical nurses were recruited for online video interviews using purposive and theoretical sampling methods in seven hospitals in Beijing, Tianjin, Shanxi, Henan, Guangdong, and Fujian, China. Data analysis was conducted using Strauss and Corbin's coding approach.

ETHICAL CONSIDERATIONS

This study was approved by the Ethics Committee of Sanming First Hospital (MingYiLun 71/2021).

FINDINGS

A total of 27 participants were included. A theoretical model of nursing staff adherence to professional ethics was constructed. The main core was adherence to professional ethics and the other cores were (1) causal conditions: professional ethics code, individual conscience; (2) intervening conditions: personal growth, social support system, matching career compensation, prediction of adverse consequences; (3) action strategies: sticking to professional values, self-regulation, flexible response, post-event improvement; and (4) outcomes: self-harmony, reduced medical disputes.

CONCLUSIONS

This study provides an interpretive understanding of why clinical nurses adhere to professional ethics in China and describes the challenges and issues posed by nurses' use of strategies to cope with ethical adversity. The findings can be used to develop future complex studies.

Psychopathological Factors Associated With Burnout in Intensive Care Nurses: A Cross-Sectional Study

BACKGROUND

Although previous studies have separately revealed that parameters such as anxiety, depression, and secondary traumatic stress (STS) are associated with burnout, there is still a limited understanding of the relationship between anxiety, depression, and STS and burnout in intensive care unit (ICU) nurses.

AIMS

To investigate the relationship between levels of burnout, anxiety, depression, and STS in ICU nurses.

METHODS

A cross-sectional study was conducted with ICU nurses (N = 164) from a university hospital in eastern Turkey. The participants completed the anxiety, depression, STS, and burnout scales along with the descriptive characteristics form. The data were analyzed using descriptive statistics, correlation, and logistic regression analysis.

RESULTS

The mean scores for STS, anxiety, depression, and burnout were 40.60 ± 13.77, 17.14 ± 12.90, 13.28 ± 9.75 and 41.39 ± 14.87, respectively. The results showed that, in the ICU nurses, anxiety, depression, and STS components explained 61% of emotional exhaustion, 38% of depersonalization, and 13% of personal accomplishment.

CONCLUSIONS

While the present findings supported the paradigm that burnout in ICU nurses is associated with STS, anxiety, and depression, they also revealed some details about the psychopathological factors associated with burnout. These details were as follows: (1) individuals who resorted to avoidance as a component of STS on a high level were more likely to experience emotional exhaustion and depersonalization, (2) individuals with severe depressive symptoms were more likely to experience a decrease in their personal accomplishment, and (3) individuals with anxiety symptoms were more likely to experience both emotional exhaustion and personal accomplishment.

A scoping review of alternative methods of delivering ethics education in nursing

AIM

We conducted a scoping review of nursing ethics education to examine educational formats that go beyond traditional lectures.

DESIGN

This study was a scoping review.

METHODS

We used seven databases and relevant search terms, including nursing ethics, morals, values, nursing students and nursing ethics education.

RESULTS

Of 5,190 papers, 14 quasi-experimental studies met the inclusion criteria. All papers examined practices and self-study added to traditional lecture styles (i.e. the control group). Five practices emerged as follows: combined web (i.e. Internet) and lecture, web-based self-study, simulation, group learning and analysing ethical issues. The purpose, method and evaluation method differed based on the country in which the study was conducted. These educational interventions yielded significant differences in knowledge and in nursing students' critical thinking and ethical sensitivity postintervention. Multi-faceted ethics education will lay the foundation for effective practical training and practice.

Moral and Professional Values of Nurses in Lebanon

BACKGROUND

Moral and professional values vary among cultures. The purpose of this study was to explore the moral and professional values of registered nurses at a university medical center in a Middle Eastern country and determine the relationship among formal ethics education, background variables (age, gender, nursing degree, regular daily prayer), and nurses' professional and moral values.

METHOD

A cross-sectional survey method with 123 nurses was used. Data on background variables, moral and professional values, and confidence in ethical decision-making were assessed.

RESULTS

Professional values were significantly higher among older nurses and nurses with master's degrees compared with younger nurses and nurses with bachelor's degrees. Daily prayer was related to higher mean scores for moral values. Nurses were confident in their ethical decision-making; however, formal education in ethics did not influence professional or moral values.

CONCLUSION

Although formal education in ethics did not influence the professional or moral values of nurses in Lebanon, this finding does not negate the need for future studies to investigate the content and duration of ethics education that is likely to affect professional or moral values. [J Contin Educ Nurs. 2021;52(9):429-437.].

Common ethical dilemmas of family caregivers of palliative patients in Indonesia

Family caregivers, especially in Asian countries, have a profound role in caring for a sick family member. However, there are wide variations between the Asian and western world in terms of culture and facilities. Therefore, the problems and needs of family caregivers between those two regions may also be distinct, and it is important to explore and elaborate based on our empirical evidence. In Indonesia, motives and values in caregiving and religion become the wheel-power of the family caregivers in providing care. This affects action and consequences for caregivers. This paper attempts to elaborate on common ethical dilemmas that usually face by family caregivers in Indonesia. Unfortunately, family caregivers typically are not prepared to make those challenging decisions. Therefore, we recommend not only that family caregivers need to be involved in the caring process, but also their issues and ethical dilemmas should be assessed and addressed by health care professionals, especially nurses, who have the most frequent contact with patient and family caregiver.

How do healthcare professionals respond to ethical challenges regarding information management? A review of empirical studies

Aim

This study is a systematic review that aims to assess how healthcare professionals manage ethical challenges regarding information within the clinical context.

Method and Materials

We carried out searches in PubMed, Google Scholar and Embase, using two search strings; searches generated 665 hits. After screening, 47 articles relevant to the study aim were selected for review. Seven articles were identified through snowballing, and 18 others were included following a system update in PubMed, bringing the total number of articles reviewed to 72. We used a Q-sort technique for the analysis of identified articles.

Findings

This study reveals that healthcare professionals around the world generally employ (to varying degrees) four broad strategies to manage different types of challenges regarding information, which can be categorized as challenges related to confidentiality, communication, professional duty, and decision-making. The strategies employed for managing these challenges include resolution, consultation, stalling, and disclosure/concealment.

Conclusion

There are a variety of strategies which health professionals can adopt to address challenges regarding information management within the clinical context. This insight complements current efforts aimed at enhancing health professional-patient communication. Very few studies have researched the results of employing these various strategies. Future empirical studies are required to address this.

Abbreviations

CIOMS: Council of International Organization of Medical Sciences; WHO: World Health Organization; AMA: American Medical Association; WMA: World Medical Association; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis; ISCO: International Standard Classification of Occupations; ILO: International Labour Office; SPSS: The Statistical Package for the Social Sciences

Real-world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice

BACKGROUND

Ethical issues arise daily in the delivery of palliative care. Despite much (largely theoretical) literature, evidence from specialist palliative care practitioners about day-to-day ethical challenges has not previously been synthesised. This evidence is crucial to inform education and adequately support staff.

AIM

To synthesise the evidence regarding the ethical challenges which specialist palliative care practitioners encounter during clinical practice.

DESIGN

Systematic review with narrative synthesis (PROSPERO registration CRD42018105365). Quality was dual-assessed using the Mixed-Methods Appraisal Tool. Tabulation, textural description, concept mapping and thematic synthesis were used to develop and present the narrative.

DATA SOURCES

Seven databases (MEDLINE, Philosopher's Index, EMBASE, PsycINFO, LILACS, Web of Science and CINAHL) were searched from inception to December 2019 without language limits. Eligible papers reported original research using inductive methods to describe practitioner-reported ethical challenges.

RESULTS

A total of 8074 records were screened. Thirteen studies from nine countries were included. Challenges were organised into six themes: application of ethical principles; delivering clinical care; working with families; engaging with institutional structures and values; navigating societal values and expectations; philosophy of palliative care. Challenges related to specific scenarios/contexts rather than the application of general ethical principles, and occurred at all levels (bedside, institution, society, policy).

CONCLUSION

Palliative care practitioners encounter a broad range of contextual ethical challenges, many of which are not represented in palliative care ethics training resources, for example, navigating institutional policies, resource allocation and inter-professional conflict. Findings have implications for supporting ethical practice and training practitioners. The lack of low- and middle- income country data needs addressing.

A Case-Centered Approach to Nursing Ethics Education: A Qualitative Study

Nurses deal with ethical decisions as they protect patients’ rights, but a consensus on effective approaches to nursing ethics education is lacking. The “four topics” method can facilitate decision-making when nurses experience ethical dilemmas in practice. This study aimed to describe nursing students’ perspectives on and experiences of a case-centered approach to nursing ethics education using the four topics method. This qualitative study consisted of two phases. First, we delivered case-centered nursing ethics education sessions to nursing students using the four topics method. Then, we conducted two focus group discussions that explored students’ perspectives on and experiences of nursing ethics education. Data were analyzed using conventional content analysis. Four themes were identified: the importance of ethics education as perceived by nursing students, problems in current nursing ethics education, the experience of case-centered nursing ethics education using the four topics approach, and suggestions for improving nursing ethics education. The case-centered approach using the four topics method is effective in enhancing nursing students’ nursing ethics ability. It is crucial to understand that nursing students would like to set up their own ethical standards and philosophy. Continuous efforts to encourage students’ participation and to provide ethical reflection opportunities during clinical practice are needed to better connect theory with clinical practice.

Situating moral distress within relational ethics

Nurses may, and often do, experience moral distress in their careers. This is related to the complicated work environment and the complex nature of ethical situations in everyday nursing practice. The outcomes of moral distress may include psychological and physical symptoms, reduced job satisfaction and even inadequate or inappropriate nursing care. Moral distress can also impact retention of nurses. Although research has grown considerably over the past few decades, there is still a great deal about this topic that we do not know including how to deal well with moral distress. A critical key step is to develop a deeper understanding of relational practice as it pertains to moral distress. In this article, exploration of the experience of moral distress among nurses is guided by the key elements of relational ethics. This ethical approach was chosen because it recognizes that ethical practice is situated in relationships and it acknowledges the importance of the broader environment on influencing ethical action. The findings from this theoretical exploration will provide a theoretical foundation upon which to advance our knowledge about moral distress.