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Koivisto T, Paavolainen M, Olin N, Korkiakangas E, Laitinen J. Strategies to mitigate moral distress as reported by eldercare professionals. Int J Qual Stud Health Well-being 2024; 19:2315635. [PMID: 38373153 PMCID: PMC10878340 DOI: 10.1080/17482631.2024.2315635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 02/03/2024] [Indexed: 02/21/2024] Open
Abstract
Eldercare workers experience higher levels of moral distress than other health and social care service workers. Moral distress is a psychological response to a morally challenging event. Very little is known about moral distress in the context of eldercare and about the mechanisms of preventing or mitigating moral distress. This qualitative study was conducted as part of the "Ensuring the availability of staff and the attractiveness of the sector in eldercareservices" project in Finland in 2021. The data were from 39 semi-structured interviews. This qualitative interview data were examined using two-stage content analysis. The key finding of this study, as reported by eldercare professionals, is that strategies to mitigate moral distress can be found at all organizational levels : organizational, workplace and individual. The tools that emerged from the interviews fell into four main categories:) organizational support and education 2) peer support 3) improving self-care and competence and 4) defending patients. The main identified categories confirmed the earlier findings but the qualitative, rich research interview data provided new insights into a little-studied topic: mitigating moral distress in eldercare. The main conclusion is that, in order to mitigate moral distress, ethical competence needs to be strengthened at all organizational levels.
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Affiliation(s)
- Tiina Koivisto
- CONTACT Tiina Koivisto Finnish Institute of Occupational Health, PO Box 40, Helsinki00032, Finland
| | | | - Nina Olin
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Jaana Laitinen
- Finnish Institute of Occupational Health, Helsinki, Finland
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Uçar Ö, Çelik S, Karahan E, Altıntaş S, Yücel M. Exploring the relationship between spiritual care and patient advocacy of nurses from generations X, Y and Z working in intensive care clinics: A cross-sectional study. Intensive Crit Care Nurs 2024; 84:103754. [PMID: 38917680 DOI: 10.1016/j.iccn.2024.103754] [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: 03/06/2024] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE To determine the relationship between spiritual care and patient advocacy across three generations of nurses working in intensive care units. DESIGN Cross-sectional survey. METHODS Data collection took place from July to August 2022 with 120 nurses in Turkey. Data collection tools included the Spiritual Caregiving Competency Scale, the Spirituality and Spiritual Care Assessment Scale, and the Patient Advocacy Scale for Nurses. Data on nurses' demographics were evaluated using descriptive statistical methods (number, percentage, mean, standard deviation). Independent sample t-test, one-way ANOVA, Pearson correlation, and linear multiple regression analysis were used to evaluate the relationships between variables, with results reported as 95% confidence intervals (CI). RESULTS More than half of the nurses were from Generation Y (39.2 %) and Generation Z (42.5 %). Generation Z's mean patient advocacy score (156.96 ± 23.16) was statistically significantly higher than Generation X's (139.32 ± 34.26). We determined that the spiritual competence scale communication sub-dimension score of Generation Y nurses working between 1-10 years was higher than that of Generation Z nurses. Additionally, as the patient advocacy scores of all generations increased, so did spiritual competence scores. CONCLUSION The study found differences in patient advocacy and spiritual care competencies between generations. Thus, we recommend organizing courses, seminars, and in-service training on patient advocacy and spiritual care for intensive care nurses. IMPLICATIONS FOR CLINICAL PRACTICE This study estimates nurses' spiritual care competencies and patient advocacy levels from different generations and sheds light on the literature to eliminate differences in care between generations in nursing practices that evolve and change over time. It is recommended that courses, seminars, in-service training, spiritual activities, and interactive meetings be organized to encourage the participation of intensive care nurses to minimize the differences in spiritual care and patient advocacy among all generations of intensive care nurses.
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Affiliation(s)
- Özge Uçar
- Department of Nursing, Faculty of Health Science, Bartın University, Bartın, Turkey.
| | - Sevim Çelik
- Department of Nursing, Faculty of Health Science, Bartın University, Bartın, Turkey
| | - Elif Karahan
- Department of Nursing, Faculty of Health Science, Bartın University, Bartın, Turkey
| | - Sibel Altıntaş
- Department of Nursing, Faculty of Health Science, Bartın University, Bartın, Turkey
| | - Meryem Yücel
- Department of Nursing, Faculty of Health Science, Bartın University, Bartın, Turkey
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Do Thi N, Lee G, Susmarini D. Psychometric evaluation of the Vietnamese version of nurses' ethical behaviors for protecting patient rights scale (V-NEBPPRS): a methodological study. BMC Nurs 2024; 23:405. [PMID: 38886788 PMCID: PMC11184832 DOI: 10.1186/s12912-024-02060-2] [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: 02/01/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Recognizing patients' rights as fundamental human rights, the global healthcare community, including the World Health Organization and various nursing organizations, has emphasized the critical role of nurses in upholding these rights through ethical practice and patient-centered care. However, in the complex landscape of healthcare, nurses in Vietnam face various ethical issues and challenges that may impede their ability to protect patient rights effectively, necessitating tools for better ethical decision-making and practice. PURPOSE This study aims to translate the Nurses' Ethical Behaviours for Protecting Patient Rights Scale (NEBPPR) into Vietnamese and evaluate the validity and reliability of the V-NEBPPRS. METHODS The original scale underwent a cross-cultural translation process to be adapted into Vietnamese. Construct validity was assessed using confirmatory factor analysis (CFA). The convergent validity, discriminant validity, and reliability of the V-NEBPPRS were evaluated. RESULTS After removing four items with factor loading below 0.5, the V-NEBPPRS comprises 24 items divided into five factors. CFA demonstrated a good model fit (χ2/df = 2.86; GFI = 0.87; IFI = 0.85; CFI = 0.84; RMSEA = 0.07). Convergent and discriminant validity were confirmed with extracted mean variance ranging from 0.54 to 0.67, 0.54 to 0.67, and composite reliability from 0.73 to 0.81. Cronbach's α coefficient was 0.85 for the total scale and ranged from 0.70 to 0.79 for five subscales. CONCLUSION The V-NEBPPRS is a reliable tool, providing nursing leaders and researchers with the means to utilize the V-NEBPPRS for assessing and promoting nurses' awareness and behaviour in safeguarding patients' rights, thereby contributing to improved overall health outcomes.
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Affiliation(s)
- Ninh Do Thi
- College of Nursing, Ewha Womans University, Seoul, South Korea
- Faculty of Nursing, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Gunjeong Lee
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Dian Susmarini
- College of Nursing, Ewha Womans University, Seoul, South Korea.
- Faculty of Health Sciences, Jenderal Soedirman University, Purwokerto, Indonesia.
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Kim D, Hong Y, Chang SO. Ways of interdisciplinary approaches to advocating for nursing home residents with dementia. J Adv Nurs 2024. [PMID: 38771071 DOI: 10.1111/jan.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/04/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024]
Abstract
AIM To explore how nursing home staff advocate for residents with dementia. DESIGN Phenomenographic qualitative research. METHODS Twenty nursing home staff from four disciplines (six nurses, four physical therapists, five social workers and five care workers) were purposively recruited from three different nursing homes. Data were collected through semi-structured interviews conducted from February 2023 to March 2023, and the analysis followed the sequential steps of phenomenographic analysis. RESULTS The analysis identified five categories of description: focusing on what happened, finding the gaps in perspectives, how to bridge for finding a common perspective, how to tailor care such that each resident receives equitable care and how to establish interdisciplinary sharing for a consistent advocative pattern. Their structural relationship was also identified as an outcome space. CONCLUSION The cyclical advocacy structure illustrated that nursing home staff engage in an ongoing process of advocacy during conflict situations as part of interdisciplinary care, emphasizing continuity of care rather than separate occurrences of care. IMPLICATIONS FOR THE PROFESSION This study revealed that, in advocating for residents with dementia, nursing home staff adopted an approach that fosters consistent care and proactive prevention, achieved through the formation of shared knowledge applicable uniformly across similar situations. IMPACT This study contributes significantly to the continuing education or training of interdisciplinary staff in nursing homes. The revelations of the study hold significance not only for the practical application but also for the theoretical advancement of concepts related to safeguarding the dignity, human rights and personhood of residents with dementia, with the ultimate goal of enhancing their quality of life within nursing homes. REPORTING METHOD Reporting complied with the COREQ criteria for qualitative research. PATIENT OR PUBLIC CONTRIBUTION Nursing home directors have contributed to the validation of data analysis and interpretation.
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Affiliation(s)
- Dayeong Kim
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Youjung Hong
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
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Hayward M, Critcher J. Adultification: risk factors, harmful effects and implications for nursing practice. Nurs Child Young People 2024; 36:14-20. [PMID: 37779324 DOI: 10.7748/ncyp.2023.e1488] [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] [Accepted: 05/16/2023] [Indexed: 10/03/2023]
Abstract
Adultification, whereby children and young people are perceived as older or more mature than they actually are, disproportionately affects those from minority ethnic backgrounds. It can also occur in other contexts, for example when children and young people are placed in a position of adult responsibility. Nurses have a duty to support and protect children and young people, which includes protecting them from adultification and the negative effects it can have on health and well-being. This article discusses strategies nurses can use to prevent adultification - such as developing awareness, avoiding adultifying language and listening to children and young people - and actions to take when suspecting adultification from colleagues.
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Affiliation(s)
- Melanie Hayward
- Institute for Health and Social Care, Buckinghamshire New University, High Wycombe, England
| | - Julie Critcher
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Medway, England
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Ghobadi A, Sayadi L, Nayeri ND, Shabestari AN, Varaei S. The nurses' perception of the factors influencing professional misconduct: A qualitative study. Nurs Ethics 2024; 31:281-295. [PMID: 37599451 DOI: 10.1177/09697330231184469] [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: 08/22/2023]
Abstract
BACKGROUND Professional misconduct undermines safe and quality care; however, little is known about its nature and influential factors. AIM This study aimed to explain the factors influencing professional misconduct in nurses. RESEARCH DESIGN This qualitative study was conducted using the conventional content analysis method. PARTICIPANTS AND RESEARCH CONTEXT Data were collected using semi-structured interviews with 19 nurses working in the hospital selected through a purposeful method and analyzed by Graneheim and Lundman approach. ETHICAL CONSIDERATIONS The ethics committee of Tehran University of Medical Sciences approved this study with the ethics code IR.TUMS.FNM.REC.1400.187. Informed consent was obtained from all participants. Participants were assured of confidentiality. FINDINGS Factors influencing professional misconduct by nurses were categorized into three main categories: human factors (nurses' professional characteristics, personal characteristics of nurses and patient/companion, patient's clinical condition), procedural factors (procedural conditions, possibility of proving misconduct), and organizational factors (recruitment process, conditions of resources, managing misconduct, bureaucracy, and ward characteristics). CONCLUSION This study assists in explaining the factors influencing professional misconduct by nurses. Therefore this study's results can help managers and planners develop interventions to prevent and correct factors that contribute to misconduct and strengthen factors that prevent misconduct in order to ensure quality and safe patient care.
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Affiliation(s)
- Akram Ghobadi
- Department of Medical-Surgical, School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Sayadi
- Nursing and Midwifery Care Research Center, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shokoh Varaei
- School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
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Ibrahim AM. Nurses' ethical responsibilities: Whistleblowing and advocacy in patient safety. Nurs Ethics 2024:9697330241235306. [PMID: 38415609 DOI: 10.1177/09697330241235306] [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: 02/29/2024]
Abstract
BACKGROUND In the dynamic landscape of healthcare, nurses play a crucial role as ethical stewards, responsible for whistleblowing, nurse advocacy, and patient safety. Their duties involve ensuring patient well-being through ethical practices and advocacy initiatives. AIM This study investigates the ethical responsibilities of nurses regarding whistleblowing and advocacy in reporting concerns about patient safety. RESEARCH DESIGN A cross-sectional study utilized cluster and simple random sampling to gather a representative sample of actively practicing registered nurses. Data collection involved a demographic form, Nurse Whistleblowing Intentions Scale, Nursing Advocacy Scale, and Clinical Decision-Making Scale. PARTICIPANTS AND RESEARCH CONTEXT The study utilizing a robust sample size determination formula for reliable findings included 96 diverse nurses, predominantly females. Engaged actively in direct patient care across various outpatients clinics. The recruitment process specifically sought individuals with expertise in safety protocols and reporting, contributing to a nuanced understanding of the study's focus. ETHICAL CONSIDERATIONS Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. A thorough ethical review was conducted to guarantee participant protection and adherence to ethical principles. RESULTS Surveyed nurses demonstrated positive whistleblowing (Overall Mean Score: 3.58), high advocacy (Overall Mean Score: 12.2), and nuanced ethical decision-making for patient safety (Overall Mean Score: 15.78). Demographic factors, such as nationality and ethical training, significantly impacted whistleblowing intentions, while age, gender, and ethical training correlated with nursing advocacy behavior. Associations with experience and qualification emerged in ethical decision-making. CONCLUSION The gained insights foster targeted interventions, improving ethical practices, advocacy, and informed decision-making in nursing. This study explores the intricate link between demographics and ethical considerations among surveyed nurses, acting as a catalyst for ongoing initiatives to strengthen the ethical foundation in healthcare sector.
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Waldemar A, Bremer A, Strömberg A, Thylen I. Family presence during in-hospital cardiopulmonary resuscitation: effects of an educational online intervention on self-confidence and attitudes of healthcare professionals. Eur J Cardiovasc Nurs 2024:zvad111. [PMID: 38165264 DOI: 10.1093/eurjcn/zvad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024]
Abstract
AIMS Guidelines support family-witnessed resuscitation (FWR) during cardiopulmonary resuscitation in hospital if deemed to be safe, yet barriers amongst healthcare professionals (HCPs) still exist. This study aimed to evaluate the effects of an educational online video intervention on nurses' and physicians' attitudes towards in-hospital FWR and their self-confidence in managing such situations. METHODS AND RESULTS A pre- and post-test quasi-experimental study was conducted October 2022 to March 2023 at six Swedish hospitals involving the departments of emergency care, medicine, and surgery. The 10 min educational video intervention was based on previous research covering the prevalence and outcome of FWR, attitudes of HCP, patient and family experiences, and practical and ethical guidelines about FWR.In total, 193 accepted participation, whereof 91 answered the post-test survey (47.2%) with complete data available for 78 and 61 participants for self-confidence and attitudes, respectively. The self-confidence total mean scores increased from 3.83 to 4.02 (P < 0.001) as did the total mean scores for attitudes towards FWR (3.38 to 3.62, P < 0.001). The majority (71.0%) had positive views of FWR at baseline and had experiences of in-hospital FWR (58.0%). Self-confidence was highest amongst participants for the delivery of chest compressions (91.2%), defibrillation (88.6%), and drug administration (83.3%) during FWR. Self-confidence was lowest (58.1%) for encouraging and attending to the family during resuscitation. CONCLUSION This study suggests that a short online educational video can be an effective way to improve HCP's self-confidence and attitudes towards the inclusion of family members during resuscitation and can support HCP in making informed decisions about FWR.
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Affiliation(s)
- Annette Waldemar
- Department of Cardiology in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, SE-351 95 Växjö, Sweden
| | - Anna Strömberg
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Ingela Thylen
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
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Zolkefli Y, Chandler C. Patient's best interest as viewed by nursing students. Nurs Ethics 2024:9697330231225392. [PMID: 38165167 DOI: 10.1177/09697330231225392] [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: 01/03/2024]
Abstract
BACKGROUND In recent years, patient advocacy has emerged as a prominent concept within healthcare. How nursing students decide what is best for their patients is not well understood. OBJECTIVE The objective is to examine nursing students' views on doing what is best for patients during their clinical experiences and how they seek to establish patient interests when providing care. Research questions guiding the interview were as follows: (1) What are nursing students' perceptions of patient interests? (2) What factors influence nursing students' perceptions of advocating for patient's interests? RESEARCH DESIGN Qualitative descriptive research using thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT Data was collected through individual online interviews with nine nursing students with clinical experience. ETHICAL CONSIDERATIONS The study was approved by the University Research Ethics Committee. Participants provided digital informed consent. RESULTS The students asserted that they are able to understand the patients' interests by placing emphasis on the patients' needs. They believe that it is crucial to adopt a collaborative strategy for the provision of care to meet these requirements. In addition, some of them expressed concern over the most effective methods of advocating for the interests of patients. Three themes were identified. (1) Focussing on patient needs first, (2) taking a collective approach, and (3) learning how to advocate. CONCLUSIONS Students understand and value the ethical commitments associated with advocating for the patient's best interest by considering factors such as prioritising the patient's needs, adopting a strategy that involves everyone, and acquiring the ability to undertake the advocacy role. Additionally, nursing education strategies in clinical contexts require additional study to inspire students to do what is in their patient's best interests.
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Cignarella A, Marshall A, Ranse K, Opdam H, Buckley T, Hewitt J. Identity Disclosure Between Donor Family Members and Organ Transplant Recipients: A Description and Synthesis of Australian Laws and Guidelines. JOURNAL OF BIOETHICAL INQUIRY 2023:10.1007/s11673-023-10287-y. [PMID: 38060147 DOI: 10.1007/s11673-023-10287-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/20/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION The disclosure of information that identifies deceased organ donors and/or organ transplant recipients by organ donation agencies and transplant centres is regulated in Australia by state and territory legislation, yet a significant number of donor family members and transplant recipients independently establish contact with each other. AIM To describe and synthesize Australian laws and guidelines on the disclosure of identifying information. METHOD Legislation and guidelines relevant to organ donation and transplantation were obtained following a search of government and DonateLife network websites. Information about the regulation of identity disclosure was extracted and synthesised using a process guided by Walt and Gilson's (1994) policy analysis framework. FINDINGS Nineteen documents were examined. Six guidelines refer to and were consistent with current legislation. Four documents did not address identity disclosure. All jurisdictions prohibit healthcare professionals from disclosing identifying information. In three states, the prohibition extends to all members of the public including donor family members and transplant recipients. CONCLUSION Restrictions on identity disclosure have implications for public promotion of donation and transplantation where sharing of stories and images of organ donors and transplant recipients is common. Further research is required to understand the perspective of donor family members, transplant recipients, and healthcare professionals impacted by the current laws.
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Affiliation(s)
- Anthony Cignarella
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia.
- Peninsula Health, Frankston Hospital, Learning Hub, 2 Hastings Road Frankston, Melbourne, VIC, 3084, Australia.
| | - Andrea Marshall
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
| | - Helen Opdam
- Intensive Care Unit, Austin Health, The Austin Hospital, 145 Studley Road Heidelberg, Melbourne, VIC, 3084, Australia
- Australian Organ and Tissue Authority, 14 Childers Street Level 3, Canberra City, ACT, 2601, Australia
| | - Thomas Buckley
- School of Nursing and Midwifery, The University of Sydney, Susan Wakil Health Building Level 8, D-18 Western Avenue Camperdown, Sydney, NSW, 2006, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
- Law Futures Centre, Griffith University Law School, 170 Kessels Road, Nathan, QLD, 4111, Australia
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O'Sullivan DJ, Bearne LM, Harrington JM, McVeigh JG. Can social prescribing put the 'social' into the biopsychosocial management of people with long-term musculoskeletal disorders? Musculoskeletal Care 2023; 21:1341-1352. [PMID: 37639305 DOI: 10.1002/msc.1810] [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] [Received: 08/03/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Chronic musculoskeletal disorders (MSD) are a significant burden on individuals' quality of life and society and are made more complex by the presence of multimorbidity. It is recommended that interventions targeting MSD be sustainable, equitable and incorporate the biopsychosocial model of care (BPS). AIMS A criticism of the BPS approach is that the social component of this model is not addressed adequately during the management of people with long-term MSD and that a gap exists between theory and implementation. The use of social prescribing (SP) as an intervention to bridge this gap is discussed. RESULTS AND DISCUSSION Social prescribing is a holistic non-medical person-centered approach to well-being that utilizes link workers (LW) to support individuals with long-term conditions (LTC) in the community. Social prescribing referrals are received from primary healthcare practitioners to LW and range from light touch signposting for employment or financial advice to more intensive support for LTC such as obesity, decreased physical activity and mental health needs. CONCLUSION There is evidence to suggest that SP interventions are effective in the management of LTC; however, due to the paucity of high-quality evidence, it is difficult to be conclusive. Large-scale randomised controlled trials are recommended to support the use of SP interventions in the management of LTC.
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Affiliation(s)
- Declan J O'Sullivan
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Lindsay M Bearne
- Population Health Research Institute, St George's, University of London, London, UK
| | - Janas M Harrington
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
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Bos M, Schouten J, De Bot C, Vermeulen H, Hulscher M. A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses' activities in daily practice regarding antibiotic use. JAC Antimicrob Resist 2023; 5:dlad123. [PMID: 38021036 PMCID: PMC10667038 DOI: 10.1093/jacamr/dlad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Antimicrobial stewardship (AMS), the set of actions to ensure antibiotics are used appropriately, is increasingly targeted at all those involved in the antimicrobial pathway, including nurses. Several healthcare organizations have issued position statements on how bedside nurses can be involved in AMS. However, it remains unclear how nurses, in reality, contribute to appropriate antibiotic use. Objectives To systematically search the literature to describe the activities bedside nurses perform regarding antibiotic use in daily clinical practice, in relation to the activities proposed by the aforementioned position statements. Methods We searched MEDLINE, Embase, CINAHL and grey literature until March 2021. Studies were included if they described activities regarding antibiotic use performed by bedside nurses. Methodological rigour was assessed by applying the Mixed Method Appraisal Tool. Results A total of 118 studies were included. The majority of the proposed nurses' activities were found in daily practice, categorized into assessment of clinical status, collection of specimens, management of antimicrobial medication, prompting review and educating patient and relatives. Nurses may take the lead in these clinical processes and are communicators in all aspects of the antimicrobial pathway. Patient advocacy appears to be a strong driver of bedside nurses' activities. Conclusions Nurses' activities are already integrated in the day-to-day nursing practice and are grounded in the essence of nursing, being a patient advocate and showing nursing leadership in safeguarding the antimicrobial treatment process. An essential element of the nursing role is communication with other stakeholders in the patient-centred antimicrobial pathway. Educating, engaging and empowering nurses in this already integrated role, could lead to a solid, impactful nursing contribution to AMS.
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Affiliation(s)
- Maria Bos
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cindy De Bot
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- School of Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
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de Oliveira Vargas MA, Cardozo DDO, Farias Brehmer LCD, Tomaschewski-Barlem JG, Souza Ramos FR, Schneider DG, Manoel MS. Development of the Patient Advocacy Scale for Intensive Care Nurses. J Nurs Meas 2023; 31:534-545. [PMID: 37848231 DOI: 10.1891/jnm-2021-0104] [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: 10/19/2023]
Abstract
Background and Purpose: To describe the process of developing and validating the content of the Patient Advocacy Scale for Nurses in Intensive Care (EAPEnf-UTI). Methods: Methodological research. To achieve the elaboration objective, five stages were developed: (a) definition of the theme, (b) generation of the number of items, (c) determination of the measurement format, (d) validation of face and content, and (e) content adjustment. Results: The instrument elaborated from a survey and integrative literature review, and the measurement format chosen was the 5-point Likert scale. The validation of face and content was performed by expert judges and by pretest. The final instrument had 57 items. Conclusion: EAPEnf-UTI is a pioneering instrument built in the Brazilian context, whose future validation will allow the capturing of situations specific to intensive care units and the professional practice of intensive care nurses.
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Affiliation(s)
- Mara Ambrosina de Oliveira Vargas
- Nursing Department and the Post-Graduation Program in Nursing, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daniela de Oliveira Cardozo
- Nurse at the Polydoro Ernani of São Thiago, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Laura Cavalcanti de Farias Brehmer
- Nursing Department and the Post-Graduation Program in Nursing, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Jamila Geri Tomaschewski-Barlem
- Nursing Department and the Post-Graduation Program in Nursing, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Flávia Regina Souza Ramos
- Post-Graduation Program in Nursing, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Dulcinéia Ghizoni Schneider
- Post-Graduation Program in Nursing, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Mayara Souza Manoel
- Nurse at Multiprofessional Residency in Family Health, Florianópolis, Santa Catarina, Brazil
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Farias ODO, Fontenele MGM, Lima FET, Galvão MTG, da Silva VM, Lopes MVDO. Analysis of the health advocacy concept from the perspective of the evolutionary method. Rev Esc Enferm USP 2023; 57:e20230170. [PMID: 37882698 PMCID: PMC10601892 DOI: 10.1590/1980-220x-reeusp-2023-0170en] [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] [Received: 05/20/2023] [Accepted: 08/09/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To analyze the concept of Health Advocacy from the methodological framework of the Evolutionary Model. METHOD The concept of interest was evaluated from the perspective of published studies identified in the databases: Web of Science, CINAHL, EMBASE, SCOPUS, MEDLINE and articles of interest. The attributes were determined from 19 scientific productions. Data were analyzed using thematic analysis, proposed by Bardin. RESULTS The following operational definition was obtained: Health Advocacy is an intentional action, implemented jointly and in favor of individuals and communities, especially for those who suffer from health inequalities, with the aim of preserving and improving health, well-being and empowerment for health promotion. FINAL CONSIDERATIONS Thus, a broader concept of Health Advocacy was abstracted, from the micro to the macro, which contemplates the development of the patient's autonomy; includes individuals and groups in care plans and involves them in political activities as possibilities to provide assistance and correct health inequalities.
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Tomagová M, Kohanová D, Žiaková K, Čáp J. Nurses' Perception of Professionalism in Practice: A Review of Qualitative Studies. Nurs Sci Q 2023; 36:387-398. [PMID: 37800707 DOI: 10.1177/08943184231187866] [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: 10/07/2023]
Abstract
Professionalism is a fundamental concept in nursing and a central aspect of nursing care. The review aimed to synthesize evidence presented in qualitative studies related to the perception of professionalism in nursing practice. Six main analytical themes were generated from primary studies included in the literature review: everyday practice, ethical aspects of nursing care, nurses' identity, nurses' professional growth, achieving autonomy, complexity of relationships. Presented themes are considered key elements of nursing professionalism, are closely interconnected, and support the multidimensional structure of professionalism in nursing. Nursing professionalism means providing high-quality care while upholding the values of integrity, accountability, and respect.
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Affiliation(s)
- Martina Tomagová
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University Bratislava, Martin, Slovakia
| | - Dominika Kohanová
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University Bratislava, Martin, Slovakia
| | - Katarína Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University Bratislava, Martin, Slovakia
| | - Juraj Čáp
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University Bratislava, Martin, Slovakia
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Laari L, Duma SE. Barriers to nurses health advocacy role. Nurs Ethics 2023; 30:844-856. [PMID: 36999769 DOI: 10.1177/09697330221146241] [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: 04/01/2023]
Abstract
BACKGROUND Speaking up to safeguard patients is a crucial ethical and moral obligation for nurses, but it is also a difficult and potentially dangerous component of nursing work. Health advocacy is gaining impetus in the medical literature, despite being hampered by barriers resulting in many nurses in Ghana remaining mute when faced with advocacy-required situations. We explored situations that thwart nurses from performing their health advocacy role. RESEARCH QUESTION What would cause nurses to take no action when they witness situations that require them to act as health advocates for their clients or communities? RESEARCH DESIGN An inductive, descriptive qualitative design was used to collect and analyse data on barriers that prevent nurses from practising their health advocacy role in Ghana. Individual one-on-one in-depth interviews were conducted using a semi-structured interview guide. The data were analysed using qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT Twenty-four professional nurses and midwives registered with the Nursing and Midwifery Council were recruited from three regional hospitals in Ghana. These public hospitals were chosen from the upper, middle and coastal regions. ETHICAL CONSIDERATIONS The UKZN Ethics Review Committee in South Africa and the GHS Ethics Review Committee in Ghana both gave their approval for this study. FINDINGS Intrapersonal barriers, interpersonal barriers, and structural barriers emerged as major obstacles that nurses experience when performing their health advocacy role. CONCLUSIONS Barriers to health advocacy have undermined nurses' ability to function as health advocates and are preventing them from utilising their health advocacy position in nursing practise. Giving nursing students positive role models in the classroom and in the clinic can help them become more effective health advocates.
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Affiliation(s)
- Luke Laari
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Sinegugu E Duma
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Fazelipour M, Dhatt A, Sun T, Nemir A, Wilbur K. Pharmacy Students Practicing Health Advocate Competency Roles in Workplace-Based Training. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100118. [PMID: 37714657 DOI: 10.1016/j.ajpe.2023.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Health advocacy competency roles are found in the educational outcomes of many health disciplines, yet their development is neglected in the professional curriculum and clinical learning environment. We explored how pharmacy students conceptualize health advocacy through their practice in workplace-based learning and any feedback they receive. METHODS We conducted a longitudinal diary study of Canadian pharmacy students completing Advanced Pharmacy Practice Experiences in hospital and community practices in their graduating year. At pre-determined intervals, 25 students recorded workplace-based activities they recognized as health advocacy and any feedback they received from supervisors, patients, or other staff. Written diary data from 180 records were analyzed by 5 researchers according to inductive content analysis steps and principles. RESULTS Pharmacy student records reflecting health advocacy roles were organized into 5 categories including, (1) disease prevention; (2) health promotion; (3) seamless care; (4) usual pharmacist care; and (5) professional advocacy. Although many activities were consistent with current competency role descriptions, they do not reflect educational outcomes associated with patient- or systems-level support necessary to address socio-political determinants of health. Although Advanced Pharmacy Practice Experience in training evaluation reports included scores for items related to health advocacy competency, few students confirmed receiving specific written or verbal feedback. CONCLUSION Pharmacy students construct health advocacy roles in workplace-based training through biomedical-oriented practices with little direct input offered by supervisors. Pharmacy educational outcomes require contemporary updates to health advocacy competency descriptions which offer examples for practical enactment at system-level and recommendations for feedback and assessment.
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Affiliation(s)
- Mojan Fazelipour
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Amninder Dhatt
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Tom Sun
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Arwa Nemir
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Kerry Wilbur
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada.
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Sokratous S, Mpouzika M, Kaikoushi K, Alexandrou G, Karanikola M. Attitudes, beliefs, and knowledge regarding medical cannabis among healthcare students in the Republic of Cyprus: a cross-sectional descriptive correlational study. Front Psychiatry 2023; 14:1196915. [PMID: 37520218 PMCID: PMC10375702 DOI: 10.3389/fpsyt.2023.1196915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Background Although international research-based literature from the last 2 decades seems to favor the use of medical cannabis (MC), there is a lack of evidence concerning healthcare students' education on MC in the Republic of Cyprus and across the world. Therefore, this study explores healthcare students' attitudes, beliefs, and knowledge regarding the use of MC. We paid special attention to differences across specific sociodemographic (gender, age, and religion status) and educational (level of study and study field) characteristics. Methods A descriptive cross-sectional study was conducted between November 2019 and March 2020. All active undergraduate and postgraduate healthcare students (nurses, physiotherapists, speech therapists, pharmacists, and occupational therapists; N = 900) studying in public and private universities in the Republic of Cyprus were eligible to participate (final sample: N = 819, response rate = 91%). To collect data on the attitudes, beliefs and knowledge of the participants, we used the Medical Cannabis Questionnaire (MCQ). To analyze the data, we employed the Pearson's chi-square test for group differences, in addition to assessing the descriptive and inferential statistics. Results Approximately 82.2% believed that MC education should be integrated into the clinical practice requirements. Statistically significant differences were observed between genders in terms of beliefs/risk associated with the use of MC, with males being more likely to believe that there are significant mental-health benefits associated with using ΜC compared to females (84.9% vs. 76.2%, p<0.05). Females were more likely than males to believe that using MC poses serious physical (76.8% vs. 60.6%, p<0.001) and mental-health (77.9% vs. 66%, p<0.001) risks. Moreover, participants who received formal education about MC during their study/training were more prepared to answer patient/client questions about ΜC (p < 0.001). In addition, participants who received formal education had more frequently friends (p < 0.001) or family members who used MC (p < 0.005). Conclusion This study provides useful information for curriculum development, educational changes, and policy decisions related to cannabis use for medical purposes in the Republic of Cyprus. The results showed that the majority of the healthcare students who participated in the study favored MC use. However, the participants reported a lack of knowledge and recommended additional evidence-based research and education to enhance their knowledge about MC use. Therefore, we recommend the implementation of formal education on MC among healthcare students in the Republic of Cyprus during their study and clinical training. Furthermore, it is important to include MC-related theoretical and clinical/laboratory courses during studies and clinical practice.
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Affiliation(s)
- Sokratis Sokratous
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Meropi Mpouzika
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | | | - Maria Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Ballard T. Human and Civil Rights in the Nursing Profession: History as a Guide to Navigate Advocacy in Nursing. J Psychosoc Nurs Ment Health Serv 2023; 61:3-4. [PMID: 37389942 DOI: 10.3928/02793695-20230607-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
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20
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Lusardi MM. 2023 Carol B. Lewis Distinguished Lecture Address to the APTA Geriatrics Membership Combined Sections Meeting, February 23, 2023 Key Words & Challenges: Defining Our Role in Caring for Older Adults. J Geriatr Phys Ther 2023; 46:93-102. [PMID: 36935462 DOI: 10.1519/jpt.0000000000000378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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21
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Adjei MD, Diji AKA, Oduro E, Bam VB, Dzomeku VM, Budu IH, Lomotey AY, Sakyi R, Kyerew AA. Experiences of patient advocacy among nurses working in a resource constrained emergency department in Ghana. Int Emerg Nurs 2023; 67:101252. [PMID: 36801654 DOI: 10.1016/j.ienj.2022.101252] [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] [Received: 03/02/2022] [Revised: 11/28/2022] [Accepted: 12/23/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Patient advocacy at the emergency department is stressful and cumbersome as a result of the increasing patient-to-nurse ratio and high patient turnovers. It is also unclear what patient advocacy entails and the experiences of patient advocacy in a resource-constrained emergency department. This is significant because advocacy underpins the care provided in the emergency department. AIM The primary aim of this study is to explore the experiences and underpinning factors that influence patient advocacy among nurses working in a resource constrained emergency department. METHODS A descriptive qualitative study was conducted among 15 purposively sampled ED nurses working at a resource-constrained secondary-level hospital facility. Study participants were individually interviewed via a recorded telephone conversation, after which the interviews were transcribed verbatim and inductively analyzed using the content analysis approach. The study participants described patient advocacy, situations in which they advocated for patients, the factors that motivated them and the challenges they encountered practicing patient advocacy. RESULTS Three major themes generated from the study included: "stories of advocacy", "motivating" factors and "challenging" factors. ED nurses understood patient advocacy and also advocated for patients in various instances. There were factors such as personal upbringing, professional training and religious training that motivated them and they were challenged by negative inter-professional experiences, patient and relatives' attitudes and healthcare system factors. CONCLUSION Participants understood patient advocacy and incorporated it into daily nursing care. Unsuccessful advocacy causes disappointment and frustrations. There were no documented guidelines on patient advocacy.
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Affiliation(s)
- Mabel Dorothy Adjei
- Nursing And Midwifery Training College, P.M.B 4, Sunyani Bono Region, Ghana; Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana.
| | | | - Evans Oduro
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | - Victoria Bubunyo Bam
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana.
| | | | - Isaac Hayford Budu
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Richard Sakyi
- Nursing And Midwifery Training College, P.M.B 4, Sunyani Bono Region, Ghana; Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
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Lynne-Joseph A. "As a clinician, you have to be passionately involved": Advocacy and professional responsibility in gender-affirming healthcare. Soc Sci Med 2023; 321:115788. [PMID: 36842306 DOI: 10.1016/j.socscimed.2023.115788] [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] [Received: 10/14/2022] [Revised: 01/15/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
Previous research has studied how clinicians such as physicians, nurses, social workers, and nutritionists understand advocacy as a professional responsibility. Analyses have typically focused on individual healthcare professions and have viewed ambiguity around the conceptualization of advocacy as detrimental. Little research has considered how multiple professions within a single field of healthcare interpret clinician advocacy, nor how ambiguity might be productive in a multidisciplinary field. This article addresses these gaps by utilizing science and technology studies scholarship on buzzwords to analyze how clinicians in the field of gender-affirming healthcare have come to understand advocacy as a professional responsibility despite significant ambiguity around the goals, tactics, and targets of advocacy. Gender-affirming healthcare refers to any kind of physical or mental healthcare that transgender and gender diverse (TGD) people obtain to affirm their gender identity. Drawing on interviews with 30 U.S. clinicians, observation of nine transgender health conferences, and content analysis of 202 professional journal articles and 11 professional association statements, I argue that ambiguity around advocacy has been key to its uptake as a responsibility across multiple professions in this field. Foregrounding interview data, I show how polysemy allows clinician respondents across professions to reassert their expertise as they delineate what constitutes good gender-affirming healthcare and defend the emergent field in three problem domains: health insurance, the marginalization of TGD people, and the legality of gender-affirming healthcare. I also demonstrate how theoretical work on buzzwords explains why three clinician respondents rejected advocacy as a professional responsibility.
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Affiliation(s)
- Alyssa Lynne-Joseph
- Wichita State University, Department of Sociology, 1845 Fairmount Street, Wichita, KS, 67260, USA.
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Abstract
BACKGROUND Physical restraints are routinely employed to ensure patient safety in Japanese acute care. Little is known about nursing students' perspectives and how they begin to question their value and knowledge in the face of restraint experiences in clinical practice. OBJECTIVE To investigate nursing students' questions about patient restraints and how they understand the ethics of the use of restraints in nursing. RESEARCH DESIGN Qualitative descriptive research using narrative analysis. PARTICIPANTS AND RESEARCH CONTEXT Experiential data were generated and thematically analyzed from semi-structured interviews with 16 nursing students who had completed their bachelor's degree program requirements. ETHICAL CONSIDERATIONS The study was approved by academic and clinical ethics agencies. Participants provided written informed consent. RESULTS Physical restraints were encountered in 16 incidents, 3 with children and 13 with older patients with dementia. Students struggled to comprehend the policies and protocols of restraint use and worried their use was primarily for security rather than therapeutic purposes. Five themes were identified: (1). Questioning the tension between person-centered care, patient autonomy, and restraints, (2). Questioning the nature of restraints in which participants analyzed the policies and protocols around restraint use, (3). Questioning the professional nursing self whereby students reflected on how restraint use challenged their nursing values, and (4). Questioning professional nursing practice, in which students explored how restraints fit within a nursing perspective and positioned themselves as patient advocates. Students encountering physical restraints should ask questions based on values of patient-centeredness, autonomy, and advocacy. There is a need for education that facilitates reflection and questioning so that it informs students' ethical thinking which may enhance nurse advocacy to reduce restraint use. CONCLUSIONS Restraints provide contexts in which students must face tensions between nursing values and clinical reality. Further research on nursing education strategies within non-psychiatric settings is needed to reduce physical restraints.
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Chiang HM, Wong AYP, Tan SLH, Mohapatra L, Chan OH, Ho AHY. Continuity of Care Advocate Model (CCAM): Healthcare Workers' Perspectives on Quality Stroke Care at an Acute Unit, Rehabilitation Center and Community Rehabilitation Program in Singapore. QUALITATIVE HEALTH RESEARCH 2023; 33:53-62. [PMID: 36420949 DOI: 10.1177/10497323221139392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Physicians, nurses, social workers, and allied health professionals including physiotherapists and occupational therapists play important roles as they work closely with stroke survivors to improve functional independence in daily activities and quality of life. Yet, in Singapore little is known about their perspectives on what constitute quality stroke care based on their clinical experiences. In this project, our qualitative interviews with 15 healthcare workers at a major stroke center in the country yielded a Continuity of Care Advocate Model (CCAM) to help us better understand our participants' experience-based perspectives on quality stroke care. We found that CCAM, constructed based on the perspectives of HCWs across a stroke care continuum, is a holistic model of quality stroke care which prioritizes support for patients and their families throughout the patient's health trajectory. We conclude by discussing how this model is aligned with and differs from current research on definitions of care continuity.
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Hutchinson K, Ryder T, Coleman H, Nullwala R, Herkes G, Bleasel A, Nikpour A, Wong C, Todd L, Ireland C, Shears G, Bartley M, Groot W, Kerr M, Vagholkar S, Braithwaite J, Rapport F. Determining the role and responsibilities of the community epilepsy nurse in the management of epilepsy. J Clin Nurs 2022. [PMID: 36494199 DOI: 10.1111/jocn.16582] [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: 06/08/2022] [Revised: 08/28/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study is to enhance the understanding of the core elements and influencing factors on the community-based epilepsy nurse's role and responsibilities. BACKGROUND Internationally, epilepsy nurse specialists play a key role in providing person-centred care and management of epilepsy but there is a gap in understanding of their role in the community. DESIGN A national three-stage, mixed-method study was conducted. METHODS One-on-one, in-depth semi-structured qualitative interviews were conducted online with 12 community-based epilepsy nurses (Stage 1); retrospective analysis of data collected from the National Epilepsy Line, a nurse-led community helpline (Stage 2); and focus group conducted with four epilepsy nurses, to delve further into emerging findings (Stage 3). A thematic analysis was conducted in Stages 1 and 3, and a descriptive statistical analysis of Stage 2 data. Consolidated Criteria for Reporting Qualitative studies checklist was followed for reporting. RESULTS Three key themes emerged: (1) The epilepsy nurse career trajectory highlighted a lack of standardised qualifications, competencies, and career opportunities. (2) The key components of the epilepsy nurse role explored role diversity, responsibilities, and models of practice in the management of living with epilepsy, and experiences navigating complex fragmented systems and practices. (3) Shifting work practices detailed the adapting work practices, impacted by changing service demands, including COVID-19 pandemic experiences, role boundaries, funding, and resource availability. CONCLUSION Community epilepsy nurses play a pivotal role in providing holistic, person-centred epilepsy management They contribute to identifying and addressing service gaps through innovating and implementing change in service design and delivery. RELEVANCE TO CLINICAL PRACTICE Epilepsy nurses' person-centred approach to epilepsy management is influenced by the limited investment in epilepsy-specific integrated care initiatives, and their perceived value is impacted by the lack of national standardisation of their role and scope of practice. NO PATIENT OR PUBLIC CONTRIBUTION Only epilepsy nurses' perspectives were sought.
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Affiliation(s)
- Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Honor Coleman
- Melbourne School of Psychological Science, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Geoffrey Herkes
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Andrew Bleasel
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Armin Nikpour
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Chong Wong
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Lisa Todd
- Epilepsy Action Australia, North Ryde, New South Wales, Australia
| | - Carol Ireland
- Epilepsy Action Australia, North Ryde, New South Wales, Australia
| | | | - Melissa Bartley
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Wendy Groot
- Epilepsy Australia, Melbourne, Victoria, Australia.,Epilepsy Tasmania, Launceston, Tasmania, Australia
| | - Michael Kerr
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Sanjyot Vagholkar
- MQ Health General Practice, Macquarie University, North Ryde, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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Cultural Competence in Nursing Care. CLIN NURSE SPEC 2022; 36:285-289. [DOI: 10.1097/nur.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kearns AJ. The principle of double effect and external whistleblowing in nursing. Nurs Outlook 2022; 70:807-819. [PMID: 36400577 DOI: 10.1016/j.outlook.2022.09.001] [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] [Received: 06/20/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.
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Affiliation(s)
- Alan J Kearns
- School of Theology, Philosophy, and Music, Dublin City University, Dublin, Ireland.
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Professional autonomy and patient advocacy in nurses. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Glasgow MES, Colbert AM. Nursing's Wicked Problems: Partnering With Academic Leadership to Develop Solutions. Nurs Adm Q 2022; 46:275-282. [PMID: 36028508 DOI: 10.1097/naq.0000000000000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nursing is in a challenging place, and we are facing many incredibly complex issues that are steeped in culture and tradition. These "wicked problems" often arise when organizations face constant change or unprecedented challenges. In this article, we discuss current issues that hinder all nurse leaders from elevating nursing as a profession, with a particular focus on the role and contributions of the academic nurse leader in creating and sustaining positive change. By prioritizing meaningful collaboration, reimagining education for nursing outside the hospital walls, investing in evidence for practice, and advocating by amplifying new voices, we can identify shared goals and develop coordinated plans of action. The goal of academic nursing is to work to understand wicked disciplinary problems while also analyzing and critiquing what is not working, articulating possible solutions, and collaborating with other nurse leaders to address these complex issues. This also means that academic nursing should be held equally accountable for delivering results.
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Figueira AB, Barlem ELD, Brum AN, Mattos LM, Barlem JGT, Toescher AMR. Clustering the engagement of Brazilian nurses in political advocacy. Rev Bras Enferm 2022; 75:e20210105. [PMID: 36134767 DOI: 10.1590/0034-7167-2021-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/18/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the level of nurses' engagement in political advocacy by performing cluster analysis. METHODS observational study, with a quantitative approach. A total of 184 nurses working in primary, secondary, and tertiary care in a city in the south of Brazil completed the Policy Advocacy Engagement Scale. Data analysis consisted of descriptive statistics, cluster analysis, analysis of variance, and chi2. The Institutional Review Board approved the study. RESULTS four differentiated clusters were found according to professional experience, level of healthcare complexity, and unit. The cluster analysis revealed that patient advocacy for community-based obtained the highest mean, indicating that political advocacy is effective in organizational environments and that professional qualification favors greater engagement in political advocacy. CONCLUSIONS the results reveal that nurses play an active role in political advocacy, seeking to promote positive changes in health, especially those working in tertiary care, the nurse group that obtained the highest means.
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Benedict J. Patient Advocacy in Vascularized Composite Allotransplantation. Front Psychol 2022; 13:943393. [PMID: 35923735 PMCID: PMC9340068 DOI: 10.3389/fpsyg.2022.943393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
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Vechter T, Drach-Zahavy A, Goldblatt H. Picking the "Proper Hat?" Emerging Ethical Dilemmas while Juggling Nursing and Research Roles. J Nurs Manag 2022; 30:2278-2290. [PMID: 35815708 DOI: 10.1111/jonm.13735] [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: 03/11/2022] [Revised: 06/15/2022] [Accepted: 07/03/2022] [Indexed: 11/27/2022]
Abstract
AIMS To explore ethical dilemmas inherent in two potentially conflicting roles: practicing nurse and researcher. BACKGROUND Ethical guidelines for practice and research in nursing have been widely discussed. Yet examining ethical dilemmas that emerge from engaging in the dual role of nurse-researcher is rare. METHOD A qualitative approach was employed, using semi structured interviews with 15 nurse-researchers. Data were analyzed using thematic analysis. RESULTS One theme emerged with three subthemes of nurse-researcher role definitions: primarily nurse, primarily researcher, and combined nurse-researcher. Each subtheme had three dimensions: (a) how ethical dilemmas were expressed in encounters with role colleagues, (b) coping strategies, and (3) implications for nurse-researchers. CONCLUSION Primarily nurses or primarily researchers experienced conflict in encounters with role colleagues, developed less effective coping strategies, and reported impaired well-being. Conversely, combined nurse-researchers said each role nourished the other. IMPLICATIONS FOR NURSING MANAGEMENT Nursing policymakers and managers should support the nurse-researcher role by developing a code of ethics that acknowledges the dual role's inherent dilemmas, assimilate organizational routines and roles that support nursing research, and encourage forums for discussing staff dilemmas.
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Affiliation(s)
- Tamar Vechter
- Pat Matthews Academic School of Nursing at Hillel Yaffe Medical Center, Hadera, Israel
| | - Anat Drach-Zahavy
- Faculty of Social Welfare and Health Sciences, Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Hadass Goldblatt
- Faculty of Social Welfare and Health Sciences, Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
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How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care. Intensive Care Med 2022; 48:910-922. [PMID: 35773499 PMCID: PMC9273549 DOI: 10.1007/s00134-022-06771-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Intensive care is a stressful environment in which team-family conflicts commonly occur. If managed poorly, conflicts can have negative effects on all parties involved. Previous studies mainly investigated these conflicts and their management in a retrospective way. This study aimed to prospectively explore team-family conflicts, including its main topics, complicating factors, doctors' conflict management strategies and the effect of these strategies. METHODS Conversations between doctors in the neonatal, pediatric, and adult intensive care unit of a large university-based hospital and families of critically ill patients were audio-recorded from the moment doubts arose whether treatment was still in patients' best interest. Transcripts were coded and analyzed using a qualitative deductive approach. RESULTS Team-family conflicts occurred in 29 out of 101 conversations (29%) concerning 20 out of 36 patients (56%). Conflicts mostly concerned more than one topic. We identified four complicating context- and/or family-related factors: diagnostic and prognostic uncertainty, families' strong negative emotions, limited health literacy, and burden of responsibility. Doctors used four overarching strategies to manage conflicts, namely content-oriented, process-oriented, moral and empathic strategies. Doctors mostly used content-oriented strategies, independent of the intensive care setting. They were able to effectively address conflicts in most conversations. Yet, if they did not acknowledge families' cues indicating the existence of one or more complicating factors, conflicts were likely to linger on during the conversation. CONCLUSION This study underlines the importance of doctors tailoring their communication strategies to the concrete conflict topic(s) and to the context- and family-related factors which complicate a specific conflict.
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Suvarnakich P, Montrikul Na Ayudhaya B. Compliance with the ethical competence framework by head nurses. Nurs Ethics 2022; 29:1304-1317. [PMID: 35724976 DOI: 10.1177/09697330221105634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Head nurses have duties in providing nursing care and ethical supervision to the nurses in the unit. Compliance with the ethical competence framework for head nurses is essential in fostering an ethical climate in the organization. OBJECTIVE The objective of this research is to study the head nurses' compliance with the ethical competence framework by the Thailand Nursing and Midwifery Council (TNMC). METHODS The study is a qualitative research, using in-depth interviews conducted among 20 head nurses practicing in a super tertiary hospital in Bangkok, Thailand. The sample was selected using a criterion sampling method. The head nurses' ethical experience relating to work practice was analyzed by thematic analysis. ETHICAL CONSIDERATIONS The ethical approval of this study was obtained from the Committee for Research Ethics (Social Sciences), Mahidol University, and from the Institutional Review Board of the hospital in which the study was conducted. RESULTS From the thematic analysis of the ethical experience practiced by the head nurses, 8 themes and 16 sub-themes were categorized across 5 ethical competencies based on the ethical competence framework by the TNMC. It was found that all the identified themes and sub-themes conformed to the ethical competence framework, and demonstrated the head nurses' compliance with the framework. DISCUSSION Head nurses' ethical experience in practice conforms to the ethical competence framework by the TNMC. The framework that is based on the Code of conduct and the nursing culture that places the importance of the seniority system may facilitate the compliance with the ethical competence framework. CONCLUSION Head nurses demonstrated compliance with the ethical competence framework by the TNMC. Nevertheless, improvements could be done to the framework by adding details such as more examples of ethical decision-making scenarios, personnel's rights, and social media usage guidelines.
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Affiliation(s)
- Photchana Suvarnakich
- Faculty of Social Sciences and Humanities, 26685Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Boonwadee Montrikul Na Ayudhaya
- Department of Humanities, Faculty of Social Sciences and Humanities, 26685Mahidol University, Salaya, Nakhon Pathom, Thailand
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Ortega-Galán ÁM, Ruiz-Fernández MD, Roldán-Rodríguez L, Ramos-Pichardo JD, Cabrera-Troya J, Gómez-Beltrán PA, Ortiz-Amo R. Unbearable Suffering: A Concept Analysis. J Hosp Palliat Nurs 2022; 24:159-166. [PMID: 35135981 DOI: 10.1097/njh.0000000000000844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To understand and analyze the concept of "unbearable suffering" using a concept analysis method and to propose a new nursing diagnosis, the Walker and Avant method of concept analysis was used. Following the concept analysis method in 8 steps, a literature search was carried out in the MEDLINE, Dialnet, WOS, and PsycINFO databases between 2016 and 2020. Articles of theoretical or empirical nature, written in English, with the abstract available were included. As a result, 11 articles (4 theoretical and 7 empirical) were included. In addition, 2 cases were developed. The proposed new diagnosis, "unbearable suffering," refers to the situation of an individual who, because of a variety of factors, regardless of the cause, feels that he/she is unable to bear the suffering he/she is experiencing. The diagnosis is proposed for inclusion in "Domain 9: Coping/Stress Tolerance" and "Class 2: Coping Responses" of the North American Nursing Diagnosis Association taxonomy. Recognition of a nursing diagnosis for unbearable suffering could be key in identifying this type of suffering and facilitating interventions to reduce or mitigate it. Nurses play a fundamental role in situations of high levels of end-of-life suffering.
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Demirören N, Su S, Basit G. The effect of advocacy education of nursing students on attitudes towards disability: a quasi-experimental study. Int J Nurs Educ Scholarsh 2022; 19:ijnes-2021-0164. [DOI: 10.1515/ijnes-2021-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/14/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
To determine the effect of advocacy education on the attitude of nursing students towards persons with disabilities.
Methods
This study is a one-group pretest-posttest design: a quasi-experimental study. The study population consisted of 38 students who were enrolled in the advocacy course in the final year of nursing school in a public university. A ten-week Disability Advocacy Education Program was implemented. Data was collected using the Data Sheet and Multidimensional Attitudes Scale Toward Persons with Disabilities.
Results
Male students were found to have higher mean scores after the education; there was no statistically significant difference for other variables such as family structure, place of residence, and whether they have received education on disabilities.
Conclusions
Nursing students have a positive attitude towards people with disabilities, and that male students’ attitudes improved after education.
Implications for International Audience
Advocacy education provided to students help them develop a positive attitude towards people with disabilities.
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Affiliation(s)
- Nesime Demirören
- Necmettin Erbakan University, Faculty of Nursing, Fundamentals of Nursing Department , Meram , Konya , Turkey
| | - Serpil Su
- Necmettin Erbakan University, Faculty of Nursing, Fundamentals of Nursing Department , Meram , Konya , Turkey
| | - Gülden Basit
- Necmettin Erbakan University, Faculty of Nursing, Fundamentals of Nursing Department , Meram , Konya , Turkey
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Carminati L, Héliot YG. Between Multiple Identities and Values: Professionals' Identity Conflicts in Ethically Charged Situations. Front Psychol 2022; 13:813835. [PMID: 35529578 PMCID: PMC9068603 DOI: 10.3389/fpsyg.2022.813835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
This study explored identity conflict dynamics in interpersonal interactions in professionals facing ethically charged situations. Through semi-structured interviews (N = 47), we conducted a qualitative study among doctors and nurses working for the English National Healthcare Service and analyzed the data with grounded theory approaches. Our findings reveal that identity conflict is triggered by three micro processes, namely cognitive and emotional perspective taking, as well as identifying with the other. In these processes, identity conflict is signaled by emotions and recognized as a clash not only between identities and their values, but also within one identity and its multiple values. Behavioral and psychological outcomes of identity conflict involve seeking peer support, doing reflective practices and identity growth. This article contributes to identity literature by providing a multilevel approach of identity conflict dynamics able to account for both interpersonal and intrapsychic processes, deeply hold values and emotions, as well as crucial behavioral and psychological consequences.
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Affiliation(s)
- Lara Carminati
- Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
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Revell SMH, Sethares KA, Chin ED, Kellogg MB, Armstrong D, Reynolds T. A Transformative Learning Experience for Senior Nursing Students. Nurse Educ 2022; 47:161-167. [PMID: 34878425 DOI: 10.1097/nne.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research suggests that clinical practicums in hospital-based settings are important, even if condensed, to provide students with the opportunity for real-world learning experiences. Rational dialogue makes learning meaningful and empowers students to learn by reflecting on experiences. PROBLEM The COVID-19 pandemic minimized availability of traditional one-to-one mentorship practicums. APPROACH This article describes the use of critical reflection on experiences in an undergraduate senior mentorship course to assess student learning through the thematic analysis of writing assignments. Guided by Mezirow's transformative learning theory, students completed a traditional group clinical practice, written reflective journals and virtual seminars focused on role development, and reflection on concurrent learning in clinical and simulation experiences. OUTCOMES Transformative learning was evident in their writing. Student journals demonstrated themes of responding to change, discovering resilience, developing confidence, finding gratitude, embracing advocacy, and transforming and becoming. CONCLUSIONS Through critical reflection, students recognized the opportunities mentorship afforded them, despite challenges.
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Affiliation(s)
- Susan M Hunter Revell
- Professor (Drs Hunter Revell and Sethares), Associate Professor (Dr Chin), Assistant Professor (Dr Kellogg), Part-time Lecturer (Dr Armstrong), and Senior Lecturer (Ms Reynolds), College of Nursing and Health Sciences, University of Massachusetts Dartmouth
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Safeguarding the patient: a grounded theory study of registered nurse anesthetists' main concerns in the process of extubation in the anesthesia setting. BMC Nurs 2022; 21:56. [PMID: 35264171 PMCID: PMC8905009 DOI: 10.1186/s12912-022-00817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background
The process of extubation is complex as it takes place in the technical and challenging environment of the operating room. The extubation is related to complications of varying severity and a critical moment for the patient, who is in a vulnerable condition when emerging from anesthesia. Registered Nurse Anesthetists (RNAs) in Sweden have specialist training and performs extubations independently or in collaboration with an anesthesiologist. Aim
To obtain a deeper understanding of Registered Nurse Anesthetists’ main concerns and how they resolve these in the process of extubation when caring for a patient during general anesthesia. Participants A total of 17 RNAs, eight male and nine female, were included in the study. Twelve RNAs in the first step of data collection (I); and five RNAs the second step of data collection (II). Method A classic grounded theory approach with a qualitative design was used for this study. Findings The RNAs’ main concern in the process of extubation were Safeguarding the patient in a highly technological environment, which the solved by Maintaining adaptability. Facilitators as well as challenges affected how the RNAs solved their main concern and represented the categories: ‘Having a back-up plan’, ‘Getting into the right frame of mind’, ‘Evaluating the patient’s reactions’, ‘Using one’s own experience’, ‘Dealing with uncertainty’, ‘Pressure from others’, and ‘Being interrupted’. The theory, Safeguarding the patient in the process of extubation, emerged. Conclusion To be able to safeguard the patient in a highly technological environment, the RNAs must oscillate between facilitators and challenges. By maintaining adaptability, the RNAs resolved the difficulties of oscillating, indicating a need for finding a balance between maintaining attentiveness on what is important to keep the patient safe in the process of extubation and all of the disturbances present in the OR.
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Abstract
The nursing literature emphasizes that there are still inadequacies, differences, and inconsistencies in the definition of nurses' advocacy role, and that nursing education plays an important role in educating nurses for patient advocacy. The aim of the present study is to determine the effects of advocacy education onsocial justice advocacy and ethical sensitivity. Pre-test, post-test, parallel group, randomized controlled study. The study was carried out on 80 undergraduate nursing students in Turkey. Students was divided into experimental (40) and control (40) groups. Experimental group received advocacy education cirruculum. Both groups were applied as Socio-Demographic Characteristics, as pre- test and post-tests Social Justice Advocacy Scale, and Moral Sensitivity Questionnaire. The data were statistically evaluated with, the chi-square test, Two-Way Anova. The study was approved by Selcuk University Faculty of Health Sciences Non-Interventional Clinical Research Ethics Committee (09.25.2019/1218). Written informed consent was obtained from all participants. The pre-test score of the intervention group and that of the control group were similar(p > 0.05). The study group's post-test score was significantly higher than its pre-test score and the post-test score of the control group "social justice advocacy skills" and "moral sensitivity Questionnaire." In two-way analysis of variance in repeated measures, there was a significant main effect of the type of groups. The two-way ANOVA results in repeated measures showed that group-time interaction was significant. The advocacy education cirruculum the experimental group increased in the social justice advocacy knowledge, attitude and skills and moral sensitivity. The advocacy education cirruculum the experimental group increased the social justice advocacy skills and moral sensitivity. The Advocacy education cirruculum can be suggested to be integrated into the undergraduate nursing curriculum.
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Affiliation(s)
| | - Akın Belgin
- 518003Lokman Hekim University, Ankara, Turkey
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Byrne G, Keogh B, Daly L. Self-management support for older adults with chronic illness: implications for nursing practice. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:86-94. [PMID: 35094539 DOI: 10.12968/bjon.2022.31.2.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Self-management is a key skill that older adults with multiple comorbidities require. Self-management interventions include medication management, self-monitoring and self-awareness and self-management often requires the older adult to manage the emotional consequences of having multiple comorbidities. The benefits of self-management for older adults include reduced reliance on the health system, enhanced quality of life, empowerment of the individual and reduction in the burden associated with chronic illness. Many factors can influence an older adult's ability to self-manage, including health literacy, mental health difficulties and socio-economic factors. Self-management support is the provision of structures, services and programmes to support and enhance the skills of older adults in managing their own conditions. Nurses are in a pivotal position across the continuum of care, using both person-centred care and the 'Making Every Contact Count' approach, to support older adults to self-manage their conditions.
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Affiliation(s)
- Gobnait Byrne
- Assistant Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Brian Keogh
- Assistant Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Louise Daly
- Assistant Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Hatefimoadab N, Cheraghi MA, Benton DC, Pashaeypoor S. Ethical advocacy in the end-of-life nursing care: A concept analysis. Nurs Forum 2022; 57:127-135. [PMID: 34549431 DOI: 10.1111/nuf.12656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
AIM This concept analysis was conducted to identify and define the features and functions of ethical advocacy in the end-of-life nursing care. BACKGROUND Ethical advocacy is key to the role of the nurse in delivering quality and competent care. Despite this, the dimensions of this concept are poorly understood. DESIGN/DATA SOURCE Databases such as Google Scholar, Scopus, Web of Science, Science Direct, and PubMed were searched systematically. To search these databases, the following keywords were used: "patient advocacy," "nursing," "ethics," "end-of-life care," and their combinations. REVIEW METHODS Walker and Avant's method was utilized as a comprehensive review of the literature to explore how ethical advocacy in nursing can be used to improve the quality of care. RESULTS The defining attributes of the concept of ethical advocacy included adhering to ethical principles of nursing, championing social justice in the provision of healthcare, safeguarding and defending patient's rights by applying collective wisdom, and involving hospital ethics committees. Antecedents are organizational and personal power and ethical leadership. The optimal consequence of ethical advocacy can be getting the best ethical governance. CONCLUSION Based on this analysis, the concept of ethical advocacy is one of the most important roles for nurses which requires their awareness of this concept.
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Affiliation(s)
- Nasim Hatefimoadab
- Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad A Cheraghi
- Department of Critical Care and Nursing Management, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Health Sciences Phenomenology Association, Ministry of Health and Medical Education, Tehran, Iran
| | - David C Benton
- National Council of State Boards of Nursing, Chicago, Illinois, USA
| | - Shahzad Pashaeypoor
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Figueira AB, Barlem ELD, Brum AN, Mattos LM, Barlem JGT, Toescher AMR. Cluster do engajamento dos enfermeiros brasileiros na advocacia política. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0105pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivos: analisar o nível de engajamento dos enfermeiros na advocacia política por meio da análise de cluster. Métodos: estudo observacional, com abordagem quantitativa. Um total de 184 enfermeiros que atuam na atenção primária, secundária e terciária em uma cidade do sul do Brasil preencheram a Policy Advocacy Engagement Scale. A análise dos dados consistiu em estatística descritiva, análise de cluster, análise de variância e chi2. O Comitê de Ética em Pesquisa aprovou o estudo. Resultados: foram encontrados quatro clusters diferenciados de acordo com a experiência profissional, nível de complexidade assistencial e unidade. A análise de agrupamento revelou que a advocacia do paciente para a comunidade obteve a maior média, indicando que a advocacia política é efetiva em ambientes organizacionais e que a qualificação profissional favorece maior engajamento na advocacia política. Conclusões: os resultados revelam que os enfermeiros exercem um papel ativo na advocacia política, buscando promover mudanças positivas na saúde, principalmente os que atuam na atenção terciária, grupo de enfermeiros que obteve as maiores médias.
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Relationship between clinical performance and professional self-concept in critical care nurses. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2021-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
To determine the relationship between clinical performance and professional self-concept in critical care nurses.
Methods
This study was conducted on 308 critical care nurses. Data gathering instruments were nurses’ clinical performance questionnaire (NCPQ) and nursing professional self-concept measure (NPSCM). Independent sample t-test, one-way analysis of variance (ANOVA), and Pearson correlation coefficient were used for data analyses.
Results
The average age of the nurses was 33.74 ± 7.01 years. The clinical performance score of female nurses was significantly higher than male nurses. In the domain of clinical performance, clinical judgment and clinical inquiry had the highest and lowest scores, respectively. In the nurses’ professional self-concept, the highest and lowest scores were awarded to the subscales of self-confidence and staff relations, respectively. In addition, there was a significant positive correlation between self-concept and clinical performance of nurses.
Conclusions
Increasing professional self-concept improves the clinical performance of critical care nurses. Professional self-concept enhancement measures are recommended to improve the clinical performance of nurses in critical care units.
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Mamaril ME. The Advocacy Role of the Perianesthesia Nurse in Ethics of Safe Nursing Care: The Voice for the Patient in Mitigating Risky Practices. J Perianesth Nurs 2021; 36:741-742. [PMID: 34886958 DOI: 10.1016/j.jopan.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 11/15/2022]
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Bafandeh Zendeh M, Hemmati Maslakpak M, Jasemi M. Nurses' perceptions of their supportive role for cancer patients: A qualitative study. Nurs Open 2021; 9:646-654. [PMID: 34731513 PMCID: PMC8685772 DOI: 10.1002/nop2.1112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/15/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
Aim Supporting cancer patients is one of the integral, ethical and professional components and concepts of nursing care. Given the prominence of nurses' understanding of their supportive role in providing quality and humane nursing care for cancer patients, it is crucial for them to acquire sufficient knowledge to achieve a positive attitude towards patient support. Design Qualitative conventional content analysis approach was used. Methods This study was conducted with a qualitative approach and conventional content analysis in 2020. Participants consisted of 18 nurses of different oncology wards of teaching hospitals in Northwestern Iran recruited using the purposive sampling method. Data were collected through semi‐structured interviews and analysed simultaneously with data collection (22 july ‐ 20 june 2020). Findings The analysis of interviews showed that the main theme of “a canopy as a supportive role for cancer patients” was formed. In this theme, related subcategories included patient's psychological support (compassionate care with emotional support, having an intimate/friendly relationship with the patient and communicative behaviour facing patient needs), patient training (need‐based training, having good theoretical knowledge about the patient and having a role model for playing a supportive role for the patient) and supporting the patient with clinical self‐efficacy (being responsible with clinical competency, understanding the patient's behaviour and attempt to provide extra‐duty care).
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Affiliation(s)
- Mostafa Bafandeh Zendeh
- Department of Critical Care Nursing, Students' Research Committee, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Madineh Jasemi
- Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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Speaking Up: How Family Members Advocate for Relatives Living with a Mental Illness. Community Ment Health J 2021; 57:1547-1555. [PMID: 33486676 DOI: 10.1007/s10597-021-00775-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
Consumers with a mental health condition often feel powerless and overwhelmed in interactions with mental healthcare providers. Consumer self-advocacy and advocacy actions undertaken by their family members on the behalf of their relative contribute to a sense of empowerment for both consumers and their family members. This qualitative study explored family member perspectives of advocacy actions they took on behalf of their relatives and themselves. Data analysis of interviews with 20 family members, including parents, partners/spouses, siblings, and adult children, yielded three themes of family member advocacy actions: advocating for a relative's mental healthcare, normalizing mental illness, and engaging in social and political actions. Advocacy frameworks offer useful guidelines for speaking up for individuals who live with a mental illness.
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Zuaboni G, Elmer T, Rabenschlag F, Heumann K, Jaeger S, Kozel B, Mahlke CI, Theodoridou A, Jaeger M, Rüsch N. Psychometric evaluation of the German version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC). BMC Psychol 2021; 9:86. [PMID: 34016166 PMCID: PMC8139058 DOI: 10.1186/s40359-021-00592-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background Healthcare professionals can be a source of stigma and discrimination for people with mental illness, and anti-stigma programs are needed for this target group. However, there is no validated German language scale to assess attitudes of healthcare professionals towards people with mental illness. This study had the aim to validate the German language version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC), a self-report measure of stigmatizing attitudes. Methods Staff (n=392) on general psychiatric inpatient wards (excluding child, forensic and geriatric psychiatry) at five psychiatric hospitals in Switzerland (n=3) and Germany (n=2) participated in the study. The internal consistency of the OMS-HC was examined as well as its factor structure using exploratory and confirmatory factor analyses. To assess the scales concurrent validity, we used the Social Distance Scale. Results Internal consistency for the OMS-HC total score was good (=0.74), acceptable for the subscales Attitudes (=0.62) and Social Distance (=0.69), and poor for the Disclosure subscale (=0.55). The original three-factor structure fit our data well. The OMS-HC total score and the Social Distance subscale score were significantly correlated with the Social Distance Scale, supporting concurrent validity. Conclusion The German version of the OMS-HC demonstrated satisfactory psychometric properties and can be recommended for future research and intervention evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00592-9.
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Affiliation(s)
- Gianfranco Zuaboni
- Sanatorium Kilchberg AG, Psychiatric and Psychotherapy Hospital, Alte Landstrasse 70, 8802, Kilchberg, Switzerland.
| | - Timon Elmer
- University of Groningen, Groningen, The Netherlands
| | | | - Kolja Heumann
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg, Neuruppin, Germany
| | - Susanne Jaeger
- Department of Psychiatry and Psychotherapy I, Ulm University, ZfP Südwürttemberg, Ravensburg, Germany
| | - Bernd Kozel
- University Psychiatric Services Bern, Bern, Switzerland
| | - Candelaria I Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jaeger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Psychiatrie Baselland, Liestal, Switzerland
| | - Nicolas Rüsch
- Department of Psychiatry and Psychotherapy II, Ulm University and BKH Günzburg, Ulm/Günzburg, Germany
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Luca CE, Cavicchioli A, Bianchi M. Nurses Who Assume the Role of Advocate for Older Hospitalized Patients: A Qualitative Study. SAGE Open Nurs 2021; 7:23779608211030651. [PMID: 34377782 PMCID: PMC8323413 DOI: 10.1177/23779608211030651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/12/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patient advocacy, acting on behalf of patients' unmet needs, is fundamental to nursing, and the perception of the need for advocacy motivated this study. Nurses experience moral discomfort, which results from a divergent view regarding medical or caregivers' decisions about patients' clinical proceedings, in which patients' involvement in making those decisions is either doubtful or absent. OBJECTIVES The aim of this study is to assess the need for advocacy and explore the perspectives of nurses engaged in the care of older patients. METHODS The methodological orientation is that of a qualitative design, by using a purposive and criterion sampling. The sample was of 14 nurses of a ward of general medicine. Focus group as collecting data tool was used, followed by a thematic analysis. RESULTS Nurses demonstrated a high level of moral sensitivity to ethical problems in clinical practice and on occasions, the courage to bring the problem to the physicians or patients' family's attention, or help patients develop self-determination. However, it is difficult to advocate because of insufficient communication between professionals, insufficient knowledge of ethics, and the emotional burden it places on nurses which results in emotional resignation in the face of interprofessional teams' lack of consideration of nurses' opinions. CONCLUSION This research highlighted nurses' need for advocacy to promote patients' rights, wishes, and values. It is essential for nurses to be aware of their level of moral sensitivity and develop a strategy to regain courage to engage in advocacy. Therefore, ethics education and interprofessional ethical leadership is desired, which inspires healthcare professionals' work and allows the foundations of an ethical decisionmaking process to be laid through patients and their families' active involvement.
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Affiliation(s)
- Corina Elena Luca
- Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano,
Lugano, Switzerland
| | - Andrea Cavicchioli
- Department of Business Economics, Health and Social Care, University of Applied Sciences and
Arts of Southern Switzerland, University of Applied Sciences and Arts of Southern
Switzerland, Manno, Switzerland
| | - Monica Bianchi
- Department of Business Economics, Health and Social Care, University of Applied Sciences and
Arts of Southern Switzerland, University of Applied Sciences and Arts of Southern
Switzerland, Manno, Switzerland
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Meeker MA, White D. Transition to comfort-focused care: Moral agency of acute care nurses. Nurs Ethics 2020; 28:529-542. [PMID: 34085584 DOI: 10.1177/0969733020952128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families. AIM The aim of this study was to examine the experiences of registered nurses in acute care settings as they worked with patients and families to facilitate transition to comfort-focused care. RESEARCH DESIGN Sampling, data collection, and data analysis were guided by constructivist grounded theory, chosen because of its strength in identifying and explicating social processes. PARTICIPANTS AND CONTEXT A purposeful sample of 26 registered nurses working in acute care hospitals in one community in the northeastern United States participated in this study through semi-structured interviews. ETHICAL CONSIDERATIONS The study received approval from the university's Institutional Review Board for the Protection of Human Subjects. Participants provided informed consent. FINDINGS Nurses facilitated transition to comfort-focused care by enacting their moral commitments to patients and families. They focused on building relationships, honoring patient self-determination, and maintaining respect for personhood. In this context, they discerned a need for transition, opened a discussion, and used diverse strategies to facilitate achieving consensus on the part of patients, family members, and care providers. Regardless of how the process unfolded, nurses offered support throughout. DISCUSSION Achievement of consensus by all stakeholders is critical in the transition to comfort-focused care. This study deepens our understanding of how nurses as moral agents utilize specific strategies to assist progress toward consensus. It also offers an example of recognizing the moral agency of nurses through listening to their voices. CONCLUSION Increased understanding of effective nursing strategies for facilitating transition to comfort-focused care is essential for developing needed evidence for excellent care and strengthening end-of-life nursing education.
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Affiliation(s)
- Mary Ann Meeker
- 12292University at Buffalo, The State University of New York, USA
| | - Dianne White
- 12292University at Buffalo, The State University of New York, USA
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