Self-care as an ethical obligation for nurses

A descriptive study on holistic nursing education: Student perspectives on integrating mindfulness, spirituality, and professionalism

BACKGROUND

Mindfulness has gained prominence in education as a method for enhancing student well-being and learning, yet its integration into nursing curricula remains underexplored. Student lived experiences are essential to understanding the potential benefits and challenges of mindful nursing practice.

AIM

To explore the lived experiences of undergraduate nursing students who practice mindfulness as it relates to nursing education.

METHODS

This was a qualitative descriptive phenomenological study. Data was collected using semi-structured Zoom interviews. Recruitment used word of mouth and snowball sampling. Out of 80 applicants, 17 undergraduate nursing students were interviewed until data saturation was achieved. Data were analyzed using Edmund Husserl's approach to descriptive phenomenology, supported by Jean Watson's Theory of Human Caring and Abraham Maslow's hierarchy of needs.

RESULTS

Seven main themes emerged: Interpersonal and Transpersonal Connections, Spiritual Beliefs and Practices, Faith in the Future, Feelings of Peace, Barriers to Mindfulness in Nursing Education, Integrating Mindfulness Across the Curriculum, and Mindfulness Models in Building Professional Patterns.

CONCLUSION

Data indicate nursing educators have a significant role in guiding students to mindfulness practices for the well-being of the nursing profession.

Identifying the Role of Self-Compassion in Nursing Students' Perceptions of Readiness for Practice: A Mixed Methods Study

Purpose of Study: Nursing students must be able to provide holistic, patient-centered, compassionate care upon entering professional practice despite the stress and psychological challenges of the healthcare environment. The purpose of this study was to explore the relationship between self-compassion, as a promoter, predictor and protector of psychological health, and perceived readiness for practice. Design of Study: This study used a convergent mixed-method design with correlational and directed content analyses. A convenience sample of undergraduate senior nursing students from baccalaureate programs in the Northeastern Region of the United States participated. Methods: Participants completed a 37-item online survey consisting of a demographic questionnaire, the Self-Compassion Scale Short Form (SCS-SF), and the Casey Fink Readiness for Practice Survey ©2008 (n = 82) followed by semi-structured online interviews (n = 18). Findings: Results indicated that self-compassion and support systems positively influence perceived readiness for professional nursing practice. Conclusions: The findings promote psychological health as a component of readiness for professional nursing practice and the incorporation of self-compassion development into nursing curriculum.

Latent profile analysis of mindful self-care and associations with mental health among nurses in China

BACKGROUND

Despite the crucial role of mindfulness and self-care in nurses' physical and mental health, as well as their professional well-being, most nurses exhibit low levels of self-care. Moreover, there is a lack of understanding of the diverse subgroups of mindful self-care among nurses.

OBJECTIVES

The present study delved into the diverse groups of mindful self-care among nurses and investigated the correlation between these groups and their mental health.

METHODS

Convenience sampling was used to select nurses from Guizhou province, China, from August to September 2023. A total of 1020 nurses were investigated, and 1001 questionnaires were included, for an effective return rate of 98.1%. The demographic characteristics questionnaire, Chinese version of the Brief Mindful Self-Care Scale, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 and Perceived Stress Scale were used. Latent profile analysis was performed on the characteristics of nurses' mindful self-care, and the correlations between the latent profiles, demographic characteristics and mental well-being were identified using chi-square tests, Spearman correlation analyses and non-parametric tests.

RESULTS

A total of 1001 nurses were included, and they were divided into four heterogeneous subgroups: the Inconsistent Mindful Self-Care Group (4.40%), Balanced Development Group (43.36%), Moderate Mindful Self-Care Group (39.36%), and High Mindful Self-Care Group (12.89%). Results of single factor analysis showed that the nurses' department and average monthly income were the factors influencing the potential profiles. Mindful self-care negatively correlated with anxiety and depression but was not correlated with perceived stress. There were significant differences in perceived stress, anxiety and depression between different mindful self-care groups.

CONCLUSION

The present study used latent profile analysis to identify four distinct subgroups of hospital nurses based on their mindful self-care and revealed varying levels of anxiety, depression and perceived stress between groups. These results emphasise the need for tailored mindful self-care strategies to promote nurses' well-being.

Clinical reasoning in real-world practice: a primer for medical trainees and practitioners

Clinical reasoning is a crucial skill and defining characteristic of the medical profession, which relates to intricate cognitive and decision-making processes that are needed to solve real-world clinical problems. However, much of our current competency-based medical education systems have focused on imparting swathes of content knowledge and skills to our medical trainees, without an adequate emphasis on strengthening the cognitive schema and psychological processes that govern actual decision-making in clinical environments. Nonetheless, flawed clinical reasoning has serious repercussions on patient care, as it is associated with diagnostic errors, inappropriate investigations, and incongruent or suboptimal management plans that can result in significant morbidity and even mortality. In this article, we discuss the psychological constructs of clinical reasoning in the form of cognitive 'thought processing' models and real-world contextual or emotional influences on clinical decision-making. In addition, we propose practical strategies, including pedagogical development of a personal cognitive schema, mitigating strategies to combat cognitive bias and flawed reasoning, and emotional regulation and self-care techniques, which can be adopted in medical training to optimize physicians' clinical reasoning in real-world practice that effectively translates learnt knowledge and skill sets into good decisions and outcomes.

An Asynchronous Evidence-Based Mindfulness Intervention for Professional Nurses

Purpose: To evaluate the impact of an abbreviated (4-week) and asynchronous, mindfulness-based intervention (MBI) on nurses' perceived stress and mindful attention and awareness. Design: An evidence-based quality improvement pilot program. Methods: The participants (n = 15 nurses) attended a 4-week, asynchronous MBI. The participants attended a 90-minute webinar on mindfulness as a prerequisite, followed by 4 weeks of guided meditation and informal mindfulness practice materials. The MBI was offered remotely with self-modulated practice. Participants also provided the number of days per week they participated in formal meditation practice. Project participants completed pre- and post-intervention questionnaires. Project instruments included the Mindful Attention Awareness Scale (MAAS) and the 10-item Perceived Stress Scale (PSS). Findings: 12 complete pre-and post-intervention surveys were analyzed. Significant improvements were noted in participant mean MAAS scores post-intervention (p = .004). Cumulative PSS scores also decreased post-intervention (p = .009). Conclusion: The 4-week MBI demonstrated a statistically significant impact on nurses' perceived stress and mindful attention and awareness. Additionally, this Doctor of Nursing Practice (DNP) student led program was offered in an asynchronous and remote format, which was received well by program participants and may be a practical option for future MBIs.

A Pilot Feasibility Evaluation of a Heart Rate Variability Biofeedback App to Improve Self-Care in COVID-19 Healthcare Workers

COVID-19 exacerbated burnout and mental health concerns among the healthcare workforce. Due to high work stress, demanding schedules made attuned eating behaviors a particularly challenging aspect of self-care for healthcare workers. This study aimed to examine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) mobile app for improving well-being among healthcare workers reporting elevated disordered eating during COVID-19. We conducted a mixed methods pre-mid-post single-arm pilot feasibility trial (ClinicalTrials.gov NCT04921228). Deductive content analysis of participants' commentary generated qualitative themes. Linear mixed models were used to examine changes in pre- mid- to post-assessment scores on well-being outcomes. We consented 28 healthcare workers (25/89% female; 23/82% Non-Hispanic White; 22/79% nurses) to use and evaluate an HRVB mobile app. Of these, 25/89% fully enrolled by attending the app and device training; 23/82% were engaged in all elements of the protocol. Thirteen (52%) completed at least 10 min of HRVB on two-thirds or more study days. Most participants (18/75%) reported being likely or extremely likely to continue HRVB. Common barriers to engagement were busy schedules, fatigue, and technology difficulties. However, participants felt that HRVB helped them relax and connect better to their body's signals and experiences. Results suggested preliminary evidence of efficacy for improving interoceptive sensibility, mindful self-care, body appreciation, intuitive eating, stress, resilience, and disordered eating. HRVB has potential as a low-cost adjunct tool for enhancing well-being in healthcare workers through positively connecting to the body, especially during times of increased stress when attuned eating behavior becomes difficult to uphold.

The Health Narratives Research Group (HeNReG): A self-direction process offered to help decrease burnout in public health nurse practitioners

Founded in accordance with 19th century sex roles and public health concerns, nursing evolved as other-directed, dependent on physician-focused diagnosis, prescription decisions, and public health advancements. The result of this other direction is that public health nurse practitioners have endured significant workplace stress resulting in burnout, especially during COVID-19. To help decrease their burnout, nurses require development of self-direction. The Health Narratives Research Group (HeNReG) has the potential to reduce burnout in nurse practitioners by encouraging the development of self-direction. The HeNReG process is presented through historically analyzed documents regarding reducing burnout in health researchers by developing self-direction including: (1) three years of archived year-end feedback results provided by participants, (2) archived participant responses to specific HeNReG-related writing prompts, and (3) a comparison of HeNReG results with the outcomes of resilience programs. The conclusion-the HeNReG offers an effective option for reducing burnout in health researchers that has the potential to decrease nurse practitioner burnout in a way that resilience programs do not. Tailoring the HeNReG process to public health nurses is discussed, inviting future research for reducing burnout in public health nurses.

"Becoming a Person Who Does Self-Care": How Health Care Trainees Naturalistically Develop Successful Self-Care Practices

OBJECTIVES

Self-care is an ethical imperative for health professionals as it can mitigate the adverse effects of stress on professional functioning and health. Yet, there tends to be a lack of self-care among healthcare trainees and an insufficient focus on self-care in medical education. The objective of this study was to develop a grounded theory of how health trainees become successful self-care users.

METHODS

Semi-structured interviews were conducted with 17 students in a variety of healthcare disciplines. Data were analyzed using grounded theory methodology.

RESULTS

Health trainees underwent 4 iterative phases to become successful at self-care: Having a Wake-Up Call, Building Skills, Gaining Confidence, and Building an Identity. Our model also explained why some trainees were unsuccessful at developing self-care practices.

CONCLUSION

We offer the first theory to explain how health trainees develop effective self-care habits. Understanding how self-care practices naturalistically develop has critical implications for developing interventions and curricula: By basing curricula about self-care on knowledge of what works, we have an opportunity to be more successful as educators. Indeed, other researchers have noted a lack of success in self-care and anti-burnout interventions for healthcare professionals. We conclude by discussing implications and recommendations for medical training and curriculum for health professions, including augmenting naturally occurring processes, linking self-care to personalized values, providing opportunities for deliberate practice, focusing on persistence with self-care, and faculty promotion and acceptance of trainee self-care.

Nurses' self-care strategies: A mapping review

OBJECTIVES

Nurses have long received recommendations to employ self-care behaviors to ensure their ability to remain in the profession; however, nurses are rarely asked what self-care behaviors are beneficial. This literature review aimed to map studies on nurses' self-care strategies to provide an understanding of how these strategies are addressed in the literature and to identify gaps in need of additional exploration.

METHOD

Searches were conducted in accordance with published mapping review methodologies across MEDLINE, Embase, CINAHL, Scopus, PsycINFO, Web of Science, and identified influential nursing journals. Included studies were from the United States, peer-reviewed, and described self-care strategies related to nurses or the nursing profession.

RESULTS

Thirty-five articles were identified for inclusion and were evaluated based on agreed-upon criteria to define how the concept of self-care was studied and applied to nurses. Three main categories were identified in this review: self-care and stress; self-care and burnout; and self-care and leadership, workplace factors, and physical activity.

LINKING EVIDENCE TO ACTION

This mapping review revealed an abundance of literature related to self-care recommendations for nurses; however, there remains a dearth of studies investigating how nurses utilize self-care behaviors independently to improve their own professional well-being. Recommendations for next steps in research in this area are included.

Aesthetic Attitude Based on Kant's Aesthetics of Caring Relationships in Nursing

(1) Background: Although aesthetic attitude has been comprehended as one of the fundamental traits in nursing, there is a lack of discussion considering Kant's aesthetics of caring relationships. The purpose of this study was to illuminate aesthetic and moral characteristics of caring expressed in the caring relationship between a nurse and patient and suggest a new perspective of aesthetic attitude based on Kant's aesthetics of care ethics. (2) Methods: A theoretical reflection was contemplated regarding notions of aesthetic attitude in the caring relationship between a nurse and patient. (3) Results: human faculty of reflective aesthetic judgment to feel the beautiful and the sublime through imagination and free play in Kant's aesthetics could be applied to the aesthetic attitude in the field of nursing. (4) Conclusions: A nurse who has trained with this aesthetic attitude can act as a moral agent and contribute to the protection and promotion of human dignity in a caring relationship.

I am Seen: Processing Grief as a Pediatric Oncology Nurse Practitioner

ABSTRACT

Nurses and advanced practice providers are encouraged to embrace resilience skills to deal with compassion fatigue and prevent burnout. As a Christian nurse, I learned the importance of daily staying close to Jesus when a beloved pediatric oncology patient died and I experienced overwhelming grief. Through prayers, Bible reading, and honoring the patient with coworkers, I found hope in Jesus' presence. God sees me as his beloved child and gives me strength to continue my work.

Self-described Nursing Responses Experienced During Care of Dying Patients and Their Families: A Phenomenological Study

Critical care nurses care for dying patients and their families. Little is known about the feelings and experiences of critical care nurses and how they are affected when they provide end-of-life care. Study purpose was to understand lived experiences, responses, and feelings of critical care nurses providing end-of-life care. A descriptive phenomenological design with purposive sampling was used to recruit 19 critical care nurses who cared for dying patients and their families. Interviews were recorded and transcribed verbatim. Nurses were asked open-ended questions about experiences and responses while providing end-of-life care. Coliazzi's method of data analysis was used to inductively determine themes, clusters, and categories. Data saturation was achieved, and methodological rigor was established. Responses included personalizing the experience, sadness, ageism, anger, frustration, relief, and stress. Factors contributing to clinicians' lived experience included previous experiences with death affecting how the experience was personalized among others. Critical care nurses may be unprepared for feelings and responses encountered during end-of-life care. Preparation for feelings and responses encountered during end-of-life care in nursing education and critical care orientation classes is essential. Future research should study optimal mentoring, teaching, and preparation for providing optimal end-of-life care. Study results have implications for practice, education, and research.

Development of a Primary Palliative Nursing Care Competence Model and Assessment Tool: A Mixed-Methods Study

AIM

The purpose of this study was to develop a new primary palliative nursing care (PPNC) competence model and assessment tool.

BACKGROUND

Consensus guidelines, a national position statement, and new nursing program accreditation standards require nurses to be educated in providing PPNC. A means to assess PPNC competence for prelicensure nursing students and entry-level nurses is needed.

METHOD

The mixed-methods study utilized a three-phase design encompassing in-depth document analysis and expert workgroups; focus groups with palliative care educators, practitioners, and administrators; and stakeholder focus groups.

RESULTS

Findings across all phases resulted in development of a PPNC competence model and assessment tool, each composed of nine domains and associated competency statements.

CONCLUSION

There is a global imperative for nurses to provide high-quality PPNC. Both the model and assessment tool are vital to develop a nursing workforce with the skills to care for persons with serious illness and their families.

Clinical nurse adherence to professional ethics: A grounded theory

BACKGROUND

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

RESEARCH AIM

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

RESEARCH DESIGN

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

PARTICIPANTS AND RESEARCH CONTEXT

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

ETHICAL CONSIDERATIONS

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

FINDINGS

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

CONCLUSIONS

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

Self-care neglect through the voices of nurses working in primary healthcare clinics in Gauteng, South Africa

BACKGROUND

Self-care is essential, but while professional nurses often pay attention to the health of their patients, they give little heed to their own well-being. With the current pandemic continuing to negatively affect the world, the need for health professionals to make time for self-care is imperative. The concept "self-care" is not a new phenomenon; however, this study strives to show the importance of self-care practices in the world of nurses and its benefit for the nursing profession. The reality for nurses taking care of themselves will assist them in providing consistent quality care for their patients.

METHOD

A qualitative approach with a descriptive, phenomenological, contextual method was used in this study. Ten professional nurses employed within different primary healthcare clinics were selected through purposeful sampling. Through in-depth, individual interviews, the professional nurses shared their lived experiences with self-care practices while being employed within a primary healthcare clinic. The recorded interviews were transcribed verbatim and then analyzed using Colaizzi's method.

RESULTS

The findings revealed: Theme 1: Participants experienced internal and external factors that compromised self-care practices Theme 2: Holistic well-being and the quality of patient care are compromised by self-care neglect Theme 3: Participants experienced the need to take responsibility and accountability to promote self-care practices.

RECOMMENDATIONS

Specific recommendations were formulated to facilitate professional nurses' empowerment to practise self-care as a lifestyle. These specific recommendations focused on reducing the burden of caring for others to the extent that professional nurses working in primary healthcare settings have nothing left for themselves.

Ethical dilemmas experienced by nurses while caring for patients during the COVID-19 pandemic: An integrative review of qualitative studies

AIM

This study aimed to identify ethical dilemmas faced by nurses while caring for patients during the COVID-19 pandemic.

BACKGROUND

Nurses express several concerns during disease outbreaks, some of which are related to ethical dilemmas.

EVALUATION

It is an integrative review in which four databases were searched. Critical appraisal tools and PRISMA guidelines were used. Content analysis was performed to analyse the obtained data.

KEY ISSUES

A total of 14 studies were identified. The results are presented into four categories: concerns with beneficence-nonmaleficence; awareness of need for autonomy; challenges to justice; and coping with ethical dilemmas.

CONCLUSION

While caring for patients during the COVID-19 pandemic, nurses often put their own health and that of their families at risk. The ethical dilemmas faced by nurses are mainly caused by the lack of Protective Personal Equipment (PPE), shortages of medical supplies and personnel and the uncertainties that permeate an environment threatened by a new and highly contagious disease such as COVID-19.

IMPLICATIONS FOR NURSING MANAGEMENT

This review provides information that can inspire nurse managers working during the COVID-19 pandemic to support and empower nurses to act in accordance with ethical principles, which is important in order for nurses to protect themselves while providing efficient and effective care.

Serious mental illness in healthcare and academia: A lived experience

WHAT IS KNOWN ON THE SUBJECT?: There are individuals living with serious mental illness in both healthcare and academia. The high stress nature of these fields can worsen or trigger mental illness, burnout, moral injury, and compassion fatigue in employees. Mental health nurses have the needed skillset to foster change in these settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper describes the holistic experiences of a nurse faculty member living with serious mental illness and highlights lessons learned in both healthcare and academic settings. In addition to insights from the experience, the paper also shares suggestions for moving forward, reducing burnout, and supporting employees in these fields. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This lived experience narrative showcases the effect that high-pressure occupations have on individuals with serious mental illness. Mental health nurses have the training and experience to transform the experiences of employees in healthcare and academia. Through assessment, deep listening, and powerful questioning, these nurses in partnership with the employees themselves can design and implement interventions that have a lasting impact for these populations. ABSTRACT: Introduction First-hand accounts from clients living with mental health challenges deepen provider understanding and offer direct insight into the lives of those with chronic mental illness. There is a gap in the literature surrounding the lived experience of serious mental illness in the professional setting. Aim This narrative outlines the challenges and opportunities for those living with serious mental illness in healthcare and academia. Methods The author reviewed personal journals and reflected upon her years as both a nurse and faculty member to highlight the experience of living with serious mental illness in these professions. Findings These high-pressure fields place inordinate demands on faculty and staff; yet, there are few organizational supports in place for employees. Despite the push to improve resiliency and ease burnout, healthcare organizations and academic institutions still struggle to identify the best interventions and methods of support for staff. Discussion Mental health nurses and nurse coaches are uniquely positioned to ease this burden and help create inclusive workplaces for those with serious mental illness.

The Beat Goes On

Since the beginning of the COVID-19 pandemic, emergency nurses have been on the frontlines. Not only were emergency nurses caring for patients with physical symptoms, they were also confronted by anxiety, depression, stress, and uncertainty in patients, peers, and themselves. Even as nurses cared for patients seeking their help, they were dealing with their own struggles as members of the larger community and the organization. The purpose of this study was to examine emergency nurses’ resiliency and to provide nurse leaders a different lens for viewing resilience. Five interconnected elements surfaced through direct observations with live environmental music therapy, focus groups, and essays with emergency room nurses. Fostering the elements of emergency nurses’ song of resilience: harmony, melody, rhythm, silence/rest, and beingness may enhance individual, team, and organizational performance. Nurse leaders can support resiliency and promote healthy work environments by perceiving resilience creatively and through reflection.

Feasibility and Effect of Reiki on the Physiology and Self-perceived Stress of Nurses in a Large US Hospital

Nurses experience stress in the workplace. We evaluated the feasibility and effect of Reiki to relieve stress of staff nurses during a work shift. All Reiki treatments were completed without interruption and lasted 30 minutes. Stress scores, respiratory rate, and heart rate were significantly decreased immediately following the Reiki treatment.

The duty to care and nurses' well-being during a pandemic

Background:

The coronavirus disease 2019 pandemic is impacting the delivery of healthcare worldwide, creating dilemmas related to the duty to care. Although understanding the ethical dilemmas about the duty to care among nurses is necessary to allow effective preparation, few studies have explored these concerns.

Aim:

This study aimed to identify the ethical dilemmas among clinical nurses in Spain and Chile. It primarily aimed to (1) identify nurses’ agreement with the duty to care despite high risks for themselves and/or their families, (2) describe nurses’ well-being and (3) describe the associations between well-being and the duty to care.

Research design:

Cross-sectional self-reported anonymous data were collected between May and June 2020 via electronic survey distribution (snowball sampling).

Ethical considerations:

The Institutional Ethical Review Committees in both countries approved the study (CHUC_2020_33 and 27/2020).

Findings:

In total, 345 clinical nurses answered the primary question about the duty to care for the sick. Although in the total sample 77.4% agreed they have a duty to care for the sick, significant differences were found between the Spanish and Chilean samples. Overall, 53.6% of the nurses reported low levels of well-being; however, among those reporting low well-being, statistically significant differences were found between Spanish and Chilean nurses as 19.4% and 37.8%, respectively, disagreed with the statement regarding the duty to care.

Discussion:

Participants in both countries reported several ethical dilemmas, safety fears, consequent stress and low well-being. These results suggest that prompt actions are required to address nurses’ ethical concerns, as they might affect their willingness to work and psychological well-being.

Conclusion:

Our findings shed light on the ethical dilemmas nurses are facing related to the duty to care. Not only has the coronavirus disease 2019 pandemic given rise to ethical challenges, but it has also affected nurses’ well-being and willingness to work during a pandemic.

The construction of contemporary nursing identity from narrative accounts of practice and professional life

OBJECTIVE

To explore the contemporary narrative of nursing identity in Spain.

METHOD

This qualitative study was conducted between 2018 and 2020. Eleven registered nurses were interviewed. The conversations were recorded in audio, were semistructured, and held in a mental health clinic affiliated with a Catholic institution. Narrative analysis of the data was carried out.

FINDINGS

Two themes were identified: How do I construct my professional life?, with the subthemes 'Training and initiation in care practice', 'Ways of living the professional care experience', 'The sculpting of care' and 'Self-image and future projection'; and What do I know about my practice?, with the subthemes 'Nursing experience: shift, days, years', 'Strategy in the field of nursing care', 'Some foundations of caregiving practice', 'The specificity of the gesture of care' and 'Voice and recognition of nursing within the institution'.

CONCLUSION

Contemporary nursing identity is built in reflections on the epistemology of care, confronting the weight of tradition and breaking into new modes of self-image where the profession is legitimized and projected from historical consciousness. This claim can be used to support reflective practice in academic and healthcare settings as well as to promote a paradigm shift.

Factors related to implementation of nursing care ethical principles in Indonesia

Background: The implementation of ethical principles is crucial in carrying out nursing care, since it is part of the 12 basic competencies, that should be possessed by a nurse. This study aims to analyse the factors associated with the implementation of nurses’ ethical principles.

Design and Methods: This study used a quantitative research design, with a cross-sectional approach. The participants consisted of 389 nurses, working in the medical ward of the hospitals, in Indonesia. Data were analysed using the bivariate analysis, t-test, ANOVA and multiple linear regression test.

Results: There were no significant relationships between the demographic factors and the ethical behaviour. There was a relationship between caring behaviour and the application of ethical principles (p=0.000, and a correlation coefficient of 0.602).

Conclusion: Nurse ethical behaviour was improved, by increasing their caring attitude.

Mindful Self-Care Practice of Nurses in Acute Care: A Multisite Cross-Sectional Survey

Consistent mindful self-care practices mitigate professional burnout and improve resilience to enable nurses provide safe and effective patient care. This study determined the levels and the influencing factors of mindful self-care of nurses in acute care settings. Data were collected from a convenience sample of 258 nurses from seven acute care hospitals using the 36-item Mindful Self-Care Scale. Data were analyzed using descriptive and correlation analyses. Nurses' mindful self-care scores were low, and female nurses had higher levels of mindful self-care than male nurses. Statistically significant negative correlations were found between nurses' mindful self-care levels and their age and clinical experience. Nurses' engagement in mindful self-care is low which may negatively affect their interactions with and care of patients and their families. Therefore, a need exists to develop and evaluate more clinical-based personal and organizational strategies to enhance the mindful self-care practices of nurses.