A vulnerable journey towards professional empathy and moral courage

Promoting speaking-up behaviours among nurses working in the care for older people: A scoping review

AIM

To explore interventions employed to foster speaking-up behaviours of registered nurses (RNs) working in the care of older people.

DESIGN

Scoping review.

METHODS

The updated Joann Briggs Institute scoping review methodological guidelines were followed.

DATA SOURCES

CINAHL, PubMed, PsycINFO, and Scopus were searched.

RESULTS

A total of 1691 titles and abstracts were screened, resulting in 11 articles that met the inclusion criteria. Analysis focused upon intervention types, methodologies, speaking up strategies, barriers and effectiveness. Education was the most used intervention.

CONCLUSION

There is a lack of published research on successful interventions to promote speaking-up behaviours in the care of older people, particularly relating to poor care practices. Evidence of speaking-up interventions in the residential aged care setting is absent. This highlights the need to develop strategies to support the RN to lead and enable others to raise care concerns.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Developing strategies that enable staff, care recipients and their families to speak up about care concerns is a vital future area for nursing practice development. Nursing leadership of such strategies is central to improving the quality of care for older people, particularly those living in residential aged care.

IMPACT

Older people receiving care should feel respected and be treated humanely. Evidence suggests this is often not the case. This review found a paucity of interventions to promote speaking-up about poor care practices among RNs working in the care of older people. Future research needs to address this, to empower RNs and improve the care afforded to older people.

REPORTING METHOD

The PRISMA-ScR (Tricco et al., Annals of Internal Medicine, 169, 467-473, 2018) were adhered to throughout this scoping review.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution in this review.

Putting patients first: when home-based care staff prioritise loyalty to patients above the system and themselves. An ethnographic study

BACKGROUND

The growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients' needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints.

METHODS

An ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis.

RESULTS

Staff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient's formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient's home.

CONCLUSION

The loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff's emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care.

Communities of reflection in nurse education programs: A qualitative multi-methods study

BACKGROUND

Nursing students often face challenges reconciling theoretical concepts with clinical realities. This study examines a novel concept 'Communities of Reflection' designed and tested to enhance coherency between theory and practice. The concept involves reflection groups comprising students, preceptors, and faculty during clinical placements.

AIM

To examine the meaning of 'Communities of Reflection' regarding the coherency between theory and practice as perceived by the involved participants.

METHOD

A qualitative multi-methods approach involved nursing students, preceptors, and faculty members who participated in 'Communities of Reflection.' Data collection methods included interviews, focus groups, written reflections, and observations.

FINDINGS

The content analysis revealed that 'Communities of Reflection' facilitate a shared engagement in nursing, fostering a deeper level of reflection. Creating a safe space and embracing vulnerability are key aspects of this shared engagement.

CONCLUSION

'Communities of Reflection' offer a valuable framework for promoting coherency between theory and practice. It appears to be crucial to students' outcomes that a well-established, equitable theory-practice partnership is the solid foundation, acknowledging that emotions can serve as a catalyst for the development of professional expertise.

Nursing students' movement toward becoming a professional caring nurse

BACKGROUND

Previous research mainly focuses on how to support nursing students in caring for the patient and on educators' views of students' development as professional caring nurses. Against this background, it is important to further investigate nursing students' perspectives on what it means to become a professional caring nurse.

RESEARCH AIM

This qualitative systematic review study aims to identify and synthesize nursing students' perceptions on the meaning of becoming a caring nurse.

RESEARCH DESIGN AND DATA SOURCES

Systematic data searches were conducted by using the electronic databases MEDLINE (Ovid), CINAHL (EBSCO), Academic Search Premiere (EBSCO), and Philosopher`s Index. In total, 13 studies met the inclusion and quality criteria. The articles were analyzed by a systematic review and a thematic synthesis according to Thomas and Harden.

ETHICAL CONSIDERATION

The study followed good ethical practice guidelines outlined in the Northern Nurses' Federation.

FINDINGS

The analysis resulted in eight descriptive themes and finally in three analytical themes: Becoming is to get in touch with one's inner ethic or ethos, Becoming is a movement between courage, understanding, and being touched, and Becoming is strengthened through caring role models and a learning culture.

CONCLUSIONS

Becoming a professional caring nurse is seen as an ongoing movement toward a deeper understanding of oneself and one's being and bearing. This movement is enabled when nursing students have a sense of self-awareness, courage to stand in their vulnerability, and reflect on their responsibility, caring attitude, and inner values and ethics. The force of becoming is that the attention is directed beyond self to care for and feel empathy for others in a caring manner. Becoming is released through a caring relationship, external confirmation, and good role models. A lack of external support in the movement can potentially prevent the students from becoming a professional caring nurse.

A National Survey of Nursing Faculty Resilience, Moral Courage, and Purpose

BACKGROUND

High rates of nursing faculty burnout and moral distress fuel faculty attrition, which directly affects our ability to educate new nurses. This study investigated the relationships among resilience, moral courage, and purpose to inform strategies to promote well-being in nursing faculty.

METHOD

A descriptive, correlational study was conducted using a convenience sample of nursing faculty in the United States and Canada (n = 690). Participants completed three surveys: the Connor Davidson Resilience Scale (CD-RISC), the Moral Courage Scale for Nursing Faculty (MCNF), and the Meaning of Life Questionnaire (MSQ), as well as a single open-ended question.

RESULTS

Moral courage was moderately correlated to resilience, and the Meaning of Life Presence subscale was moderately correlated to resilience. Meaning of life presence and meaning of life search were moderately negatively correlated.

CONCLUSION

Resilience, moral courage, and purpose are essential in promoting professional fulfillment and personal well-being in nursing faculty. [J Nurs Educ. 2023;62(7):381-386.].

Factors associated with the moral courage of nurses in China: A cross-sectional study

AIM

The purpose of this study was to assess the level of moral courage among nurses in China, and to explore related influential factors, to help nursing managers take measures to improve nurses' moral courage.

DESIGN

A cross-sectional study.

METHODS

The data adopted a convenient sampling method. From September to December 2021, 583 nurses from five hospitals in Fujian Province completed the Chinese version of the Nurses' Moral Courage Scale (NMCS). Data were analysed using descriptive statistics, chi-square test, T-test, Pearson correlation analysis and multiple regression analysis.

RESULTS

The Chinese nurses perceived themselves, on average, as morally courageous. The mean NMCS score was 3.64 ± 0.692. The six factors showed statistically significant correlations (p < 0.05) with moral courage. Regression analysis showed that the main factors influencing nurses' moral courage were active learning of ethics knowledge and nursing was a career goal.

CONCLUSION

This study provides the self-evaluation level and related influencing factors of Chinese nurses' moral courage. There is no doubt that nurses still need strong moral courage to face unknown ethical problems and challenges in the future. Nursing managers should pay attention to the cultivation of nurses' moral courage, using various forms of educational activities to help nurses alleviate moral problems and improve their moral courage, to maintain patients' access to high-quality nursing.