Dignity in care: where next for nursing ethics scholarship and research?

Concept synthesis of dignity in care for elderly facility residents

BACKGROUND

Protecting the dignity of elderly residents of facilities and providing dignified care can be difficult. Although attempts have been made from several aspects, dignity is considered an area in which less real impact has been made in both theory and practice.

OBJECTIVE

The objective of this study is to characterize the concept of dignity in care for elderly subjects in residential facilities from a practical perspective through concept synthesis.

RESEARCH DESIGN

This study includes in-depth interviews with residents of elderly facilities and a literature review.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 12 residents of seven facilities in three prefectures in Japan were recruited via purposive sampling, and 27 interviews were conducted. Each digitally recorded interview was transcribed verbatim. The interview data were analyzed based on hermeneutic phenomenological research. The literature was searched using PubMed, CINAHL, and Web of Science with combinations of terms such as dignity, elderly, and residential facilities and then selected according to the predefined inclusion criteria. The descriptions about dignity in the included studies were divided into codes and compared with the results of the interviews.

ETHICAL CONSIDERATIONS

This study was approved by the institutional review board of Nagoya University's Graduate School of Medicine.

FINDINGS AND DISCUSSION

There were 1728 data codes for the interviews from which four themes were generated. In the literature review, 3716 titles were searched, and 28 articles were selected. Combining these results, five following themes and a conceptual matrix were obtained: individual dignity not affected by others; dignified care in a narrow sense; elements of the staff side; dignity in relation to family members, friends, society, and other residents; and dignity in relation to nursing care facilities and the nursing care system.

CONCLUSION

According to the established matrix, we must consider the role of the care system, facility, family, and society in providing care with dignity and the individual dignity to residents and dignity in daily care.

Enhancing the professional dignity of midwives: A phenomenological study

Background:

When midwives are not treated with respect and their professional competencies are not recognised, their professional dignity is violated.

Objective:

This study explored and described how the professional dignity of midwives in the selected hospital can be enhanced based on their experiences.

Research design:

A descriptive phenomenological research design was used with in-depth interviews conducted with 15 purposely selected midwives.

Ethical considerations:

The Faculty of Health Sciences Research Ethics Committee of the University of Pretoria approved the study. The research was conducted in an academic tertiary hospital with voluntary participants.

Findings:

To dignify midwives it is essential to enhance the following: ‘to acknowledge the capabilities of midwives’, ‘to appreciate interventions of midwives’, ‘to perceive midwives as equal health team members’, ‘to invest in midwives’, ‘to enhance collegiality’, ‘to be cared for by management’ and ‘to create conducive environments’.

Conclusion:

The professional dignity of midwives is determined by their own perspectives of the contribution that they make to the optimal care of patients, the respect that they get from others and the support that hospital management gives them. With support and care, midwives’ professional dignity is enhanced. Midwives will strive to render excellent services as well as increasing their commitment.

Formación bioética e intercultural en enfermería: revisión temática

Objetivo: analizar las tendencias de la formación bioética e intercultural en los programas de enfermería, y establecer los aspectos que deben contemplarse para mejorar la formación. Materiales y método: búsqueda de información en bases de datos científicas de acceso libre y repositorios de tesis doctorales de universidades; se utilizaron las palabras clave: “Bioética”, “Educación”, “Formación”, “Enfermería”, “Cultura”, en español e inglés. No se establecen límites según la fecha de publicación. Resultados: la mayoría de investigaciones se enfocan en el currículo académico, hay poca información sobre interculturalidad, pero se retoma el tema de transculturalidad. Conclusión: es necesario hacer de la ética y la bioética un tema trasversal en los currículos académicos, además de incluir la interculturalidad en los planes de estudio.

Ethical competence: An integrative review

Background:

Ethics, being a fundamental component of nursing practice, must be integrated in the nursing education curriculum. Even though different bodies are promoting ethics and nursing researchers have already carried out work as regards this concept, it still remains difficult to clearly identify the components of this competence.

Objective:

This integrative review intends to clarify this point in addition to better defining ethical competence in the context of nursing practice.

Method:

An integrative review was carried out, for the 2009–2014 period, in the CINAHL, MEDLINE, and EMBASE databases and in the journal Nursing Ethics. The keywords nursing ethics or ethical competence were used in order to make sure to widely encompass the concept of “ethical competence” in the case of a university curriculum in nursing. In the end, 89 articles were selected.

Ethical consideration:

We have respected the ethical requirements required regarding the sources and authorship. There is no conflict of interest in this literature review.

Results:

Ethical sensitivity, Ethical knowledge, Ethical reflection, Ethical decision-making, Ethical action, and Ethical behavior are the most frequently used terms with regard to ethical competence in nursing. They were then defined so as to better ascertain the possible components of ethical competence in nursing.

Conclusion:

Even though ethical competence represents a sine qua non competence in nursing practice, no consensus can be found in literature with respect to its definition. The identification of its components and their relationships resulting from this integrative review adds to the clarification of its definition. It paves the way for other studies that will contribute to a better understanding of its development, especially among nursing students and practicing nurses, as well as the factors that may exert an influence. More adapted education strategies can thus be put forward to support its development.