"It Is Difficult to Always Be an Antagonist": Ethical, Professional, and Moral Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada

Ethical and Legal Challenges in Caring for Older Adults with Multimorbidities: Best Practices for Nurses

This study explores the ethical and legal challenges faced by nurses in caring for older adults with multimorbidities, focusing on issues related to patient autonomy, polypharmacy, and end-of-life care. Through semi-structured interviews with 15 nurses in Riyadh, Saudi Arabia, the research highlights the complexities of obtaining informed consent from patients with cognitive impairments and the ethical dilemmas of balancing autonomy and safety. The management of polypharmacy emerged as a significant concern, with nurses emphasizing the importance of thorough documentation and coordination among healthcare providers to prevent adverse drug interactions. End-of-life care and advance directives posed further challenges, particularly when family members disagreed with patients' documented wishes. The study underscores the need for comprehensive strategies, including ongoing education, clear communication, and supportive institutional policies, to address these issues effectively. The findings suggest that enhancing nurses' understanding of ethical principles and legal requirements is crucial for improving patient care and ensuring compliance with regulatory standards. Future research should aim to develop evidence-based guidelines to support nursing practice in managing these ethical and legal challenges.

A concept analysis of psychological trauma in labour and delivery nurses

AIM

To facilitate an understanding of the risk for psychological trauma in labour and delivery nurses.

DESIGN

Concept analysis.

METHODS

The Walker and Avant method of concept analysis was applied to 56 articles. The characteristics, antecedents, and consequences of psychological trauma in labour and delivery nurses were identified.

DATA SOURCES

Peer-reviewed articles in English from CINAHL, PubMed and Google Scholar were reviewed on July 2023.

RESULTS

The characteristics of psychological trauma in labour and delivery nurses are overwhelming distress, intrusive symptoms, avoidance and numbing behaviours, hypervigilance or hyperarousal, emotional dysregulation, cognitive distortions, and interpersonal challenges. The antecedents are exposure to one or more of the following nurse-specific traumas: natural or person-made disasters, historical role limitations, second victim situations, secondary trauma, system-mediated or over-medicalized care, insufficient resources, or workplace incivility. The consequences are disruptions in mental health, diminished physical health, alterations in relationships, and variable work performance.

CONCLUSION

Labour and delivery nurses experience unique causes of psychological trauma due to their practice environment and patient population. The consequences of labour and delivery nurses' psychological trauma extend beyond individual health and impact the quality of patient care and organizational capacity.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Furthermore, research is needed to inform education, support and policy measures to mitigate harm effectively. WHAT PROBLEM DID THE STUDY ADDRESS?: Nurse-specific trauma theory has not been applied to the unique labour and delivery environment with a high incidence of patient trauma. WHAT WERE THE MAIN FINDINGS?: Multiple causes of trauma in the perinatal context have created a pervasive yet largely preventable issue. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This research will impact labour and delivery nurses, their leadership, and their patients.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Ethical-legal dilemmas of nursing practice in emergencies and disasters: a scoping review

OBJECTIVE

To map the ethical-legal dilemmas related to nursing practice in emergency and disaster situations.

METHOD

A scoping review developed in accordance with the JBI method, whose information sources were accessed in databases, in addition to gray literature. The selection was made by reading the titles, abstracts and descriptors, observing eligibility criteria, including two reviewers and a third in case of discrepancies. After reading, data extraction and content analysis of 17 selected studies were carried out.

RESULTS

Thirteen ethical-legal dilemmas were mapped related to professional/functional duty towards the family, lack of personal protective equipment and unsafe conditions at work, preparation and availability for action, skills, limits imposed by victims' religion, obligation to provide care.

CONCLUSION

Professionals, researchers and representatives of the category need to resolve demands that involve acting in emergencies and disasters, (re)cognizing the ethical-legal dilemma, and seeking (re)legal frameworks and observance of the fundamental/ethical principles that govern the profession, in the sense to support decision-making and the development of legally safe practices.

Ethical dilemmas and illicit acts in nursing: reflections on the legal (dis)order

OBJECTIVES

to reflect on aspects of the legal system that involve situations of ethical dilemmas and illegal acts applied in legal proceedings related to nursing professionals.

METHODS

theoretical-reflective essay anchored in conceptions issued by a Brazilian nursing class body, based on technical opinions, in articulation with examples extracted from judges of the Superior Court of Justice.

RESULTS

the legal sources demonstrated the need to support nursing practices through a due and clear understanding of the notions addressed. Indeed, ethical dilemmas linked to professional practice usually refer to the psychological impact of having to act differently from what feels morally, ethically, or professionally appropriate.

FINAL CONSIDERATIONS

the reflection was guided by conceptual and legal issues involving nursing practice, pointing to the need to monitor the effects of legal disorder caused by current legislation, which may have implications for the legal security of professionals.