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Perry DJ, Cintron S, Grace PJ, Jones DA, Kane AT, Kennedy HM, Malinski VM, Mar W, Toohey L. Policy education in a research-focused doctoral nursing program: Power as knowing participation in change. Nurs Inq 2024; 31:e12615. [PMID: 38013628 DOI: 10.1111/nin.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
Nurses have moral obligations incurred by membership in the profession to participate knowingly in health policy advocacy. Many barriers have historically hindered nurses from realizing their potential to advance health policy. The contemporary political context sets additional challenges to policy work due to polarization and conflict. Nursing education can help nurses recognize their role in advancing health through political advocacy in a manner that is consistent with disciplinary knowledge and ethical responsibilities. In this paper, the authors describe an exemplar of Elizabeth Barrett's "Power as Knowing Participation in Change" theory as a disciplinary lens within a doctoral nursing health policy course. Barrett (radically) emphasizes "power as freedom" instead of "power as control." This approach is congruent with nursing disciplinary values and enhances awareness of personal freedom and building collaborative relationships in the policy process. The theory was used in concert with other traditional policy content and frameworks from nursing and other disciplines. We discuss the role of nursing ethics viewed as professional responsibility for policy action, an overview of Barrett's theory, and the design of the course. Four student reflections on how the course influenced their thinking about policy advocacy are included. While not specific to policymaking, Barrett's theory provides a disciplinary grounding to increase students' awareness of freedom and choices in political advocacy participation. Our experience suggests that Barrett's work can be fruitful for enhancing nurses' awareness of choices to participate in change across settings.
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Affiliation(s)
- Donna J Perry
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, USA
| | - Saisha Cintron
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, USA
| | - Pamela J Grace
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Dorothy A Jones
- Marjory Gordon Program for Clinical Reasoning and Knowledge Development, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anne T Kane
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, USA
| | - Heather M Kennedy
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, USA
| | - Violet M Malinski
- Hunter College of Nursing & Graduate Center, City University of New York, New York, New York, USA
| | - William Mar
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, USA
| | - Lauri Toohey
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, USA
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Chou CC, Wang SY. Christian Ethical Foundations of Modern Nursing in China. J Christ Nurs 2024; 41:E32-E37. [PMID: 38436351 DOI: 10.1097/cnj.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
ABSTRACT The influence of Western Christian missionary nurses has been recorded in the history and development of nursing in China. The purpose of this study was to investigate the influence of Christianity on Chinese nursing ethics. This documentary research used content analysis to investigate Christian value trends over 13 years (1920-1932) as reflected in a major bilingual Chinese nursing journal.
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Uveges MK, Milliken A. Nurses' Ethical Obligations When Caring for Patients With Limited English Proficiency. AACN Adv Crit Care 2024; 35:66-74. [PMID: 38457613 DOI: 10.4037/aacnacc2024319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Affiliation(s)
- Melissa Kurtz Uveges
- Melissa Kurtz Uveges is Assistant Professor, Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 375, Chestnut Hill, MA 02467
| | - Aimee Milliken
- Aimee Milliken is Associate Professor of the Practice, Boston College, William F. Connell School of Nursing Chestnut Hill, Massachusetts
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Rushton CH, Gosselin T, Joseph ML. An ethical framework for human resource allocation in nursing. Nurs Manag (Harrow) 2024; 55:18-23. [PMID: 38345398 DOI: 10.1097/nmg.0000000000000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Cynda Hylton Rushton
- Cynda Hylton Rushton is the Anne and George L. Bunting professor of clinical ethics and nursing at the Johns Hopkins University, Berman Institute of Bioethics and School of Nursing in Baltimore, Md. Tracy Gosselin is the chief nurse executive, senior vice president, and chair of the Department of Nursing at the Memorial Sloan Kettering Cancer Center in New York, N.Y. M. Lindell Joseph is a clinical professor, Distinguished Scholar in Nursing, and director of the DNP and MSN Health Systems: Administration/Executive Leadership Programs at the University of Iowa College of Nursing in Iowa City, Iowa
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Neal KW. Pediatric Nurses' Experiences With Professional Boundaries and Ethical Challenges: A Secondary Analysis. Res Theory Nurs Pract 2024; 38:124-136. [PMID: 38350688 DOI: 10.1891/rtnp-2023-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Pediatric nursing is known to be challenging in relation to balancing care and relationships with children and families. There is a growing body of knowledge about the perspectives of the various aspects of care; nurses' thoughts and perspectives, parents' needs and desire for collaboration, and the continued care and support required are related. This article is a secondary analysis of data collected using the theoretical framework and methodology of Margaret Newman's Health as Expanding Consciousness to understand how pediatric nurses develop knowledge. Interviews were conducted with eight pediatric nurses working in inpatient settings with children and families experiencing chronic, complex healthcare needs. The nurses, whose experience spanned between 3 and 30 years, related to stories of how their view of practice evolved over time and with experiences and the challenges to professional boundaries and ethical practice. Reflection on these experiences brought nurses to acknowledge sometimes crossing professional boundaries and struggling with ethical issues. Ultimately, reflections brought appreciation of lessons learned and evolution of the understanding of their role in the care of these children and families.
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Snelling P. Am I my students' nurse? Reflections on the nursing ethics of nursing education. Nurs Ethics 2024; 31:52-64. [PMID: 37769641 PMCID: PMC10898194 DOI: 10.1177/09697330231193858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Despite having worked in higher education for over twenty years, I am still, first and foremost, a practicing nurse. My employer requires me to be a nurse and my regulator regards what I do as nursing. My practice is regulated by the Code and informed by nursing ethics. If I am nurse, practicing nursing, does that mean that my students are my patients? This paper considers how the relationship that I have with my students can be informed by the ethics of the nurse/patient relationship. After some initial theoretical preparation concerning argument from analogy, the paper identifies some areas for comparison between the two relationships. Areas of similarity and difference identify two areas of concern: Nurse education and educators regularly engage in coercion and surveillance in an attempt to increase student success, both of which would be considered outside nursing ethics. It is concluded that these coercive practices are not conducive to an environment where character is cultivated. Despite current financial and workforce pressures, nurse lecturers and more especially their managers would do well to return to the professional ethics of nursing to question and guide their practice.
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Abedin S, Khademi Z, Kamalzadeh H, Beigi Broujeni R. Characteristics of a good nurse as perceived by nurses. Nurs Ethics 2024; 31:79-88. [PMID: 37257094 DOI: 10.1177/09697330221147895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Nursing is a humanitarian and social field that provides health services. It combines science and art and has a rich history. Despite fundamental changes in the provision of medical services and nursing education, the concept of "good nurse" is still unclear. PURPOSE The purpose of this article is to investigate the characteristics of a good nurse from the nurses' perspective. RESEARCH DESIGN AND METHOD A qualitative study was applied using conventional content analysis. The participants were 30 nurses that selected with purposive sampling method. Data were collected through unstructured interviews and simultaneously analyzed via the conventional content analysis approach of Graneheim and Lundman. ETHICAL CONSIDERATIONS This study was approved by the Research Ethics Committee of Hormozgan University of Medical Sciences, Iran. FINDINGS The study revealed that personal characteristics (Adherence to ethical and human principles, Physical health, Attractive appearance, and Ability to communicate properly); and professional characteristics (knowledge - clinical skill - nursing roles) are essential to being a good nurse. CONCLUSION Coming to know the distinctive features of a good nurse as perceived by nurses themselves creates an opportunity for nurses to rethink their profession and to reflect on the characteristics of the good nurse.
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Abdollahi R, Ghasemianrad M, Hosseinian-Far A, Rasoulpoor S, Salari N, Mohammadi M. Nurses' moral courage and related factors: A systematic review. Appl Nurs Res 2024; 75:151768. [PMID: 38490799 DOI: 10.1016/j.apnr.2024.151768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/27/2023] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Nurses face various ethical conflicts when taking care of patients, and such conflicts require moral courage. This systematic review was conducted with the aim of investigating moral courage and its related factors among nurses. METHODS To find related studies, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PubMed, Web of Science, Google Scholar, Scopus, Embase and Science Direct databases were searched using keywords such as Courage, Moral Courage, and Nurses, and no lower time limit was imposed when conducting the searches. The identified studies were published between January 2000 and March 2023. Quality of articles was assessed using the STROBE checklist. RESULTS The pooled sample size for the 19 included studies was 7863. All studies were observational and cross-sectional. The results showed that three categories of factors most related to moral courage are individual, moral, and factors related to the organization. Underlying factors of each category are also provided within this paper. CONCLUSION Moral courage is an integral part of nursing, which as a profession, is becoming even more challenging with the advancement of science and technology. Therefore, there is a need for nurses and especially nursing managers to be considerate of factors affecting moral courage of nurses, with a view to strengthening the positive factors and reducing the negative impacts.
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Affiliation(s)
- Reza Abdollahi
- Nursing and Midwifery School, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Shabnam Rasoulpoor
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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Ford NJ, Gomes LM, Brown SB. Brave spaces in nursing ethics education: Courage through pedagogy. Nurs Ethics 2024; 31:101-113. [PMID: 37493023 PMCID: PMC10898193 DOI: 10.1177/09697330231183075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners. RESEARCH OBJECTIVE The aim of this research is to explore the influence of a structured self-assessment tool called the ESA "Engagement Self-Assessment" on the alignment and creation of a brave space in a nursing ethics course. RESEARCH DESIGN This study used an exploratory, cross-sectional survey design. PARTICIPANTS AND STUDY SETTING Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited. ETHICAL CONSIDERATIONS Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03). FINDINGS The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual "commitment to others." CONCLUSION A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space.
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Abstract
Art has limitless definitions, meanings, and modes for presentation. It is a pivotal cocreation designed to provoke and stir up artists' personal beliefs, values, and thinking. Art is uniquely received by those persons experiencing it in the moment. The author in this article illuminates the significance of the arts with the enduring ethical truths found in nursing paradigms and theoretical frameworks. The humanbecoming ethos is used to illustrate the importance of the arts in human living and its future implications for the advancement of the discipline of nursing.
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Becker RP. The Impact of Moral Distress on Staff and Novice Nurses. J Christ Nurs 2024; 41:50-56. [PMID: 38044517 DOI: 10.1097/cnj.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
ABSTRACT Moral distress is an interior affliction associated with exterior conflicts between one's values, obligations, and actions. This article builds understanding of moral distress among nurses and the importance of reducing its harmful impact, particularly to novice nurses. Moral distress is defined along with ethical issues and concepts related to moral distress, its current impact, coping with moral distress and building moral reserve, and the significance of acting according to one's conscience.
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Affiliation(s)
- Richard Philip Becker
- Richard P. Becker, DNP, RN, worked in religious education and parish ministry before obtaining his nursing degree. Rick currently serves on the nursing faculty at Saint Mary's College in Notre Dame, IN, sharing his nursing expertise in oncology and hospice homecare
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12
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Reimer-Kirkham S. Global Nursing Conversations on Pandemic Ethics. J Christ Nurs 2024; 41:12-13. [PMID: 38044511 DOI: 10.1097/cnj.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Sheryl Reimer-Kirkham
- Sheryl Reimer-Kirkham, PhD, RN, FCAN, is dean and professor of nursing at Trinity Western University, Langley, B.C., Canada. Her expertise centers on the intersection of religion, race, culture, and gender, with a particular focus on equity and health
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Lombart B. [Using restraint during treatment: Definitions, contexts and benchmarks]. Soins 2024; 69:10-15. [PMID: 38296413 DOI: 10.1016/j.soin.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
The clinical practice of nursing sometimes leads to physically restraining the patient while carrying out a therapeutic or diagnostic procedure. This laconic observation says little about the many questions raised by the use of restraint on a person during treatment. The questions are professional, institutional, philosophical, ethical, legal and deontological. The role of the nurse in the decision to use coercion to provide care is preponderant, and the moral dilemmas that this decision provokes are most often carried out individually by the professionals.
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Affiliation(s)
- Bénédicte Lombart
- Hôpital Saint-Antoine, AP-HP, GH Sorbonne université, 84 rue du Faubourg Saint-Antoine, 75012 Paris, France; Laboratoire interdisciplinaire d'études du politique Hannah-Arendt, UR 7373, Université Paris-Est Créteil, 61 avenue du Général-de-Gaulle 94010 Créteil cedex, France.
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Hagopian COP. From informed to empowered consent. Nurs Philos 2024; 25:e12475. [PMID: 38284806 DOI: 10.1111/nup.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/15/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024]
Abstract
Informed consent is ethically incomplete and should be redefined as empowered consent. This essay challenges theoretical assumptions of the value of informed consent in light of substantial evidence of its failure in clinical practice and questions the continued emphasis on autonomy as the primary ethical justification for the practice of consent in health care. Human dignity-rather than autonomy-is advanced from a nursing ethics perspective as a preferred justification for consent practices in health care. The adequacy of an ethic of obligation (namely, principlism) as the dominant theoretical lens for recognising and responding to persistent problems in consent practices is also reconsidered. A feminist empowerment framework is adopted as an alternative ethical theory to principlism and is advanced as a more practical and complete lens for examining the concept and context of consent in health care. To accomplish this, the three leading conceptions of informed consent are overviewed, followed by a feminist critique to reveal practical problems with each of them. The need for a language change from informed to empowered consent is strongly considered. Implications for consent activities in clinical practice are reviewed with focused discussion on the need for greater role clarity for all involved in consent-beyond and inclusive of the patient-physician dyad, as the practice and improvement of consent is necessarily a transdisciplinary endeavour. Specific concrete and practical recommendations for leveraging nursing expertise in this space are presented. Perhaps what is most needed in the discourse and practice of consent in health care is nursing.
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Affiliation(s)
- Chelsea O P Hagopian
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Morley G, Sankary LR. Re-examining the relationship between moral distress and moral agency in nursing. Nurs Philos 2024; 25:e12419. [PMID: 36748963 DOI: 10.1111/nup.12419] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/21/2022] [Accepted: 01/14/2023] [Indexed: 02/08/2023]
Abstract
In recent years, the phenomenon of moral distress has been critically examined-and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re-examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re-centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of 'narrow' moral distress and the value of re-considering moral distress. Finally, we provide an action-oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency.
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Affiliation(s)
- Georgina Morley
- Nursing Ethics Program, Center for Bioethics, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lauren R Sankary
- Neuroethics Program, Center for Bioethics, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Saito E, Kanzaki Y, Omote S, Murata K. [Characteristics of ethical dilemma and behavior in the support process of older adults and their families among nurses at a community general support center in Japan]. Nihon Koshu Eisei Zasshi 2023; 70:836-842. [PMID: 37673597 DOI: 10.11236/jph.22-130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Objectives This study was aimed at clarifying characteristics of ethical dilemmas and behaviors in the support process of older adults and their families among nurses at community general support centers.Methods A self-administered questionnaire survey was mailed to 449 nurses at community general support centers in Tokyo. Question items enquired their age, employment license, years of experience as a nurse, the presence of ethics-related organizations, number of cases in which nurses faced difficulties in supporting older adults and their families in decision making over the past year, the ethical dilemmas they experienced and their situations, and ethical behavior in the process of supporting older adults and their families.Results From the 143 responses (response rate: 31.8%), 135 (valid response rate: 30.1%) nurses were analyzed. Overall, 43.0% and 27.4% of the participants were in their 50s and 40s, respectively. Of these, 77.0% and 23.0% were nurses and public health nurses, respectively. In total, 52 (38.5%) respondents had an ethics-related organization. The average number of cases in which the respondents faced difficulties in supporting older adults and their families in decision making over the past year was 8.3 (standard deviation, 12.5). Of these, the average number of cases in which they faced difficulties in making ethical decisions was 4.1 (standard deviation, 6.0). Regarding the perception of ethical dilemmas, 113 (83.7%) answered "often" or "sometimes." Ethical dilemma situations included "the intentions of the user and family were different, and I had trouble deciding what to respect" 95 (84.1%); "the user's intention was different from my judgment as a professional, and I had trouble deciding what to respect" 64 (56.6%); and "the intention of the user and neighbors were different, and I had trouble deciding what to respect" 56 (49.6%). Ethical behaviors included "I observe the management rules in my organization regarding personal information data" 116 (85.9%); "I provide easy-to-understand explanations appropriate to the user's situation" 115 (85.2%); and "I decide on a support policy with several staff members when self-decision making is difficult due to the user's situation" 113 (83.7%).Conclusion More than 80% of the nurses perceived ethical dilemmas. Characteristics of the situations were that users and their families, users and professionals, and users and their neighbors had different intentions. Further research should be conducted on ethical issues related to community-based integrated care.
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Affiliation(s)
- Emiko Saito
- Graduate School of Human Health Sciences, Tokyo Metropolitan University
| | - Yuki Kanzaki
- Graduate School of Interdisciplinary Research, University of Yamanashi
| | | | - Kanako Murata
- School of Nursing and Rehabilitation Sciences, Showa University
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Oltra-Rodríguez E, González-López E, Osorio-Álvarez S, Rodríguez-Alonso A. The ethics of nursing care for transgender people. Rev Bras Enferm 2023; 76Suppl 3:e20220797. [PMID: 38055528 PMCID: PMC10695030 DOI: 10.1590/0034-7167-2022-0797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/26/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES to discuss ethical aspects in nursing care for transgender people. METHODS reflective study based on the dilemmas that emerges in nursing care for transgender people. The report was structured around the four bioethical principles. RESULTS health care for trans people is complex, transversal to many devices and specialties and longitudinal in time, that is why it requires coordinated action. There is an ethical framework in which the nursing care must be observed in the care of this group. FINAL CONSIDERATIONS the nurse as a health worker can assume several general lines in the care of transgender patients. So, complementary training should be provided not only to professionals, but also to students of nursing and other health sciences.
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Affiliation(s)
| | - Eva González-López
- Facultad de Enfermería de Gijón. Hospital de Cruz Roja de Gijón. Gijón, Asturias, Spain
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Chen J, Li F, Hu X, Yang P, He Y. A scoping review of the moral distress of military nurses in crisis military deployment. Nurs Ethics 2023; 30:922-938. [PMID: 37632155 DOI: 10.1177/09697330231189033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND "Crisis military deployment" was defined as a situation in which military personnel are suddenly ordered to duty to support an operation away from their home station and in a potentially dangerous environment. As a result of complex changes in the global political and economic landscape, military nurses are assuming an increasing number of crisis military deployment tasks. Moral distress has been widely studied among civilian nurses. However, little is known about the moral distress military nurses experience during military deployments in crisis. AIM This review discussed the current state of research on the phenomenon, unique factors, specific sources, and measurement tools. METHODS The scope of the study was defined using a framework developed by Arksey and O'Malley. Following English databases were searched: PubMed, CINAHL, Cochrane Library, Web of Science, and Embase, using MeSH terms and free word combinations; furthermore, Chinese databases: CNKI and CBMDisc, were explored using thematic terms from inception until January 20, 2023. Data were selected and defined by the inclusion and exclusion criteria and independently screened by two researchers. ETHICAL CONSIDERATIONS The scoping review adhered to sound scientific practice and respected authorship and reference sources. RESULTS Finally, 21 articles were included in the review. The moral distress of military nurses in crisis military deployments had unique and specific sources and reported positive aspects. The deployment environment and nature of the mission, responsibilities and obligations of military nurses, and the limited rights of patients were unique factors. Specific sources included third-party intervention, military triage, resource allocation, futile care, care of the enemy, and return to the battlefield. Military nurses in deployment reported positive aspects. They grow in their inner strength, build deep friendships and gain a greater sense of professional value. CONCLUSION It is important to understand the unique factors and specific sources of moral distress faced by military nurses in crisis military deployments and to identify the positive aspects. This research will help prepare military nurses for future deployments in advance by providing useful information to mitigate and eliminate moral distress.
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Affiliation(s)
- Juan Chen
- Hunan Normal University
- Chinese People's Liberation Army Joint Logistics Support Force
| | - Fan Li
- University of South China
| | | | - Pu Yang
- Chinese People's Liberation Army Joint Logistics Support Force
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Turan N, Çekiç Y. Ethics positions of nursing students in clinical decision-making. Nurs Ethics 2023; 30:1025-1037. [PMID: 37167964 DOI: 10.1177/09697330231161685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Ethics positions, consisting of the two fundamental dimensions of idealism and relativism, influence individuals' decision-making significantly. Particularly in an applied field such as nursing, the ethics positions of nurses can play a significant role in clinical decisions. Therefore, it is important to know the factors affecting the ethics positions of nurses in clinical decision-making. AIM The aim of the study is to examine the factors affecting the ethics positions of nursing students in clinical decision-making. RESEARCH DESIGN This is a two-phase sequential explanatory mixed methods study designed in accordance with the COREQ criteria. A participant Information Form and the Ethics Position Questionnaire were used to collect quantitative data. Qualitative data were obtained through focus group interviews. ETHICAL CONSIDERATIONS This study was conducted after receiving written permission from X University Ethics Board. Additionally, permission was obtained from the participating nursing faculty. PARTICIPANTS Among the fourth-year nursing students, 180 students participated in the quantitative phase and 30 students in the qualitative phase of the study. RESULTS The quantitative data analysis showed that the idealism sub-dimension mean scores of the participants were higher than the relativism sub-dimension mean scores. The analysis of the qualitative data resulted in four main themes that influence participants' ethics positions in clinical decision-making: (1) attitudes of role models in clinical practice (staff nurses/mentors/lecturers), (2) resources related to clinical practice (labs, hospitals/classrooms), (3) health system (hospital policies/school policies), and (4) personal differences (act with emotion/act with logic). CONCLUSION The results showed that the health system, role models in the clinic, personal differences, and skill-related resources affect the ethics positions of nursing students in clinical decision-making. In this regard, awareness can be raised by providing training to nursing students by academic instructors on ethics positions and the factors that are determined to affect ethics positions in clinical decision-making.
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Affiliation(s)
- Nazan Turan
- Elderly Care Pr, Vocational School of Health Services, Gazi University, Ankara, Turkey
| | - Yasemin Çekiç
- Faculty of Nursing, Psychiatric Nursing Department, Ankara University, Ankara, Turkey
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Hakimi H, Mousazadeh N, Sharif-Nia H, Nazari R, Dehghani M. The predictive factors of moral courage among hospital nurses. Philos Ethics Humanit Med 2023; 18:13. [PMID: 37848922 PMCID: PMC10583343 DOI: 10.1186/s13010-023-00141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/05/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Having moral courage is a crucial characteristic for nurses to handle ethical quandaries, stay true to their professional obligations towards patients, and uphold ethical principles. This concept can be influenced by various factors including personal, professional, organizational, and leadership considerations. The purpose of this study was to explore the predictors of moral courage among nurses working in hospitals. METHODS In 2018, an observational cross-sectional study was carried out on 267 nurses employed in six hospitals located in the northern region of Iran. The participants were selected through a simple random sampling technique. To collect data, a demographic information form was used along with two questionnaires. The first questionnaire was a standard survey on moral courage, while the second questionnaire was designed to assess the ethical climate. Linear regression was used to assess the predictors of moral courage. RESULTS Nurses had an average moral courage score of 87.07 ± 15.52 and an average moral climate score of 96.12 ± 17.17. The study showed that 16% of the variation in moral courage scores among nurses was explained by ethical climate and monthly overtime hours. CONCLUSION This study underscores the significance of establishing an ethical work environment and minimizing overtime hours in order to enhance moral courage among nurses. These findings carry weight for both nursing practice and organizational policies focused on fostering ethical conduct within healthcare settings.
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Affiliation(s)
- Hamideh Hakimi
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Noushin Mousazadeh
- Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran.
| | - Hamid Sharif-Nia
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roghieh Nazari
- Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran
| | - Maryam Dehghani
- Instructor of Pediatric Nursing, Department of Nursing, Zeyinab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Duarte ACDS, Chicharo SCR, da Silva TASM, de Oliveira AB. Ethical dilemmas and illicit acts in nursing: reflections on the legal (dis)order. Rev Bras Enferm 2023; 76Suppl 3:e20220558. [PMID: 37820187 PMCID: PMC10561415 DOI: 10.1590/0034-7167-2022-0558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/10/2023] [Indexed: 10/13/2023] Open
Abstract
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.
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Seidlein AH, Kuhn E. When nurses' vulnerability challenges their moral integrity: A discursive paper. J Adv Nurs 2023; 79:3727-3736. [PMID: 37232274 DOI: 10.1111/jan.15717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/16/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Both vulnerability and integrity represent action-guiding concepts in nursing practice. However, they are primarily discussed regarding patients-not nurses-and considered independently from rather than in relation to each other. AIM The aim of this paper is to characterize the moral dimension of nurses' vulnerability and integrity, specify the concepts' relationship in nurses' clinical practice and, ultimately, allow a more fine-grained understanding. DESIGN This discursive paper demonstrates how vulnerability and integrity relate to each other in nursing practice and carves out which types of vulnerability pose a threat to nurses' moral integrity. The concept of vulnerability developed by Mackenzie et al. (2014) is applied to the situation of nurses and expanded to include the concept of moral integrity according to Hardingham (2004). Four scenarios are used to demonstrate where and how nurses' vulnerabilities become particularly apparent in clinical practice. This leads to a cross-case discussion, in which the vulnerabilities identified are examined against the background of moral integrity and the relationship between the two concepts is determined in more detail. RESULTS AND CONCLUSION Vulnerability and integrity do not only form a conceptual pair but also represent complementary moral concepts. Their joint consideration has both a theoretical and practical added value. It is shown that only specific forms of vulnerability pose a threat to moral integrity and the vulnerability-integrity relationship is mediated via moral distress. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The manuscript provides guidance on how the concrete threat(s) to integrity can be buffered and moral resilience can be promoted. Different types of threats also weigh differently and require specific approaches to assess and handle them at the micro-, meso- and macro-level of the healthcare system.
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Affiliation(s)
- Anna-Henrikje Seidlein
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Eva Kuhn
- Section Global Health, Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
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Fithriyyah YN, Alda AK, Haryani H. Trends and ethical issues in nursing during disasters: A systematic review. Nurs Ethics 2023; 30:753-775. [PMID: 36974633 DOI: 10.1177/09697330231155602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND During a disaster, nurses face complex ethical challenges because of risky situations. It is necessary to identify trends and ethical issues of nurses in disasters to improve the quality of care and impact for nurses. METHOD This systematic review enrolled in the international registration with PROSPERO: CRD42022350765. We searched the following databases: PubMed, EBSCO MEDLINE, SCOPUS, ProQuest, ScienceDirect, and Sage Pub. The inclusion criteria were developed according to PICO and D; are Population (F): involving nurses; intervention/Exposure (I): disaster, Comparison (C): none; outcome (O): ethical practice. And Design (D): qualitative, quantitative, and mixed methods. Years of publication were 2012-2022, with full text in English. The quality of study assessment used was The Joanna Briggs Institute (JBI) Critical Appraisal tool and Mixed Methods Appraisal Tool (MMAT) version 2018. Analysis used PICO synthesis. RESULTS There were 15 studies reviewed from 2093 results, including cross-sectional (4/15, 26.6%), qualitative (9/15, 60%), and mixed methods (2/15, 13.3%) studies. The types of disasters were: COVID-19 (7/15, 46.6%), infectious (4/15, 26.6%), and all disaster events (4/15, 26.6%). The main themes were: (1) ethical issues in disasters have the potential to address ethical dilemmas, (2) factors applying nursing ethics to support ethical decision-making in disasters, (3) strategies for applying ethics and dealing with ethical issues in disasters, and (4) the impact of applying ethics in disasters. CONCLUSION Applying ethics nursing in a disaster is influenced by various factors. This framework for ethical nursing in disasters aims to help nurses, educational institutions, and policymakers develop schemes or scenarios to enhance responsible ethical decisions in disasters.
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O’Mathúna D. Ethics and frontline nursing during COVID-19: A qualitative analysis. Nurs Ethics 2023; 30:803-821. [PMID: 36971185 PMCID: PMC10051012 DOI: 10.1177/09697330221143150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. RESEARCH AIM To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic. RESEARCH DESIGN Qualitative analysis using a directed content methodology. PARTICIPANTS AND RESEARCH CONTEXT The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. ETHICAL CONSIDERATIONS Participant privacy and data confidentiality were addressed. FINDINGS Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. DISCUSSION This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. CONCLUSIONS Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available.
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Affiliation(s)
- Dónal O’Mathúna
- The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, OH, USA; Center for Bioethics and Medical Humanities, The Ohio State University, Columbus, OH, USA
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Napoleon B, Kuchenrither C. Debates as an Active Learning Strategy to Enhance Students' Knowledge of Ethics in Professional Nursing Practice and Health Care. Nurse Educ 2023; 48:E163-E167. [PMID: 37129973 DOI: 10.1097/nne.0000000000001429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Ethical debates as an active learning strategy encourage students to think critically through complex ethical issues while using evidence-based literature to compare views and support decision-making actions that affect patient outcomes. PROBLEM The current complexity of health care implies that nurses will continue to encounter ethical dilemmas that demand essential knowledge of ethical principles, critical thinking strategies, and practical communication skills. APPROACH Student groups were assigned a health care-related ethical issue and collaborated to present their pro or con position. The American Nurses Association (ANA) Code of Ethics and the American Association of Colleges of Nursing (AACN) Baccalaureate Essentials guided the structure of the student debates. CONCLUSION Utilizing the ANA Code and AACN Essentials as supportive frameworks to guide students' ethical debate preparation and execution enhanced students' knowledge and supported their critical thinking about ethical issues in health care.
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Affiliation(s)
- Betty Napoleon
- Chair and Associate Professor, Retired (Dr Napoleon), Baldwin Wallace University, Berea, Ohio; and Associate Professor (Dr Kuchenrither), Department of Nursing, Baldwin Wallace University, Berea, Ohio
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Sala Defilippis TML, Prati A, Scascighini L. Healthcare students' moral concerns and distress during the pandemic. Nurs Ethics 2023; 30:832-843. [PMID: 36989456 PMCID: PMC10064183 DOI: 10.1177/09697330221146227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND During the first wave of the new coronavirus (COVID-19) pandemic, the sudden increase in hospitalised patients put medical facilities in southern Switzerland under severe pressure. During this time, bachelor's degree programs in nursing, physiotherapy and occupational therapy were disrupted, and students in their second year were displaced. Students experienced the continuous reorganisation of their traineeship as healthcare facilities adapted to a climate of uncertainty. PURPOSE The aim of this study was to investigate the degree of moral distress and the ethical issues most often encountered by physiotherapy, nursing and occupational therapy students enrolled in a traineeship during the first wave of the COVID-19 pandemic in southern Switzerland. PARTICIPANTS AND RESEARCH CONTEXT The sample consisted of 102 participants, and the response rate was 81.6%. RESEARCH DESIGN Based on a pragmatic approach, a mixed-method with a convergent design was adopted. Data were collected between 30 April 2020 and 14 May 2020, via a survey administered to all occupational therapy, physiotherapy and nursing students in their fourth semester. ETHICAL CONSIDERATIONS Given that no vulnerable persons were involved, the Ethics Committee of Southern Switzerland waived authorisation. However, all measures were put into place to protect participants by guaranteeing their anonymity and confidentiality. RESULTS AND DISCUSSION The data analysis showed that the main source for moral distress was 'poor teamwork' and that the moral issues encountered most often by students were related to the appropriateness of care and working conditions, with a clear reference to students' own safety and that of their loved ones; the other concerns reported included the loss of learning opportunities and the perceived lack of technical knowledge and skills. CONCLUSIONS This survey offers a faithful overview of physiotherapy, nursing and occupational therapy students' experience during the first pandemic wave. This study also identifies some key recommendations for healthcare professions' education.
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Affiliation(s)
- Tiziana ML Sala Defilippis
- Department of Business Economics, Health and Social Care, University of Applied Sciences of Southern Switzerland, Manno, Switzerland
| | - Annia Prati
- Department of Business Economics, Health and Social Care, University of Applied Sciences of Southern Switzerland, Manno, Switzerland
| | - Luca Scascighini
- Department of Business Economics, Health and Social Care, University of Applied Sciences of Southern Switzerland, Manno, Switzerland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Khaghanizadeh M, Koohi A, Ebadi A, Vahedian-Azimi A. The effect and comparison of training in ethical decision-making through lectures and group discussions on moral reasoning, moral distress and moral sensitivity in nurses: a clinical randomized controlled trial. BMC Med Ethics 2023; 24:58. [PMID: 37542315 PMCID: PMC10403849 DOI: 10.1186/s12910-023-00938-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses' moral reasoning, moral distress and moral sensitivity. METHODS In this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. RESULTS Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238-15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171-2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15-5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043-12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454-16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015-0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015-0.547, P = 0.009). CONCLUSIONS The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. REGISTRATION This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016.
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Affiliation(s)
- Morteza Khaghanizadeh
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Aliakbar Koohi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Sheykh bahayi Street, Vanak Square Tehran, Tehran, P.O. Box 19575-174, Iran
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Morley G, Robinson EM, Wocial LD. Operationalizing the role of the nurse ethicist: More than a job. Nurs Ethics 2023; 30:688-700. [PMID: 37946392 DOI: 10.1177/09697330221147898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The idea of a role in nursing that includes expertise in ethics has been around for more than 30 years. Whether or not one subscribes to the idea that nursing ethics is separate and distinct from bioethics, nursing practice has much to contribute to the ethical practice of healthcare, and with the strong grounding in ethics and aspiration for social justice considerations in nursing, there is no wonder that the specific role of the nurse ethicist has emerged. Nurse ethicists, expert in nursing practice and the application of ethical theories and concepts, are well positioned to guide nurses through complex ethical challenges. However, there is limited discussion within the field regarding the specific job responsibilities that the nurse ethicist ought to have. The recent appearance of job postings with the title "nurse ethicist" suggest that some healthcare institutions have identified the value of a nurse in the practice of ethics and are actively recruiting. Discomfort about the possibility of others defining the role of the nurse ethicist inspired this paper (and special issue). If the nurse ethicist is to be seen as an integral part of addressing ethical dilemmas and ethical conflicts that arise in healthcare, then nurse ethicists ought to be at the forefront of defining this role. In this paper, we draw upon our own experiences as nurse ethicists in large academic healthcare systems to describe the essential elements that ought to be addressed in a job description for a nurse ethicist practicing in a clinical setting linked to academic programs. Drawing upon our experience and the literature, we describe how we perceive the nurse ethicist adds value to healthcare organizations and teams of professional ethicists.
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Affiliation(s)
- Georgina Morley
- Nurse Ethicist, Nursing Ethics Program, Center for Bioethics, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic, Cleveland, OH, USA
| | - Ellen M Robinson
- Nurse Ethicist and Nurse Scientist, Optimum Care (Ethics) Committee and Consultation Service, Patient Care Services, Massachusetts General Hospital, Boston, MA, USA
| | - Lucia D Wocial
- Senior Clinical Ethicist, John J. Lynch, MD Center for Ethics, MedStar Washington Hospital Center, Washington, DC, USA Senior Affiliate Faculty, Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, IN, USA
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Johnstone MJ. Nurse ethicists: Innovative resource or ideological aspiration? Nurs Ethics 2023; 30:680-687. [PMID: 37946394 DOI: 10.1177/09697330231191817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
In recent years, there have been growing calls for nurses to have a formal advanced practice role as nurse ethicists in hospital contexts. Initially proposed in the cultural context of the USA where nurse ethicists have long been recognised, the idea is being advocated in other judications outside of the USA such as the UK, Australia and elsewhere. Such calls are not without controversy, however. Underpinning this controversy are ongoing debates about the theoretical, methodological and political dimensions of clinical ethics support services generally, and more recently where nurses might 'fit' within such a service. In considering whether nurse ethicists ought to have a place in clinical ethics support services, a number of questions arise such as: Is such a role warranted? If so, what credentials should nurses assuming the title of 'nurse ethicist' be required to have? What standards of practice ought nurse ethicists be required to uphold? What is the ultimate role and function of nurse ethicists in hospital contexts? And in what contexts might a nurse ethicist be most useful? In this essay, brief attention will be given to addressing these questions. It will be concluded that, as a minimum, nurses wishing to assume an advanced nursing practice role as a nurse ethicist must have substantive grounding in the foundational knowledge of the disciplines of both moral philosophy and nursing ethics. They must also not lose sight of the ultimate goal of nursing ethics, notably, to promote and advance ethical nursing practice and the provision of 'good' nursing care.
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Barnum B. E-walks bring ethics to the bedside: A nurse ethicist's reflections. Nurs Ethics 2023; 30:720-729. [PMID: 37946386 DOI: 10.1177/09697330231160002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The unique role of the nurse ethicist in the clinical setting is one meant to enhance the ethical capacity of nurses, and front-line healthcare providers. As a nurse ethicist, it is also my goal to enhance the ethical climate of each individual work area, patient care unit, and the broader institution by encouraging ethical conversations, navigating ethical dilemmas, and seeking creative solutions to minimize moral distress and burnout. To provide preventive ethics support and education, I began regularly visiting patient care areas for ethics rounds, which I affectionately named "E-walks" (for Ethics Walks). I will discuss and reflect upon the lessons that have emerged as three key components of "E-Walks": Recognition, Solidarity and Dialogue. These themes will speak to the unique presence and availability of a nurse ethicist as a valuable resource to front-line healthcare providers who face ethical dilemmas and morally concerning cases. I will go on to argue and demonstrate that my role as the nurse ethicist lies at the intersection of bioethics and the theoretical framework of the "ethic of care," which is focused on building, creating, and sustaining caring interprofessional relationships through the work of ethics, nursing, and education.
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Affiliation(s)
- Brenda Barnum
- Center for Bioethics, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Pilkington B, Giuliante M. Nursing ethics as a distinct entity within bioethics: Implications for clinical ethics practice. Nurs Ethics 2023; 30:671-679. [PMID: 37946388 DOI: 10.1177/09697330231174535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The question of whether nursing ethics is a distinct entity within bioethics is an important and thought-provoking one. Though fundamental bioethical principles are appreciated and applied within the practice of nursing ethics, there exist distinct considerations which make nursing ethics a unique subfield of bioethics. In this article, we focus on the importance of relationships as a distinguishing feature of the foundation of nursing ethics, evidenced in its education, practice, and science. Next, we consider two objections to our claim of distinctiveness: first, that nursing ethics is merely an application of bioethical principles; second, that many bioethical subfields emphasize relationships. We respond by highlighting that throughout nursing education and generally in every career path that follows, the creation and nurturing of relationships is emphasized. Compassion and respect for the dignity of every patient is the framework upon which these therapeutic relationships are built. Much of the focus of nursing science rests on creating meaningful interpersonal experiences and human connection. After responding to each objection, we turn to the implications of this distinctiveness on clinical ethics practice, arguing that the strengths of our approach outweigh the limitations. The deep emphasis on creating meaningful interpersonal experiences and human connection supports a greater integration of relationships and social contexts into the evaluation of whether an action is ethically permissible, which is an important benefit in addressing the challenging human situations that patients face. Moreover, this perspective allows nurse ethicists to account for diverse and complex social structures and their influence in making ethical determinations. These strengths outweigh the limitations of potential inconsistencies between nurse and non-nurse clinical ethicists on the same service, a result we attribute to nursing ethics-and, in turn, the practice of the nurse ethicist-being framed by relationships to a larger extent than other bioethical subfields.
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Affiliation(s)
- Bryan Pilkington
- School of Health and Medical Sciences, College of Nursing, Seton Hall University, Nutley, NJ, USA; Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Maryanne Giuliante
- Ethics Department of Northwell Health, Memorial Sloan Kettering Cancer Centre Regional Network- Westchester, New York, NJ, USA
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Jones J, Ford PJ, Birchley G, Monteverde S. Perspectives on the role of the nurse ethicist. Nurs Ethics 2023; 30:652-658. [PMID: 37946393 DOI: 10.1177/09697330231189034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
This paper offers four contrasting perspectives on the role of the nurse ethicist from authors based in different areas of world, with different professional backgrounds and at different career stages. Each author raises questions about how to understand the role of the nurse ethicist. The first author reflects upon their career, the scope and purpose of their work, ultimately arguing that the distinction between 'nurse ethicist' and 'clinical ethicist' is largely irrelevant. The second author describes the impact and value that a nurse in an ethics role plays, highlighting the 'tacit knowledge' and 'lived experience' they bring to clinical ethics consultation. However, the second author also warns that the 'nurse ethicist' must be cautious in their approach to avoid being viewed as a resource only for nurses. The third author questions the introduction of additional professional distinctions such as 'nurse ethicist' on the basis that distinctions threaten the creation of egalitarian healthcare systems, while also acknowledging that clinical ethicists ought not strive for objective attachment in their work. In direct contrast, the final author suggests that the nurse ethicist can play a pivotal role in highlighting and addressing ethical challenges that are specific to nurses. These four short pieces raise questions and point to concepts that will be expanded upon and debated throughout this special issue of Nursing Ethics.
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Affiliation(s)
- Jenny Jones
- Retired, Metro South Health, Brisbane, QLD, Australia
| | - Paul J Ford
- Neuroethics Program, Cleveland Clinic, Cleveland, OH, USA
| | - Giles Birchley
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Settimio Monteverde
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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Schoville R, Ross T, Anderson C. The Courage to Teach Nursing Innovation: Innovation Education, Content, and Strategies. Nurse Educ 2023; 48:E137-E138. [PMID: 36730644 DOI: 10.1097/nne.0000000000001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Rhonda Schoville
- Assistant Clinical Professor, Director Health Innovation Impact Program, Director of Nursing Executive Fellow Academy (Dr Schoville), Adjunct Faculty Instructor (Ms Ross), and MSN Student (Mr Anderson), System, Population and Leadership Department, University of Michigan School of Nursing, Ann Arbor
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Abstract
Ethical issues are ubiquitous in nursing, yet there is a dearth of scholarship in normative ethics and ethical inquiry in nursing. In a concern to motivate interest in normative ethics and inquiry to build ethical knowledge, this article highlights some of the conceptual resources of normative ethics after describing the different types of ethics, including normative ethics. These conceptual resources of normative ethics include moral theories and the method of wide reflective equilibrium.
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Affiliation(s)
- Pamela G Reed
- Professor and Interim Associate Dean for Academic Affairs, College of Nursing, The University of Arizona, Tucson, AZ, USA
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Abbott J, Kerwin J, Holden C, Battin MP, Miller C, Pope TM. Hospice Nurse Ethics and Institutional Policies Toward Medical Aid in Dying. Am J Nurs 2023; 123:37-43. [PMID: 37233138 DOI: 10.1097/01.naj.0000938728.13124.c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
ABSTRACT A significant number of hospices in U.S. jurisdictions where medical aid in dying is legal have implemented policies that require nurses to leave the room when a patient ingests aid-in-dying medication. Two questions with ethical implications arise from these policies: (1) Is it ethically supportable for a hospice to require that staff leave the room while a patient ingests aid-in-dying medication? and (2) Does this requirement compromise the nurse's professional commitment to the patient and family?This article reviews the origins of this common policy, as well as nursing codes of ethics and professional organization policy statements as they relate to nursing commitments to patients. It finds that an institutional policy requiring nurses to leave the room while a patient ingests aid-in-dying medication risks violating professional nursing standards, reinforces stigma regarding medical aid in dying, and potentially abandons patients and loved ones at a critical time in their passage toward a desired and legal death. The authors describe a case that depicts these three potential risks, concluding that even if such policies are not legally prohibited by state aid-in-dying statutes, hospices should eliminate them or at least be transparent about the practice and its rationale before accepting patients who request medical aid in dying.
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Affiliation(s)
- Jean Abbott
- Jean Abbott is a professor emerita at the University of Colorado Anschutz Medical Campus in Aurora. Jeanne Kerwin is a consultant in bioethics and palliative care at Atlantic Health System, Morristown, NJ. Constance Holden is retired nursing director and current ethics consultation team and ethics committee member at Boulder Community Health, Boulder, CO. Margaret Pabst Battin is a medical ethicist and distinguished professor at the University of Utah in Salt Lake City. Charles Miller is a physician at Kaiser Permanente Hawaii. Thaddeus Mason Pope is a professor of law at Mitchell Hamline School of Law, St. Paul, MN. The authors acknowledge Thalia DeWolf, BSN, RN, CHPN, PHN, the hospice nurse who shared with us her patient dilemma and its consequences, triggering this ethical analysis. Contact author: Jean Abbott, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Schulz I, O'Neill J, Gillam P, Gillam L. The scope of ethical dilemmas in paediatric nursing: a survey of nurses from a tertiary paediatric centre in Australia. Nurs Ethics 2023; 30:526-541. [PMID: 36877536 DOI: 10.1177/09697330231153916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND No previous study has provided evidence for the scope and frequency of ethical dilemmas for paediatric nurses. It is essential to understand this to optimise patient care and tailor ethics support for nurses. RESEARCH AIM The aim of this study was to explore the scope of nurses' ethical dilemmas in a paediatric hospital and their engagement with the hospital clinical ethics service. RESEARCH DESIGN This study used a cross-sectional survey design. PARTICIPANTS AND RESEARCH CONTEXT Paediatric nursing staff in a tertiary paediatric centre in Australia completed an online survey asking about their exposure to a range of ethical dilemmas and their knowledge of the clinical ethics service. Analysis used descriptive and inferential statistics. ETHICAL CONSIDERATIONS Ethical approval was granted from the hospital research committee. The survey was anonymous, and no identifying details of participants were collected. RESULTS Paediatric nurses experienced a wide range of ethical dilemmas frequently, both in the intensive care and general areas. Knowledge and use of the clinical ethics service was poor and the most frequent challenge for nurses in managing dilemmas was feeling powerless. CONCLUSION There is a need to recognise the moral burden of ethical dilemmas for paediatric nurses in order to foster ethical sensitivity, and to provide adequate support to improve care and mitigate nursing moral distress.
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Affiliation(s)
- Ingrid Schulz
- The Victorian Paediatric Palliative Care Program, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Jenny O'Neill
- The Department of Nursing Research, The Royal Children's Hospital, Melbourne, VIC, Australia; Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; The Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter Gillam
- Department of Psychology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lynn Gillam
- The Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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Abstract
BACKGROUND Hospital ethical climate has important implications for clinical nurses' service behavior; however, the relationships are complicated by the fact that five types of ethical climate (caring, law and code, rules, instrumental, and independence) can be combined differently according to their level and shape differences. Recent developments in person-centered methods (e.g., latent profile analysis (LPA)) have helped to address these complexities. AIM From a person-centered perspective, this study explored the distinct profiles of hospital ethical climate and then examined the relationships of the profiles with clinical nurses' service behavior (both in-role and extra-role service behavior). RESEARCH DESIGN A quantitative study was conducted using cluster random sampling. Latent profile analysis and binary coded hexadecimal (BCH) analysis were conducted using Mplus 8.2. PARTICIPANTS AND RESEARCH CONTEXT A total of 871 clinical nurses in China were surveyed using the Ethical Climate Scale and Nurses' Service Behavior Questionnaire. ETHICAL CONSIDERATIONS Ethical approval was obtained from the IRB of the First Affiliated Hospital of Jinan University (No. KY-2020-090). RESULTS A four-profile hospital ethical climate model provided the best fit for the data. The four different profiles not only varied in level, but also in shape: high normative and low egoism (45.8%), high ethical climate (19.9%), low ethical climate (3.6%), and moderate ethical climate (30.8%). These profiles differentially predicted clinical nurses' overall, in-role, and extra-role service behaviors. CONCLUSIONS The results reveal new insights into the nature of hospital ethical climate and how different clinical nurses in these profiles can be best managed to accomplish different forms of service behavior.
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Affiliation(s)
- Na Zhang
- Beijing Information Science and Technology University, China
| | | | - Xing Bu
- University of Science and Technology Beijing, China
| | - Zhen Xu
- Hebei University of Engineering, China
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Abstract
BACKGROUND Moral courage is a recognized virtue. In the context of the COVID-19 pandemic, the master's students of nursing (MSNs) in China have shown tenacious moral courage. OBJECTIVE This study elaborates on the moral courage of Chinese MSNs through their experiences of volunteering during the pandemic. RESEARCH DESIGN Descriptive qualitative, interview-based. PARTICIPANTS AND RESEARCH CONTEXT Participants were nursing postgraduate students who participated in the prevention and control of the COVID-19 pandemic selected by purposeful sampling. The sample size was determined by data saturation, which was reached with 10 participants. Data were analyzed using a deductive method of content analysis. Because of the isolation policy, telephone interviews were adopted. ETHICAL CONSIDERATIONS After obtaining the approval of the ethical institution of the author's school (No. 138, 30 August 2021), verbal consent was obtained before the interview with the participants. All data were processed anonymously and confidentially. In addition, we recruited participants through MSNs' counselors, and obtained their phone numbers with their permission. RESULTS Data analysis resulted in 15 subcategories that were subsequently grouped into 3 major categories including proceed without hesitation, the outcome of practicing moral courage, and develop and maintain moral courage. CONCLUSION This qualitative study is based on the special background of the COVID-19 pandemic, and the MSNs in China have shown tenacious moral courage in the work of epidemic prevention and control. Five factors led them to take action without hesitation, and six possible outcomes followed. Lastly, this study provides some suggestions for nurses and nursing students to enhance their moral courage. To better develop and support moral courage in the future, it is necessary to use different methods and multidisciplinary approaches to study moral courage.
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Affiliation(s)
- Mingtao Huang
- School of Health Management, Fujian Medical University, China; Research Centre for Medical Humanities, Fujian Medical University, China
| | - Wenhong Dong
- School of Health Management, Fujian Medical University, China; Research Centre for Medical Humanities, Fujian Medical University, China
| | - Qianqian Zhao
- School of Health Management, Fujian Medical University, China; Research Centre for Medical Humanities, Fujian Medical University, China
| | - Nan Mo
- School of Marxism, Fujian Medical University, China; Research Centre for Medical Humanities, Fujian Medical University, China
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AH H. Nurses' ethical challenges when providing care in nursing homes during the COVID-19 pandemic. Nurs Ethics 2023; 30:32-45. [PMID: 36250534 PMCID: PMC9577762 DOI: 10.1177/09697330221105631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses' ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses' own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner.
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Affiliation(s)
- Hillestad AH
- Lovisenberg Diaconal University College, Oslo, Norway
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Chiafery M, Keady K. Nursing Ethics Liaison Program: A Pilot Study. J Clin Ethics 2023; 34:342-351. [PMID: 37991732 DOI: 10.1086/727436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
AbstractNursing is a profession rooted in ethics, yet nurses often find it difficult to navigate the ethical quandaries faced in clinical practice. The COVID-19 pandemic caused significant moral distress among staff. To support nurses and promote ethical reasoning, the Ethics Liaison Program for nursing was developed. The 36-hour program, run over nine months, proved to be highly effective in improving nurse work satisfaction, participant's confidence and knowledge about ethics and ethical reasoning, connectivity to the clinical ethics service, and patient care. This article describes program development, implementation, and evaluation.
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Mabel H, Myers G, Gorecki J, Davidson E, Hizlan S, Morley G. The Ethics Resource Caregiver Program: Equipping Nurses as Ethics Champions. J Clin Ethics 2023; 34:27-39. [PMID: 36940359 DOI: 10.1086/723320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
AbstractBackground: Nurses face ethical issues and experience moral distress in their everyday work. A nursing ethics champion program was developed at a hospital in the United States. METHODS As part of a quality improvement project, pre- and post-training surveys were developed to assess whether the program was feasible and sustainable, enhanced nurse confidence in recognizing and addressing ethical issues and moral distress, and increased nurse knowledge of institutional resources for addressing the same. Qualitative and quantitative analyses were performed. RESULTS Thirteen nurses from both the critical care and medical/surgical settings participated in the program. The program proved feasible. Attrition after the educational sessions raised concerns about sustainability. Survey results suggest an association between participating in the program's educational sessions and increased nurse confidence in recognizing and addressing ethical issues and moral distress, as well as identifying institutional resources that can assist nurses with the same. DISCUSSION Opportunities for future nursing ethics champion programs include increasing the interactivity and duration of educational sessions, making programs multidisciplinary, and creating materials for nurses to more easily share with colleagues. It would be valuable for future research to measure the impact of nursing ethics champion programs on nursing turnover. IMPLICATIONS A nursing ethics champion program has the potential to help nurses feel better equipped to navigate ethical issues and moral distress in their everyday work.
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Petrovic K, Perry B, Walsh P. Aligning Nursing Ethics With Critical and Open Pedagogy in Nursing Education: A Literature Review. Nurse Educ 2023; 48:E1-E5. [PMID: 35900936 DOI: 10.1097/nne.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is a need to increase access to nursing education that is meaningful and socially just. PURPOSE To investigate the alignment of critical and open pedagogy in nursing education with nursing principles of ethics. METHOD Narrative thematic synthesis literature review of Canadian and American sources related to nursing education. RESULTS Thematic analysis of 29 full-text sources that align nursing ethical principles with critical and open pedagogy in nursing education. CONCLUSION Critical and open pedagogy aligns with nursing practice ethics and facilitates meaningful and socially just nursing education experiences.
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Affiliation(s)
- Kristin Petrovic
- Academic Coordinator (Ms Petrovic) and Professor (Dr Perry), Faculty of Health Disciplines, and Associate Professor, Distance Education (Dr Walsh), Faculty of Humanities and Social Sciences, Athabasca University, Athabasca, Alberta, Canada
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Thompson SM. Health information technology: Ethical concerns in nursing practice and research. Nursing 2022; 52:40-43. [PMID: 36394624 DOI: 10.1097/01.nurse.0000892660.27816.d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Health information technology (HIT) has become essential for nursing practice. However, the lack of digital literacy leaves some nurses unaware of serious ethical issues that may occur when using it. This article describes the ethical issues that arise with the use of HIT in everyday nursing practice as well as in research activities, and outlines options for mitigation.
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Affiliation(s)
- Sondatre M Thompson
- Sondatre Thompson is a student at the Nelda C. Stark College of Nursing at Texas Woman's University
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Lee B, Oh Y, Lee E, Nam KA. Validation of the Korean Version of Nurses' Moral Courage Scale. Int J Environ Res Public Health 2022; 19:11642. [PMID: 36141912 PMCID: PMC9516964 DOI: 10.3390/ijerph191811642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Research that examines moral courage has received a great deal of attention from scholars and practitioners in recent years due to the impact of moral distress experienced by nurses. Although it needs to identify the phenomenon related to moral courage among nurses, there has been a lack of instrumentation to investigate the quantitative aspects of moral courage among Korean nurses. This study aimed to test the validity of the Korean version of the Nurses' Moral Courage Scale. (2) Methods: A cross-sectional study was conducted through convenience sampling of 243 nurses from two general hospitals in South Korea. (3) Results: The Korean version of the Nurses' Moral Courage Scale was developed from construct validity evidence, including 12 items in four domains: 'Compassion and true presence', 'Moral integrity', 'Moral responsibility', and 'Commitment to good care'. Concurrent validity was obtained according to the significant correlation coefficients among the variables: moral courage, moral sensitivity, and professional moral courage. (4) Discussion: Our research contributes to the knowledge and understanding of moral courage in the nursing context and encourages future researchers to conduct a quantitative analysis of moral courage among Korean nurses using the validated K-NMCS.
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Affiliation(s)
- Boram Lee
- Graduate School of Health Science, Hallym University, Hallymdaehakgil 1, Chuncheon 24252, Gangwon-do, Korea
- Seoul North Municipal Hospital, 38, Yangwonyeok-ro, Jungnang-gu, Seoul 02062, Korea
| | - Younjae Oh
- College of Nursing, Research Institute of Nursing Science, Hallym University, Hallymdaehakgil 1, Chuncheon 24252, Gangwon-do, Korea
| | - Eunhee Lee
- College of Nursing, Research Institute of Nursing Science, Hallym University, Hallymdaehakgil 1, Chuncheon 24252, Gangwon-do, Korea
| | - Kyoung A Nam
- College of Nursing, Research Institute of Nursing Science, Hallym University, Hallymdaehakgil 1, Chuncheon 24252, Gangwon-do, Korea
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Okumoto A, Yoneyama S, Miyata C, Kinoshita A. The relationship between hospital ethical climate and continuing education in nursing ethics. PLoS One 2022; 17:e0269034. [PMID: 35862376 PMCID: PMC9302802 DOI: 10.1371/journal.pone.0269034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background In recent years, there has been a growing interest in the importance of creating a healthy ethical climate. Although relationship with various factors and the ethical climate have been reported, understanding of the relationship between ethical education and ethical climate is limited. Aim This study aims to investigate the relationship between ethical climate, personal characteristics, and continuing education for ethics. Methods This study conducted a quantitative cross-sectional survey of 605 nurses in 3 teaching hospitals in Japan. Multiple-regression analysis was used to assess the relationship between ethical climate and demographic characteristics and continuing education. Further mean of ethical climate scores were compared between received continuing education and did not, using analysis of covariance adjusted for demographic variables. Findings The ethical climate showed significant association with hospital, gender, specialty of the unit, experience of ethics education, in-service ethical training, and workshops/ academic conferences on nursing ethics. In multiple-regression analysis, attending in-service ethical training increased the mean of ethical climate score (p = 0.031) and workshops/ academic conferences decreased the mean score (p = 0.028). Adjusted-mean of ethical climate score of nurses who had in-service training was significantly higher than those who had not (p = 0.038), whereas adjusted-mean of it of nurses who had attended workshops/ academic conferences was significant lower (p = 0.033). Discussion In-service training on ethics was associated with the positive ethical climate. Hospital should enhance ethical education. Conclusion Ethical climate related to the nurses’ personal characteristics and continuing education. We propose that organizational support for ethical education may be effective in raising the ethical climate of the workplace.
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Affiliation(s)
- Ayaka Okumoto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
| | - Satoko Yoneyama
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Chiharu Miyata
- Course of nursing science, Mie University Graduate School of Medicine, Mie, Japan
| | - Ayae Kinoshita
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Dockery TH. Bridging the Racial Divide: Nurses Leading by Christ's Example. J Christ Nurs 2022; 39:162-165. [PMID: 35665421 DOI: 10.1097/cnj.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Recent civil unrest has proven that positive role models are essential to help bridge the nation's racial divide. Nurses are primed to be among these role models as trusted and respected healthcare professionals. Nursing's code of ethics defines nurses' moral obligations to respect all people and advocate for justice. Christian nurses face a higher calling: to love one's neighbors as themselves. This article explores the application of a Christian worldview of Fawcett's metaparadigm of nursing as a foundation for nurses to extend the love of Christ and promote racial healing.
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Affiliation(s)
- Tajuane H Dockery
- Tajuane H. Dockery, DNP, RN-BC, is a recent graduate of Liberty University. She has worked in the healthcare industry for more than 25 years. She lives in Columbia, SC, and attends the Meeting Place Church of Greater Columbia
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48
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Fowler MD. Watching Nursing Ethics: Helping Clarice to Stand. J Christ Nurs 2022; 39:144-145. [PMID: 35665417 DOI: 10.1097/cnj.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Marsha D Fowler
- Marsha D. Fowler, PhD, MDiv, MS, RN, FAAN, FRSA , is Professor of Ethics and Spirituality, Azusa Pacific University, Azusa, CA. She is past-chair of the ANA Ethics Committee and member of the expert panel on ethics, American Academy of Nursing. Dr. Fowler served as Historian and Code Scholar, and co-lead writer for the revision of the ANA Code of Ethics with Interpretive Statements , 2015. She authored Guide to the Code of Ethics: Development, Interpretation, and Application (ANA, 2015), and edited Religion, Religious Ethics and Nursing (Springer)
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Rushton CH, Nelson KE, Antonsdottir I, Hanson GC, Boyce D. Perceived organizational effectiveness, moral injury, and moral resilience among nurses during the COVID-19 pandemic: Secondary analysis. Nurs Manag (Harrow) 2022; 53:12-22. [PMID: 35776417 PMCID: PMC9245532 DOI: 10.1097/01.numa.0000834524.01865.cc] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It's crucial to understand the perspective of nurses during the pandemic to determine actionable steps for moving forward. This analysis looks at nurses' perceptions of their organizations' effectiveness during the first surge of the COVID-19 pandemic and its impact on moral injury and moral resilience.
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Affiliation(s)
- Cynda Hylton Rushton
- At Johns Hopkins University in Baltimore, Md., Cynda Hylton Rushton is the Anne and George L. Bunting Professor of Clinical Ethics, Nursing and Medicine at the Berman Institute of Bioethics & School of Nursing; Katie Nelson is a PhD candidate; Inga Antonsdottir is the program coordinator for the COVID Dementia Caregivers Supplement Project, and a graduate research assistant/coordinator for the Memory and Aging Services Innovation (MASI) Center in the Department of Psychiatry & Behavioral Sciences; Ginger C. Hanson is an assistant professor, and Danielle Boyce is an assistant professor, neurology
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Dennis V. The Challenges of Ethical Decision Making in Nursing. AORN J 2022; 116:1-2. [PMID: 35758743 DOI: 10.1002/aorn.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 11/07/2022]
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