An exploration of managing emotional labour and maintaining professional integrity in children's hospice nursing

BACKGROUND

Research exploring nurse-parent relationships in children's hospices is rare.

AIM

To investigate how children's hospice nurses manage emotional labour and professional integrity in their long-term relationships with parents.

METHODS

A purposive sample of six children's nurses, from hospices across England, recorded audio diaries and participated in telephone interviews. Narratives were thematically analysed.

FINDINGS

Three overarching, cross-cutting themes were identified-purposeful positioning; balancing personability and professionalism; coping with and counterbalancing emotional labour. All themes were indicative of and/or built upon emotional intelligence constructs, such as self-awareness, self-regulation, appropriate (managed) empathy, social skills and intrinsic motivation. Innate features of children's hospice work were important for perpetuating intrinsic motivation and satisfaction.

CONCLUSION

This study provided an insight into the management of emotional labour and professional integrity by experienced children's hospice nurses. The identification of emotional intelligence skills merits further exploration in this environment, as well as other children's palliative care settings.

Moral Stress and Moral Distress: Confronting Challenges in Healthcare Systems under Pressure

Stresses on healthcare systems and moral distress among clinicians are urgent, intertwined bioethical problems in contemporary healthcare. Yet conceptualizations of moral distress in bioethical inquiry often overlook a range of routine threats to professional integrity in healthcare work. Using examples from our research on frontline physicians working during the COVID-19 pandemic, this article clarifies conceptual distinctions between moral distress, moral injury, and moral stress and illustrates how these concepts operate together in healthcare work. Drawing from the philosophy of healthcare, we explain how moral stress results from the normal operations of overstressed systems; unlike moral distress and moral injury, it may not involve a sense of powerlessness concerning patient care. The analysis of moral stress directs attention beyond the individual, to stress-generating systemic factors. We conclude by reflecting on how and why this conceptual clarity matters for improving clinicians' professional wellbeing, and offer preliminary pathways for intervention.

Professional integrity in maternal - fetal innovation and research: an essential component of perinatal medicine

OBJECTIVES

Clinical innovation and research on maternal-fetal interventions have become an essential for the development of perinatal medicine. In this paper, we present an ethical argument that the professional virtue of integrity should guide perinatal investigators.

METHODS

We present an historical account of the professional virtue of integrity and the key distinction that this account requires between intellectual integrity and moral integrity.

RESULTS

We identify implications of both intellectual and moral integrity for innovation, research, prospective oversight, the role of equipoise in randomized clinical trials, and organizational leadership to ensure that perinatal innovation and research are conducted with professional integrity.

CONCLUSIONS

Perinatal investigators and those charged with prospective oversight should be guided by the professional virtue of integrity. Leaders in perinatal medicine should create and sustain an organizational culture of professional integrity in fetal centers, where perinatal innovation and research should be conducted.

How should we foster the professional integrity of engineers in Japan? A pride-based approach

I discuss the predicament that engineering-ethics education in Japan now faces and propose a solution to this. The predicament is professional motivation, i.e., the problem of how to motivate engineering students to maintain their professional integrity. The special professional responsibilities of engineers are often explained either as an implicit social contract between the profession and society (the "social-contract" view), or as requirements for membership in the profession (the "membership-requirement" view). However, there are empirical data that suggest that such views will not do in Japan, and this is the predicament that confronts us. In this country, the profession of engineering did not exist 10 years ago and is still quite underdeveloped. Engineers in this country do not have privileges, high income, or high social status. Under such conditions, neither the social-contract view nor the membership-requirement view is convincing. As an alternative approach that might work in Japan, I propose a pride-based view. The notion of pride has been analyzed in the virtue-ethics literature, but the full potential of this notion has not been explored. Unlike other kinds of pride, professional pride can directly benefit the general public by motivating engineers to do excellent work even without social rewards, since being proud of themselves is already a reward. My proposal is to foster a particular kind of professional pride associated with the importance of professional services in society, as the motivational basis for professional integrity. There is evidence to suggest that this model works.