Introduction The act of caring in nursing requires previous deliberation and decision, however this perception only arises when an ethical problem emerges. Objective: Identify ethical problems of nurses action in the area of beginning of human life Method: Exploratory and descriptive method, with a qualitative approach. Semi-structured interviews were used to collect data, who were submitted to content analysis. The sample was constituted by 26 nurses. Results 18 categories of problem areas and 56 ethical problems in early human (...) life were identified. The results obtained are very diverse, including areas such as termination of pregnancy, informed consent or maintaining privacy. However, other problem areas also emerge and numerous new subcategories/ethical problems, including: dealing with miscarriage, extreme situations, minors’ pregnancy, serious malformations detected at birth, consent regarding care during childbirth, Non- identification of a ethical problem, nurse social recognition and non-involvement of the person in labour. Conclusion Nurses face different ethical problems that impact their lives. We intend to contribute in helping to make decisions in this field, which the outset is of hope and joy, but which hides, behind this evidence, countless situations of suffering for everyone involved. The identification of ethical problems in this field, it is the first step to reflect about theme and helping decision-making for nurses that are taking care in this area of beginning of human life, when confronted whit the same type of ethical problems. (shrink)

Having a decreased sense of security leads to unnecessary suffering and distress for patients. Establishing trust is critical for nurses to promote a patient's sense of security, consistent with trauma‐informed care. Research regarding nursing action, trust, and sense of security is wide‐ranging but fragmented. We used theory synthesis to organize the disparate existing knowledge into a testable middle‐range theory encompassing these concepts in hospitals. The resulting model illustrates how individuals are admitted to the hospital with some predisposition to (...) trust or mistrust the healthcare system and/or personnel. Patients encounter circumstances increasing their emotional and/or physical vulnerability to harm, leading to experiences of fear and anxiety. Without intervention, fear and anxiety lead to a decreased sense of security, increased distress, and suffering. Nurse action can ameliorate these effects by increasing a hospitalized person's sense of security or by promoting the development of interpersonal trust, also leading to an increased sense of security. Increased sense of security results in diminished anxiety and fear, and increased hopefulness, confidence, calm, sense of value, and sense of control. The consequences of a decreased sense of security are harmful to patients and nurses should know that they can intervene in ways that both increase interpersonal trust and sense of security. (shrink)

Social inclusion/exclusion involves just/unjust social relations and social structures enabling or constraining opportunities for participation and health. In this paper, social inclusion/exclusion is explored as a dialectic. Three discourses – discourses on recognition, capabilities, and equality and citizenship – are identified within Canadian literature. Each discourse highlights a different view of the injustices leading to social exclusion and the conditions supporting inclusion and social justice. An Integrated Framework for Social Justice that incorporates the three discourses is developed and used to (...) critique the dominant focus on distributive justice within foundational Canadian nursing documents. We propose a broader conceptualization of social (in)justice that includes both relational and structural dimensions. Opportunities for multilevel interventions to promote social justice are identified. This framework is congruent with nursing's moral imperative to promote health equity and with the multiple roles played by nurses to promote social justice in everyday practice. (shrink)

Care as a concept has long been central to the nursing discipline, and care ethics have consequently found their place in nursing ethics discussions. This paper briefly revisits how care and care ethics have been theorized and applied in the discipline of nursing, with an emphasis on Tronto’s political view of care. Adding to the works of other nurse scholars, we consider that Tronto’s care ethics is useful to understand caring practices in a sociopolitical context. We also (...) contend that this vision can be used specifically to politicize nurses, by encouraging them to think critically about the context in which they work and how they can participate to change the status quo, notably by prompting the democratization of care in institutional settings. We illustrate this by demonstrating how moral distress that can occur with aggressive or futile treatments in the intensive care unit can be reduced if nurses are systematically included in the decision-making process. By showing some ways in which nursing political actions can begin to change the status quo as it pertains to futile treatments at the end of life, we can help empower nurses to strive to be included in political spaces and voice their concerns to have their professional needs met. (shrink)

Several important ethical dilemmas emerge when nurses join a public-sector strike. Such industrial action is commonplace in South Africa and was most notably illustrated by a national wage negotiation in 2010. Media coverage of the proceedings suggested unethical behaviour on the part of nurses, and further exploration is merited. Laws, policies and provisional codes are meant to guide nurses’ behaviour during industrial action, while ethical theories can be used to further illuminate the role of nurses in industrial (...) class='Hi'>action. There are, however, important aspects to consider before judging whether nurses act unethically when striking. Following Loewy’s suggestion that the nature of the work, the proceeding commitment of the nurse to the patient, the prevailing situation when the strike is planned and the person(s) who stand(s) to benefit from the strike be considered, coupled with a consideration of the South African historical socio-political context, important aspects of the ethics of nurses’ behaviour in industrial action transpire. (shrink)

Although the need to theorize ethics within the complexities of nursing practice has been identified within the nursing literature, to date the link between ethics epistemology and specific nursing actions has received limited attention. In particular, little exploration has been carried out to examine how nurses ‘know’ what is ethical and the knowledge they draw upon to inform their nursing actions within the complexities of their everyday practice. This study describes a participatory inquiry project that focused (...) on developing and articulating an epistemology of ethics while in the midst of everyday nursing work. Epistemological and methodological insights are discussed in light of the challenges nurses face in contemporary healthcare contexts. (shrink)

We bear witness to a sweeping social movement for change—fostered and driven by a powerful group of Black nurses and nursing students determined to call out and dismantle anti‐Black racism and discrimination within the profession of nursing. The Black Nurses Task Force, launched by the Registered Nurses' Association of Ontario (RNAO) in July 2020, is building momentum for long‐standing change in the profession by critically examining the racist and discriminatory history of nursing, listening to and learning from (...) the lived experiences of the Black nursing community, and shaping concrete, actionable steps to confront anti‐Black racism and discrimination in academic settings, workplaces, and nursing organizations. The Black Nurses Task Force and the RNAO are standing up and speaking out in acknowledgment of the magnitude of anti‐Black racism and discrimination that exist in our profession, health system, justice system, and economic system. This social movement is demonstrating, in actions, how individuals and a collective act as change agents to drive meaningful and widespread change for our present and future Black nurses. We also acknowledge the Black nurses who have gone before us. (shrink)

Based on action research as a practitioner‐involving approach, this article communicates the findings of a two‐year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to (...) the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice‐oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride. (shrink)

Few qualitative studies explore the phenomenon of positive ethical climate and what actions are perceived as promoting it. Therefore, the aim of this study was to explore and describe actions that acute care ward nurses perceive as promoting a positive ethical climate. The critical incident technique was used. Interviews were conducted with 20 nurses at wards where the ethical climate was considered positive, according to a previous study. Meeting the needs of patients and next of kin in a considerate way, (...) as well as receiving and giving support and information within the work group, promoted a positive ethical climate. Likewise, working as a team with a standard for behaviour within the work group promoted a positive ethical climate. Future research should investigate other conditions that might also promote a positive ethical climate. (shrink)

This paper provides an analysis of nursing as a knowledgeable discipline. We examined ways in which knowledge operates in the practice of home care nursing and explored how knowledge might be fruitfully understood within the ambiguous spaces and competing temporalities characterizing contemporary healthcare services. Two popular metaphors of knowledge in nursing practice were identified and critically examined; evidence-based practice and the nurse as an intuitive worker. Pointing to faults in these conceptualizations, we suggest a different way of (...) conceptualizing the relationship between knowledge and practice, namely practice as being activated by contextualized knowledge. This conceptualization is captured in an understanding of the intelligent creation of context by the nurse for nursing practice to be ethical and effective. (shrink)

Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and (...) distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change. (shrink)

Those who want to know anything about strike action by Italian nurses will find very little written about it. This contribution intends to show that, whatever they are prepared to admit, Italian nurses are not used to strike action because they mostly think of their profession as a form of mission. Even if we could agree with the idea of nursing as a profession subscribing to an ideal of service, we have to distinguish between a real profession (...) and philanthropic work; vocational motivation is not enough to make a good professional. Historically, nurses perceived strikes as contradictory to human need and action; patients must never be left alone. However, Italian nurses are now interested in a dramatic transformation of many aspects of their professional life, becoming conscious of the duty to protect themselves from every kind of exploitation, even if the typical idealism and dedication of nurses makes them vulnerable. (shrink)

There is tension in the US healthcare system due to conflicting goals of maximizing the public's health and at the same time ensuring shareholder profit among the many private organizations that provide care to those in need. As a result, nurses (often the frontline workers in this mixed public/private and economized system) may experience dissonance between their professional values and the capitalistic values embodied in the healthcare system. Beyond the workplace, nurses are also committed to championing health and wellness, to (...) advocating for social justice, and driving health policy. Yet, constrained by the conflicts between neoliberal values in an economized system and the values of care that inspire many to join the healthcare profession, nurses may lose the ability to live up to their moral ideals, to champion social justice, and to improve public health outcomes. In this paper, we use the critical theory of Juergen Habermas to explore these tensions and to suggest a path forward for nurses. We suggest that by engaging in dialog with each other and the public, and working for greater inclusivity, nurses can find ways to deconstruct ideologies inherent in our current healthcare system, to consider alternatives, and liberate healthcare from the dominance of market forces. (shrink)

Background Recently, palliative care is increasingly important, with an emphasis on the process of dying with dignity. However, nurses who care for such patients experience the associated ethical dilemmas. Objective To explore the meaning of nurses’ experiences in dealing with ethical dilemmas in relation to palliative sedation. Research design A qualitative research design was employed with a thematic analysis approach. Participants and research context Using purposive sampling, 15 nurses, working at palliative care units for at least 1 year, were recruited (...) as participants. Data were collected using unstructured in-depth interviews, and data collection and analysis was performed simultaneously. Ethical considerations Ethical approval was obtained from the authors’ institutional review board. All participants provided informed consent. For the face-to-face interview, the South Korean standard COVID-19 quarantine guidelines, such as mandatory masking and social distancing, were followed. Results Dilemmas raised by patients, were related to concerns about appropriate drug dose; dilemmas raised by nurses, were related to passive care, sense of guilt for failure to predict death, and colleague’s disrespectful attitudes toward patients; dilemmas from patients’ families were related to demands for palliative sedation and reversal of those demands. Care actions to deal with ethical dilemmas comprised evidence-based care, person-centered thinking, reflecting on the death situation, compassion, providing explanation and help to family members. Conclusion Nurses’ ethical dilemmas were pre-dominantly influenced by themselves, rather than by the patients or their families, especially if they felt they could not do their best for patients. The core concept of care actions to deal with the ethical dilemmas, was person-centered care and compassion. Then, how patients and their family members perceive person-centered care and compassion, should be further explored to improve palliative sedation. (shrink)

Despite the burgeoning of publications in nursing ethics, only more recently has empirical evidence on nursing ethics been published. How nursing ethics can be empirically studied as well as enriched by empirical data will be the focus of this paper. Two empirical studies will be briefly presented and their contribution to ethics discussed. The first one is a quantitative research project about nurses' ethical behavior in daily practice. Using an adapted version of Kohlberg's theory of moral development, (...) this study tried to describe and explore nurses' responses to ethical dilemmas in daily nursing practice. The second study attempted to describe the specificity of residential palliative care. A qualitative approach was used to explore and describe the processes that take place on an inpatient palliative care unit, and the experiences of patients, relatives and palliative care team members. The analysis of the value of both research projects for ethics underlines the power of empirical understanding in the relationship between research and ethics. The need for integration of both qualitative and quantitative research methodologies is argued. (shrink)

Transformative ‘cultural shifts’ in nursing: participatory action research and the lsquo;project of possibility’For some time scholars have called for changes in nursing in order to address the subjugated position of nurses within health care. This paper argues that through an engagement with participatory action research, nurses open up a possibility to bring about transformative shifts in nursing culture. The motivation for nurses to engage with this research process arises out of an acknowledgement that they can (...) no longer live with the sense of pain and crisis endemic in much of their nursing practice, and a desire to take action to bring about transformative change within their local ward cultures. However, their participation in critical reflective and collaborative processes that underpin action research exposes an array of minor scattered nursing practices which frustrate possibilities for transformative change. Drawing on empirical accounts from research conducted by the author, the paper argues that once made explicit, these minor practices and the regimes of truth that nurture and sustain them, can be reconstructed and the possibility of transformative cultural shifts in nursing will then emerge. (shrink)

Se realizó una investigación en sistemas y servicios de salud de tipo descriptiva transversal, con el objetivo de elaborar un sistema de acciones de capacitación para el profesional de la enfermería comunitaria en la prevención del embarazo en la adolescencia. Se aplicaron métodos teóricos y empíricos propios de la investigación científica. El universo lo constituyeron 20 profesionales de enfermería que laboran en consultorios del Área Salud "Tula Aguilera". La muestra quedó conformada por los 12 profesionales que aceptaron participar en el (...) estudio. El criterio de exclusión fue la libre decisión de cada individuo para participar o retirarse de la investigación. Se aplicó una encuesta estandarizada, previo consentimiento informado, para determinar el nivel de conocimientos sobre salud reproductiva en la adolescencia. Los resultados constatados reflejaron que la mayoría de los encuestados tenían criterios estrechos, no fundamentados científicamente ni actualizados sobre el tema, por lo que se diseñó un sistema de acciones de capacitación basado en conocimientos científicos actualizados, pertinentes y contextualizados. Cada actividad se propuso demostrar la factibilidad e importancia de utilizar técnicas participativas y la fundamentación de las ventajas de su uso en diferentes actividades comunitarias, encaminadas a enfatizar en la organización, movilización, concientización y capacitación a los diferentes sujetos sociales involucrados en la prevención del embarazo en la adolescencia, para que estos se conviertan en transformadores de su propia realidad, en correspondencia con sus necesidades y demandas sociales. A descriptive transversal study was carried out on health systems and services aiming at designing a system of training actions for the community professional nurses in order to prevent pregnancy in adolescence. Theorical and empirical methods were applied. The universe was made up of twenty professionals who consented to participate in the study. The inclusion criterion was the free decision of each individual on either participating or not in the investigation. A standard survey was applied -with a previous informed consent , to determine the knowledge about reproductive health in adolescence. The results revealed that most of the surveyed people had narrow criteria with no updated scientific grounds on the issue, thus a system of training actions based on updated scientific pertinent contextualized information was designed Each activity aimed at demonstrating the feasibility study of using participative techniques as well as the reasons for the advantages of their use in a variety of community activities to emphasize the organization and understanding of the different social subjects involved in the prevention of pregnancy in adolescence. (shrink)

Ethical problems regularly arise during daily care in nursing homes. These include violation of patients' right to autonomy and to be treated with respect. The aim of this study was to investigate how caregivers emphasize daily dialogue and mutual reflection to reach moral alternatives in daily care. The data were collected by participant observation and interviews with seven caregivers in a Norwegian nursing home. A number of ethical problems linked to 10 patients were disclosed. Moral problems were revealed (...) as the caregivers acted in ways that they knew were against patients' interest. We used a theoretical interpretation according to Habermas' discourse ethics on the importance of dialogue when deciding moral courses of action for patients. This theory has four basic requirements: communicative competence, equality, self-determination, and openness about motives. (shrink)

This provocative book paved the way for nursing research informed by f eminist scholarship, critical theory, and post-modern thought. Controv ersial then, relevant today.

Obesity is now commonly recognised to be a significant public health issue worldwide with its increasing prevalence frequently described as a global epidemic. In the United Kingdom, primary care nurses are responsible for weight management through the provision of healthy eating advice and support with lifestyle change. However, nurses themselves are not immune to the persistent and pervasive global levels of weight gain. Drawing on a Gadamerian informed phenomenological study of female primary care nurses in England, this paper considers the (...) complex gendered understandings and experiences of being overweight, and of food and eating. The nurses’ emotional and injurious experiences of being large is found to be capable of producing embodied caring practices, involving a fusion of horizons with patients over how it feels to inhabit a large body. Yet, even though subjected to similar derogatory stereotypes as patients, they simultaneously reinforce the dominant and damaging individualising psychopathology inherent to anti‐obesity discourses. This suggests an urgent need to expose and challenge harmful discourses surrounding women’s body size and weight in order to avoid nursing practices that unthinkingly reproduce culturally dominant and gendered understandings of weight, body size, food and eating. (shrink)

Se realizó una intervención comunitaria en el asentamiento rural "El León" de Camagüey basada en los resultados de un estudio anterior. Su objetivo fue implementar un sistema de acciones socio-sanitarias colectadas en un manual que organizó contenidos de antropología socio cultural, psicología y sociología de la salud, fue conducida por profesionales de enfermería cuyo encargo social les asigna una mayor permanencia e intercambio con los pobladores. Se potenció el trabajo comunitario a partir de febrero de 2010. La investigación constituyó un (...) diseño mixto, con un estudio cuasi experimental sin grupo control combinado con métodos cualitativos. La evaluación final efectuada en el periodo 2013-2015 exhibió modificaciones positivas en indicadores del Análisis de la Situación de Salud y el entorno comunitario. Se demostró la importancia de la aplicación de las acciones comunitarias por el personal de enfermería como agente de cambio de desarrollo local y protagonista de sostenibilidad. A community intervention was carried out at the rural settlement "El León". Its objective was to implement a system of actions led by nursing professionals whose social role assigns them longer permanence and interchange with the inhabitants of the community. Community work was fostered from February 2010 with social and sanitary actions based on socio-cultural anthropology, psychology and health sociology knowledge. The investigation had a mixed design, being a quasi-experimental study without control group combined with qualitative methods. The final evaluation, which took place from 2013-2015, showed positive modifications in Health Analysis indicators and community environment. The importance of the application of community actions by nursing personnel as agents of change for local development and sustainability leaders was demonstrated. (shrink)

Reacting against the dominance of obligation-based moral theories in both general and nursing ethics, the author proposes a 'strong' (action-guiding) account of a virtue-based approach to moral decision-making within contemporary nursing practice. Merits and criticisms of obligation and virtue-based approaches to morality are identified and examined. One of the author's central premises is that the notions of moral goodness and badness carry more moral weight than the traditionally important notions of moral rightness and wrongness. Therefore, the author (...) argues that in order to deliver morally good care, it is vital to consider the kind of nurse one is and this means examining one's moral character. This book will be rewarding reading for a wide range of readers including clinical nurses, nurse educators and nurse ethicists; indeed, anyone interested in morality and ethics and the work of nurses will find this book stimulating reading. (shrink)

Nurses working in a newborn intensive care unit report that treatment decision disagreements for infants in their care may lead to ethical dilemmas involving all health-care providers. Applying Rest’s Four-Component Model of Moral Action as the theoretical framework, this study examined the responses of 224 newborn intensive care unit nurses to the Nurses Ethical Involvement Survey. The three most frequent actions selected were as follows: talking with other nurses, talking with doctors, and requesting a team meeting. The multiple regression (...) analysis indicates that newborn intensive care unit nurses with greater concern for the ethical aspects of clinical practice (p =.001) and an increased perception of their ability to influence ethical decision making (p =.018) were more likely to display Nurse Activism. Future research is necessary to identify other factors leading to and inhibiting Nurse Activism as these findings explained just 8.5% of the variance. (shrink)

The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses’ power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant (...) discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions. (shrink)

Purpose/methods: This study investigated the relationship between ethics education and training, and the use and usefulness of ethics resources, confidence in moral decisions, and moral action/activism through a survey of practicing nurses and social workers from four United States (US) census regions. Findings: The sample (n = 1215) was primarily Caucasian (83%), female (85%), well educated (57% with a master's degree). no ethics education at all was reported by 14% of study participants (8% of social workers had no ethics (...) education, versus 23% of nurses), and only 57% of participants had ethics education in their professional educational program. Those with both professional ethics education and in-service or continuing education were more confident in their moral judgments and more likely to use ethics resources and to take moral action. Social workers had more overall education, more ethics education, and higher confidence and moral action scores, and were more likely to use ethics resources than nurses. Conclusion: Ethics education has a significant positive influence on moral confidence, moral action, and use of ethics resources by nurses and social workers. (shrink)

Ethics in nursing: continuity and change -- Cultural issues, methods and approaches to nursing ethics -- Nursing ethics: what do we mean by 'ethics'? -- Becoming a nurse and member of the profession -- Power and responsibility in nursing practice and management -- Professional responsibility and accountability in nursing -- Classical areas of controversy in nursing and biomedical ethics -- Direct responsibility in nurse/patient relationships -- Conflicting demands in nursing groups of patients -- (...) Ethics in healthcare management: research, evaluation and performance management -- The political ethics of healthcare: health policies and resource allocation -- Corporate ethics in healthcare: strategic planning and ethical policy development -- Making moral decisions and being able to justify our actions -- The relevance of moral theory: justifying our ethical policies. (shrink)

This study focuses on change strategies generated through a dialogical–reflexive–participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in‐depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional‐centered (...) work to a more inclusive, patient‐centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained. (shrink)

Background:The concept of patient advocacy is still poorly understood and not clearly conceptualized. Therefore, there is a gap between the ideal of patient advocacy and the reality of practice. In order to increase nursing actions as a patient advocate, a comprehensive and clear definition of this concept is necessary.Research objective:This study aimed to offer a comprehensive and clear definition of patient advocacy.Research design:A total of 46 articles and 2 books published between 1850 and 2016 and related to the concept (...) of patient advocacy were selected from six databases and considered for concept analysis based on Rodgers’ evolutionary approach.Ethical considerations:This study was approved by the Research Ethics Committee of Tarbiat Modares University.Findings:The attributes of patient advocacy are safeguarding (track medical errors, and protecting patients from incompetency or misconduct of co-workers and other members of healthcare team), apprising (providing information about the patient’s diagnosis, treatment, and prognosis, suggesting alternatives of healthcare, and providing information about discharge program), valuing (maintaining self-control, enabling patients to make decisions freely, maintaining individualization and humanity, maintaining patient privacy, and acting in the patients’ values, culture, beliefs, and preferences), mediating (liaison between patients, families, and healthcare professionals, being patients’ voice, and communicate patient preferences and cultural values to members of the healthcare team), and championing social justice in the provision of healthcare (confronting inappropriate policies or rules in the healthcare system, identifying and correcting inequalities in delivery of health services, and facilitating access to community health services and health resources).Discussion and conclusion:The analysis of this concept can help to develop educational or managerial theories, design instruments for evaluating the performance of nurses in patient advocacy, develop strategies for enhancing patient advocacy, and improve the safety and quality of nursing care in the community and healthcare system. (shrink)

Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma‐ and violence‐informed care have been proposed as models of care to improve healthcare access, yet practitioners lack guidance on how to implement these models. In this paper, we build upon an existing framework of equity‐oriented care for (...) primary healthcare settings by proposing strategies to guide nurses in operationalizing cultural safety and trauma‐ and violence‐informed care into nursing practice at the individual level. This component is one strategy to redress inequitable access to care among Indigenous Peoples in Canada. We conceptualize barriers to accessing healthcare as intrapersonal, interpersonal, and structural. We then define three domains for nursing action: practicing reflexivity, prioritizing relationships, and considering the context. We have applied this expanded framework within the context of Indigenous Peoples in Canada as a way of illustrating specific concepts and focusing our argument; however, this framework is relevant to other groups experiencing marginalizing conditions and inequitable access to healthcare, and thus is applicable to many areas of nursing practice. (shrink)

Background:Complex and expensive treatment options have increased the frequency and emphasis of ethical decision-making in healthcare. In order to meet these challenges effectively, we need to identify how nurses contribute the resolution of these dilemmas.Aims:To identify the values, beliefs and contextual influences that inform decision-making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice.Design:An interpretive exploratory study was undertaken, 11 registered acute care nurses working in a district general hospital in England were interviewed, (...) using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification.Participants and context:Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis.Ethical considerations:Ethical approval was obtained from the local National Research Ethics Committee.Findings:Four major themes emerged: ‘best for the patient’, ‘accountability’, ‘collaboration and conflict’ and ‘concern for others’. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single-site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas.Discussion:Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision-making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro- and micro-decision-making.Conclusion:Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas. (shrink)

As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage it.

The nurse perspective is critical in survey research investigating various aspects of healthcare services, staff, and patient outcomes. Researchers are responsible for ensuring that survey research utilizing survey questionnaires employs research methodological strategies that are aligned with the ethical principles of beneficence, respect for persons, and justice. The purpose of this paper is to discuss best practices to facilitate high-quality survey data collection for nurse survey participants. Recommendations are based on the fundamental ethical principles described in the Belmont Report, an (...) overview of evidence published in the current literature, and the application of practical knowledge. Literature searches conducted in PubMed resulted in the inclusion of over 50 articles from a wide range of disciplines. The results include actionable methods for researchers to consider and follow when conducting survey research utilizing nurse participants. This article serves as a resource to guide researchers through ethically responsible design, implementation, and reporting of nurse survey research. (shrink)

The integration of technology in care is core business in nursing and this role requires that we must understand and use technology informed by evidence that goes much deeper and broader than actions and behaviours. We need to delve more deeply into its complexity because there is nothing minor or insignificant about technology as a major influence in healthcare outcomes and experiences. Evidence is needed that addresses technology and nursing from perspectives that examine the effects of technology, especially (...) related to increasing demands for efficiency, the relationship of technology to nursing and caring, and a range of philosophical questions associated with empowering people in their healthcare choices. Specifically, there is a need to confront in practice the ways technique influences care. Technique is the creation of a kind of thinking that is necessary for contemporary healthcare technology to develop and be applied in an efficient and rational manner. Technique is not an entity or specific thing, but rather a way of thinking that seeks to shape and organize nursing activity, and manage efficiently individual difference(s) in care. It emphasizes predetermined causal relationships, conformity, and sameness of product, process, and thought. In response is needed a radical vision of nursing that attempts in a real sense to ensure we meet the needs of individuals and their community. Activism and advocacy are needed, and a willingness to create a certain detachment from the imperatives that technique demands. It is argued that our responsibility as nurses is to respond in practice to the errors, advantages, difficulties, and temptations of technology for the benefit of those who most need our assistance and care. (shrink)

Background: Informal coercion, that is, situations where caregivers use subtle coercive measures to impose their will on patients, is common in adult psychiatric inpatient care. It has been described as ‘a necessary evil’, confronting nurses with an ethical dilemma where they need to balance between a wish to do good, and the risk of violating patients’ dignity and autonomy. Aim: To describe nurses’ experiences of being involved in informal coercion in adult psychiatric inpatient care. Research design: The study has a (...) qualitative, inductive design. Participants and research context: Semi-structured interviews with 10 Swedish psychiatric nurses were analysed with qualitative content analysis. Ethical considerations: The study was performed in accordance with the Declaration of Helsinki. In line with the Swedish Ethical Review Act, it was also subject to ethical procedures at the university. Findings: Four domains comprise informal coercion as a process over time. These domains contain 11 categories focusing on different experiences involved in the process: Striving to connect, involving others, adjusting to the caring culture, dealing with laws, justifying coercion, waiting for the patient, persuading the patient, negotiating with the patient, using professional power, scrutinizing one’s actions and learning together. Discussion: Informal coercion is associated with moral stress as nurses might find themselves torn between a wish to do good for the patient, general practices and ‘house rules’ in the caring culture. In addition, nurses need to be aware of the asymmetry of the caring relationship, in order to avoid compliance becoming a consequence of patients subordinating to nurse power, rather than a result of mutual understanding. Reflections are thus necessary through the process to promote mutual learning and to avoid violations of patients’ dignity and autonomy. Conclusion: If there is a need for coercion, that is, if the coercion is found to be an ‘unpleasant good’, rather than ‘necessary evil’ considering the consequences for the patient, it should be subject to reflecting and learning together with the patient. (shrink)

This article describes how an empirically supported theory of human behaviour, perceptual control theory, can be used to advance nursing practice and improve health outcomes for people who are accessing nursing care. Nursing often takes a pragmatic approach to the delivery of care, with an emphasis on doing what appears to work. This focus on pragmatism can sometimes take precedence over any consideration of the underlying theoretical assumptions that inform decisions to take one particular approach over another (...) or the mechanisms through which nursing interventions have their effects. For nursing to develop as a profession, there needs to be an increased focus on the core principles that underpin the delivery of care. In addition to understanding what works, nurses must develop their understanding of how and why particular approaches work or do not work. Understanding the fundamental principles that underpin nurses’ actions will lead to more efficient and effective approaches to the delivery of nursing care. It will also enable nurses to maximize those elements of their practice that are most beneficial for people and minimize other activities that either have little effect or actually lead to worse outcomes. In this article, we will propose that the phenomenon of control is fundamental to human health. Perceptual control theory provides a coherent theoretical framework that enables us to understand the phenomenon of control through a functional model of human behaviour. People are healthy when their neurochemical, physiological, biological, psychological and social states are all controlled satisfactorily. We will explain the implications of understanding health as control throughout the paper. From this perspective, we will argue that the aim of nurses and nursing should be to support people to maintain or recover control over those aspects of their lives that are important and meaningful to them. (shrink)

Deciding to take industrial action or go on strike has been an issue of great concern for nurses. While it is typical for most groups of workers to undertake industrial action in the pursuit of better wages and working conditions or improved quality of services, historically, nurses have found this a difficult course to pursue. Frequently, nurses have been caught between acceptance of themselves as ordinary workers and a professional model, which has carried with it the implication that (...) a profession does not engage in industrial action (although, in reality, professions, including medical practitioners, have undertaken industrial action). Nurses in Australia have gone on strike, although widespread industrial action was not undertaken until the 1980s, when lengthy industrial campaigns, including strikes, were used in an effort to achieve enhanced status for the profession, improved career paths and increased salaries. While debate remains about the efficacy of this course of action, large numbers of nurses have been involved in these campaigns. Significant changes in salaries and status were achieved in the 1980s. (shrink)

Moral deliberation has been receiving more attention in nursing ethics. Several ethical conversation models have been developed. This article explores the feasibility of the so-called CARE (Considerations, Actions, Reasons, Experiences) model as a framework for moral deliberation in psychiatric nursing practice. This model was used in combination with narrative and dialogical approaches to foster discourse between various stakeholders about coercion in a closed admission clinic in a mental hospital in the Netherlands. The findings demonstrate that the CARE model (...) provides a substantial framework for structuring moral deliberations. Narratives and dialogue are useful tools for broadening issues in conversations, to engage various stakeholders (including patients), and to gain shared understandings. (shrink)

This paper discusses a classic Aristotelian understanding of science, nature, and methods of inquiry and proof. It then discusses nursing as a practical science and provides some demonstrations through the application of classical methods. In the Aristotelian tradition an individual substance is a unity of form and matter: form being the intelligible universal that becomes the concept, while matter is the principle of individuation. Science is mediate intellectual causal knowledge. Inquiry uses hypothetical argument, and proof that is from valid (...) syllogistic reasoning with true premises provides necessity and certitude. This proof requires knowledge of the natural kind that gives origin to the attributes under investigation. The variability of nature is overcome by reasoning on the supposition of the end.Within the classical understanding of speculative and practical science, nursing is a practical science. As a science, nursing investigates the principles and causes of its subject, be that human beings, health or nursing behaviours as knowable nursing operations. The goal is knowledge of practice for the sake of practice, but nursing as a science is not operable. Nursing practice, that is nursing art or technologies, must complete the science. Reasoning on the supposition of the end, for example of cardiac compensation, allows one to identify necessary activities and physical states. Three causal demonstrations about decubiti show that demonstrations are possible. Classical science would teach us that the practical science of nursing studies human nature in order to identify principles and causes of health and principles and causes of nursing operations themselves. It also requires that the science ends in practical operation. Thus, proper decisions and individual actions in particular patient situations must complete nursing science. (shrink)

When nurses have active and untreated addictions, patient safety may be compromised and nurse-health endangered. Genuine responses are required to fulfil nurses' moral obligations to their patients as well as to their nurse-colleagues. Guided by core elements of relational ethics, the influences of nursing organizational responses along with the practice environment in shaping the situation are contemplated. This approach identifies the importance of consistency with nursing values, acknowledges nurses interdependence, and addresses the role of nursing organization as (...) moral agent. By examining the relational space, the tension between what appears to be opposing moral responsibilities may be healed. Ongoing discourse to identify authentic actions for the professional practice issue of nursing under the influence is called upon. (shrink)