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)

Nursing practice as bricoleur activity: a concept explored The debates concerning the nature of nursing practice are often rooted in tensions between artistic, scientific and magical/mythical practice. It is within this context that the case is argued for considering that nursing practice involves bricoleur activity. This stance, which is derived from the work of Levi‐Strauss, conceives elements of nursing practice as an embodied, bricoleur practice where practitioners draw on the ‘shards (...) and fragments’ of the situation‐at‐hand to resolve the needs of the individual patient for whom they care. This conceptualisation of nursing practice will be analysed with a particular emphasis on its implication for nursing epistemology, pedagogy and praxis. The evidence to support this argument is drawn from empirical work that investigated nurses’ use of intuition, the work of Levi‐Strauss, and issues in nursing epistemology and ontology. The paper itself is written from the perspective of a bricoleur who uses ‘bits and pieces’ from the domains of nursing, philosophy, psychology, education, sociology and anthropology. (shrink)

Person‐centredness is common speak in nursing and health care literature. Increasingly there is an expectation that practitioners adopt person‐centred principles in their practice and organizations are expected to respect the values of the service user. However, in the research methodology literature, there is little explicit attention paid to the concept of person‐centredness in research practice. Instead, there continues to be a reliance on traditional ‘ethical principles’ to guide effectiveness in research work. This paper argues that the principles (...) of person‐centredness that are espoused in nursing practice should also underpin nursing and health care research. A framework for person‐centred research is proposed and issues concerning its implementation in practice are discussed. (shrink)

In nursing practice, awareness of ethical inner values and a common understanding of nursing and caring are needed. It is therefore important to highlight ideas of caring in nursing practice. The aim of this paper was to illuminate nursing, caring and ethical inner values in caring and caring in nursing practice. By being attentive, open, respectful and treating the patient as a person, nurses can enhance both their own and the patient's sense (...) of personal meaning in the caring relationship. Nurses can use self‐reflection to create an awareness of nursing, caring and ethical inner values in caring. (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)

This article presents the derivation of moral competence in nursing practice by identifying its attributes founded on Thai culture. In this process moral competence is formed and based on the Thai nursing value system, including personal, social and professional values. It is then defined and its three dimensions (moral perception, judgment and behavior) are also identified. Additionally, eight attributes as indicators of moral competence are identified and selected from three basic values. The eight attributes are loving kindness, (...) compassion, sympathetic joy, equanimity, responsibility, discipline, honesty, and respect for human values, dignity and rights. All attributes are discussed by addressing the three moral dimensions in order to present how to deal with ethical issues in nursing practice. As a summary, a model of moral competence is presented to demonstrate moral competence in nursing practice in Thailand. (shrink)

The term ‘moral resilience’ has been gaining momentum in the nursing ethics literature. This may be due to it representing a potential response to moral problems such as moral distress. Moral resilience has been conceptualised as a factor that inhibits immoral actions, as a favourable outcome and as an ability to bounce back after a morally distressing situation. In this article, the philosophical analysis of moral resilience is developed by challenging these conceptualisations and highlighting the risks of such limiting (...) perspectives. It is argued that moral resilience is best understood as a virtue with two associated vices, faintheartedness and rigidity. The intellectual virtue of practical wisdom is required to express resilience as a virtue. This understanding leads to recommendations for professional education, for practice and for further research. (shrink)

This chapter contains sections titled: Introduction Tracing a History of Nursing Ethics The Sociopolitical Context of Nursing and Nursing Ethics The Renewal of Ethics in Nursing: The Insufficiency of Bioethics Desired Futures Nursing Leadership in Practice and Policy through Attention Ethics Summary References.

To address longstanding workforce shortages, increase efficiency and control the costs associated with the modern health-care provision, there has been a worldwide policy to promote increased flexibility within the health-care workforce. This is being done primarily by extending the ‘scope of practice’ of existing occupational roles into what is referred to as ‘advanced’ practice. The development of the advanced practice nurse (APN) has occurred within the context of a shortage of medical staff, and the need to control (...) cost. However, the means by which substantially repurposed occupational groups such as these, are incorporated into complex, hierarchical organisations such as the UK national health service (NHS) remains poorly understood. Using modern sociological theory, the development of the APN role has been examined in terms of power, control, professional identity and gender relations. Each of the theoretical approaches used adds to the quality of the discussion, although none provide a comprehensive picture. However, when synthesised, they do provide an enhanced insight into the evolution of the role. It is argued here that by critically examining the development of the APN role, this will enable both a better understanding of, and the means to influence, its future direction of travel. (shrink)

Nurses play a key role in the provision of services in relation to sexuality in both primary and sexual and reproductive health‐care. Given the intersection of sexualities with a range of social injustices, this study reviews research on nursing practice concerning sexuality from an emancipatory/social justice perspective. A systematic review of English articles published in nursing journals appearing on the Web of Science database from 2009 to 2014 was conducted. Thirty‐eight articles met the inclusion criteria. Analysis consisted (...) of a descriptive phase (types and location of studies, aspects of sexualities focused on, target health users and aspects of nursing practice focused on) and a critical/emancipatory phase. In terms of practice, our analysis revealed that: barriers exist to the integration of issues relating to sexuality in nursing practice; the social location of nurses and their personal feelings regarding sexuality influence their practice; content that addresses gendered norms and media that assist in communication underpin some emancipatory practices. Few studies locate analyses of nursing practice within gendered, cultural and social norms; consider advocacy as part of the practice of nurses; or analyse the promotion of health user participation in health services and structures. The implications for emancipatory practice are drawn out. (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 article reviews the literature on deception to illuminate the phenomenon as a background for an appraisal within nursing. It then describes nursing as a practice of caring. The character of the Good Samaritan is recommended as indicative of the virtue of compassion that ought to underpin caring in nursing practice. Finally, the article concludes that a caring nurse, responding virtuously, acts by being compassionate, for a time recognizing the prima facie nature of the rules (...) or principles of truth telling. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

Many of the activities of clinical practice happen to, with or upon vulnerable human beings. For this reason numerous nursing authors draw attention to or claim a significant moral domain in clinical practice. A number of nursing authors also discuss the emotional involvement and/or emotional labour which is often experienced in clinical practice. In this article I explore the importance of emotion for moral perception and moral agency. I suggest that an aspect of being a (...) good nurse is having an emotional sensitivity to other human beings (patients), because this emotional sensitivity allows the nurse to perceive more accurately the context and perspective of the patient. It is thus important to the moral agency of the nurse and to morally sensitive clinical practice. As such education of the emotions should be a feature of the moral education of the nurse. A useful conception of the role of educated emotion in the moral life can be discovered in Aristotelian ethics. (shrink)

Worldwide, healthcare has been touched by neoliberal policies to the extent that it has some of its characteristics, such as being asymmetrical, competitive, dehumanized, and profit driven. In Colombia, Law 100/93 was created as an ambitious reform aimed at integrating the social security and public sectors of healthcare in order to create universal access, and at the same time to generate market competence with the objective of improving effectiveness and responsiveness. Instead, however, Colombian health reform has served to generate competition (...) which has aggravated inequalities among people. Within this context, we practice nursing. As nurses, our responsibility is to advocate for our patients. We cannot ignore what is happening worldwide in hospitals and community health settings because our responsibility is to promote health, prevent disease, and care for human beings. So, today, when the world pushes for economical profit and competence on one hand, and, on the other, for moral compromises to care, respect, and advocacy for all human beings, being a nurse in the Colombian health system represents a challenge for us. This challenge is especially significant because harm and benefit, justice and injustice, respect and disrespect are separated by a fine line that is easy to transgress. (shrink)

Designed specifically for the educational needs of RN to BSN students This is a unique, innovative professional nursing ethics textbook designed specifically for the educational needs of RN to BSN students. Written by experts in the field, it discusses ethical concepts geared to the licensed nurse who has spent several years in practice but is learning high-level concepts and applications. The text addresses different areas of professional practice and is rich with case studies illustrating clinical scenarios involving (...) ethical awareness and decision-making. The book fulfills the necessary criteria for the AACN Essentials for Baccalaureate Education and the QSEN and ISOM competencies. Clear and concise, the text relates content to the nurse’s current practice and professional development without extraneous information typically included in other texts. Progressing from simple to complex, chapters build on previous practice experience to focus on ethical decision-making in a variety of practice environments. The book incorporates a “four boxes” decision-making model and addresses essential communication skills, how to recognize and resolve moral distress, and the role of an ethics committee. It discusses common ethical issues likely to be encountered and ethical practice as it relates to quality and safety. Case Study Dilemmas that include evidence-based research provide the opportunity to apply ethical decision-making principles. QSEN application principles are also featured in each chapter, and interactive exercises and questions and PowerPoints provide further opportunity for critical thinking. Key Features: Addresses the specific needs of students in the RN to BSN course Fulfills AACN Essentials, IOM Competencies, and QSEN KSAs Builds upon previous practice experience of RN to BSN students Discusses ethical decision-making in a variety of practice environments Includes Case Study Dilemmas to apply ethical decision-making principles. (shrink)

Every day nurses are required to make ethical decisions in the course of caring for their patients. Ethics in Nursing Practice provides the background necessary to understand ethical decision making and its implications for patient care. The authors focus on the individual nurse’s responsibilities, as well as considering the wider issues affecting patients, colleagues and society as a whole. This third edition is fully updated, and takes into account recent changes in ICN position statements, WHO documents, as well (...) as addressing current issues in healthcare, such as providing for the health and care needs of refugees and asylum seekers, bioethics and the enforcement of nursing codes. (shrink)

Nursing staff of many specialities are taking on and developing their roles in new and advanced practice areas. Patients will be offered new services from highly skilled advanced nurse practitioners. Such nurses need guidance, direction and information to assist them in their new roles. This book will offer insight and guidance on a variety of issues that are likely to be encountered by the Nurse Practitioner in everyday practice.

The concern for ethical principles and values is not limited to health professionals alone. However, ethical principles in nursing act as safety valves for social control to prevent professional misconduct and abuse of the rights of clients. As a result of colonial experience, developing countries like Botswana usually follow the European lead, especially examples from the UK. This article examines the ethical problems and dilemmas associated with rural nursing practice in Botswana, a developing country in sub-Saharan Africa. (...) The major ethical problems identified are related to the distribution of and access to health resources in rural communities. It is proposed that nurses must assume responsibility in the field of access and allocation by working collaboratively with governments and other professional bodies, and that nurses as a global community must work together as a team to support each other. (shrink)

It is well established, following Menzies' work, that nursing practice produces considerable anxiety. Like Menzies, we bring a psychoanalytic perspective to a theorization of anxiety in nursing and do so in order to consider nursing practice in the light of psychoanalytic theory, although from a Lacanian perspective. We also draw on Bataille's notion of ‘surplus’. These concepts provide the theoretical framework for a study investigating how some clinical nurses are able to remain in clinical (...) class='Hi'>practice rather than leave the profession or seek work at a distance from the bedside. We conducted focus groups and present here an analysis of two fragments of nurses' speech. We found the nurses responded from one of two positions. In the first position, the nurses focus on doctors, complain about the surplus afforded them, and call for it to be eliminated. In this way, the nursing group is similar to other groups, considered by Bataille, who also attempt to get rid of a surplus. However, in the second position, the nurses stay with the surplus, tolerating it as they nurse the patient. This latter position is one where the nurse practises with a focus on the patient rather than being distracted by their dispute over the doctor's privilege. The importance of this paper is in its illustration of two distinct positions from which the nurse can practise: one that is not optimal because the nurse is distracted and the other that is more focused on practice, and thus the nurse is in a position to provide the best care possible to patients. (shrink)

is to discuss the nurse leader's role in ensuring congruence between caring missions and caring practices. Ethical principles are discussed as the foundation necessary for creating an ethical climate for nursing practice. Components of ethical climate are presented and strategies to create a positive ethical climate for nursing practice are provided....

This paper explores essential characteristics of current nursing practice from the perspectives of clinically experienced registered nurses in various fields of health care in Sweden. Nursing practice has been the subject of much debate in the past and because of its complexity as well as continuous changes in society it is important to continue the debate. A qualitative study, including 16 group interviews with altogether 74 participants, was conducted. Nursing practice was viewed as a (...) multifaceted field. The participants struggled to define nursing but were able to describe it using concrete examples. The analysis, using interpretive description, identified current practice as essentially consisting of: ‘A practice pervaded by comprehensive responsibility’, ‘A practice that recognises a patient's unique needs’, ‘A practice based on multifaceted knowledge’ and ‘A practice that mediates between traditional values and changing demands’. Current nursing practice can be understood as striving to be in close proximity to the patient, but in tension with pervasive requirements and societal changes. Going forward, it is necessary to continue to reflect on and discuss the nature of nursing practice in an interprofessional context. Studies from primary and home care are also needed to broaden the understanding of nursing practice. (shrink)

The limitations of rational models of ethical decision making and the importance of nurses’ human involvement as moral agents is increasingly being emphasized in the nursing literature. However, little is known about how nurses involve themselves in ethical decision making and action or about educational processes that support such practice. A recent study that examined the meaning and enactment of ethical nursing practice for three groups of nurses (nurses in direct care positions, student nurses, and nurses (...) in advanced practice positions) highlighted that humanly involved ethical nursing practice is also simultaneously a personal process and a socially mediated one. Of particular significance was the way in which differing role expectations and contexts shaped the nurses’ ethical practice. The study findings pointed to types of educative experiences that may help nurses to develop the knowledge and ability to live in and navigate their way through the complex, ambiguous and shifting terrain of ethical nursing practice. (shrink)

This article describes the nature of ethical dilemmas in perioperative nursing practice. Using the Critical Incident Technique, common ethical dilemmas experienced by periop erative nurses are explored. The aim of the study was to elicit the ethical dilemmas that arise in perioperative nurses' practice. The study has a descriptive design and the data are critical incidents described by 48 anaesthetic nurses and 76 operating theatre nurses. An analysis of the critical incidents gave four domains of ethical dilemmas: (...) those arising as value conflicts in the intraoperative phase of surgery; those emanating from the patient's right of self- determination ; those arising in caring for patients; and those resulting from the alloca tion of scarce resources and the demands of increased effectiveness. (shrink)

Clerical frames for nursing practice: missionary nurses at Rehoboth This paper presents a discourse analysis of publications of the Christian Reformed Church regarding its Rehoboth Mission near Gallup, New Mexico, among the Navajo. All issues of The Banner, Acts of Synod of the Christian Reformed Church, the Rehoboth Hospital Bulletin, and the Annual Report of the Rehoboth Mission from 1880 to the present were reviewed for references to health‐care at Rehoboth from 1903 to 1943. Four religiously framed discourses (...) were identified: discourses justifying provision of health‐care at the mission, discourses of the Navajos as immature and potentially dangerous, needing to be civilized, discourses of cleanliness, and discourses of calling. This paper adds to a growing body of knowledge about religious frames within which nurses have practiced in North America. (shrink)

This article explores risk in professional nursing practice. Professional risk refers to the threat of professional discipline if it is found that a registered nurse has violated professional nursing practice standards. We argue professional risk is socially constructed and understood differently by nurse regulatory bodies, unions, professional associations and frontline nurses. Regulatory bodies emphasize professional accountability of nurses; professional associations focus on system problems in health‐care; unions undertake protecting nurses' right to health and safety; and frontline (...) nurses experience fear and uncertainty in their attempt to interpret practice standards to avoid professional discipline. Perspectives of professional risk are investigated by analyzing three professional nursing bodies' views of professional codes governing the right of nurses to refuse unsafe work assignments. The workplace dynamics surrounding work refusal experienced by frontline nurses are illustrated primarily through the lens of the 2003 SARS influenza outbreak in Ontario, Canada. We conclude that frontline nurses in Ontario are required to manage risk by following professional protocols prioritizing patient care and professional accountability which disregard the systemic, unpredictable and hazardous circumstances in their everyday practice. Moreover, we argue professional protocols cannot anticipate every eventuality in clinical practice creating the fear of professional discipline for nurses. (shrink)

Nursing professionals in a variety of practice settings routinely use implied consent. This form of consent is used in place of or in conjunction with informed or explicit consent. This article looks at one aspect of a qualitative exploratory study conducted in a Day of Surgery Admission unit. This article focuses on the examination of nurses’ understandings of implied consent and its use in patient care in nursing practice. Data were collected through one-on-one interviews and analysed (...) using a thematic analysis. Nurses participating in this study revealed that they routinely used implied consent in their nursing practice. This article will look at whether implied consent supports or impedes a patient’s autonomy. (shrink)

ANGUS J, HODNETT E and O’BRIEN-PALLAS L. Nursing Inquiry 2003; 10: 218–228Implementing evidence-based nursing practice: a tale of two intrapartum nursing unitsDespite concerns that the rise of evidence-based practice threatens to transform nursing practice into a performative exercise disciplined by scientific knowledge, others have found that scientific knowledge is by no means the preeminent source of knowledge within the dynamic settings of health-care. We argue that the contexts within which evidence-based innovations are implemented (...) are as influential in the outcomes as the individual practitioners who attempt these changes. A focused ethnography was done in follow-up to an earlier trial that evaluated the effectiveness of a marketing strategy to encourage the adoption of evidence-based intrapartum nursing practice. Bourdieu's (1990, 1991) concepts of habitus, capital and social field were used in our refinement of the analysis of the ethnographic findings. Nursing leadership, interprofessional struggle with physicians, the characteristics of the community and the physical environment were prominent issues at all of the sites. Detailed descriptions of the sociohistorical context and of the experiences at two sites are presented to illustrate the complexities encountered when implementing innovations. (shrink)

Nursing practice occurs in the context of conversations with healthcare users, other healthcare professionals, and healthcare institutions. This discussion paper draws on symbolic interactionism and Fairclough's method of critical discourse analysis to examine language that nurses use to describe the people in their care and their practice. We discuss how nurses’ use of language constructs meaning about healthcare users and their own work. Through language, nurses are articulating what they believe about healthcare users and nursing (...) class='Hi'>practice. We argue that the language nurses use can contribute to viewing their practice as tasks on bodies that must be accomplished efficiently and objectively within the biomedical model, rather than relational and person‐centered. Moreover, the language nurses use can perpetuate a sense of powerlessness within healthcare systems yet paradoxically they are in a position of power over healthcare users. Nurses’ compliance with the efficiency and biomedical model results in a lack of emphasis on the full breadth of nursing work, which could be enacted in relational rather than power‐laden practices. We conclude by positing that careful use of language among nurses in all settings is essential, if we are to begin to articulate what nursing is to ourselves and to others. (shrink)

In this paper, we explore the concept of bearing witness in nursing practice. We examine the description of bearing witness in the nursing literature, particularly that offered by William Cody who suggests that bearing witness results in the limited moral obligation of “true presence.” We then turn to Lorraine Code's work on testimony, drawing parallels between the concepts of testimony and bearing witness. Code suggests that receiving testimony results in a responsibility to respond, and that this is (...) an ethico‐political obligation. We discuss these ideas in relation to a Canadian exemplar of witnessing the Truth and Reconciliation Commission of Canada's work to understand and address the historical injustices done to Indigenous peoples in Canada. Here, we focus on the Commission's definition of witnessing and highlight the experience of Shelagh Rogers who served as an honorary witness. As an outcome of our analysis, we suggest that bearing witness in nursing practice is most usefully conceptualized as both a moral and a political obligation. Implications for nursing practice are suggested, including first, the need to critically examine our own understandings of power and privilege in order to authentically bear witness and avoid being complicit in injustice, and second, the concomitant responsibility to take action to challenge injustice once we have borne witness to it. (shrink)

The commodification of health care, particularly primary care, presents challenges to care and knowledge development. The purpose of this study is to examine how nurses perceive and develop their knowledge in a commodified context. A mixed‐methods study was conducted that included a closed‐question survey and in‐depth interviews with nurses in public primary care in Catalonia. There were 104 valid responses to the questionnaire and 10 in‐depth interviews. The main findings of the survey were related to workload and limited time for (...) nursing care. Six themes emerged from the in‐depth interviews: (1) limited time for nursing, (2) feelings of burnout, (3) awareness of patient and family satisfaction, (4) organizational factors that favor nurses' needs, (5) organizational factors that hinder nurses' needs, and finally (6) public administration requirements. Participants perceive excessive workload and time constraints and feel that this affects their nursing care and their physical and mental health. However, nurses purposefully use knowledge patterns to cope with the problems associated with commodification. Nurses have multidimensional, contextualized, and integrated knowledge that allows them to optimize their care based on the needs of their patients. This research examines many challenges related to nursing practice and the nursing discipline and opens the door for further research that encompasses all areas of nursing. (shrink)

The everyday expressions of nursing practices are driven by their entanglement in complex flows of social, cultural, political and economic interests. Early expressions of trained nursing practice in the United States and Europe reflect claims of moral, spiritual and clinical exceptionalism. They were both imposed upon—and internalized by—nursing pioneers. These claims were associated with an endogenous narrative of discipline and its physical manifestation in early nursing schools and hospitals, which functioned as “total institutions.” By contrast, (...) the external forces—diffuse yet pervasive—impacting upon contemporary nursing more closely align with the power dynamics explored in Gilles Deleuze's concept of the Society of Control. The example of sensor technology and telemetric monitoring of nurses’ locations in the clinical setting exemplifies the intense presence of surveillance, performance metrics and the “rationalization” of nursing practice. It falls upon nurses to recognize, accept or challenge these dynamics in order to shape the future of nursing practice into a discipline which embodies our values and priorities. (shrink)

This paper reports on the findings of a study that considered how anxiety might function to organise nurses’ practice. With reference to psychoanalytic theory this paper analyses field notes taken during a series of nursing change‐of‐shift handovers. The handover practices analysed met all the criteria for a ritual, as understood in psychoanalytic theory, and functioned to alleviate anxiety in the short term while symbolically expressing a forbidden and unknown knowledge. We argue that the handover ritual contained certain prohibitions, (...) yet allowed some expression of the prohibited knowledge in a disguised way. The prohibition concerned how the patient affected the nurse, that is, moved the nurse to love and hate the patient. We argue that this prohibition is expressed, in disguise, via the displacement of affection for the patient onto other nurses and through negative stereotyping of some patients. We also argue that these prohibitions of the handover mirror broader prohibitions within nursing, and thus the rituals of the handover become an expression of how professional prohibitions are enacted in practice. We conclude that the important implicit function of the handover ritual is to keep anxiety at bay, thereby enabling the nurse to commence practice rather than being immobilised by the effect of potentially overwhelming anxiety. (shrink)

Illness creates a range of negative emotions in patients including anxiety, fear, powerlessness, and vulnerability. There is much debate on the ‘therapeutic’ or ‘helping’ nurse–patient relationship. However, despite the current agenda regarding patient-centred care, the literature concerning the development of good interpersonal responses and the view that a satisfactory nursing ethics should focus on persons and character traits rather than actions, nursing ethics is dominated by the traditional obligation, act-centred theories such as consequentialism and deontology. I critically examine (...) these theories and the role of duty-based notions in both general ethics and nursing practice. Because of well-established flaws, I conclude that obligation-based moral theories are incomplete and inadequate for nursing practice. I examine the work of Hursthouse on virtue ethics’ action guidance and the v-rules. I argue that the moral virtues and a strong (action-guiding) version of virtue ethics provide a plausible and viable alternative for nursing practice. I develop an account of a virtue-based helping relationship and a virtue-based approach to nursing. The latter is characterized by three features: (1) exercising the moral virtues such as compassion; (2) using judgement; and (3) using moral wisdom, understood to include at least moral perception, moral sensitivity, and moral imagination. Merits and problems of the virtue-based approach are examined. I relate the work of MacIntyre to nursing and I conceive nursing as a practice: nurses who exercise the virtues and seek the internal goods help to sustain the practice of nursing and thus prevent the marginalization of the virtues. The strong practice-based version of virtue ethics proposed is context-dependent, particularist, and relational. Several areas for future philosophical inquiry and empirical nursing research are suggested to develop this account yet further. (shrink)

This article aims to deepen the understanding of courage through a theoretical analysis of classical philosophers’ work and a review of published and unpublished empirical research on courage in nursing. The authors sought answers to questions regarding how courage is understood from a philosophical viewpoint and how it is expressed in nursing actions. Four aspects were identified as relevant to a deeper understanding of courage in nursing practice: courage as an ontological concept, a moral virtue, a (...) property of an ethical act, and a creative capacity. The literature review shed light on the complexity of the concept of courage and revealed some lack of clarity in its use. Consequently, if courage is to be used consciously to influence nurses’ ethical actions it seems important to recognize its specific features. The results suggest it is imperative to foster courage among nurses and student nurses to prepare them for ethical, creative action and further the development of professional nursing practices. (shrink)

This brief tour of American law has demonstrated a little of the breadth and currency of legal liability actions which affect nursing. As health care changes and nursing roles change with it, so too will the nature of liability in this area. The American penchant for litigation is such that the chances of disentangling nurses from the continued onslaught of negligence litigation seem remote.

This comprehensive collection offers a unique look at nursing practice, theory, research and nursing history from various critical theoretical perspectives. It aims to initiate an international discussion among scholars from diverse countries, particularly Germany and Anglo-American countries, coming from distinctive schools of thought, e.g. German Critical theory and Post-structural approaches, and influenced by their respective histories of sciences. This book analyzes and criticizes nursing theory, nursing research and practice along several dimensions: Nursing Ethics, (...) Subjectivity, Body and Flesh (Leib), Technology, Power, History, and Education. (shrink)

The concept of phronesis is venerable and is experiencing a resurgence in contemporary discourses on professional life. Aristotle’s notion of phronesis involves reasoning and action based on ethical ideals oriented towards the human good. For Aristotle, humans possess the desire to do what is best for human flourishing, and to do so according to the application of virtues. Within health care, the pervasiveness of economic agendas, technological approaches and managerialism create conditions in which human relationships and moral reasoning are becoming (...) increasingly de‐valued. This creates a tension for nurses, and nursing leaders, as the desire to do what is morally right is often in conflict with contextual demands. In this paper, Aristotle’s writing on phronesis is examined with a focus on his classic conceptions of eudaimonia, the virtues, deliberation, judgement, and praxis. Building on Aristotle’s work, a number of contemporary views are explored with a focus on what various conceptualizations offer for the discipline of nursing. These expanded conceptions of phronesis include attention to: embodiment in practice; open‐mindedness including the capacity to stay curious and open to recognizing what we do not know; perceptiveness as a disposition towards insight and aesthetic understanding; and reflexivity as an ongoing process of interrogation and inquiry into ourselves and our actions. Drawing on these concepts, we discuss the affordances of phronesis as a morally informed guiding force to attend to modern‐day challenges in nursing practice and nursing leadership. (shrink)

Nurses are well positioned to contribute to child protection efforts but are underutilised. This paper describes a critical discursive analysis of nursing responses to child neglect and abuse (CN&A) in British Columbia, Canada. Legal and practice guidelines were analysed alongside nurse interview texts, offering a glimpse into how nurses prevent CN&A in their everyday practice with families. Results show how the primacy of mandatory reporting to child protection authorities coordinates a series of deferrals and how nurses engage (...) with and interrupt these deferrals in everyday practice. Nurses' relational approaches are essential to gain access to the private sphere of the family to assess, plan, elicit cooperation with interventions and monitor the situation. They considered reporting to be one among many possible responses. This study highlights how nursing contributions to prevention are largely overlooked and points to the potential for a more significant role for nurses in a public health approach to child protection. (shrink)