Rubin SB, Zoloth L, eds. 374 pages. Hagerstown, MD: University Publishing Group; 2000. $29.95. ISBN 1555720536. Order phone 800-654-8188. Field of medicine: Medical ethics and quality of care. Format: Softcover book. Audience: Medical ethicists, physicians, professors, and students. Purpose: To bring together classic essays on the ethics of medical error and new essays by leaders in the field. Content: The book is divided into three parts: The Conception and Perception of Error, Error in Medical Practice, and Error in Ethics Consultation. The sections comprise 21 essays by authors with diverse backgrounds, including practicing physicians and professors of medicine, biomedical ethics, philosophy, religion, law, and sociology. Some essays are republished versions of classic articles; others are new material written for this book. Highlights: The five essays in part 1 provide an interesting and useful introduction to the significance of mistakes in medicine. Part 2 contains the essays that are most relevant to the practicing physician. Many offer clinically relevant cases, both historical and contemporary, that lead into engaging discussions of medical mistakes. Several essays offer a practical approach to improving how physicians can address the problem of error in medicine. Limitations: A minority of essays were written or coauthored by physicians. Some of the purely academic perspectives on error are thought-provoking but are not as useful to medical practice because they are so abstract. A profile of the author at the beginning of each essay would help to quickly orient the reader; this information instead appears at the end of the book. Related reading: Although numerous articles on this subject have appeared in the medical literature, there have been no notable book-length treatments since Bosk's Forgive and Remember: Managing Medical Failure (Univ of Chicago Pr, 1979). Commentary: Medical education does not prepare students and practitioners to recognize and deal with mistakes. This lack of openness isolates physicians and causes them to internalize feelings of guilt for mistakes, even those beyond their control. This process does not serve well the physician, the patient, or the medical community. Learning to accept the inevitability of error is the first step in lessening the chance of future errors. Reviewers: Helaina Laks Kravitz, MD, Student Health Center, University of California, Davis, Davis, and Richard L. Kravitz, MD, Center for Health Services Research in Primary Care, University of California, Davis, Sacramento, California.

Margin of Error: The Ethics of Mistakes in the Practice of Medicine

Background: Many clinical educators feel unprepared and/or unwilling to report unsatisfactory trainee performance. This systematic review consolidates knowledge from medical, nursing, and dental literature on the experiences and perceptions of evaluators or assessors with this failure to fail phenomenon.Methods: We searched the English language literature in CINAHL, EMBASE, and MEDLINE from January 2005 to January 2015. Qualitative and quantitative studies were included. Following our review protocol, registered with BEME, reviewers worked in pairs to identify relevant articles. The investigators participated in thematic analysis of the qualitative data reported in these studies. Through several cycles of analysis, discussion and reflection, the team identified the barriers and enablers to failing a trainee.Results: From 5330 articles, we included 28 publications in the review. The barriers identified were (1) assessor’s professional considerations, (2) assessor’s personal considerations, (3) trai...

The failure to fail underperforming trainees in health professions education: A BEME systematic review: BEME Guide No. 42.

Background:Nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one’s moral values. Nurses need moral courage in all areas and at all levels of nursing. Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Nevertheless, what the concept of moral courage means in nursing contexts remains ambiguous.Objective:This article is an analysis of the concept of moral courage in nursing.Design:Rodgers’ evolutionary method of concept analysis provided the framework to conduct the analysis.Data sources:The literature search was carried out in September 2015 in six databases: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and The Philosopher’s Index. The following key words were used: “moral” OR “ethical” AND “courage” OR “strength” AND “nurs*” with no time limit. After applying inclusion and exclusion criteria, 31 studies were included in the final analysis.Ethi...

Moral courage in nursing A concept analysis

'Failure to fail' in nursing - A catch phrase or a real issue? A systematic integrative literature review.

Background:Moral courage is one of the most fundamental virtues in nursing profession; however, little attention has been paid to it; as a result, no exact and clear definition of moral courage has ever been accessible.Objective:This study is carried out for the purposes of defining and clarifying its concept in nursing profession.Methods:This study used a hybrid model of concept analysis comprising three phases, namely, a theoretical phase, field work phase, and a final analysis phase. To find relevant literature, electronic search of valid databases was utilized using keywords related to the concept of courage. Field work data were collected over an 11 months’ time period from 2013 to 2014. In the field work phase, in-depth interviews were performed with 10 nurses. The conventional content analysis was used in two theoretical and field work phases using Graneheim and Lundman stages, and the results were combined in the final analysis phase.Ethical consideration:Permission for this study was obtained fro...

Concept analysis of moral courage in nursing A hybrid model

The factors preventing registered nurses from failing students in practice are multifaceted and have attracted much debate over recent years. However, writers rarely focus on what is needed to fail an incompetent pre-registration nursing student in their final placement. This hermeneutic study explored the mentor experience of failing a pre-registration nursing student in their final placement. A total of 19 mentors were recruited from 7 different healthcare organisations in both inner city and rural locations in the southeast of England. Participants took part in individual reflective interviews about their experience of failing a pre-registration nursing student in their final placement. These experiences were interpreted through a hermeneutic discovery of meaning. The new horizon of understanding which developed as a result of this research is framed within the context of moral stress, moral integrity and moral residue with the overall synthesis being that these mentors' stories presented a new horizon of moral courage.

Failing a student nurse A new horizon of moral courage

This practical guide explores professional values in nursing, helping you to develop safe, compassionate, dignified, person-centred and evidence-based nursing practice. The emphasis of the book is on fundamental values of equality, dignity and caring. The authors discuss holistic nursing care, working in partnership with people and families, workin

Professional Values in Nursing

High quality, supportive practice learning experiences are crucial for ensuring that student nurses and midwives develop into competent practitioners who are fit for practice. The practice educator role is one model of practice learning support but the role is relatively new and has been little investigated. This paper reports on an appreciative inquiry that explored the current practice educator role at one university in England, with the aim of reaching a consensus for how the role could be enhanced. The first phase involved in-depth interviews with 18 participants: practice educators (n = 10); student nurse representatives (n = 5) and practice based education leads (n = 3). The interviews were analysed thematically. Three themes related to social processes involved in the role: being a bridge, being there, and social identity. The other themes described contributions to the practice learning environment: safeguarding, support, critical thinking. The second phase used a modified Delphi technique. Participants ranked trigger statements, related to the themes, in order of importance. Two consensus workshops were held where the statements were reviewed by practice educators, students and learning environment leads, following which principles and practices of the practice educator role were agreed. In conclusion, the strength of the practice educator role is that it bridges the worlds of university and practice. This bridging resulted from social processes that required a sustained presence in practice to engage in the reality of everyday practice and gain the shared social identity of a practitioner.

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The role of the practice educator in supporting nursing and midwifery students' clinical practice learning: An appreciative inquiry

Background

Cancer risk assessment tools are designed to help detect cancer risk in symptomatic individuals presenting to primary care. An early detection of cancer risk could mean early referral for investigations, diagnosis and treatment, helping to address late diagnosis of cancer. It is not clear how best cancer risk may be communicated to patients when using a cancer risk assessment tool to assess their risk of developing cancer.


Objective

We aimed to explore the perspectives of service users and primary care practitioners on communicating cancer risk information to patients, when using QCancer, a cancer risk assessment tool.


Design

A qualitative study involving the use of individual interviews and focus groups.


Setting and participants

Conducted in primary care settings in Lincolnshire with a convenience sample of 36 participants (19 service users who were members of the public) and 17 primary care practitioners (general practitioners and practice nurses).


Results

Participants suggested ways to improve communication of cancer risk information: personalizing risk information; involving patients in use of the tool; sharing risk information openly; and providing sufficient time when using the tool during consultations.


Conclusion

Communication of cancer risk information is complex and difficult. We identified strategies for improving communication with patients involving cancer risk estimations in primary care consultations.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.13016

Communicating cancer risk in the primary care consultation when using a cancer risk assessment tool: Qualitative study with service users and practitioners

This paper reports on a study of experiences of young people aged 14 to 18 years who were nursed on acute adult hospital wards in NHS hospitals in England. In spite of British government guidelines, young people from 14 years of age continue to be admitted to adult wards in the UK. Although much has been written about the transition of the young person to adult services, there is little research about the experiences of young people who are nursed on adult wards. Hermeneutic phenomenology was used to explore the lived experiences of eight young people who had been nursed on adult wards between 2004 and 2010. Data were collected in 2010. In-depth interviews were recorded, transcribed and analysed using Colaizzi's framework (Colaizzi, 1978). Themes explored included expectations of what the experience may be like, young people's first impressions of the ward environment, the feelings of the young person while in hospital, the attitudes of people towards them including, both staff and other patients, and fut...

/pdf/exploring-the-experiences-of-young-people-nursed-on-adult-2kf69cbrsv.pdf

Sharon Black

Papers

Failing a student nurse A new horizon of moral courage

Professional Values in Nursing

The role of the practice educator in supporting nursing and midwifery students' clinical practice learning: An appreciative inquiry

Communicating cancer risk in the primary care consultation when using a cancer risk assessment tool: Qualitative study with service users and practitioners

Exploring the experiences of young people nursed on adult wards