Showing papers in "Nursing Ethics in 2019"
TL;DR: This narrative synthesis suggests the combination of the experience of a moral event, the experienceof ‘psychological distress’ and a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress.
Abstract: Aims:The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distressBackground:Moral distress is said to occur when one has made a moral judgement but is unable to act upon it However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenonDesign:Systematic literature review and narrative synthesis (November 2015–March 2016)Data sources:Ovid MEDLINE® In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO® 1967–Present, CINAHL® Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education AbstractsReview methods:Literature relating to moral distress was systematically retrieved and subjected to relevanc
174 citations
TL;DR: The ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource is considered.
Abstract: Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues - missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care left undone - suggesting that nurses, in certain contexts, are actively engaged in rationing care - in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care - despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource.
85 citations
TL;DR: In order to meet patients’ needs, it is an ethical duty for healthcare staff to be able to recognise experiences of EL, that is, to communicate with the patients about these experiences in an appropriate manner, which in turn demands knowledge about existential issues and skills to deal with them.
Abstract: Background:According to ethical guidelines, healthcare professionals should be able to provide care that allows for the patients’ values, customs and beliefs, and the existential issues that are co...
63 citations
TL;DR: It is suggested that guidance by the Professional Values Model may help in enhancement of motivation efforts of the nurse managers and therefore should be taken into account.
Abstract: One of the most important criteria for professionalism is accumulation of knowledge that is usable in professional practice. Nursing models and theories are important elements of accumulating nursing knowledge and have a chance to guarantee the ethical professional practice. In recent years, there has been an increase in the use of models in nursing research and newly created terminology has started to be used in nursing. In this study, a new model, termed as the Professional Values Model, developed by the authors was described. Concepts comprising the conceptual framework of the model and relations between the concepts were explained. It is assumed that awareness about concepts of the model will increase not only the patients' satisfaction with nursing care, but also the nurses' job satisfaction and quality of nursing care. Contemporary literature has been reviewed and synthesized to develop this theoretical paper on the Professional Values Model in nursing. Having high values in nursing increases job satisfaction, which results in the improvement of patient care and satisfaction. Also, individual characteristics are effective in the determination of individual needs, priorities, and values. This relation, proved through research about the Professional Values Model, has been explained. With development of these concepts, individuals' satisfaction with care and nurses' job satisfaction will be enhanced, which will increase the quality of nursing care. Most importantly, nurses can take proper decisions about ethical dilemmas and take ethical action when they take these values into consideration when giving care. The Professional Values Model seems suitable for nurse managers and it is expected that testing will improve it. Implementation of the Professional Values Model by nurse managers may increase motivation of nurses they work with. It is suggested that guidance by the Professional Values Model may help in enhancement of motivation efforts of the nurse managers and therefore should be taken into account.
58 citations
TL;DR: Identifying ethical stressors in the workplace and giving proper feedback to the authorities to eliminate these factors and improve the ethical climate in these workplaces can help enhance job satisfaction in nurses and lead to higher quality care.
Abstract: Background:Moral distress and ethical climate are important issues in the workplace that appear to affect people’s quality of work life.Objectives:This study was conducted to determine the relationship of moral distress and ethical climate to job satisfaction in critical care nurses.Materials and methods:This descriptive-correlation study was conducted on 142 critical care nurses, selected from five social security hospitals in north Iran through census sampling. Data were collected using a demographic questionnaire, the Moral Distress Scale–Revised, the Olson’s Hospital Ethical Climate Survey, and the Brayfield and Rothe Job Satisfaction index.Ethical considerations:The research project was approved by the Ethics Committee of Mazandaran University of Medical Sciences and the Medical Deputy of the Social Security Organization.Findings:The mean scores obtained by the critical care nurses for moral distress, ethical climate, and job satisfaction were 87.02 ± 44.56, 3.51 ± 0.53, and 62.64 ± 9.39, respectivel...
56 citations
TL;DR: The focus of the studies was on finding associations between ethical climate and work-related factors such as job satisfaction, moral distress, and turnover intentions.
Abstract: Background:In the past two decades, interest in the concept of ethical climate and in its research has increased in healthcare. Ethical climate is viewed as a type of organizational work climate, a...
56 citations
TL;DR: It seems when nurses make moral decisions, they experience a conflict between personal and professional values in their careers and thus experience moral tension, which can provide a way for them to distance themselves from patients, thereby making nurses indifferent to moral care.
Abstract: Background:To provide care with high quality, nurses face a number of moral issues requiring them to have moral abilities in professional performance. Moral sensitivity is the first step in moral performance. However, its relation to the quality of care patients receive is controversial.Research objective:This study aims to determine the relationship between the moral sensitivity of nurses and the quality of care received by patients in the medical wards.Research design:A descriptive correlational study using validated tools, including Moral Sensitivity Questionnaire and the Quality Patient Quality Scale.Participants and research context:In total, 198 nurses and 198 patients in 17 medical wards of hospitals affiliated with Tabriz University of Medical Sciences, Iran.Ethical considerations:The study was reviewed and approved by the Ethics Committee of Tabriz University of Medical Sciences.Findings:The mean values of nurses’ moral sensitivity and nurses’ quality care were 136.47 ± 13.30 and 196.36 ± 44.10, ...
54 citations
TL;DR: It is argued that concurrent care policy is socially just since it has potential to promote well-being in vulnerable children and families and can limit the inequity children at end-of-life experience in access to high-quality hospice care.
Abstract: Recent estimates indicate that over 40,000 children die annually in the United States and a majority have life-limiting conditions. Children at end of life require extensive healthcare resources, including multiple hospital readmissions and emergency room visits. Yet, many children still suffer from symptoms at end of life-including fatigue, pain, dyspnea, and anxiety-with less than 10% of these children utilizing hospice care services. A critical barrier to pediatric hospice use was the original federal regulations associated with the hospice care that required a diagnosis of 6 months to live and the discontinuation of all curative treatments. The Concurrent Care Provision of the United States' Affordable Care Act eliminated the need to forgo curative therapies in order to enroll in hospice for children in Medicaid or Children's Health Insurance Program. Concurrent care for children can help mitigate the tension families experience in choosing between essential forms of care, as well as contribute to improved end-of-life outcomes for the child and possibly bereavement outcomes for the family. Understanding concurrent care for children from a social justice perspective has important advocacy and research implications for hospice and palliative care clinicians providing care for children and their families. We apply Powers and Faden's theory of social justice "as the moral foundation of public health and health policy" to the provision of concurrent care to children near end of life and families in the United States. The goals of applying this theory are to explore additional insights and perspectives into concurrent care policy may provide and to assess the usefulness of this theory when applied to end-of-life health policy. We argue that concurrent care policy is socially just since it has potential to promote well-being in vulnerable children and families and can limit the inequity children at end-of-life experience in access to high-quality hospice care.
51 citations
TL;DR: This article argues that the concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body and the obstetric focus on the foetus over the woman, and suggests that a focus on care ethics has the potential to remedy these problems.
Abstract: The bioethical principle of respect for a person’s bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. We propose that large institutions that prioritize a midwife–institution relationship over a midwife–woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles.
48 citations
TL;DR: An analysis of the concept of caring encounter in nursing from the patients’ and nurses’ point of view clarified the conceptual differences between relationship and caring communion as the mutuality in the caring encounter differs from the dependence on the other pronounced in the relationship.
Abstract: Background:The concept ‘encounter’ occurs in caring literature as a synonym for dialogue and relation describing deeper levels of interaction between patient and nurse. In nursing and caring resear...
48 citations
TL;DR: The conceptualization of old age as reported by seniors and students mainly carried negative connotations, reflecting the profoundly based stereotypes within society regarding the older people.
Abstract: Background:Old age–based discrimination is observed as the most tolerated prejudice in society and has also been witnessed in healthcare institutions.Aims:The aim of this study is to explore age-ba...
TL;DR: The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples’ ability to enact moral agency in making such decisions.
Abstract: In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples' ability to enact moral agency in making such decisions.
TL;DR: Psychometric evaluation showed that the 4-sub-scale, 21-item Nurses’ Moral Courage Scale demonstrates good reliability and validity at its current state of development showing a good level of internal consistency for a new scale.
Abstract: Background:Moral courage is required at all levels of nursing. However, there is a need for development of instruments to measure nurses’ moral courage.Objectives:The objective of this study is to ...
TL;DR: There is need for plans to increase nurses’ awareness of certain professional duties and improve their professional performance in all areas alongside their care duties.
Abstract: Background:In order to prove their commitment to the nursing profession, nurses need to base their professional activities on certain acknowledged values. Although a large number of studies have ad...
TL;DR: It was observed that moral empowerment program has been effective in reducing the mean score of moral distress and it is recommended that nursing managers and hospital directors implement empowerment program, in order to reduce the moral distress of nurses and improve the quality of care.
Abstract: Background:Moral distress has been experienced by about 67% of critical care nurses which causes many complications such as job dissatisfaction, loss of capacity for caring, and turnover for nurses...
TL;DR: The nurses’ ethical leadership, ethical climate, and job satisfaction levels are moderate, and there is a positive relationship between them.
Abstract: Background:The development of ethical leadership approaches plays an important role in achieving better patient care. Although studies that analyze the impact of ethical leadership on ethical clima...
TL;DR: In this paper, a cross-sectional, correlational design was employed to collect data from 193 nurses using the Spiritual Well-being Scale and the Moral Distress Scale-Revised.
Abstract: Background:Moral distress is increasingly recognized as a problem affecting healthcare professionals, especially nurses. If not addressed, it may create job dissatisfaction, withdrawal from the moral dimensions of patient care, or even encourage one to leave the profession. Spiritual well-being is a concept which is considered when dealing with problems and stress relating to a variety of issues.Objective:This research aimed to examine the relationship between spiritual well-being and moral distress among a sample of Iranian nurses and also to study the determinant factors of moral distress and spiritual well-being in nurses.Research design:A cross-sectional, correlational design was employed to collect data from 193 nurses using the Spiritual Well-Being Scale and the Moral Distress Scale-Revised.Ethical considerations:This study was approved by the Regional Committee of Medical Research Ethics. The ethical principles of voluntary participation, anonymity, and confidentiality were considered.Findings:Mean...
TL;DR: The model structures of the older patients' dignity from both the nurses’ and patients’ perspectives support the idea of a multidimensional structure of human dignity.
Abstract: Introduction:Dignity is one of the most important values sensitively perceived by patients in nursing care. Older patients have been identified as having a high risk of losing their dignity in inst...
TL;DR: The results indicate that nurses are negatively affected to face the concepts of death, euthanasia and work with dying patient and the implementation of training and consulting services to nurses at appropriate intervals during both education and professional life are required.
Abstract: Background:Attitudes of nurses towards death and related concepts influence end-of-life care. Determining nurses’ views and attitudes towards these concepts and the factors that affect them are nec...
TL;DR: It is argued that care ethics can only profit from a loosely organized academic profile that allows for flexibility and critical attitude that brings us close to the good emerging in specific practices, and proposes to conceive care ethics as an interdisciplinary field of inquiry, incorporating a dialectical relation between empirical research and theoretical reflection.
Abstract: Background:For many years the body of literature known as ‘care ethics’ or ‘ethics of care’ has been discussed as regards its status and nature There is much confusion and little structured discus
TL;DR: The use of the problem-based learning method in ethics education enhances moral development among nursing students, however, further studies are needed to determine whether such method improves moral decision-making, moral reasoning, practical considerations, and familiarity with the ethical issues among Nursing students.
Abstract: Background:Moral reasoning is a vital skill in the nursing profession. Teaching moral reasoning to students is necessary toward promoting nursing ethics.Objectives:The aim of this study was to comp...
TL;DR: The result of this study may indicate that nurses with high moral sensitivity can sense and identify moral problems, but not resolve them, and supporting nurses to solve ethical problems, not benumbing them, can be important for better nursing care and prevention of nurses’ resignation.
Abstract: Background:Moral distress occurs when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Moral distress was found to cause negative feelings, burnout, and/or resignation. Not only external factors such as lack of staff but also internal ones affect moral distress. Moral sensitivity, which is thought of as an advantage of nurses, could effect moral distress, as nurses being unaware of existing ethical problems must feel little distress.Objectives:To examine the impact of moral sensitivity on moral distress among psychiatric nurses, and affirm the hypothesis that nurses with higher moral sensitivity will suffer moral distress more than nurses with less moral sensitivity in two different samples.Ethical consideration:The study obtained ethical approval from the Research Ethics Committee of the Faculty of Medicine at Mie University (# 1111, 20.4.2010), and by the Turku University Ethics Board (29.5.2012). Permissions to undertake the ...
TL;DR: Investigating the relationship between the level of ethical sensitivity in emergency service nurses and their levels of burnout and job satisfaction found a weak and negative correlation between Moral Sensitivity Questionnaire and Maslach Burnout Inventory scores.
Abstract: Background:Rising levels of burnout and decreasing job satisfaction can inhibit healthcare professionals from providing high-quality care due to a corresponding decrease in their ethical sensitivity.Aim:This study aimed to determine the relationship between the level of ethical sensitivity in emergency service nurses and their levels of burnout and job satisfaction.Research design:This research employed a descriptive and cross-sectional design.Participants and research context:This study was conducted with a sample of 236 nurses, all of whom worked in emergency service between 24 July 2015 and 28 April 2016. Data were collected using the Moral Sensitivity Questionnaire, Maslach Burnout Inventory, and Minnesota Job Satisfaction Scale.Ethical considerations:This study was approved by the Institutional Ethics Review Board of Ondokuz Mayis University.Findings:There was a weak and negative correlation (r = –0.158, p = 0.015) between Moral Sensitivity Questionnaire and Maslach Burnout Inventory scores. There wa...
TL;DR: The salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour were explored to explore why nurses do not act with moral courage to change this harmful practice.
Abstract: Background:Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses’ intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses’ beliefs regarding the use of physical restraints would provide additional social information about nurses’ intention to perform this practice.Aim:To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour.Research design:A belief elicitation study was conducted.Participants and research context:Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed.Ethical considerations:Ethical approval was obtained from the...
TL;DR: Hospitalized adolescents stated that healthcare services should protect their personal privacy and autonomy and respect the adolescent’s identity and communicate intimately with them to provide the dignity.
Abstract: Background:Adolescents can be vulnerable to diminished dignity in the hospital because young people have significantly different healthcare needs than children and adults. They like to cooperate wi...
TL;DR: The present findings indicate the need for more robust assessment tools with adequate psychometric properties and the descriptive analysis of empathy, which is important to the evaluation of the quality of care provided to older people.
Abstract: Introduction:Empathy is a complex human experience that involves the subjective intersection of different individuals. In the context of nursing care in the geriatric setting, the benefits of empat...
TL;DR: Nursing administrators should be conscious of the role of moral distress and bullying in the nursing workplace in increasing burnout, as mediated by their perceptions of workplace bullying.
Abstract: Background:Moral distress and workplace bullying are important issues in the nursing workplace that appear to affect nurse’s burnout.Aim:To investigate the relationship between moral distress and b...
TL;DR: According to the results of the study, there was a reverse significant relationship between moral distress and perceived organizational justice; therefore, the head nurses are expected to contribute to reducemoral distress and to increase perceived organizationalJustice in nurses.
Abstract: Background:The nature of the nursing profession pays more attention to ethics of healthcare than its therapeutic dimension. One of the prevalent moral issues in this profession is moral distress. M...
TL;DR: Three main themes were found that expressed the moral demands experienced and negotiated by nurses: adapting to the person, activating patients’ strengths and collaboration with patients and informal caregivers.
Abstract: Background:Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disabili...
TL;DR: Team-based learning is a better alternative to lecture to teach ethics in medical education and was found superior to lecture at long-term retention tests.
Abstract: Background:Medical education literature suggests that ethics education should be learner-centered and problem-based rather than theory-based. Team-based learning is an appropriate method for this s...