Background The high public demand for healthcare services during the COVID-19 pandemic and strict infection control measures, coupled with threat of severe illness and death, and limited resources, led to many healthcare workers (HCWs) experiencing ethically challenging situations (ECSs). Objective To systematically explore first-hand accounts of ECS-evoking moral distress among HCWs during this public health emergency. Research design This was an open cohort study. All participants were asked whether they had been in ECS-evoking moral distress during the pandemic. Those who (...) had were asked to describe these situations. Answers were systematically analyzed according to three levels of root causes for ECSs, using thematic analysis. Participants and research context In January 2022, 977 HCWs from four Norwegian university hospitals participated. Ethical considerations The study received ethical approval from the Norwegian Ethical Review Authority (No. 130944). Results In total, 508 participants (52%) reported that they had experienced ECS-evoking moral distress during the pandemic, whereof 323 provided a qualitative description. We found that while a few reported ECSs caused at the patient level, and some described situations at the unit/team level, the vast majority reported situations caused at the system level, predominantly related to resource scarcity, particularly poor staffing. Conclusion Our findings strongly indicate that efforts to mitigate moral distress among HCWs should be targeted at the system level. More specifically, the study findings highlight resource limitations, particularly poor staffing, as a major cause of moral distress during the pandemic. (shrink)

Background: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was (...) used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study’s coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress’ biomedical ethics of respect for patients’ autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care. (shrink)

Normative issues associated with the design and implementation of population-based lung cancer screening policies are underexamined. This study was an exposition of the ethical justification for screening and potential ethical issues and their solutions in Canadian jurisdictions. A qualitative description study was conducted. Key informants, defined as policymakers, scientists and clinicians who develop and implement lung cancer screening policies in Canada, were purposively sampled and interviewed using a semi-structured guide informed by population-based disease screening principles and ethical issues (...) in cancer screening. Interview data were analyzed using qualitative content analysis. Fifteen key informants from seven provinces were interviewed. Virtually all justified screening by beneficence, describing that population benefits outweigh individual harms if high-risk people are screened in organized programs according to disease screening principles. Equity of screening access, stigma and lung cancer primary prevention were other ethical issues identified. Key informants prioritized beneficence over concerns for group-level justice issues when making decisions about whether to implement screening policies. This prioritization, though slight, may impede the implementation of screening policies in a way that effectively addresses justice issues, a goal likely to require justice theory and critical interpretation of disease screening principles. (shrink)

Background Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL’s experience. Research aim The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. Research design A qualitative (...) descriptive design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. Participant and research context Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. Ethical considerations This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. Findings UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. Conclusions The UBCCNL’s experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed. (shrink)

Background With the deepening trend of global aging, the issue of dignity of older adults has received widespread attention. The research on the dignity of older adults in nursing homes in China has only just begun, and it is necessary to further explore the dignity experience of older adults in nursing homes. Research Objective To investigate the thematic features of dignity experiences of older adults residing in nursing homes in mainland China. Furthermore, it may serve as a starting point for (...) further research that formulates intervention strategies. Research Design This is a qualitative descriptive study. Twenty older adults living in one of two private nursing homes between September and November 2022 were selected as participants. For each patient, we conducted semi-structured interviews, from which we extracted and assessed information using qualitative content analysis method. SRQR reporting guidelines were used. Ethical considerations ‘Ethical considerations' with information regarding ethical review, informed consent process and confidentiality. Results Five themes and eight subthemes emerged from the transcripts: (1) self-esteem (sense of self-worth and becoming a burden), (2) perceived value to society (being respected and belonging), (3) interpersonal relationships (relationships with others and respectful behavior toward others), (4) autonomy (control of daily life and participation in decision-making), and (5) acceptance and adaptation. Conclusion Dignity in older adults can be preserved by realizing self-worth, relieving the burden of self-perceived, promoting belonging, strengthening social ties, enhancing autonomy, and engaging in activities. (shrink)

Background There is considerable variation in the functionality of bioethical services in different institutions and countries for children in hospital, despite new challenges due to increasing technology supports for children with serious illness and medical complexity. We aimed to understand how bioethics services address bioethical concerns that are increasingly encountered in paediatric intensive care. Methods A qualitative descriptive design was used to describe clinician’s perspectives on the functionality of clinical bioethics services for paediatric intensive care units. Clinicians who were (...) members of formal or informal clinical bioethics groups, or who were closely involved with the process of working through ethically challenging decisions, were interviewed. Interviews took place online. Resulting transcripts were analysed using thematic analysis. Results From 33 interviews, we identified four themes that described the functionality of bioethics services when a child requires technology to sustain life: striving for consensus; the importance of guidelines; a structure that facilitates a time-sensitive and relevant response; and strong leadership and teamwork. Conclusions Clinical bioethics services have the potential to expand their role due to the challenges brought by advancing medical technology and the increasing options it brings for treatment. Further work is needed to identify where and how bioethics services can evolve and adapt to fully address the needs of the decision-makers in PICU. (shrink)

Background During the COVID-19 pandemic, virtual visiting technologies were rapidly integrated into the care offered by intensive care units (ICUs) in the UK and across the globe. Today, these technologies offer a necessary adjunct to in-person visits for those with ICU access limited by geography, work/caregiving commitments, or frailty. However, few empirical studies explore the ethical issues associated with virtual visiting. This study aimed to explore the anticipated or unanticipated ethical issues raised by using virtual visiting in the ICU, such (...) that healthcare professionals can be informed about how to carry out virtual visits ethically, safely and productively. Methods We used a descriptive exploratory qualitative research approach recruiting a convenience sample of newly-graduated junior doctors facilitating ICU virtual visits in a tertiary academic centre. Eight newly graduated junior doctors, seven female and one male, aged 23–27, participated in semi-structured interviews. We analysed transcripts using an inductive coding approach. Results Five overarching themes emerged. Two of the themes namely, ‘fulfilling a moral instinct to connect families’ and ‘promoting autonomy’, arose from participants’ descriptions of how virtual visits aligned with healthcare standards and practices they considered ethical. Three further themes, ‘preserving dignity and privacy’, ‘managing emotional distress’, and ‘providing equitable access’ to virtual visiting technologies, highlight how virtual visits might exacerbate ethical issues related to family communications. Conclusion Virtual visiting may potentially both ameliorate and exacerbate aspects of ethical healthcare delivery for ICU patients and family members. ICU team members should consider unique ethical considerations related to using virtual visiting. We recommend virtual communications skills training for staff and advocate for the use of easily accessible educational resources for families who wish to visit critically unwell patients remotely. (shrink)

The generation of route descriptions is a fundamental task of navigation systems. A particular problem in this context is to identify routes that can easily be described and processed by users. In this work, we present a framework for representing route networks with the qualitative information necessary to evaluate and optimize route descriptions with regard to ambiguities in them. We identify different agent models that differ in how agents are assumed to process route descriptions while navigating through route networks (...) and discuss which agent models can be translated into PDL programs. Further, we analyze the computational complexity of matching route descriptions and paths in route networks in dependency of the agent model. Finally, we empirically evaluate the influence of the agent model on the optimization and the processing of route instructions. (shrink)

Medical assistance in dying (MAiD) was legalized in Canada following the Carter v. Canada ruling of 2015. In spite of legalization, the ethics of MAiD remain contentious. The bioethical literature has attempted to differentiate MAiD from withdrawing life-sustaining treatment (WLT) in an effort to examine the nature of the moral difference between the two. However, this research has often neglected the firsthand experiences of the clinicians involved in these procedures. By asking physicians if they perceive the major bioethical accounts as (...) clinically useful, we seek to distinguish between aspects of the contemporary bioethical landscape which are useful at the bedside and those which are divorced from the realities faced by clinicians. We applied a qualitative descriptive approach to explore physicians’ experiences and bioethical distinctions in providing MAiD and WLT. Semi-structured interviews were conducted with 21 physicians, and the transcripts were thematically analyzed to identify common patterns and divergences in their perspectives. Three core themes were found: (1) consensus on MAiD’s moral equivalence with WLT despite differences between the practice, (2) discord regarding the use of the term ‘killing’, and (3) disjuncture between bioethical debates and practice. Theme 1 comprised of three sub-themes: (1.1) no moral difference between MAiD and WLT, (1.2) physician versus underlying medical condition as cause of death, and (1.3) relief of suffering. In order to have practical utility for clinical practice, it is essential for bioethicists to engage in dialogue with patients and their medical providers pursuing MAiD or WLT. Theoretical debates that are divorced from the realities of terminal illness do not assist physicians with navigating the ethical terrain of ending a patient’s life. This research captures meaningful accounts regarding MAiD and WLT that is rooted in the lived experience of the providers of these services in order for bioethical debates to have substantive impact in clinical practice and in legislation surrounding future health policies. (shrink)

BackgroundInformed consent as stipulated in regulatory human research guidelines requires volunteers to be well-informed about what will happen to them in a trial. However, researchers may be faced with the challenge of how to ensure that a volunteer agreeing to take part in a clinical trial is truly informed. This study aimed to find out volunteers’ comprehension of informed consent and voluntary participation in Human Immunodeficiency Virus (HIV) clinical trials during the registration cohort.MethodsWe conducted a qualitative study among volunteers (...) who were enrolled in the registration cohort of HIV clinical trials in Dar es Salaam, Tanzania. A purposive sampling strategy was used to obtain twenty study participants. The data were collected between June and September 2020 using a semi-structured interview guide. In-depth interviews were used to collect the data to obtain deep insights of the individual study participants on the comprehension of informed consent and participation in the clinical trial. A thematic analysis approach was used to analyze the data. Themes and subthemes were supported by the quotes from the participants.ResultsVolunteers described comprehension of informed consent from different perspectives. They reported that various components of the informed consent such as study procedure, confidentiality, risk and benefits were grasped during engagement meetings. Furthermore, the volunteers’ decision to participate in the registration cohort was voluntary. However, trial aspects such as health insurance, free condoms, and medical checkups could have indirectly influenced their reluctance to withdraw from the study.ConclusionEngagement meetings may increase the comprehension of informed consent among potential participants for HIV clinical trials. However, trial incentives may influence participation, and thus future research should focus on the challenges of giving incentives in the study. This will ensure comprehension and voluntary participation in the context of HIV clinical trials. (shrink)

Phenomenology and Quantum theory have defined themselves against the subject-object tradition of thought and against the modern objectivistic attempt to unify explanation of reality or being. Scientific technology and calculative way of thinking have prevailed over meditative and qualitative thinking in modern times. Despite scientific efforts to eliminate any inconsistency caused by metaphysical speculations and systems, in everyday life and science we encounter such phenomena which cannot be explained unambiguously and fully on the basis of purely conventional criteria. This (...) paper focuses on Bohr's framework of complementarity. The idea enables us exploring and describing a given phenomenon in such manner that we get adequate knowledge of the same phenomenon or subject of interest only by completing incompatible descriptions. (shrink)

In the contemporary scene, psychological researchers seeking alternative research strategies are turning increasingly toward interpretation theory. However, other strategies are also available, and one of these is descriptive science. Descriptive practices as the basis for the clarification of meanings have received less emphasis because of several epistemological assumptions about meaning that have appeared in the literature of interpretive science. Based upon the work of contemporary transcendental philosophers, especially J. N. Mohanty, this article argues that a descriptive scientific perspective can respond (...) to some of the hermeneutic arguments about meaning and that solid findings can be established descriptively. It is argued that both description and interpretation are legitimate but that they are tied to different conditions and interests. (shrink)

ABSTRACT Objective: To describe how local research ethics committees (LRECs) consider and apply research ethics in the evaluation of biomedical research proposals. Design: A qualitative study was conducted using purposeful sampling, focus groups and a grounded theory approach to generate data and to analyse the work of the LRECs. Setting and participants: 11 LRECs of the Mexican Institute of Social Security (IMSS). Results: LRECs considered ethics to be implicit in all types of research, but that ethics reviews were only (...) necessary for projects that included the direct participation of human beings. The LRECs appeared to understand the importance of consent, as in the completion of a consent form, but did not emphasise the importance of the process of acquiring ‘informed’ consent. The committees considered their main roles or functions to be: (a) to improve the methodological quality of research and to verify – if applicable – the ethical aspects; (b) to encourage personnel to undergo research training; (c) to follow‐up research to oversee the adherence to norms and compliance with a specified research timetable. Conclusions: This study provides a valuable insight into how these LRECs understand the ethical review process. The emphasis of the committees was on rules, regulations, improving research methodology and research training, rather than a focus on efforts to protect the rights and well being of research subjects. The results encourage further normative and descriptive lines of investigation concerning education and the development of LRECs. (shrink)

Qualitative description of the movement of objects can be very important when there are large quantity of data or incomplete information, such as in positioning technologies and movement of robots. We present a first step in the combination of fuzzy qualitative reasoning and quantitative data obtained by human interaction and external devices as GPS, in order to update and correct the qualitative information. We consider a Propositional Dynamic Logic which deals with qualitative velocity and enables (...) us to represent some reasoning tasks about qualitative properties. The use of logic provides a general framework which improves the capacity of reasoning. In this way, we can infer additional information by using axioms and the logic apparatus. In this paper we present sound and complete relational dual tableau that can be used for verification of validity of formulas of the logic in question. (shrink)

The paper is a critical comment on D. Hoffman. The Scrambling Theorem: A simple proof of the logical possibility of spectrum inversion. Consciousness and Cognition, 2006, 15, 31–45.

Assisted reproduction (ART), particularly that performed using donated gametes, increases the prospect of healthy babies being delivered to increasing numbers of people striving for parenthood. The psychosocial, ethical and legislative issues related both to the donation and receipt of gametes are perceived as extraordinarily complicated. In 2009, a research project aimed at mapping the issues was drawn up and implemented in the Czech Republic. The project should have provided material for consultation purposes, for the work of ethical and legislative bodies, (...) and for better interdisciplinary and international communication in reproductive medicine. Work on the project was affected by several unforeseen events, particularly by the drafting and adoption of a new law on ART (to which the project was initially to have contributed material once concluded). The article describes the dynamic and structural changes occurring within the project due to drafting of the bill as well as the changes and consequences resulting from other circumstances related to the topic researched. (shrink)

Background In Canadian jurisdictions without specific legislation pertaining to research consent, the onus is placed on researchers to determine whether a child is capable of independently consenting to participate in a research study. Little, however, is known about how child health researchers are approaching consent and capacity assessment in practice. The aim of this study was to explore and describe researchers' current practices. Methods The study used a qualitative descriptive design consisting of 14 face-to-face interviews with child health researchers (...) and research assistants in Southern Ontario. Transcribed interviews were analysed for common themes. Results Procedures for assessing capacity varied considerably from the use of age cutoffs to in-depth engagement with each child. Three key issues emerged from the accounts: (1) requirements that consent be provided by a single person thwarted researchers' abilities to support family decision-making; (2) little practical distinction was made between assessing if a child was capable, versus determining if study information had been adequately explained by the researcher; and (3) participants' perceived that review boards' requirements may conflict with what they considered ethical consent practices. Conclusion The results suggest that researchers' consent and capacity knowledge and skills vary considerably. Perceived discrepancies between ethical practice and ethics boards' requirements suggest the need for dialogue, education and possibly ethics board reforms. Furthermore we propose, where appropriate, a ‘family decision-making’ model that allows parents and their children to consent together, thereby shifting the focus from separate assent and consent procedures to approaches that appropriately engage the child and family. (shrink)

Meta‐synthesis of qualitative research can be an important way to consolidate and grow nursing knowledge and theory. However, from recent readings of such works in the nursing literature, one can observe that there is increasing use of meta‐synthesis being used as a way to simply aggregate qualitative research findings in a manner claimed to be similar to quantitative meta‐research while also remaining compatible with the qualitative research tradition. The aim of this paper is to discuss whether this (...) meta‐aggregation form of research has a sound epistemological foundation and should be considered a viable form of meta‐synthesis. The conclusion drawn is that meta‐aggregation falls short of being a sound method and is not compatible with the qualitative research philosophy. It is also concluded that meta‐aggregation should not be seen as a form of qualitative meta‐synthesis. Meta‐synthesis is best understood as a way to re‐interpret, compare and translate disparate qualitative studies using different conceptual apparatus into a consolidated knowledge of fundamental importance to nursing care practitioners. To conclude, aggregating qualitative research tends to turn rich descriptions into thin abstractions that are of little use to nursing practice knowledge and does not advance nursing science. (shrink)

In this paper we analyse the role of description in qualitative research. Our point is this: the description itself has a necessary role in qualitative research; though that role is necessary, it is not enough, interpretation is also necessary, but this interpretation must be supported on a realist epistemology setting up clearly what is observation. In order to defend this point we show some problems in the relationship description-interpretation; then, we choose two proposals that defend (...) the role of description in qualitative research; finally, we respond what is the role of description in qualitative research. En este artículo analizamos cuál es el papel de la descripción en la investigación cualitativa. Afirmamos que la descripción en sí misma tiene un papel necesario en la investigación cualitativa; aunque este papel es necesario, no es suficiente, también se necesita la interpretación, pero esta interpretación debe respaldarse en una epistemología realista que tenga claro qué cuenta como observación. Para defender esta afirmación, mostramos algunos problemas en la relación descripción-interpretación; luego, elegimos dos propuestas que defienden el papel de la descripción en la investigación cualitativa y, finalmente, respondemos cuál es el papel de la descripción en la investigación cualitativa. (shrink)

Background Individuals living with multimorbidity and/or mental health issues, low education, socioeconomic status, and polypharmacy are often called complex patients. The complexity of their health and social care needs can make them prone to disease burden and suffering. Therefore, they frequently access health care services to seek guidance for managing their illness and suffering. Aims The aim of this research was to describe the approaches used by nurses to alleviate the suffering of individuals with multimorbidity and complex needs in acute (...) care settings. Research Design A qualitative descriptive approach. Participants and Research Context Semi-structured interviews were conducted with 19 nurses working in general, medical-surgical, specialized, and intensive care settings across five hospitals in Pakistan. Reflexive thematic analysis was used for analysis. Ethical Considerations Ethical approval was obtained from the Ethical Committee of Al-Nafees Medical College Islamabad, Pakistan. Findings Four themes were generated: Deeper Exploration of Patients’ Health-Illness Situation and Complexity, Prioritizing Patient Psychosocial and Emotional Needs, Instilling Hope and Encouragement in Patients, and Creating a Comforting Environment to Foster Sharing of felt needs. Discussion Nurses emphasized the need of deeper inquiry into patients illness situation and complexity to discern the impact of determinants on their well-being and develop care plans that are tailored to address psychosocial, emotional, and physical suffering of this patient population. Conclusions Alleviation of patient suffering is integral to compassionate nursing care. Nurses use a multifaceted approach entailing sensitive understanding, recognizing sociocultural and structural determinants impact on patient situation, and individual and interdisciplinary altruistic actions to alleviate patient suffering. (shrink)

The present article explores problems of descriptive reporting, relativism, and the lack of systematic follow-up of qualitative research. Such issues are discussed in relation to components of phenomenologically based research reports, with emphasis on the articulation of the research approach, and steps to facilitate validation. The value of a descriptive science derived from phenomenological principles is discussed as forming a common ground for initial qualitative inquiry, while providing a critically reflective base upon which rational consensus can be developed. (...) I suggest that the values of follow-up, tentativeness, and humility in research reporting, and a rational framework of critical validation, constitute a common core of science. In addition, phenomenological tenets are discussed as providing a corrective to the uncritical search for absolutes, or the "anything counts" conception of relativistic movements. (shrink)

Knowledge about aspects that influence recovery and adaptation in the postacute phase of disabling health events is key to understanding how best to provide appropriate rehabilitation and health services. Qualitative longitudinal research makes it possible to look for patterns, key time points and critical moments that could be vital for interventions and supports. However, strategies that support robust data management and analysis for longitudinal qualitative research in health‐care are not well documented in the literature. This article reviews three (...) challenges encountered in a large longitudinal qualitative descriptive study about experiences of recovery and adaptation after traumatic brain injury in New Zealand, and the strategies and technologies used to address them. These were (i) tracking coding and analysis decisions during an extended analysis period; (ii) navigating interpretations over time and in response to new data; and (iii) exploiting data volume and complexity. Concept mapping during coding review, a considered combination of information technologies, employing both cross‐sectional and narrative analysis, and an expectation that subanalyses would be required for key topics helped us manage the study in a way that facilitated useful and novel insights. These strategies could be applied in other qualitative longitudinal studies in healthcare inquiry to optimise data analysis and stimulate important insights. (shrink)

Background: Currently, graduating nurses face pandemic-related uncertainty including gaps in risk perception, unexpected Covid-19 moral dilemmas, and distress surrounding personal health risk. Research question/aim/objectives/Method: The purpose of this basic qualitative descriptive study is to describe the willingness of graduating nurses to provide care during the Covid-19 pandemic. Participants and research context: One week prior to graduation, students were required to submit a written assignment describing willingness to practice in light of the ongoing pandemic. Ethical considerations: This study was approved (...) by an Institutional Review Board. Findings/results: Eighty-four ( n = 84) assignments were used for analysis. Of these, 82% (n = 69) of the graduating nurses describe a willingness to voluntarily care for Covid-19 patients. After summarizing narrative responses, two themes emerged including self-assessment of personal and familial risk and conflicting obligations. Discussion: The assessment of risk to self and family are key in determining whether graduating nurses will care for Covid-19 patients. Conflicting obligations may contribute to stress and uncertainty potentially leading to early burnout. Conclusion: Findings from this study can inform academicians of the need to adequality prepare graduating nurses for Covid-19-associated risks and ethical decision making. Organizations should alter residencies and orientation to support the needs of new nurses. (shrink)

Qualitative description of movements can be very important for representation and reasoning about dynamic systems which are complex in structure or whenever numerical data are incomplete or inaccessible. For this reason, we present a hybrid approach based on the combination of qualitative reasoning, quantitative data and logical methods. In this article, we introduce a new propositional dynamic logic QM for representation and reasoning with relative movements of objects. In this way, we can infer additional information about movements (...) by using axioms and the logic apparatus. We present a sound and complete deduction system in dual tableaux style for the logic QM. The system can be used for verification of validity of formulas of the logic in question. (shrink)

This study presents a qualitative description of situations at work that staff members perceive as giving rise to ethical issues. All staff members working with patients across seven wards were given the opportunity to freely describe ethical considerations in an ethical diary over the course of one week. One hundred and five staff members kept a diary. The diaries were analysed with qualitative content analysis where four dominant themes emerged: good care, order and clarity, loyalty, and inadequacy. (...) These results contain statements in which patients are respected and listened to, as well as statements that express a desire for relatively strict, routine-based care. Relatively few statements were of a reflective or discussing nature which highlights the need for clinical ethical support. There is a need of a visible and supportive leadership which encourages ethical reflection. Reflections on real cases could provide an opportunity to challenge existing practices and thereby promote ethical awareness. (shrink)

Qualitative research, particularly phenomenology, is increasingly popular as a method for midwifery and health-related research. These approaches enable rich and detailed explanations to be uncovered and bring experience to life. Important recommendations and practice- based implications may then be raised and debated for future use. This book brings together a range of phenomenological methods and insights into one accessible text. Illustrated with plenty of examples of successful phenomenological research, Qualitative Research in Midwifery and Childbirth keeps the focus applied (...) to midwifery and childbirth and makes clear the links to practice throughout. The book introduces three key phenomenological approaches âe" descriptive, interpretive and the life world âe" and includes a comparative chapter which discusses the differences between these varied perspectives and methods. Each chapter focuses on how these approaches are used within midwifery research. The remaining chapters present a number of different research projects. These demonstrate how different phenomenological approaches have been used to explore and uncover experiences of childbirth and maternity as well as offering important insights into how women experience different facets of the birth experience during the antenatal, intra-partum and postnatal period. Designed for researchers and students undertaking research projects on midwifery and childbirth, this text includes contributions from a range of international and highly regarded phenomenological authors and researchers. (shrink)

Background Ethics consultations are established in contemporary health care. Informal ethics consultations often occur and are possibly beneficial, yet they have not been empirically studied. We sought to describe features of informal ethics consultations and to identify facilitators and disruptors of patient participation in such ethics consultations. Methods We used a mixed methods (quantitative and qualitative) evaluation design and conveniently sampled 64 sequential informal ethics consultations over a period of 3 years in two academic health care centers in one (...) city in Canada. Data were collected by the two participating ethicists. We used statistical description for the quantitative data and thematic analysis for the qualitative data. Results Patients participated in only two (3%) of the informal ethics consultations. Factors that disrupted patient participation in ethics consultations were related to patients’ issues (mental impairments), family issues (family withholding information from the patient), and team members’ issues (efficiency considerations). Conclusion Informal ethics consultations may be used for ethics capacity building of health care providers rather than for engagement with addressed patients. Further research on informal ethics consultations is required, including in different sites. (shrink)

BackgroundContradictory evidence exists about the emotional burden of participating in qualitative research for palliative care patients and carers and this raises questions about whether this type of research is ethically justified in a vulnerable population. This study aimed to investigate palliative care patients' and carers' perceptions of the benefits and problems associated with open interviews and to understand what causes distress and what is helpful about participation in a research interview.MethodsA descriptive qualitative study. The data were collected in (...) the context of two studies exploring the experiences of care of palliative care patients and carers. The interviews ended with questions about patients' and carers' thoughts on participating in the studies and whether this had been a distressing or helpful event. We used a qualitative descriptive analysis strategy generated from the interviews and the observational and interactional data obtained in the course of the study.ResultsThe interviews were considered helpful: sharing problems was therapeutic and being able to contribute to research was empowering. However, thinking about the future was reported to be the most challenging. Consent forms were sometimes read with apprehension and being physically unable to sign was experienced as upsetting. Interviewing patients and carers separately was sometimes difficult and not always possible.ConclusionThe open interview enables the perspectives of patients and carers to be heard, unfettered from the structure of closed questions. It also enables those patients or carers to take part who would be unable to participate in other study designs. The context is at least as important as the format of the research interview taking into account the relational circumstances with carers and appropriate ways of obtaining informed consent. Retrospective consent could be a solution to enhancing participants control over the interview. (shrink)

This paper investigates how principals can be supported in their work as teacher leaders. My focus is on how principals can help teachers respond ethically to classroom challenges. I argue that in aiding teachers, school leaders themselves need support and ongoing development. I turn to the care of the self to conceptually explore ethical self-cultivation. I then argue that a practice, Descriptive Inquiry, serves as a way for principals to care for themselves. To make this argument, I draw on a (...) qualitative study of four long-term elementary school principals. (shrink)

BackgroundSexual harassment in the workplace has many negative consequences for nurses and the delivery of patient care. Appropriate policies and strategies can help to create a safe work environment for nurses. Therefore, the present study aimed to investigate Iranian nurses’ strategies for preventing sexual harassment in the workplace.Materials and methodsThis qualitative descriptive-explorative study used conventional content analysis to investigate how Iranian nurses cope with sexual harassment. Participants were selected using a purposeful sampling method. Data was collected through in-depth, semi-structured (...) interviews from September 2020 to April 2021. In order to obtain rich information, maximum variation was considered. The Guba and Lincoln criteria were used to increase the study’s trustworthiness, while the Graneheim and Lundman approach was used to analyze the content.ResultsOne hundred and twelve codes, one main category, four categories, and 12 subcategories were extracted. The main category, strategies to prevent sexual harassment among nurses in the workplace, includes four categories: behavioral response, working conditions adjustment, informing, and performance of hospital security guards. The most common strategy used by nurses was behavioral response.ConclusionBasic measures are required to prevent sexual misconduct against nurses, which is an obvious part of the professional organizational culture. Managers and policymakers should develop workplace ethics, legal accountability, and safety. They should also develop training programs and prevention strategies to help nurses improve their coping skills. Further quantitative and qualitative research in other healthcare groups is required to confirm the findings of this study. (shrink)

BackgroundAssessing and understanding the language that women use to express physical, emotional, and social concerns of breast cancer experiences can often be overlooked, even though there is evidence that effective communication between cancer patients and health care providers improves quality of life. This study aims to assess the use of metaphors in conceptualizing breast cancer experience lived by Saudi Arabian women.Materials and MethodsThis is an interpretative phenomenological qualitative study, a purposeful sample of 18 breast cancer patients at an oncology (...) outpatient’s clinic in Saudi Arabia were invited to engage in face-to-face interviews. Data was analyzed using Metaphor Identification Procedure.ResultsFour themes were constructed: dark hidden force, battling imminent death, dreaming and awakening calls, and inner and outer transformation.ConclusionIdentifying metaphors may be beneficial toward improving communication between health care providers and breast cancer patients, who often experience difficulties expressing their needs. (shrink)

As mixed methods research approaches become increasingly more common, it is imperative they are conducted in a thoughtful and rigorous manner to yield useful results. While researchers have begun to explore the use of various qualitative research methodologies in mixed methods research, there is a gap in literature discussing the philosophical congruence of using interpretive description in mixed method studies, and how to ensure rigor while integrating interpretive description results. Our purpose in writing this article is to (...) discuss the issues of fit, purpose, process, context, and design when using interpretive description in mixed methods research approaches by drawing on examples from the literature. Further, we explore the contributions that interpretive description can make in a mixed methods inquiry. This article offers a first step in using a purposeful approach to mixed methods interpretive description studies to increase transparency and rigor in this relatively new methodology. (shrink)

Background: The nature of systemic lupus erythematosus (SLE) and the far-reaching unpleasant consequences of this disease and the treatments can put the dignity of the women with the disease at risk. Yet, the dignity of this population of patients has not been the subject of much research. Objective: The present study aims to define and describe the concept of dignity of women with SLE. Research design: This is a qualitative descriptive study in which data were collected via individual, in-depth, (...) semi-structured interviews. The collected data were analyzed using methods of content analysis in MAXQDA 2010. Participants and research context: In total, 29 individuals (14 patients, 8 family caregivers, and 7 nurses) were selected by purposeful sampling from the internal wards of a teaching hospital located in the south of Iran. The study was conducted between June 2023 and February 2024. Sampling continued until the data were saturated. Ethical considerations: The Institutional Review Board of the university has verified that the study complies with research ethics. Findings: Analysis of the data extracted from the interviews resulted in three themes: respect for identity, compassion in care and treatment, and fulfillment of support needs. Conclusions: The women with SLE who were surveyed in the present study needed to have their feminine identity and social identity respected and be comprehensively supported by their treatment team and family caregivers. In such a context, care characterized by compassion and empathy and treatment teams’ respectful and professional interactions with the patients contribute to maintaining the patients’ dignity. Nursing managers and staff can use the findings of the present study to create a supportive clinical environment in order to better maintain the dignity of women with SLE. (shrink)

The evaluation of the quality of the processes of educational and social inclusion of people with disabilities is considered a key element in the improvement of their living conditions. The research presented here is part of the analyses carried out in Italy and abroad on the identification of indicators and categories able to provide a representative picture of the processes of school inclusion by assessing the strengths and weaknesses of the system in local contexts. Assessing the quality of inclusive education (...) is complex because the contextual aspects of educational interventions cannot be ignored. In a research-action approach, the study analyses the Italian situation in the regions of Lazio and Campania through the point of view of 291 specialized teachers or in the process of specialization in the support of pupils with special educational needs Their evaluations, based on a scale from 1 (insufficient) to 5 (excellent), were obtained through a structured questionnaire that collects their opinions on cultural and educational aspects, on management, organisational and collaborative activities between teachers, school directors, local authorities and families, and finally on elements of a pedagogical and didactic nature necessary for quality school inclusion. The descriptive and inferential statistical analysis of the aggregate data sketches a school whose strength in terms of inclusion lies in pedagogical and didactic planning. On the other hand, collaborative aspects, especially synergies between schools and local authorities, are pointed out and hinder effective co-planning of different types of support. These results therefore argue in favour of a systematization of integrated networks of support services for all pupils with special educational needs Regarding training, teachers generally have a negative view of in-service training, which should be deepened and extended to all categories of teachers. The article concludes on the need to promote the development and systematization of qualitative research and documentary collections on good practices of inclusive education in schools. (shrink)

Philosophy of aesthetics and beauty has traditionally prioritized the sense of vision while deprioritizing the more basic-bodily and thus less “noble” sense of touch. This paper examines bodily aspects of how beauty appears in the experience of visual art and motivates the view that touch is fundamental to such experiences. We appeal to Merleau-Ponty to show the relevance given to touch in his phenomenology of aesthetics, to unfold the meaning of touch as “reversible,” and to understand how vision can be (...) conceptualized as a form of touch. Further, we present four cases of feeling touched by beauty in experiences of visual art collected through interviews with art museum visitors. The descriptions of these experiences show that when people open themselves to an artwork they also open themselves to themselves. Based on the qualitative descriptions, we discuss how Merleau-Ponty’s phenomenology of touch is revelatory of the meaning of feeling “touched” in experiences of beauty. (shrink)

This analytic autoethnographic and autobiographical essay addresses several interrelated questions regarding the use of ethnographic and otherwise ‘qualitative’ research methods in the study of contemporary urban society. The testy relationship between qualitative and quantitative research has historical as well as logico-deductive roots that continue to haunt the social sciences. As to hermeneutics, the debate parallels my academic career journey from Indiana University to Brooklyn College by way of New York University during which I learned that the normative practices (...) of the social and not so social sciences come in a myriad of different competing, and occasionally conflicting, pre- and proscriptions. My intention in this essay is not to construct a fine, or even a crude, philosophical discourse but to argue for more attention to be paid to what social scientists do best as opposed to the labels they apply to each other and their trades. As the positivist founders of sociology would agree, social science is not exempt from the laws of social science. At the conclusion, an example will be given of the kind of knowledge accessible only through direct observation and best conveyed by thick description. (shrink)

Background: Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives (to implement research protocols and advance science), setting (research facilities), and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether (...) research nurses experience unique ethical challenges distinct from those experienced by nurses in traditional patient-care settings. Research objectives: The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice. Research design: The study utilized a qualitative descriptive design with individual interviews. Participants and research context: Participating nurses (N = 12) self-identified as having experienced ethical challenges during screening. The majority were Caucasian (90%), female (83%), and worked in outpatient settings (67%). Approximately 50% had > 10 years of research experience. Ethical considerations: The human subjects review board approved the study. Written informed consent was obtained. Findings: Predominant themes were revealed: (1) the inability to provide a probable good, or/do no harm, and (2) dual obligations (identity as a nurse vs a research nurse). The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship. Discussion: Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science. Conclusion: Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

Some properties such as having a beard and being a philosopher are intuitively qualitative, while other properties such as being identical to Plato and being a student of Socrates are intuitively non-qualitative. It is often assumed that, necessarily, a property is qualitative if and only if it can be designated descriptively without the aid of directly referential devices. I argue that this linguistic thesis fails in both directions: there might be non-qualitative properties that can be designated (...) descriptively, and there appear to be qualitative properties that can only be designated directly. I conclude that while the linguistic thesis is ultimately untenable as stated, it can be plausibly recast as a thesis about our concepts rather than the properties they designate. (shrink)

Background Despite its negative impact on patients and nurses, the use of restraint in somatic health care continues in many settings. Understanding the reasons and justifications for the use of restraint among nurses is crucial in order to manage this challenge. Aim To understand nurses’ justifications for restraint use in neurosurgical care. Research design A qualitative, descriptive design was used. Data were analysed with inductive qualitative content analysis. Participants and research context Semi-structured interviews with 15 nurses working in (...) three neurosurgical departments in Sweden. Ethical considerations Approved by The Regional Ethics Committee, Stockholm, Sweden. Findings The analysis resulted in three categories. The category Patient factors influencing restraint use describes patient factors that trigger restraint, such as a diminished decision-making competence, restlessness, and need for invasive devices. The category Specific reasons for justifying restraint describes reasons for restraining patients, such as restraint being used for the sake of the patient or for the sake of others. The category General reasoning in justifying restraint describes how nurses reason when using restraint, and the decision to use restraint was often based on a consequentialist approach where the nurses’ weighed the pros and cons of different alternatives. Discussion Nurses with experience of restraint use were engaged in a constant process of justifying and balancing different options and actions. Restraint was considered legitimate if the benefit exceeded the suffering, but decisions on which restraint measures to use and when to use them depended on the values of the individual nurse. Conclusion How nurses reason when justifying restraint, why they use restraint, and who they use restraint on must be considered when creating programs and guidelines to reduce the use of restraint and to ensure that when it is used it is used carefully, appropriately, and with respect. (shrink)

Background On a daily basis, healthcare professionals deal with various ethical issues and it can be difficult to determine how to act best. Clinical ethics support (CES) has been developed to provide support for healthcare professionals dealing with complex ethical issues. A long-term perspective of participating in inter-professional dialogue and reflective-based CES sessions is seemingly sparse in the literature. Research aim The aim was to describe experiences of impact of Inter-professional Ethics Communication in groups (IEC) based on Habermas’ theory of (...) communicative actions, after 6 months from the perspective of an inter-professional team. Research design A qualitative inductive approach was chosen, and individual interviews ( n = 13) were conducted. Interview data were analysed using qualitative content analysis. Participants The participants, 10 females and two males, represented assistant nurses, registered nurses, physicians, occupational therapists, physiotherapists, welfare officers and psychologists. Each had attended at least four IEC sessions. Ethical considerations The study was approved by the Regional Ethical Review Board in Umeå, Sweden, and it has been undertaken in accordance with the Helsinki Declaration. Findings Overall, the descriptions expressed a perceived achievement of a deepened and integrated ethical awareness that increased the participants’ awareness of ethically difficult situations as well as their own ethical thinking, actions and approaches in daily work. Perspectives were shared and the team become more welded. They carried the memories of the reflections within them, which was perceived as supportive when encountered new ethically situations. Discussion Putting words to unarticulated thoughts may stimulate repeated reflections, leading to new insights and alternative thoughts. Conclusion The outcome of IEC sessions 6 months following the last session can be described as an incorporated knowledge that enables actions in ethically difficult situations based on an ethical awareness both at a ‘We-level’ and an ‘I-level’. (shrink)

Protecting human subjects from being exploited is one of the main ethical challenges for clinical research. However, there is also a responsibility to protect and respect the communities who are hosting the research. Recently, attention has focused on the most efficient way of carrying out clinical research, so that it benefits society by providing valuable research while simultaneously protecting and respecting the human subjects and the communities where the research is conducted. Collaboration between partners plays an important role and that (...) is why we carried out a study to describe how collaborative partnership and social value are emerging in clinical research. A supra-analysis design for qualitative descriptive secondary analysis was employed to consider a novel research question that pertained to nurse leaders’ perceptions of ethical recruitment in clinical research and the ethics-related aspects of clinical research from the perspective of administrative staff. The data consisted of two separate pre-existing datasets, comprising 451 pages from 41 interviews, and we considered the research question by using deductive-inductive content analysis with NVivo software. A deductive analysis matrix was generated on the basis of two requirements, namely collaborative partnership and social value, as presented in An Ethical Framework for Biomedical Research by Emanuel et al. The findings showed that collaborative partnership was a cornerstone for ethical clinical research and ways to foster inter-partner collaboration were indicated, such as supporting mutual respect and equality, shared goals and clearly defined roles and responsibilities. In addition, the social value of clinical research was an important precondition for ethical clinical research and its realisation required the research partners to demonstrate collaboration and shared responsibility during the research process. However, concerns emerged that the multidimensional meaning of clinical research for society was not fully recognised. Achieving greater social value for clinical research required greater transparency, setting research priorities, shared responsibility for the dissemination and use of the findings and stronger community awareness of the ethics-related aspects of clinical research. Collaborative partnership and social values are essential for protecting the human subjects and communities involved in clinical research. (shrink)

BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania. MethodsAn exploratory descriptive (...) class='Hi'>qualitative design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania. (shrink)

This paper sets out from the hypothesis that the embodied competences and expertise which characterise dance and sports activities have the potential to constructively challenge and inform phenomenological thinking. While pathological cases present experiences connected to tangible bodily deviations, the specialised movement practices of dancers and athletes present experiences which put our everyday experiences of being a moving body into perspective in a slightly different sense. These specialised experiences present factual variations of how moving, sensing and interacting can be like (...) for us as body-subjects. To use of these sources inevitably demands that qualitative research methodologies – especially short-term ethnographical fieldwork – form part of the research strategy and qualify the way the researcher involves a second-person perspective when interviewing dancers and athletes about their experiences. In the subsequent phases analysing the data generated, I argue that researchers first strive to achieve internal consistency of empirical themes identified in the case of movement practices in question thus keeping to a contextualised and lived perspective, also denoted as an emic perspective. In subsequent phases phenomenological insights are then actively engaged in the exploration and discussion of the possible transcendental structures making the described subjective experiences possible. The specialised and context-defined experiences of ‘what a moving body can be like’ are accordingly involved as factual variations to constructively add to and potentially challenge phenomenological descriptions. Lastly, I exemplify how actual research strategies have been enacted in a variety of projects involving professional dancers’, golfers’ and sports dancers’ practices and experiences, respectively. (shrink)

A model for the structure of point-like fermions as tightly bound composite states is described. The model is based upon the premise that electromagnetism is the only fundamental interaction. The fundamental entity of the model is an object called the vorton. Vortons are semiclassical monopole configurations of electromagnetic charge and field, constructed to satisfy Maxwell's equations. Vortons carry topological charge and one unit each of two different kinds of angular momenta, and are placed in magnetically bound pair states having angular (...) momentum l=1/2. The topological charge prevents the mutual annihilation of the vorton pair. The helicity eigenstates of the vortons' intrinsic angular momenta form the basis for a set of internal quantum numbers for the pair which distinguish the different (point-like) pair states. Sixteen fourcomponent spinor states, eight leptonic and eight hadronic, are obtained. Eleven of these are identified with the quantum numbers of the experimentally known particles: e, ve, μ, vμ, τ, vτ; p, n, Λ, Λc, and b. Thus one new heavy lepton with its neutrino and three new quark states are predicted. Some possibilities for the extension of this model are discussed. (shrink)

This article begins with a review of studies in perception and depth psychology concerning the experience of exposure to sacred artworks in Roman Catholic and Eastern Orthodox contexts. This follows with the results of a qualitative inquiry involving 45 Roman Catholic, Eastern and Coptic Orthodox, and Protestant Christians in Canada. First, participants composed narratives detailing memories of spiritual experiences involving iconography. Then, in the context of a darkened room evocative of a sacred space, they viewed artworks depicting Biblical themes (...) and interpreted their meanings. Stimuli included “Western” paintings from the Roman tradition—a selection from the Gothic, Northern Renaissance, and Renaissance canon—and matched “Eastern” icons in the Byzantine style. Spiritual experience narratives were analyzed in terms of word frequencies, and interpretations of sacred artworks were analyzed thematically. Catholics tended to utilize emotional language when recalling their spiritual experiences, while religious activity was most often the concern of Protestants, and Orthodox Christians wrote most about spiritual figures and their signifiers. A taxonomy of response styles was developed to account for participants’ interpretations of Western and Eastern artworks, with content ranging from detached descriptions to projective engagement with the art-objects. Our approach allows for representation of diverse Christians’ interpretations of sacred art, taking into consideration personal, collective, and cultural-religious sources of meaning. Our paradigm also offers to enrich our understanding of the numinous or emotional dimension of mystical contact. (shrink)

The technological possibilities for new data sources in media psychology, such as online live recordings, called Live Streaming, are growing continuously. These sources do not only offer plentiful quantitative material but also a fairly new access to ecologically valid and unobtrusive observation of problem-solving and decision-making processes. However, to exploit these potentials, epistemological and methodological reflection should guide research. The availability of Big Data and naturally occurring data sets allows to revise the historical controversies on the eligibility of self-description. (...) Drawing on such reflections, media psychology can contribute to renovate well established research methods, such as think aloud protocols, in order to enhance their empirical claims. Apart from other confident attempts to improve these methods, phenomenology and ethnomethodology offer a fruitful account to develop innovative data sources for self-description. Yet, this approach does not support a recurrence of self-description’s previous application but proposes an epistemological shift towards more subtle observations. In order to convey the potentials of media psychology, the risk of repeating classical mistakes, such as introspectionism, have to be regarded. Beyond these fallacies, however, modern digital technology holds encouraging potentials which have already partly been sighted by video gaming research. Due to the similarity of digital environments to laboratory setups, there remains to be a continuity from offline to online research, from traditional data to Big Data. Nevertheless, a true advance into new possibilities requires understanding the qualitative meaning of such data. (shrink)

This article presents a descriptive, interpretive theory of ethical responsibility in public health nursing. The theory is based on qualitative empirical studies, a purposeful literature review and meta-ethnography of public health nurses’ experiences of ethical responsibility, interpreted within a philosophical framework. Levianasian philosophy provides the main direction for the authors’ interpretations. The path for theory development consists of three phases: an inspirational phase, an explorative phase and the third phase ‘ joining the dots’. The theory illustrates that ethical responsibility (...) in public health nursing is related to the life existentials of temporality and human relationships. Due to blurred boundaries in these essential life structures, public health nurses can experience a sense of satisfaction but also worries, uncertainties and loneliness. The study reveals paradoxical connections between fear and courage, and between freedom, autonomy and a sense of entrapment in responsible relationships. The authors purport that the results of this study are relevant for education and practice and can provide direction for further studies on developing theories of ethical responsibility in other nursing specialities. (shrink)

Background: Prisons are contexts where nurses are required to have specific skills to ensure that, in a setting designed for the expiation of crime, prisoners receive the same type of care as anyone else. But this is not always the case, giving rise to ethical issues. Research questions: ‘How do correctional nurses describe their working experience in prisons? What issues emerged?’ Methodology: This is a qualitative descriptive study. Following purposive sampling, we conducted five focus groups. Thematic analysis was used (...) to analyse the data. Participants and research context: Our sample included 31 correctional nurses in seven prisons in Northern Italy. Ethical considerations: The scientific merit of this study was recognized by the Academic Board of the University of Genoa. Approval to conduct the study was obtained from the Liguria Regional Government that funded this study and from the Local Health Authority that was the prison nurses’ employer. Formal consent was obtained from all the nurses who volunteered to participate in this study. Findings: Five themes emerged from the focus groups: (1) prisoners’ healthcare needs, (2) negotiation between custody and care, (3) satisfaction of working in prisons, (4) obstacles to quality care and (5) safety. ‘Manipulation’ was a transversal theme that emerged from all the focus groups. Discussion: The problems generated by the clash between prison security and nursing care priorities did not enable nurses to practice autonomously and provide the best possible to care prisoners, giving rise to ethical issues and moral distress. This in turn causes high nursing turnover rates that negatively impact continuum of care. Conclusion: In Italy, correctional nurses urgently require specific education interventions with the participation of all those who work in prisons. Interventions based on the post-modern concept of restorative nursing could offer prison nurses the opportunity to both resolve ethical issues and reduce moral distress. (shrink)