In this note on nursing ethics, Mr Martin Bunzl, a philosopher who is involved in seminars on medical ethics at his university, describes the ethical dilemmas of the nurse in the USA. He sets out the arguments to support the view that a nurse ought always to follow the orders of the physician and critically evaluates them both from an ethical and a legal standpoint. The practical implications of the view that a nurse's responsibility is to do what is (...) in the best interests of patients are also discussed. (shrink)

With this paper, we walk out some central ideas about posthumanisms and the ways in which nursing is already deeply entangled with them. At the same time, we point to ways in which nursing might benefit from further entanglement with other ideas emerging from posthumanisms. We first offer up a brief history of posthumanisms, following multiple roots to several points of formation. We then turn to key flavors of posthuman thought to differentiate between them and clarify our collective (...) understanding and use of the terms. This includes considerations of the threads of transhumanism, critical posthumanism, feminist new materialism, and the speculative, affirmative ethics that arise from critical posthumanism and feminist new materialism. These ideas are fruitful for nursing, and already in action in many cases, which is the matter we occupy ourselves with in the final third of the paper. We consider the ways nursing is already posthuman—sometimes even critically so—and the speculative worldbuilding of nursing as praxis. We conclude with visions for a critical posthumanist nursing that attends to humans and other/more/nonhumans, situated and material and embodied and connected, in relation. (shrink)

Nurses’ religious beliefs influence their motivations and perspectives, including their practice of ethics in nursing care. When the impact of these beliefs is not recognized, great potential for unethical nursing care exists. Thus, this article examines how the theology of one religious tradition, Seventh-day Adventism (SDA), could affect nurses. An overview of SDA history and beliefs is presented, which explains why ‘medical missionary’ work is central to SDAs. Theological foundations that would permeate an SDA nurse’s view of the (...) nursing metaparadigm concepts of person, health, environment (i.e. community), and nursing (i.e. service) are presented. The ethical principles guiding SDA nurses (i.e. principled, case-based, and care ethics) and the implications of these theological foundations for nurses are noted in a case study. (shrink)

PERRON A and HOLMES D. Nursing Inquiry 2011; 18: 191–204Constructing mentally ill inmates: nurses’ discursive practices in correctionsThe concepts of discourse, subjectivity and power allow for innovative explorations in nursing research. Discourse take many different forms and may be maintained, transmitted, even imposed, in various ways. Nursing practice makes possible many discursive spaces where discourses intersect. Using a Foucauldian perspective, were explored the ways in which forensic psychiatric nurses construct the subjectivity of mentally ill inmates. Progress (...) class='Hi'>notes and individual interviews constitute discursive spaces within which nurses construct patients’ subjectivities. Progress notes provide a written (and permanent) form of discourse, while interviews set the space for a more fluid and contextual form of discourse. We identified five types of subjectivities – the (in)visible patient, the patient as risk, the deviant patient, the disturbed patient and the disciplined patient. These subjectivities were rooted in various types of discourses circulating in the selected setting. Despite the multiple discursive dimensions of forensic psychiatric nursing, progress notes remain the main formal source of information regarding nursing care even though it is not representative of the care provided nor is it representative of nurses’ complex discursive practices in corrections. (shrink)

During the Nazi regime (1933–1945), more than 300 000 psychiatric patients were killed. The well‐calculated killing of chronic mentally ‘ill’ patients was part of a huge biopolitical program of well‐established scientific, eugenic standards of the time. Among the medical personnel implicated in these assassinations were nurses, who carried out this program through their everyday practice. However, newer research raises suspicions that psychiatric patients were being assassinated before and after the Nazi regime, which, I hypothesize, implies that the motives for these (...) killings must be investigated within psychiatric practice itself. An investigation of the impact of the interplay between the notes left by nurses and those by psychiatrists illustrates the active role of the psychiatric medical record in the killing of these patients. Using theoretical insights from Michel Foucault and philosopher Giorgio Agamben and analyzing one part of a particularly rich patient file found in the Langenhorn Psychiatric Asylum in the city of Hamburg, I demonstrate the role of the record in both constructing and deconstructing patient subjectivities. De‐subjectifying patients condemned them to specific zones in the asylum within which they were reduced to their ‘bare life’‐ a precondition for their physical assassination. (shrink)

Nursing in the United Kingdom is undergoing massive retrenchment. An increasing number of nurses are unable to obtain employment following qualification and agency nursing and short-term contracts are becoming the norm. Amalgamations of colleges of nursing have resulted in redundancies of nurse teachers and a significant reduction in student nursing places. The profession of nursing in the UK is in a state of crisis from which it may never recover. Nurses have generated and facilitated this (...) situation in their self-interested quest for professional status. Essentially, nurses have turned their backs on many nursing skills and allowed others to take on the role. British nursing may find its survival through its health care assistants. Nurses in other countries should take note and take steps to safeguard the profession on an international level. (shrink)

Background: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses’ ethical care provision. Conscientious objection is one such strategy for addressing nurses’ personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. Research aim: To analyze the concepts of conscience and conscientious objection in the context of nurses. Design: Concept analysis using the method by (...) Walker and Avant. Research context: Data were retrieved from Philosopher’s Index, PubMed, and CINAHL with no date restrictions. Ethical consideration: This analysis was carried out per established, scientific guidelines. Findings: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. Discussion and conclusion: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts. (shrink)

The ethical ‘eye’ of nursing, that is, the particular moral vision and values inherent in nursing work, is constrained by the preoccupations and practices of the superordinate biomedical structure in which nursing as a practice discipline is embedded. The intimate, situated knowledge of particular persons who construct and attach meaning to their health experience in the presence of and with the active participation of the nurse, is the knowledge that provides the evidence for nurses’ ethical decision making. (...) It is largely invisible to all but other nurses. Two nurse researchers, Joan Liaschenko of the University of Minnesota and Patricia Rodney of the University of Victoria, have investigated the ethical concerns of practising nurses and noted in their separate enquiries the invisible nature of critical aspects of nursing work. Noting the similarities in their respective observations, and with the feminist ethics of Margaret Urban Walker as a theoretical framework, this article examines the concept of ‘invisibility’ as it relates to nursing work and nursing ethics. (shrink)

The aim of this study was to deepen nurses’ understanding of the importance of carefully managing the first nurse-patient encounter in a psychiatric setting according to each patient’s suffering and future hopes. The study was carried out using an action research approach. The action planned was the implementation of a conceptual model reflecting Eriksson’s caring theory. Data were collected by interviews with nurses and observational notes kept in a research diary. The data analysis followed the procedure of qualitative content (...) analysis. A generalization of the entire learning process shows the first nurse-patient encounter to be a moral commitment in nursing. A theoretical framework of nursing assessment conveying knowledge about the patient as unique and being a whole person can support the nurse in encouraging the patient to enter into a relationship. This insight stimulated the nurses in this study to reflect on the moral responsibility of continuing the relationship and initiating an ongoing nursing process. Awareness of this responsibility made them reflect more on the possibility of nurses taking autonomous actions in order not to abandon the patient and to avoid feeling guilty. (shrink)

Background: Equity in providing care is also a major value in the nursing profession. Equitable care aims to provide the entire population with safe, efficient, reliable, and quality nursing services at all levels of health. Objectives: This study was conducted to explain the process of the realization of equity in nursing care. Research design: This qualitative study uses Glaser’s approach to grounded theory. Participants and research context: Sample selection began with convenience sampling and continued with purposive sampling. (...) A total of 27 people were ultimately selected as the study subjects. Data were mainly collected through unstructured in-depth individual interviews plus observation and field notes. The data were then analyzed using the “Six C’s” coding family of Glaser. Ethical considerations: The study protocol was approved by the Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all subjects. Findings: According to the findings, participants’ main concern in providing equitable care is the rationing of nursing care. The identification of participants’ main concern led to the emergence of the core category of the study, that is, “nurses’ domination.” The other categories revolving around the core category were conceptualized according to the six C’s coding family: “nurses being dominated,” “nurses’ ineffective power in the health system,” “low attention to equitable care in health system,” “lack of clarity in measuring equitable care,” “the health structure’s inconsistency with equity,” and “the inefficiency of the care system.” Conclusion: There is a mutual relationship between providing fair care and nurses’ perceptions of equity. Nurses who have themselves experienced equity can provide their patients the experience of equity. This mutual relationship is actualized in a context in which fair care is clearly defined and demanded. (shrink)

Preparing to lecture on Aristotle's contribution to Nursing at the International Philosophy of Nursing Conference August 22, 2016, in Quebec City, Quebec, Canada, I came upon the recently published article by my IPONS colleague, Allmark (2016), “Aristotle for Nursing.” Allmark (2016) provides a comprehensive and understandable overview of Aristotle's philosophical system including the substantial nature of being and the four causes of change. Nurses using Aristotle to support practice and theoretical research will benefit from a careful reading (...) of Allmark to enrich their use of the realist understanding of knowledge of nature (epistemology) and the matter–form causal relationships within natural being (ontology and teleology). Allmark carefully displays the distinction between good health and flourishing; a distinction sometimes hard to grasp. Nurses are concerned with the end of health, but cannot achieve for others, the fullness of living which is flourishing.We will limit ourselves to expanding three areas that seem important, first, that nursing is much more than a productive science or craft, second, that Aristotle does provide an important note on the persistence of the soul, and, third, while Aristotle does not address the possibility of a personal creative highest being as Allmark says, his references to the divine are worth considering. (shrink)

Editors of scientific literature rely heavily on peer reviewers to evaluate the integrity of research conduct and validity of findings in manuscript submissions. The purpose of this study was to describe the ethical concerns of reviewers of nursing journals. This descriptive cross-sectional study was an anonymous online survey. The findings reported here were part of a larger investigation of experiences of reviewers. Fifty-two editors of nursing journals (six outside the USA) agreed to invite their review panels to participate. (...) A 69-item forced-choice and open-ended survey developed by the authors based on the literature was pilot tested with 18 reviewers before being entered into SurveyMonkeyTM. A total of 1675 reviewers responded with useable surveys. Six questions elicited responses about ethical issues, such as conflict of interest, protection of human research participants, plagiarism, duplicate publication, misrepresentation of data and ‘other’. The reviewers indicated whether they had experienced such a concern and notified the editor, and how satisfied they were with the outcome. They provided specific examples. Approximately 20% of the reviewers had experienced various ethical dilemmas. Although the majority reported their concerns to the editor, not all did so, and not all were satisfied with the outcomes. The most commonly reported concern perceived was inadequate protection of human participants. The least common was plagiarism, but this was most often reported to the editor and least often led to a satisfactory outcome. Qualitative responses at the end of the survey indicate this lack of satisfaction was most commonly related to feedback provided on resolution by the editor. The findings from this study suggest several areas that editors should note, including follow up with reviewers when they identify ethical concerns about a manuscript. (shrink)

Competent patients’ refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case (...) on the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a ‘negotiated reliance’ response where nurses and others tread as lightly as possible on the patient’s autonomy while negotiating a compromise, but are obligated to match the patient’s sacrifice by extending themselves beyond their usual professional practice. (shrink)

Background: Acting ethically, in accordance with professional and personal moral values, lies at the heart of nursing practice. However, contextual factors, or obstacles within the work environment, can constrain nurses in their ethical practice – hence the importance of the workplace ethical climate. Interest in nurse workplace ethical climates has snowballed in recent years because the ethical climate has emerged as a key variable in the experience of nurse moral distress. Significantly, this study appears to be the first of (...) its kind carried out in New Zealand. Aim/objective: The purpose of this study was to explore and describe how registered nurses working on a medical ward in a New Zealand hospital perceive their workplace ethical climate. Research design/participants/context: This was a small, qualitative descriptive study. Seven registered nurses were interviewed in two focus group meetings. An inductive method of thematic data analysis was used for this research. Ethical considerations: Ethics approval for this study was granted by the New Zealand Ministry of Health’s Central Regional Health and Disability Ethics Committee on 14 June 2012. Findings: The themes identified in the data centred on three dominant elements that – together – shaped the prevailing ethical climate: staffing levels, patient throughput and the attitude of some managers towards nursing staff. Discussion: While findings from this study regarding staffing levels and the power dynamics between nurses and managers support those from other ethical climate studies, of note is the impact of patient throughput on local nurses’ ethical practice. This issue has not been singled out as having a detrimental influence on ethical climates elsewhere. Conclusion: Moral distress is inevitable in an ethical climate where the organisation’s main priorities are perceived by nursing staff to be budget and patient throughput, rather than patient safety and care. (shrink)

Diagnostic frameworks are essential to many scientific and technological activities and clinical practice. This study examines the main fundamental aspects of such frameworks. The three components required for all diagnoses are identified and examined, i.e. their normative dimension, temporal nature and structure, and teleological perspective.The normative dimension of a diagnosis is based on (1) epistemic values when associated with Hempel's inductive risk concerning the balance between false‐positive and false‐negative outcomes, leading to probabilistic judgements; and (2) non‐epistemic values when related to (...) ideas such as well‐being, normality, illness, etc, as idealized norms or ideal points of reference.It should be noted that medical diagnoses match the three necessary components, while some essential diagnostic frameworks – the taxonomies ofGordon andNANDA– in nursing lack some components. The main lack is normative as the most popular frameworks in nursing diagnosis seem to be descriptions of observed reality rather than normative and value‐based judgements in which both epistemic and non‐epistemic values may coexist. (shrink)

Background: In modern healthcare, the role of solidarity, altruism and the natural response to moral challenges in life-threatening situations is still rather unexplored. The COVID-19 pandemic provided an opportunity to obtain a deeper understanding of nurses’ willingness to care for patients during crisis. Objective: To elucidate clinical expressions of ontological situational ethics through nurses’ willingness to work during a pandemic. Research design, participants and context: A qualitative study with an interpretive design was applied. Twenty nurses who worked in intensive care (...) unit at two Swedish hospitals during the first, second, and third waves of the COVID-19 pandemic were interviewed. The analysis was interpretative and applied a theoretical ethics perspective. Ethical considerations: The study was approved by the Swedish Ethical Review Authority and informed consent was obtained from all participants. Findings: From a philosophical perspective, the nurses expressed sovereign life expressions of mercy and compassion, which arose spontaneously in response to seeing vulnerable fellow humans. They referenced ‘‘the nurse inside me’’ and their choice of profession as motives to provide care. Ontological situational ethics in culture and norms were noted in the constructs of competence, responsibility, solidarity with colleagues and organization; and interest and learning were driving forces. Ethical demand was evident when nurses expressed ideas of meaningfulness in helping their fellow humans; but themes of ambiguity, exhaustion and unwillingness were also present. Conclusions: The nurses showed a high willingness to care for patients during a crisis. Responding to the ethical demand and to care for vulnerable human beings while risking their own health and lives could be interpreted as an inter-human vocation. These spontaneous altruistic actions saved the lives of many patients during the pandemic and need to be understood and supported. (shrink)

Background: Compassion is the core of nursing care and the basis of ethical codes. Due to the complex and abstract nature of this concept, there is a need for further investigations to explore the meaning and identify compassionate nursing care. Objectives: The purpose of this study was to identify and describe compassionate nursing care based on the experiences of nurses, patients, and family caregivers. Research design: This was a qualitative exploratory study. Data were analyzed using the conventional (...) content analysis method. Participants and research context: Nurses, hospitalized patients, and family caregivers in different educational hospitals in an urban area of Iran were selected from February 2016 to December 2017 using a purposeful sampling method (n = 34). In-depth and semi-structured interviews, focus group interviews, and field notes were used for data collection. Ethical considerations: The study was approved by the University’s Ethics Committee. The participants were informed about the aim and method of the study, reasons for recording the interviews, confidentiality of data, and voluntary nature of participation in this study. Findings: Data from interviews and filed notes were analyzed and classified into three themes: “effective interaction,” “professionalism,” and “continuous comprehensive care.” Discussion and conclusion: Emerged themes of this study involved holistic care in the current literature on nursing with an emphasis on effective interaction and professionalism. Nurses can understand patients’ and family caregivers’ comprehensive needs through interaction skills. In addition, clinical proficiency, maintaining professional ethics’ standards along with holism, and continuity in care are examples of compassionate care. Education program about compassionate care can enhance the quality of nursing care. (shrink)

Professionalized nursing and anarchism could not be more at odds. And yet, if nursing wishes to have a future in the precarious times in which we live and die, the discipline must take on the lessons that anarchism has on offer. Part love note to a problematic profession we love and hate, part fever dream of what could be, we set out to think about what nursing and care might look like after it all falls down, because (...) it is all falling down. Drawing on alternate histories, alternate visions of nursing history, we imagine what nursing values would look like, embracing anarchist principles. We consider examples of community survival, mutual aid, and militant joy as strategies to achieve what nursing could be if nurses put an end to their cop shit, shrugging off their shroud of white cisheteropatriarchal femininity that manifests as professionalism and civility. We conclude with a call to action and a plan for skill-building because this can all be different. (shrink)

Humanism has appeared intermittently in the nursing literature as a concept that can be used in understanding nursing. I return to the concept in response to noticing the term appearing in the context of health humanities, where it is loosely associated both with humanities and being humane. I review the usage and critiques of humanism in both nursing and medical literature and then re‐evaluate what the idea of humanism might hold for nursing, trying to avoid the (...) traps of an over‐determination of the human subject, or dichotomizing nursing as art or science, technology or caring. I draw on writings on humanism primarily from Emmanuel Levinas and Edward Said to emphasize strands in humanism of obligation towards others and of critical discernment within history and culture directed towards democratic practices. I discuss in passing the strong association in the UK particularly between humanism and scientism as a note of caution about the plurality of the term humanism. I conclude that humanism is a tradition that does offer productive ways of thinking about nursing with the proviso that it ought to be treated carefully as a problematic tradition and not as a new essence for nursing. (shrink)

Background: Discrimination in nursing has led to the formation of some taboos that often impact the individual’s professional development. Nurses use strategies to overcome discrimination that can lead to consequences. Research objective: This study assessed nurses’ experiences to explore the consequences of Iranian nurses’ strategies to overcome intra-professional discrimination. Research design: This qualitative content analysis study employed purposive sampling to reach 25 nurses working at educational hospitals in Tehran, Tabriz, and Ilam, Iran. The data were collected using deep and (...) unstructured interviews along with notes in a period of time between April 2016 and May 2017. Interviews were simultaneously analyzed using inductive and conventional content analysis method after being transcribed. Ethical consideration: This study was approved by the Regional Committee of Medical Research Ethics. Also, voluntary participation, anonymity, and confidentiality were considered. Findings: Two themes emerged from our analysis due to consequences of nurses’ efforts to overcome intra-professional discrimination: “seeking justice” and “passivity.” Discussion: Nurses’ efforts to overcome professional discrimination have led to outcomes. These outcomes can be affect on their individual effort to achieve organizational goals, provide better care or feel disabling or nurses turnover. Conclusion: Strategies adopted by nurses to overcome intra-professional discrimination have led to consequences which vary from negative to positive and impact their performance. (shrink)

This paper examines the concept of empowerment and how it relates to nursing. It notes that empowerment is a concept used to describe most human activities. The fact that empowerment applies to almost any activity denotes its ambiguity rather than its parsimony. To clarify the concept a definition is offered together with some suggestions for its origin. Some examples of empowerment programmes are given, including the Freirian empowerment philosophy that has had a profound effect in Brazil. The paper (...) then focuses on nursing and discusses whether or not nursing can empower patients. It is argued that nursing cannot empower patients, at least at the present time. Two specific problems are identified as the main reasons why nursing cannot empower patients. It is argued that the first problem or reason is a philosophical one explored using the philosophy of existentialism. The second problem is the nurse–patient interaction and the psychological dynamics involved within such interaction. For example, the continued use of the term ‘patient’ by nurses and other healthcare professionals is seen as militating against empowerment. This is because of the traditional conception of a patient, which invariably assumes not only the patient's sick role but also the passivity associated with being a patient. Furthermore, the hierarchical nature of the profession makes it difficult to empower others. The paper examines some research studies related to patient empowerment. The findings suggest there are problems and some of them stem from the hierarchical and authoritarian nature of nursing. The paper concludes by suggesting ways by which the ideals of patient empowerment may be turned into reality. (shrink)

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

Introduction: Ethical competence in professional practice can be considered essential among nurses and nurses in ambulance care encounter ethical dilemmas frequently. To enhance ethical competence among students in the ambulance specialist nursing program, high-fidelity simulation scenarios including ethical dilemmas were introduced as a learning activity. Research aim: The research aim was to investigate the usefulness of high-fidelity simulation in ambulance specialist nurse education to teach ethical reasoning when caring for children. Research design: This study was conducted as a qualitative (...) interview study, complemented with observations and using field notes and qualitative interviews for data collection. Data was analysed using deductive qualitative content analysis based on a care ethical model. Participants and research context: Participants ( n = 35) were recruited from an ambulance nurse educational program at a Swedish university. Data was collected after the students took part in two high-fidelity simulations involving children in an ambulance care setting. Ethical considerations: The study has been vetted and approved by the ethical council at the University of Borås, Sweden. The study follows the Helsinki Declaration’s advice on ethical principles. Results: The results showed that most of the students expressed some form of ethical reasoning during the simulation sessions, which were elaborated and reflected upon during the debriefing part of the sessions. The simulation design seemed to have a great impact on the outcome of the student’s ethical reasoning, where increased immersion led to deeper emotional engagement among the students which increased awareness of their personal preconceptions. Conclusions: This study aimed to investigate whether high-fidelity simulations could be useful to stimulate ethical reflections and contribute to increased ethical competence among students. In conclusion, a well-designed high-fidelity simulation can be useful as an educational tool to learn and enhance ethical competence among specialist ambulance nursing students. (shrink)

Background Social inequities in the healthcare system threaten global health. Efforts to establish equity in healthcare is a key goal of healthcare systems worldwide. Social justice is a basic value of the nursing profession that always merits attention. Objective This study aimed to identify and explain the processes of the nursing profession’s participation in establishing social justice in healthcare system. Research design and methods This qualitative study was conducted using the grounded theory method. Participants and research context Data (...) were collected through in-depth, semi-structured, individual interviews with 26 participants, 23 of whom were members of the nursing profession. Sampling started purposefully and, then, continued with theoretical sampling. Field notes were also taken for data collection. Data analysis was performed using Corbin and Strauss’ 2015 method. Ethical considerations The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran. Findings The “Professional Dynamics in the Path of Justice” was the study’s core category. This theory is the result of nine main categories: “inefficient professional authority,” “social justice, a neglected component in education,” “clinical concerns, barriers to nurses’ presence in society,” “individual input reserves to facilitate social justice,” “inadequate maturity of the profession in the path of equity in health,” “promoting justice in clinical practice,” “a tendency to community-oriented profession,” “use of personal approaches for justice promotion,” and “emerging justice-expanding nursing.” These categories cover the underlying factors, strategies, and outcomes of the nursing profession’s participation in establishing social justice process in healthcare. Conclusion The theory of professional dynamics in the path of justice can be used as a practical guide to describe the role of nurses in establishing social justice. Further studies with a quantitative approach to applying this theory are recommended. (shrink)

Nurses play a crucial role in reducing health disparities and advancing health equity for individuals and communities. The future nursing workforce relies on their nursing education to prepare them to promote health equity. Nursing educators prepare students through a variety of andragogical learning strategies in the classroom and in clinical experiences and by intentionally updating and revising curricular content to address knowledge and competency gaps. This critical review aimed to determine the extent to which health equity concepts (...) are explicitly present in prelicensure undergraduate nursing curricula globally. Of 434 articles screened, 22 articles describing 20 studies met inclusion criteria. Frequency and quantity of health equity content, concepts and topics, teaching strategies, evaluation strategies, and the overall extent of integration varied widely. Notably, only two articles described overall well‐integrated explicit health equity content, and there was little attention to whether students transfer this learning into practice. A focus on individualism rather than population and community was noted, highlighting the presence of whiteness in nursing. Results from this review confirm that nursing education has room to improve with respect to health equity in the curricula. (shrink)

The aim of this paper is to analyse how the broad context of nursing practice plays a stimulating and/or a restricting role in the process of ethical caring. Three areas of special attention are noted. First, on the societal level, some developments that influence the state of affairs in the caring sector are indicated. Secondly, concerning the nursing and medical professions, an interprofessional dialogue based on specific competence is outlined. Thirdly, there is a discussion of how health care (...) institutions can evolve from a business undertaking to a pedagogic-moral area where nurses can learn the moral attitudes that are essential to achieve ‘good care’. (shrink)

MACKINNON K. Nursing Inquiry 2012; 19: 259–269 We cannot staff for ‘what ifs’: the social organization of rural nurses’ safeguarding workRural nurses play an important role in the provision of maternity care for Canadian women. This care is an important part of how rural nurses safeguard the patients who receive care in small rural hospitals. This study utilized institutional ethnography as an approach for describing rural nursing work and for exploring how nurses’ work experiences are socially organized. Rural (...) nurses advocated for safe healthcare environments by ensuring that skilled nurses were available for every shift, day and night, at their local hospital. Rural nurses noted that this work was particularly difficult for the provision of maternity care. This article explores two threads or cues to institutional organization that were identified in our interviews and observations; namely staffing and safety standards, and the need for flexibility in staffing in small rural hospitals. Rural nurses’ concerns about ensuring that skilled nurses are available in small rural hospitals do not enter into current management discourses that focus on efficiency and cost savings or find a home within current discourses of patient safety ‘competencies’. (shrink)

Two questionnaire surveys are reported describing the attitudes of 127 Japanese nurses towards developing a do not resuscitate (DNR) policy. The background information features the Japanese health care situations: a lack of policies for end-of-life care decisions; frequent life-prolonging treatments initiated without the patient’s knowledge or consent; ethical dilemmas confronting nurses in relation to such treatments; and the public’s growing concern over end-of-life care. A hypothetical DNR policy was used in which a health professional asked patients about their decision regarding (...) DNR. The respondents supported this model DNR policy as an ideal. However, they noted that this policy was at variance with Japanese culture. Recommendations for Japanese nurses emerged from the data. In order to make an impact on end-of-life decision making, nurses should take culturally appropriate actions: (1) teach patients about their rights; and (2) work with physicians to provide patients with accurate information about their condition. (shrink)

In summary, the usual elements of a typical health care ethics consultation note might reasonably accommodate the needs and expectations of relevant parties, and would therefore include: 1. identification of the relevant ethical issues, questions, or dilemmas; 2. reference to any relevant facts--medical, nursing, social, psychological, spiritual, legal, political, etc.; 3. a prioritized list of recommendations to improve coordinated care; 4. a clear and concise articulation of relevant arguments, wtih specific reference to the list of recommendations as well as (...) to the institution's overall ethos; 5. a contextual statement, identifying the perceived degree of consensus or support for the recommendations and conclusions, as well as any inherent agendas. (shrink)

This article focuses on how solidarity is negotiated in interactions during medical visits between nurse practitioners and patients. Drawing on data from ethnographic field notes, audio-recorded interactions and interviews involving one NP and 20 patients, the article outlines ways in which the NP creates a sense of solidarity by lessening the social distance between herself and her patients. These attempts at solidarity do not correlate with what has been noted in previous studies of medical visits involving medical doctors and (...) may represent a difference in how both the NP and the patients view the NP as a mid-level provider. As NPs are taking on a more prominent role in the healthcare landscape, it is important to understand what the interactional norms are and how these may deviate from the norm set by MDs. (shrink)

This study used historical research methodology to assess the work of US nurses caring for patients with cancer from 1920 to 1950. Primary sources, obtained from several US archives, included nursing procedure books, student nurses’ lecture notes, hospital and nursing annual reports, and meeting minutes. Secondary sources included journal articles and textbooks. The aim was to document the clinical work of nurses caring for patients with cancer and assess this work for evidence of emerging specialization in cancer (...) nursing. Following a review of cancer in the 1920s, nursing education specific to cancer, nursing care related to specific cancer therapies, and the practice of concealing a diagnosis of cancer, were examined. Nurses were consistently educated in cancer nursing, but their cancer education became more focused over the decades. Nurses were closely involved with cancer patients as they monitored their patients’ radium or assisted patients following radical surgery. The issue of concealing the diagnosis of cancer was problematic to some nurses. This paper reveals the nature of nurses’ hospital work with cancer patients and demonstrates a core body of cancer nursing knowledge. The emergence of cancer nursing as a specialty is presented. (shrink)

Nursing research in China is at an early stage of development and little is known about the practices of Chinese nurse researchers. This interview study carried out at a university in central China explores the informed consent practices of Chinese nurse researchers and the cultural considerations of using a western technique. Nine semistructured interviews were conducted in English with assistance and simultaneous translation from a Chinese nurse with research experience. The interviews were analyzed by one western and two Chinese (...) researchers and major themes were identified. All participants endorsed informed consent as ethically required. Differences were noted between some of the informed consent practices typically recommended in the USA and those identified in this study, such as: recruitment using local and government officials, recruiting directly from medical records without special permission, family consultation in consent and consent control, and not revealing randomization to intervention groups receiving different treatments. (shrink)

This article deals with making decisions about starting terminal care. The results are part of a larger survey on nurses’ conceptions of terminal care in community health centres in Finland. The importance, frequency and timing of decision making as well as communication and the number of investigations and procedures carried out are examined. The relationship between decision making and the size of a health centre’s catchment population is also discussed. The results make it possible to compare the current situation in (...) Finland with the national law on patients’ rights. The sample consisted of 328 nurses who worked on the wards of 32 community health centres. The data were collected by means of a structured questionnaire and processed with the Statistical Package for Social Sciences software. The nurses agreed that explicit decision making and documentation about starting terminal care were necessary, but it was highlighted that the practice had many shortcomings. Decisions were often made too late and the patients were not always aware of their situation; family members and the nursing staff were mostly better informed. It was noted that many investigations and other procedures were carried out on terminally ill patients, often at the request of family members. Decision making was found to have some relationship to the size of a health centre’s catchment area. (shrink)

Background: Nurses who practice limitation of therapeutic effort become fully involved in emotionally charged situations, which can affect them significantly on an emotional and professional level. Objectives: To describe the experience of intensive care nurses practicing limitation of therapeutic effort. Method: A qualitative, phenomenological study was performed within the intensive care units of the Madrid Hospitals Health Service. Purposeful and snowball sampling methods were used, and data collection methods included semi-structured and unstructured interviews, researcher field notes, and participants’ personal (...) letters. The Giorgi proposal for data analysis was used on the data. Ethical considerations: This study was approved by the Ethical Research Committee of the relevant hospital and by the Ethics Committee of the Rey Juan Carlos University and was guided by the ethical principles of voluntary enrollment, anonymity, privacy, and confidentiality. Results: In total, 22 nurses participated and 3 themes were identified regarding the nurses’ experiences when faced with limitation of therapeutic effort: (a) experiencing relief, (b) accepting the medical decision, and (c) implementing limitation of therapeutic effort. Conclusion: Nurses felt that, although they were burdened with the responsibility of implementing limitation of therapeutic effort, they were being left out of the final decision-making process regarding the same. (shrink)

Mongolian philosophical underpinnings of well‐being were expressed in the form of mythology, shamanism and Mongolian Buddhism before the development of modern nursing in Mongolia. Among these forms, the philosophical underpinnings of well‐being, mythology and shamanism were formed as a result of the roots of Mongolian philosophy, whereas Buddhism spread relatively late. As a result of Mongolian mythology, an alternative approach calleddom zasalwas formed, and it remains one of the important foundations of the idea of well‐being among people. Among the (...) various concepts of shamanism, the concept ofsunesubest expresses the underpinning of well‐being, and the idea that healing and nursing care can be provided not only by those living in this world but also by spirit beings. Since Mongolians still use these ideas even in modern times, it should be noted that following them too narrowly may conflict with concepts based on scientific evidence. Along with the development of Buddhist philosophy in Mongolia, the Oriental philosophical underpinnings of well‐being have spread. One of the most important concepts is the five basic elements of life (tavan mahabhutas) and three elements of the body (khii, shar andbadgan). While developing the concepts of life and the body, thearga‐bilegmodel (yin‐yang in Chinese), developed at the theoretical level in Chinese philosophy, has become a popular basis for culture and customs among Mongolians. Therefore, it has been difficult to judge whether the origin of thearga‐bilegmodel is Mongolian or Chinese; however, this is undeniably an important underpinning for well‐being in both countries. (shrink)

Marginalization has been used as a guiding concept for nursing research, theory and practice. Its properties have been identified and updated in 1994 and 1999, respectively. This article re-examines marginalization, considering it to be a concept that changes with pivotal historical events. The events of September 11, 2001, and the war between the US/UK and Iraq are such pivotal events. The notion of the linguistic habitus and symbolic violence as outlined by Bourdieu provide new insights about the dynamics of (...) marginalization. Specifically noted is the marginalization of persons and cultures based on their designation by the current US administration, and as interpreted through mainstream media, as actual or potential ‘terrorists’. A parallel situation in nursing is discussed, beginning with nursing's own marginality, related to the dynamics of symbolic violence. Nursing is argued to be vulnerable to having essential words and practices co-opted by dominant institutions and altered in meaning, that is, made incongruent with the discipline's emphasis on core values of confidentiality, equity and care. In response to marginalization and exteriorization those affected can use voice and testimony to ‘recreate the centre’. Suggestions for protecting our practices and philosophy are included. (shrink)

Collaboration for nursing is a core competence and therefore educational interventions are essentials for collaborative skills. To identify such interventions, we carried out a study to understand nursing students' collaborative process. A narrative inquiry method was used to explore the collaborative process of first‐year undergraduate nursing students. The analysis was conducted on field notes from 70 h of observation of 87 nursing students' collaboration during skills lab activities. It also included transcriptions of four focus group (...) discussions with 11 students. The results are presented as a sequential process of (1) navigating in unfamiliar territory, (2) navigating together to cope, and (3) navigating together towards independency and the future nursing profession. We identified a transition from teacher‐led assistance and guidance to student interdependency and reciprocal learning, ending with student‐led assistance supporting independency. In line with Vygotsky's theory of zone of proximal development, different scaffolding interventions are needed depending on where the students are in the collaborative process. (shrink)

Midwives and nurses play a critical role in safeguarding the lives of women in resource-constrained African countries. Working within the context of scarce resources may undermine their moral agency and hinder their ability to care. The purpose of this paper is to understand the influence of resource scarcity on midwifery and nursing care and practice. A critical ethnography was conducted in the obstetric department of three tertiary-level facilities in Ghana. Purposive sampling was used to recruit 30 midwives and nurses (...) and semistructured interviews, field notes and documentary materials were used to generate in-depth understanding. Ethical approval was granted from Canada and Ghana and written, and ongoing informed consent was obtained from the participants. Five conceptual themes depicting the impact of scarce resources on midwifery and nursing care were discovered: compromised care, constrained care, dehumanized care, missed care and disengaged care. Improving the maternal health of women and averting avoidable maternal morbidity and mortality require governments and institutions to invest in health infrastructure that will support the delivery of ethical and safe midwifery care for women in their most vulnerable period. (shrink)

This study departs from the built-in tension of the dual goals of forensic psychiatric care in Sweden, which are to protect society as well as to care for patients. The majority of violence that takes place is perpetrated by men. Therefore, the views of nursing staff on violence as a gendered phenomenon have an impact on the care provision. There is a need for further knowledge of how norms of violence are intertwined with the construction of gender. The aim (...) of this study was to use a gender perspective to demonstrate the views of nursing staff on security and care and the consequences for their relationships with patients. The study adopts an ethnographic approach, with data consisting of field notes from participatory observations and interviews with nursing staff at two maximum-security clinics. We show how the perceptions of nursing staff about gender relations are based on heteronormative thinking, which affects their practice. This implies that if gender is ignored in relation to the dual goals, there is a risk of perpetrating patterns of unequal conditions. Therefore, it is vital to make gender visible to counteract unequal conditions for nursing staff and address patients' individual care needs. (shrink)

In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a (...) western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) “I’m sorry, there’s nothing else”: increasing supports for patients and families; (2) “someone will commit suicide”: improving supports for nurses: (3) “Everyone needs to be heard”: improving patient care communication; and (4) “I didn’t see it coming”: providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions. (shrink)

In the years following the COVID‐19 pandemic, issues such as high job demands, burnout, and turnover continue to influence the nursing workforce, with heavier impacts to marginalized groups. Understanding the work and life contexts of nurses of color can help guide strategies for workplace equity and meaningful support. This qualitative study explored the experiences of nurses of color in the United States during the pandemic, focusing on feelings about the profession and job decisions. The overarching theme was “answering the (...) call,” with subthemes of “COVID shone a light,” “being consumed by COVID,” and “is it worth it?” Participants shared how their racial identities shaped their perceptions and job decisions in positive and negative ways, noting how racism impacted many facets of their work and added to the stressors felt in the workplace and the community. Findings provide insight into the underrepresented perspectives of nurses of color and suggest strategies to eliminate racism in nursing. (shrink)

The global climate crisis is an immediate threat, causing inequitable health impacts across different populations. Climate justice connects the causes and effects of climate change to structural injustices in society. Nurses and community‐based organizations (CBOs) partner in promoting justice and health equity. The purpose of this article is to describe how nurses and their CBO partners envision, perceive, and experience climate justice in the communities they serve. Participants were recruited via a screening survey sent to nursing and public health (...) organizations in the United States. This descriptive mixed‐methods study utilized participatory photo mapping (i.e., combined participatory photography, community mapping, and interviews) to capture participants’ understanding and experiences of climate justice. Recruitment methods identified eight partnerships across six states. Participants depicted how climate injustice is reinforced by colonial severance from Nature. Participants noted that state violence and corporate climate pollution degraded the public's health. Climate justice was described as a long struggle to regain spiritual relationships within Nature, fostering belonging, abundance, and protected communities of care. Planetary health and well‐being were central to participants’ experiences with climate justice. Future research could explore barriers and facilitators to addressing climate injustice and promoting climate justice in diverse settings. (shrink)

Nurses who try to reduce inequalities in health care by defending individuals they care for should be able to perceive ethical situations sensitively as patient advocates. This study aimed to examine the effects of ethics education provided to nursing students on ethical sensitivity and patient advocacy. The study adopted a pre-test, post-test, one-group quasi-experimental design and was conducted at a public university in Turkey. The sample comprised 44 nursing students taking the Professional Ethics course. Data were collected from (...) October 13, 2021, to January 6, 2022, using a Descriptive Characteristics Form, the Moral Sensitivity Questionnaire, and the Patient Advocacy Scale for Nurses. The study was approved by an ethics committee. While no significant difference was found between the pre-test and post-test mean Moral Sensitivity Questionnaire scores (t = 0.426, p > 0.05), a significant difference was noted between the total mean Patient Advocacy Scale for Nurses scores (Z = − 2.443, p < 0.05). The findings showed that ethics education provided to the nursing students did not affect ethical sensitivity but increased patient advocacy. (shrink)

Background: It is acknowledged that publishers now require all primary research papers to demonstrate that they have obtained ethical approval for their research. Objectives: To assess the rate of reporting of ethical approval in clinical trials in core nursing journals in mainland China. Research design: A retrospective observational study. Participants: All clinical trials published in all of the 12 core nursing periodicals from 2016 edition China Science and Technology Journal Citation Report (core version) between 2013 and 2016 were (...) retrieved by hand to explicate rate of reporting ethical approval and informed consent. Ethical considerations: The study did not require approval from the research ethics committee as it did not involve human subjects or records. Results: In total, 40,278 papers were published in 12 nursing periodicals between 2013 and 2016. Out of these, 9488 (23.6%) focused on clinical trials. Informed consent obtained from patients or the legally authorized representative was reported in 51.8% of clinical trials. Notably, only 27.4% of clinical trials reported that they had obtained written consent. Furthermore, 25.9% of clinical trials described ethical approval; however, the rate of reporting informed consent and ethical approval in these 12 nursing journals in China during 4 years from 2013 to 2016 improved markedly, with 38.1%, 44.0%, 59.0% and 66.6%, respectively ( p < 0.001), and 17.6%, 21.9%, 28.6% and 35.8%, respectively ( p < 0.001). In addition, both reporting informed consent and reporting written informed consent had a positive significant correlation with the reporting ethical approval ( p < 0.05 or < 0.01). Conclusion: Chinese scientific nursing journals have improved the rate of reporting informed consent and ethical approval in clinical trials during the last 4 years. However, it should be noted that nearly half of clinical trials still did not report either ethical approval or whether informed consent was obtained. Efforts from editors, researchers, sponsors and authors are needed to ensure the transparency of ethical scrutiny and adherence to ethical guidelines in publishing clinical trials in Chinese nursing journals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Perspectives on Bioethics*Pat Milmoe McCarrick (bio) and Martina Darragh (bio)The literature of feminist bioethics has flourished in the last decade. Women’s health care, women’s role both as patient and health care professional, the many new reproductive technologies, the exclusion of women as research subjects, as well as the broader topic of feminist contributions to ethical theory itself, have all become topics of interest for feminist bioethical writers.Although feminism (...) is anything but a monolithic enterprise, Karen Lebacqz’ essay on feminism in the new, revised Encyclopedia of Bioethics (II A, 1995) says that “all feminists agree that women are oppressed and this oppression is wrong.” Rosemarie Tong refines this statement to include variations of feminism: “... feminist theory is not one, but many theories or perspectives and... each feminist theory or perspective attempts to describe women’s oppression, to explain its causes and consequences, and to prescribe strategies for women’s liberation” (VII, Tong 1989). She describes different feminist views in Feminine and Feminist Ethics (II A, 1993), labelling them liberal, Marxist, radical, psychoanalytic, socialist, existentialist, and postmodern. Alison Jaggar critiques these different forms of feminism in Feminist Politics and Human Nature, and Susan Sherwin applies these perspectives to the field of bioethics in No Longer Patient: Feminist Ethics and Health Care.One of the central activities in current feminist bioethics is a revisitation of ethical theory itself. There is a distinction between “feminine” and “feminist” ethics in this field (II A, Tong 1993). “A feminine approach to ethics consists of observations of how the traditional approaches to ethics fail to fit the moral experiences and intuitions of women. In contrast, a feminist approach to ethics applies a specifically political perspective and offers suggestions of how ethics must be revised if it is to get at the patterns of dominance and oppression as they affect women” (IV, Sherwin 1992). Carol Gilligan’s two books, In a Different Voice and Mapping the Moral Domain, Nel Noddings’s Caring: A Feminine Approach to Ethics and Moral Education, and Virginia Held’s Feminist Morality: [End Page 85] Transforming Culture, Society, and Politics can be thought of as feminine critiques of contemporary ethics.Gilligan’s notion of the “ethics of care” has served as a point of departure for a discussion of a type of relational ethics that focuses on concrete experiences, pairs emotions with reason, and balances justice with care. This “ethics of care” has been both celebrated and criticized. The concept of “care” in ethics dates back to the “cura” tradition of care in ancient Rome and was further developed by philosophers Soren Kierkegaard and Martin Heidegger and psychologists Rollo May and Erik Erikson. Nursing theorists have built on this tradition both in theory and in practice (II A, Reich, Care, Encyclopedia of Bioethics, 1995). “Care” often is discussed in opposition to the liberal notion of “justice” (III, Sterba, Justice, Encyclopedia of Bioethics, 1995).Gilligan’s theory was developed to provide a counter model to Lawrence Kohlberg’s six steps in the development of a human moral nature: (1) acting to avoid punishment, (2) acting to promote reciprocity, (3) conforming to get approbation, (4) respecting authority to maintain social order, (5) acting freely if others are not harmed, and (6) following self-legislated, self-imposed, universal principles of justice, reciprocity, and respect for the dignity of humans as individuals. In contrast, Gilligan holds that the moral self is an individual working with other individuals to identify mutually agreeable solutions to thorny human relations problems. Gilligan called Kohlberg’s the male moral point of view as an ethics of justice and hers the female moral view as an ethics of care. Her levels are (1) inward-directed care, (2) other-directed care subjugating personal wants and needs to others (eventually leading to anger), (3) a philosophy of care that balances egoism and altruism, recognizing the women’s connection to others and theirs to her.According to Jocelyn Downie and Susan Sherwin (IV, 1993), oppression, as used by feminists, is understood as an interlocking series of restrictions and barriers that reduce the options available to members of a group defined by morally insignificant characteristics, here gender. The literature itself can be... (shrink)