Nursing Ethics最新文献

This article presents a scoping review aimed at mapping the main sources of moral distress among nursing professionals. The review was conducted according to the Arksey and O'Malley methodology, using the SPIDER framework to guide the systematic search in the BVS, PubMed, PsycArticles, Scielo, and Scopus databases. Initially, 2320 publications were identified. After the application of inclusion and exclusion criteria, 83 studies were selected for analysis in terms of their methodological characteristics, objectives, practice contexts, and various sources of moral distress identified. The analysis facilitated the grouping of these sources into specific situations, reflecting the challenges experienced by nurses under different practice settings. This review augments the knowledge of the causes of moral distress in nursing, highlighting the impact of this phenomenon on the physical and mental health of professionals, as well as on the quality of care provided.

Truth-telling for terminally ill patients is a challenging ethical and social issue for Chinese health care professionals. However, despite the existence of ethical and moral standards for nurses, they frequently encounter moral dilemmas when making decisions about truth-telling to patients with end-stage diseases in China. This article aims to provide ethical strategies for clinical nurses in China regarding truth-telling decisions for terminally ill patients on the basis of their individual autonomy. This article first presents a common case scenario in China and then critically discusses ethical issues related to ethical principles and philosophical theories. The aim is to provide the much needed strategy for truth-telling for nurses who are terminally ill rather than to focus on attitudes toward disclosure. This article focuses on nursing morality, ethics, norms, and philosophy in health care and discusses countermeasures taken by nurses in truth-telling decision-making in combination with Chinese Confucian culture. The analysis identifies key ethical strategies tailored to Chinese nurses' practices, emphasizing individual autonomy, cultural sensitivity, and family dynamics in truth-telling decisions. The complexity of end-of-life illness requires Chinese nurses to strengthen the communication training needed to deliver bad news, as well as critical and autonomous thinking and good communication skills when implementing patient- and family-centered care, to achieve true delivery of bad news, thereby increasing patient autonomy and promoting more successful collaboration among patients, families, and providers. To improve the quality of care. Chinese nurses should integrate ethical principles with Confucian values to enhance patient-centered communication, respecting autonomy while adapting to cultural nuances in end-of-life care.

Healthcare is increasingly impacted by chronic short staffing of nurses, which causes and is caused by increased nurse burnout and decreased retention. Nurses' unions seek to address these problems by proposing safer nurse-to-patient ratios, retention bonuses for working through the COVID-19 pandemic, Personal Protective Equipment (PPE) stockpiles, sabbatical leaves, measures aimed at reducing workplace violence, and maintaining or increasing wages and benefits to keep nurses at the bedside. Chronic short staffing and burnout directly affect the quality and availability of patient care-as the International Council of Nurses has pointed out, there is no healthcare without healthcare workers. This article draws on Neiman's argument that the US healthcare system is best understood as a system of competing interests aimed at fulfilling the community's obligation to provide access to quality healthcare. Nurses' unions use contract negotiations, legislative advocacy, and strikes to pressure other members of the healthcare community to address chronic short staffing, burnout, and retention. Nurses' unions in the US thus play a unique role in the system of competing interest as an organized group whose primary interest aligns with the community's obligation to provide access to quality healthcare. This article argues that nurses' professional duty to care for patients includes a duty to support nurses' unions as an important way to address the factors outside of nurses' direct practice that impacts the quality and accessibility of the care that nurses provide to patients. This duty to support unions applies to unionized and non-unionized nurses in the US, and includes duties to participate in union activities, to not cross picket lines, and to avoid work for strikebreaking nurse agencies.

Background: The global migration of nurses from resource-constrained to affluent nations raises complex ethical concerns, often rooted in historical power imbalances and neocolonial legacies. The Nepal-UK Memorandum of Understanding (MoU) on nurse recruitment, while presented as a solution to workforce shortages, exemplifies this complex dynamic, prompting critical questions about its implications for individual nurses and the healthcare systems involved.

Aim: This qualitative study explored the ethical complexities and dilemmas associated with the Nepal-UK nurse recruitment Memorandum of Understanding (MoU). This bilateral agreement has sparked debate about its potential impact on both individual nurses and the healthcare systems of Nepal and the UK.

Research design: A qualitative exploratory design utilizing semi-structured interviews was employed. Data were analyzed using reflexive thematic analysis.

Participants and research context: Twelve Nepali nurses from two private hospitals in Kathmandu, Nepal, participated in the study.

Ethical considerations: The study was approved by the Nepal Health Research Council. All participants provided informed consent and were assured of confidentiality and anonymity.

Results: Four themes emerged from the data: (1) The lingering legacy of colonialism casts a shadow on the Nepal-UK relationship, raising concerns about potential exploitation and unequal power dynamics. (2) Nepali nurses grapple with the ethical dilemmas of pursuing personal dreams while acknowledging their responsibilities towards their communities and Nepal's healthcare system. (3) The MoU's claims of ethical recruitment are scrutinized, with nurses questioning its fairness and sustainability. (4) The agreement is challenged as a potential band-aid solution that may perpetuate global health inequities rather than fostering a genuine partnership.

Conclusions: The Nepal-UK MoU, while offering opportunities for individual nurses, also raises alarms about brain drain, exploitation, and the perpetuation of global health disparities. The study underscores the urgent need for a paradigm shift in international nurse recruitment practices, prioritizing genuine partnership, equitable distribution of benefits, and sustainable solutions that address the root causes of healthcare workforce challenges in both source and destination countries.

Background: Patient privacy is important as one of the most principle components of quality healthcare and safe care. In teaching hospital emergency rooms, it is a challenge for staff to respect for privacy.

Research aim: Recognizing the importance of this issue, this study aims to assess the privacy status of patients in emergency departments.

Research design: This study employs a cross-sectional design.

Participants and research context: This study was conducted in patients of the four emergency departments of the teaching hospitals. 426 patients completed the demographic and clinical profile, as well as a privacy questionnaire, in four teaching hospitals selected based on quota sampling after obtaining informed consent. The data were analyzed with SPSS 26 and independent t-tests and one-way ANOVA.

Ethical considerations: This study was approved by the ethical committee and the designated authority within hospitals.

Findings: According to the findings, the majority of the respondents were married (65.05%), with a diploma level (30.25%), self-employed (37.5%), and female (50/50%). The most frequent hospitalizations were also for internal emergencies (45.1%), night shifts (42.3%), and workdays (63.8%), with mean age of 41.78 (years and a duration of hospitalization of 6.34 hours). The patient privacy score in the emergency department was 67.61 ± 13.30 and in the physical, psychosocial, and spiritual/religious dimensions was reported as 3.31 ± 15.37, 6.97 ± 36.72, and 6.18 ± 15.50, respectively. The patient privacy showed a significant difference by type of emergency, number of beds, and nurses to bed ratio (p = .001).

Conclusions: Based on the results of the study, as the level of patient privacy was average for patients, in order to increase patient trust and improve the services provided, it is suggested that more focus be placed on structural changes, the development of guidelines, training in medical and nursing ethics, and the establishment of hospital ethics committees.

Background: The ethics of care and justice represent two modes of moral reasoning that nurses use in solving real-life ethical dilemmas. Research aim: The present study investigated what types of dilemmas nurses encounter in everyday work and to what extent they use care versus justice reasoning to solve them. Research design: The study used a cross-sectional survey design. Participants reported a real-life ethical dilemma and its resolution through an online survey. Open-ended data were analysed with an adjusted taxonomy of real-life moral dilemmas and moral orientations. Quantified data were analysed with statistical methods (χ²-test, analysis of variance). Participants and research context: Participants were 334 registered nurses and 177 practical nurses from four health and social care organisations in Finland. Ethical considerations: The study was approved by the Research Ethics Committee of Finnish Institute for Health and Welfare. Findings: Nurses reported six types of ethical dilemmas. Nurses used more care reasoning on the needs of others and conflicting demands dilemmas than on applying rules, social pressure and reacting to transgression dilemmas. Applying rules and needs of others dilemmas were the most common types of ethical dilemmas in both occupations. Practical nurses reported more non-ethical dilemmas than registered nurses did. Discussion: Ethical dilemmas of nurses are diverse, and the use of care and justice reasoning is differentiated according to the type of dilemma. Care reasoning dominates nurses' ethical decision-making when responding to the needs of patients. Nurses use justice reasoning when they apply regimens, rules and procedures. In everyday ethics, care and justice reasoning complement each other. Conclusions: Highly regulated healthcare environments prefer rule-oriented justice reasoning that may supersede care reasoning in addressing patients' situations. Focus on technical-professional expertise may further hamper nurses' ethical decision-making. Nursing education and management should encourage nurses to use ethical concepts and values in their work.

In this paper, we reflect on factors that seem to have influenced the accessibility of medical assistance in dying (MAID) in the Canadian context. Since legalization in 2016, the uptake of MAID has increased rapidly to equal or exceed rates in other countries. In that MAID implementation involves numerous ethical/moral complexities, we consider four factors that appear to have influenced this growth. First, we reflect on the vague language contained within the legislation that has been interpreted by a community of practice in which making MAID accessible is an important priority. Second, we consider policies of effective referral and self-referral that have been strategies for enhancing accessibility in relation to a wider context that contains conscientious objection. Third, we examine the apparent impact of centralized clinical teams and coordination services that have enhanced accessibility for persons residing in rural and remote areas. Fourth, we reflect on ways in which public awareness of MAID has been enhanced through policies that enable healthcare providers to introduce the topic of MAID as an option within advance care planning. We conclude with a consideration of how these intersecting factors may be shaping the moral complexity inherent in the idea of making MAID accessible.

Background: The smart home-based elder care presents a promising technological solution to address the challenges of aging. However, it has also unveiled a spectrum of ethical concerns, which may cause older adults to submit to negative emotions and psychological pressure.

Aim: To delineate the ethical dilemmas encountered by older adults in the context of smart home-based elder care, and to construct a model that elucidates the ethical issues across different dimensions.

Research design: This study follows a qualitative phenomenological research design.

Participants and research context: The sample comprised 15 older adults and 10 adult children in two communities in Jinan, Shandong, China. Structured, in-depth interviews were performed to collect data and the Colaizzi descriptive analysis framework was adopted to analyze data. An ethical dilemma model was constructed based on framework of the Society Ecosystems Theory.

Ethical considerations: The proposal was approved by the Research Ethics Committee of the Second Hospital of Shandong University, China. Participation in this study was voluntary. Written and verbal consent was gained. All recordings were kept under the principle of confidentiality.

Results: Ethical dilemmas of smart home-based elder care were grouped into three themes with 10 sub-themes, and a model composed of three systems was built based on these findings.

Discussion: The ethical dilemmas experienced by the older adults with smart home-based elder care were various and multi-layered, which could be elucidated by the ethical dilemma model.

Conclusion: The model emphasizes the necessity for collaborative efforts among the whole society and the elderly individuals. Tailored support strategies should be implemented to address the ethical dilemmas of the macro, meso, and micro system. The results may improve the elderly population to receive a more content and convenient elder care experience.

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.