Nursing Ethics最新文献

Background: Nurses frequently experience ethical issues in their area of practice. In the challenging reality of today's healthcare environment, nursing students need to be prepared to deal with ethical issues in their future roles. Nevertheless, Chinese nursing students' ethical sensitivity status and the factors influencing it have not been described.

Objective: This study aims to explore the level of ethical sensitivity and its influencing factors among Chinese nursing students.

Research design: This was a cross-sectional study. We firstly cross-culturally adapted the Japanese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) into a Chinese version. Then, we administered the Chinese version of ESQ-NS, the Caring Ability Inventory (CAI), and general information questionnaire to nursing undergraduates.

Participants and research context: The invitations were sent to 600 nursing undergraduates from four universities in Hunan, China.

Ethical considerations: The study was supported by the Institutional Review Board (IRB) of the lead university. The Approval No. was E202092.

Results: A total of 489 undergraduate nursing students participated in the study. The mean score for ethical sensitivity of the samples was 36.34 ± 4.90, and 187.99 ± 22.64 for their humanistic care ability. Pearson's correlation coefficient test indicated a meaningful and positive relationship between the ethical sensitivity and humanistic care ability (r = 0.576 and p < .01). And regression analysis showed that age, school year, experience in studying nursing ethics, how much you like nursing major, and humanistic care ability were of relevance to nursing students' ethical sensitivity.

Discussion: Our findings suggest that the mean ethical sensitivity score of Chinese nursing students is 36.34 (13-52). The humanistic caring ability of Chinese nursing students is still at a low level.

Conclusion: Future interventions for improving the ethical sensitivity of the nursing students should consider general information of participants and their humanistic care ability.

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.

Background: Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses' prioritizations in their work to achieve well-being and health for nursing home residents.

Aim: The aim of this study was to explore nursing home nurses' priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic.

Research design, participants, and research context: We conducted a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis.

Ethical considerations: Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649).

Findings: We identified an overarching theme-nursing home nurses struggling on multiple fronts, "just do it"-and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives' expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing.

Conclusions: Nurses' priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses' priorities. Nursing home nurses need organizational and managerial support to prioritize.

Background: Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of  professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists.

Research question: What factors contribute to Moral distress among physiotherapists and how do they cope?

Objectives: To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena.

Research design: A 2017-2022 mixed-methods study: (1) Survey of 407 physiotherapists quantitatively testing a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis.

Participants and context: Israeli physiotherapists from various occupational settings recruited via professional networks.

Ethical considerations: The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use.

Findings: Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress.

Discussion: Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors.

Conclusions: Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies.

Background: A persistent devaluation of care-work, difficult working conditions, and low salaries have led to challenges with staff recruitment and retention in the homecare sector in France. A new homecare organization adopting an innovative organizational model recently experimented an hourly payment method yielding positive outcomes.

Objectives: Using Tronto's caring framework, this paper analyzes the strategies used by the founders as they developed their innovative model and the nursing activities performed during home visits.

Design: A longitudinal qualitative study was conducted between 2017 and 2023. Homecare nursing teams were shadowed for 1-2 days per year yielding detailed field notes on caregiving activities, both before and after the new payment method. Secondary data included reports, videos, articles, and unpublished documents found online.

Ethical considerations: While there is no requirement in France to obtain ethical approval in non-interventional research, verbal consent was obtained by all participants prior to their involvement in the study; confidentiality and anonymity were strictly maintained; and pseudonyms were assigned to protect identities.

Findings: 63 interviews and 185 h of shadowing and observations were conducted. Results revealed a virtuous cycle of caring facilitated and encouraged by new incentives that resonated with nurses' professional ethics. The favorable working environment and the hourly payment method enabled nurses to provide caregiving in accordance with their values.

Conclusions: As the new hourly payment experiment is scaled-up nationally, it is imperative that it is not isolated from the organizational model. Without the underpinning values and principles, the hourly payment method alone is unlikely to shift the value attributed to caring.

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.

Palliative care aims to improve the quality of life for seriously ill individuals and their caregivers by addressing their holistic care needs through a person- and family-centered approach. While there have been growing efforts to integrate Artificial Intelligence (AI) into palliative care practice and research, it remains unclear whether the use of AI can facilitate the goals of palliative care. In this paper, we present three hypothetical case examples of using AI in the palliative care context, covering machine learning algorithms that predict patient mortality, natural language processing models that detect psychological symptoms, and AI chatbots addressing caregivers' unmet needs. Using these cases, we examine the ethical dimensions of utilizing AI in palliative care by applying five widely accepted moral principles that guide ethical deliberations in AI: beneficence, nonmaleficence, autonomy, justice, and explicability. We address key ethical questions arising from these five core moral principles and analyze the potential impact the use of AI can have on palliative care stakeholders. Applying a critical lens, we assess whether AI can facilitate the primary aim of palliative care to support seriously ill individuals and their families. We conclude by discussing the gaps that need to be further addressed in order to promote ethical and responsible AI usage in palliative care.

Background: There are legal protections for nurse researchers at public universities who employ community-based participatory research (CBPR) in research about social or health inequities. Dissemination of CBPR research data by researchers or participants may divulge unjust laws and create an imperative for university involvement.

Research question: What are United States-based legal dissemination protections for CBPR health equity nurse researchers?

Research design: Three case examples employing CBPR are examined: 1) a mixed methods study with participants reporting illegal discrimination in a municipal initiative about capacity building in community-based organizations serving children; 2) a visual methods study exposing potential clean air law violations in environmental justice research; and 3) a study examining workload violations and illegal discrimination among hotel workers.

Participants and research context: The cases involved participants from protected social class backgrounds. The research is described with respect to: background, funding, research purpose, and research team; research participants' power and legal vulnerability; dissemination of relevant research information balancing vulnerability and power; research dissemination issues; potential legal issues involved; and laws researchers may use.

Ethical considerations: IRB approval was obtained for the studies. Using a social justice ethical framework, studies highlight actual or potential legal aspects of data dissemination in the context of gathering data about injustice.

Findings: Legal protections for research data dissemination, whistleblower protection, research advancement protection, anti-harassment protection, false claims, defamation, and visual data liabilities are described.

Conclusion: Knowledge of legal research data dissemination protections is an essential competency for nurse researchers invested in uplifting social justice.

Background: Disaster scenarios challenge both novice and experienced nurses to navigate complex ethical dilemmas in resource-limited environments. Traditional nursing education often leaves new nurses unprepared for the ethical demands of disaster nursing. Utilitarianism must often guide triage ethics and decision-making. There is a critical need to equip nursing students with these ethical competencies.

Research question/aim: This study explores nursing students' lived experiences using introductory triage ethics in mass casualty incident simulation (MCIS).

Research design: A qualitative, interpretive phenomenological approach was employed, analyzing reflective journal responses from senior nursing students following MCIS participation.

Participants and research context: Participants were senior-year nursing students from a private university in the U.S., engaging in MCIS as part of their curriculum, which simulated resource-limited disaster scenarios requiring real-time ethical decisions.

Ethical considerations: The study received Institutional Review Board (IRB) approval, and participants provided informed consent. Data were anonymized and did not affect academic evaluation.

Findings: Two major themes emerged: 1. Living in Ethical Dilemmas (subthemes: We Could Have Saved Them If…, Looking Past Obvious Suffering, How Can We Be Prepared?, We Can't Abandon Them). 2. Development of Ethical Competency (subthemes: Knowing You've Done Enough, Finding New Perspectives, There Is No Right Answer). Students grew in moral reasoning and emotional resilience, transitioning from patient-centered care to utilitarian decision-making.

Conclusions: Participation in the mass casualty incident simulation allowed nursing students to confront and navigate complex ethical challenges in real time, fostering significant growth in moral reasoning and emotional resilience. Through immersion in simulated ethical dilemmas, students grappled with the tension between patient-centered care and the realities of utilitarian decision-making. This experience catalyzed a deeper understanding of ethical ambiguity and the development of moral clarity, equipping them with foundational skills for ethically navigating crises. Nursing curricula should recognize and incorporate opportunities that facilitate this ethical growth through experiential learning.