Nursing Ethics最新文献

Philosopher Judith Butler has influenced how people talk about vulnerable bodies and sees vulnerability as universal, existential, and relational. Being vulnerable is part of the human condition. The main theoretical areas that run across Butler's work; power, knowledge and subjectivity, performativity, and ethics-are of particular relevance to nursing practice. This review aims to explore how Butler's theoretical work is reflected in research literature within a nursing context. We conducted a scoping review guided by Arksey and O'Malley's methodological framework. A systematic literature search of CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science identified 15 papers. Butler's theoretical work was applied at an individual and social level in research literature within a nursing context. Nurses need to reflect on their clinical practice and role as health professionals in relation to power and performativity in encounters with patients who are marginalized. Nurses' working conditions, recognition, and understanding are strongly influenced by society, and calling nurses heroes undermines their capacity to challenge and resist the hero identity. The healthcare system's impact on patient-nurse encounters challenges patients' and nurses' subjectivity, performativity, and power relations. The review allowed us to describe how Butler's theoretical work can facilitate a reflection on nursing practice which is a prerequisite for caring, ethical relationships, and working conditions within a nursing context. Butler's concepts can provide useful perspectives on how nurses understand, communicate with, and care for patients, as well as a nuanced understanding of the nursing role and power relations and structures.

Background: Global health systems operate amid dynamic factors, including demographic shifts, economic variations, political changes, technological progress, and societal trends that lead to VUCA reality (Volatility, Uncertainty, Complexity, and Ambiguity). To address these challenges, healthcare organizations are increasingly turning to Strategic Technological Processes and digital transformation.

Research objective: Against this background, the current study examined the personal experiences, conflicts, difficulties, and moral dilemmas attendant upon accommodating this digital transformation of healthcare professionals.

Participants: The study involved 27 healthcare professionals working in Israeli hospitals, whose experiences and perspectives were central to understanding the impact of digital transformation in healthcare settings.

Research design: The study methodology rested on in-depth interviews, which were analyzed through the prism of the Listening Guide analytical technique.

Ethical considerations: The research obtained pre-approval from the Ethics Committee at the researcher's institution.

Findings: The study revealed that the healthcare professionals are indeed facing ethical conflicts and personal challenges related to digitalization (such as providing the best quality of care, being the best caregiver, and acting for the betterment of the hospital). It also identified dilemmas resulting from conflicts between the needs and demands of the health system and the healthcare professionals' values and resources.

Discussion: The study findings highlight the impact of ethical and moral challenges accompanying strategic organizational and digital transformation changes implemented by healthcare organizations worldwide. These challenges arise as healthcare institutions adapt to the demands of the 21st century, potentially leading to burnout and moral distress among healthcare professionals, further exacerbating the already stressful reality they face.

Conclusion: In conclusion, the study emphasizes the critical necessity for comprehensive support strategies to alleviate stress and burnout among healthcare professionals. As healthcare organizations and personnel navigate significant organizational changes to address contemporary challenges, prioritizing the well-being of healthcare workers through effective support mechanisms becomes imperative.

Background: Prioritization decision-making arises when nurses encounter intricate situations that demand ethically challenging judgments about care. This phenomenon has rarely been studied in nursing homes. Prioritization decision-making may lead to instances where individuals in social and healthcare may not receive all services they need. Making prioritization decisions and awareness of their consequences can increase nurses' workload.

Aim: To describe prioritization decision-making regarding unfinished nursing care in nursing homes.

Research design: A qualitative descriptive study conducted through individual theme interviews. Participants were recruited through social media. The data was analyzed using inductive content analysis.

Participants and research context: Nurses (n = 23) working in nursing homes for the elderly people in Finland. Data were collected between June 2022 and February 2023.

Ethical considerations: Finnish legislation does not mandate an ethical review or research permits, as the participants took part as private individuals. [ask authors to make reference here to informed consent process and anonymity].

Findings: Nurses stated that the need for prioritization decision-making arises from challenges associated with nurses' engagement with person-centered care, the culture of the work community, the burden due to workload and challenges associated with the leadership. Prioritization decision-making was based on the interests of residents, striving for an efficient workflow and nurse's personal interests. Nurses did not receive support for decision-making regarding unfinished care, and protocols for prioritization had not been established in their work communities. Prioritization decision-making and unfinished care were concealed and left unspoken.

Conclusion: Nursing leaders should address this hidden phenomenon, making it visible through discussions with nurses and by involving them in the development of protocols. The findings can be utilized for developing new approaches to support nurses and reduce their workload and for enhancing the quality and person-centeredness of nursing care in nursing homes.

Background: The ethical competence of head nurses plays a pivotal role in nursing ethics. Ethical climate is a prerequisite for ethical competence, and moral resilience can positively influence an individual's ethical competence. However, few studies have focused on the relationship between ethical climate, moral resilience, and ethical competence among them.

Objectives: To investigate the relationship between ethical climate, moral resilience, and ethical competence, and examine the mediating role of moral resilience between ethical climate and ethical competence among head nurses.

Design: A quantitative, cross-sectional study.

Methods: A total of 309 Chinese head nurses completed an online survey, including ethical climate questionnaire, Rushton moral resilience scale, and ethical competence questionnaire. Inferential statistical analysis includes Pearson's correlation and a structural equation model.

Ethical considerations: This study received ethical approval from the Institutional Review Board of Xiangya Nursing School of Central South University (No. E2023146).

Results: Head nurses' ethical climate score positively impacted ethical competence (r = 0.208, p < .001), and ethical climate could affect ethical competence through the mediating role of moral resilience.

Conclusion: This study emphasized the value of ethical climate in moral resilience of head nurses, ultimately leading to an enhancement in their ethical competence.

Background: Morality is a fundamental component of nurses' daily work. Nurses' cognitive tendencies toward moral disengagement in high-stress work environments can easily lead them to engage in counterproductive work behaviors that are not conducive to the organization. However, there is limited research on how to mitigate the impact of moral disengagement on counterproductive work behavior.

Objective: The objective was to explore the impact of moral disengagement on counterproductive work behavior, as well as the reverse regulatory mechanism of moral identity on the relationship between moral disengagement and counterproductive work behavior.

Research design: This was a quantitative, cross-sectional study.

Participants and research context: From September to October 2023, nurses from emergency departments of major hospitals in Hunan Province were recruited, and 500 questionnaires were distributed and collected using the WeChat app Credamo Seeing Numbers.

Ethical consideration: All study procedures were approved by the Ethics Committee of Hunan Normal University (No. 2023-388).

Findings: Moral disengagement had a positive effect on counterproductive work behavior directed at the organization (CWB-O) as well as counterproductive work behavior directed at individuals (CWB-I). Moral identity was not significant in moderating the relationship between moral disengagement and CWB-O. Moral identity had an inverse moderating effect on the mechanism of action between moral disengagement and CWB-I.

Conclusion: Counterproductive work behavior guided by moral disengagement is detrimental to organizations, and moral identity can inhibit the effect of moral disengagement on CWB-I. Nursing administrators should focus on improving nurses' moral identity and improving the healthcare workplace environment so that moral identity can better exert its inhibitory effect on counterproductive work behavior among nurses.

Emergency departments in many nations worldwide have been struggling for many years with crowding and the subsequent provision of care in hallways and other unconventional spaces. While this issue has been investigated and analyzed from multiple perspectives, the ethical dimensions of the place of emergency department care have been underexamined. Specifically, the impacts of the place of care on patients and their caregivers have not been robustly explored in the literature. In this article, a feminist ethics and human geography framing is utilized to argue that care provision in open and unconventional spaces in the emergency department can be unethical, as vulnerability can be amplified by the place of care for patients and their caregivers. The situational and pathogenic vulnerability of patients can be heightened by the place of the emergency department and by the constraints to healthcare providers' capacity to promote patient comfort, privacy, communication, and autonomy in this setting. The arrangements of care in the emergency department are of particular concern for older adults given the potential increased risks for vulnerability in this population. As such, hallway healthcare can reflect the normalized inequities of structural ageism. Recommendations are provided to address this complicated ethical issue, including making visible the moral experiences of patients and their caregivers, as well as those of healthcare providers in the emergency department, advocating for a systems-level accounting for the needs of older adults in the emergency department and more broadly in healthcare, as well as highlighting the need for further research to examine how to foster autonomy and care in the emergency department to reduce the risk for vulnerabilities.

Background: Gerontechnologies are increasingly used in the care for older people. Many studies on their acceptability and ethical implications are conducted, but mainly from the perspective of principlism. This narrows our ethical gaze on the implications the use of these technologies have.

Research question: How do participants speak about the impact that gerontechnologies have on the different phases of care, and care as a process? What are the moral implications from an ethic of care perspective?

Research design: Secondary analysis of semi-structure interviews, whose segments on specific technologies were analysed through reflexive thematic analysis.

Participants and research context: Sixty-seven Swiss stakeholders involved in the use of gerontechnologies, including professional caregivers, informal caregivers, and older persons themselves.

Ethical considerations: The research study was evaluated by the Ethics Commission of Northwest and Central Switzerland (EKNZ). All participants received an information document before the interview date detailing the purpose, procedure, and anonymization measures. After explaining the study during the agreed upon interview time and upon receiving their written informed consent, the interview process began.

Findings/results: Four themes are identified: Identifying care needs, Taking responsibility, Hands-on work, Responding to care. As part of these themes, many codes highlighting the ambivalent impact of gerontechnologies are created, ranging from 'Expanded capacity for…identifying care needs' to 'Create new & (un)necessary…hands-on work'. The moral implications of these results from the care ethics perspective are discussed, through the ethical elements of: attentiveness, responsibility, competence, and responsiveness.

Conclusions: The moral implications of gerontechnologies on care phases from the care ethics perspective open up several questions on whether they actually help give care a central role in social life and provide more competent care.

Background: Intensive care nurses frequently encounter ethical issues with potentially severe consequences for nurses, patients, and next of kin. Therefore, ethical issues in intensive care units (ICU) should be recognized and managed.

Research objectives: To analyze ethical issues reported by intensive care nurses and how reported issues were managed within the organization using register data from the HaiPro critical incident reporting system (CIRS), and to explore the suitability of this system for reporting and managing ethical issues.

Research design: This was a retrospective descriptive register study. CIRS reports on ethical issues in adult ICUs (n = 12) in one hospital district in Finland over 25 months (2019-2021) were analyzed through inductive content analysis and descriptive quantification. The CIRS's suitability for reporting and managing ethical issues was evaluated through a strengths, weaknesses, opportunities, and threats (SWOT) analysis.

Ethical considerations: The study was approved by the University Ethics Committee, and permission to conduct the research was granted before data collection within the organization.

Results: CIRS reports on ethical issues (n = 35) made by nurses were found in seven of the 12 ICUs. The CIRS managers of these units managed these reports. The ethical issues described by the nurses were divided into four main categories: nature, situational information, consequences, and contributing factors. Management of reported ethical issues was divided into three main categories: preventive actions proposed by nurses, proposals for actions by CIRS managers, and actions taken by CIRS managers.

Conclusions: Systematic register data broadly describe ethical issues and their management, indicating that the CIRS could be suitable for reporting and managing ethical issues, thereby enabling the monitoring and development of ethical quality at the unit and organizational levels.

Background: Several ethical issues are associated with providing living organ transplantation services, and there is limited information on these issues faced by the teams providing service to refugees or asylum seekers.

Aim: To determine the challenges healthcare professionals face in organ transplant centers providing services to Syrians under temporary protection status and discern whether these difficulties align with ethical issues in living organ transplantation.

Research design: This study employed a qualitative design and conducted individual semi-structured, in-depth interviews with 18 transplant team members in Istanbul between September and November 2022. Data analysis was based on Braun and Clarke's thematic analysis.

Participants and research context: The participants comprised 18 healthcare professionals, including 6 physicians and 12 nurses working in organ transplant teams in Istanbul.

Ethical considerations: The University's Ethics Committee provided approval. Participants were informed regarding confidentiality and signed an informed consent form.

Results: Three themes emerged from the data on ethical issues faced by organ transplantation services to Syrians: (a) beneficence or double equipoise, (b) autonomy, and (c) justice. Transplant teams experience problems related to preserving double equipoise in the provision of living donor organ transplantation because of language barriers, poor socioeconomic conditions, and cultural factors, which increases transplant teams' individual and indirect social burden. Although problems arise from the language barrier when obtaining informed consent in the autonomy theme, institutional and national policies in preventing donor abuse have a comforting effect. Health workers had the least problems with the justice theme, wherein national health policies are determined.

Conclusion: Fewer issues related to autonomy and justice were reported in providing organ transplantation services to Syrians, with the most intense reported issues being maintaining double equipoise. The results revealed the need to develop institutional, national, and international policies with individual solutions to prevent difficulties healthcare professionals face in this process.

Background: Previous research mainly focuses on how to support nursing students in caring for the patient and on educators' views of students' development as professional caring nurses. Against this background, it is important to further investigate nursing students' perspectives on what it means to become a professional caring nurse.

Research aim: This qualitative systematic review study aims to identify and synthesize nursing students' perceptions on the meaning of becoming a caring nurse.

Research design and data sources: Systematic data searches were conducted by using the electronic databases MEDLINE (Ovid), CINAHL (EBSCO), Academic Search Premiere (EBSCO), and Philosopher`s Index. In total, 13 studies met the inclusion and quality criteria. The articles were analyzed by a systematic review and a thematic synthesis according to Thomas and Harden.

Ethical consideration: The study followed good ethical practice guidelines outlined in the Northern Nurses' Federation.

Findings: The analysis resulted in eight descriptive themes and finally in three analytical themes: Becoming is to get in touch with one's inner ethic or ethos, Becoming is a movement between courage, understanding, and being touched, and Becoming is strengthened through caring role models and a learning culture.

Conclusions: Becoming a professional caring nurse is seen as an ongoing movement toward a deeper understanding of oneself and one's being and bearing. This movement is enabled when nursing students have a sense of self-awareness, courage to stand in their vulnerability, and reflect on their responsibility, caring attitude, and inner values and ethics. The force of becoming is that the attention is directed beyond self to care for and feel empathy for others in a caring manner. Becoming is released through a caring relationship, external confirmation, and good role models. A lack of external support in the movement can potentially prevent the students from becoming a professional caring nurse.