Nursing Ethics最新文献

This paper explores the philosophical concept of epistemic injustice and contends its significance and relevance to mental health nurse education and clinical practice. The term epistemic injustice may be unfamiliar to mental health nurses, yet the effects are readily visible in the dismissing, silencing, and doubting of service users' knowledge, testimony, and interpretation. Existing professional values and clinical standards lack depth and critical exploration pertaining to epistemology and associated ethical concerns. Despite central tenets of person-centred care and valuing the service users' voice, epistemic injustice continues to occur. Epistemic injustice cannot be summed up merely by asking nurses to listen to service users. This represents an oversimplification of epistemology, ignoring the complexities of social influence and knowledge exchanges. Epistemic injustice brings something new and innovative to the nursing curriculum and fits within the principles of heutagogy. It encourages deep reflexivity surrounding the ethical issues of power inequalities and intersectionality. Inclusion in mental health nursing education allows for the social and political powers of psychiatric diagnosis as a form of silencing and stigma to be examined. Practical application is made to mental health nursing education and practice with epistemological values and ethical reflexive prompts. These can be utilised by educators and lecturers for pre-registration mental health nurse education, post-registration, and continued professional development.

Currently, in the United States, there is no legal obligation for medical professionals or civil courts to uphold patients' Advance Directives (ADs) regarding end-of-life care. The applicability and standing of ADs prepared by Alzheimer's patients is a persistent issue in bioethics. Those who argue against giving ADs full status take two main approaches: (1) appealing to beneficence on behalf of the Alzheimer's patient and (2) claiming that there is no longer any personal equivalence between the AD's creator and the subject of the AD. In this paper, I present profound arguments against both approaches. Firstly, I argue that the principle of beneficence cannot apply in the case of Alzheimer's patients, and, secondly, that the moral and legal authority of the AD need not depend on strict equivalence of personal identity. I conclude by arguing that valid ADs protect the dignity and autonomy of Alzheimer's patients and that, therefore, there are moral obligations to uphold ADs which should be reflected in public policy and legislation.

Background: Social justice is recognized by reputable international organizations as a professional nursing value. However, there are serious doubts as to whether it is embodied in Catalan nursing education.

Objectives: To explore what nursing students take away from two teaching activities led by expert patients (one presentation and three expert patient illness narratives) on the topics of social justice, patient rights, and person-centered care.

Research design: Qualitative study using a content analysis approach. The research plan included (1) think-pair-share activities (additional faculty-assisted presentation and three faculty-assisted, semi-structured scripted narratives); (2) paired reflections; (3) focus groups; and (4) content analysis of paired reflections and focus groups.

Participants and research context: Fourth-year nursing degree students at the Autonomous University of Barcelona (UAB), Spain. Convenience sampling was used.

Ethical considerations: The UAB Research Ethics Committee did not deem it necessary to apply any specific measures. We fully explained to patients that they could decide what medical information they would share with the students that was relevant to their learning, and we provided students with guidelines about patient confidentiality, dignity, and respect.

Findings/results: The students engaged in reflection about their education (recognizing that it had been centered on the professional and not the patient) and their relationship with the patient, in which they reproduced low-involvement patient care by modeling behaviors of their nurse educator. Moreover, they valued a person-centered care model with an emphasis on the emotional part but left out decision-making as an individual right of people.

Conclusions: The think-pair-share activities were useful to spark self-reflection among students, who identified aspects to change in their own practice, and reflected about their own education process, both of which promote change.

Moral distress has been identified as an occupational hazard for clinicians caring for vulnerable populations. The aim of this systematic review was (i) to summarize the literature reporting on prevalence of, and factors related to, moral distress among nurses within acute mental health settings, and (ii) to examine the efficacy of interventions designed to address moral distress among nurses within this clinical setting. A comprehensive literature search was conducted in October 2022 utilizing Nursing & Allied Health, Embase, CINAHL, PsychInfo, and PubMed databases to identify eligible studies published in English from January 2000 to October 2022. Ten studies met inclusion criteria. Four quantitative studies assessed moral distress among nurses in acute mental health settings and examined relationships between moral distress and other psychological and work-related variables. Six qualitative studies explored the phenomenon of moral distress as experienced by nurses working in acute mental health settings. The quantitative studies assessed moral distress using the Moral Distress Scale for Psychiatric Nurses (MDS-P) or the Work-Related Moral Stress Questionnaire. These studies identified relationships between moral distress and emotional exhaustion, depersonalization, cynicism, poorer job satisfaction, less sense of coherence, poorer moral climate, and less experience of moral support. Qualitative studies revealed factors associated with moral distress, including lack of action, poor conduct by colleagues, time pressures, professional, policy and legal implications, aggression, and patient safety. No interventions targeting moral distress among nurses in acute mental health settings were identified. Overall, this review identified that moral distress is prevalent among nurses working in acute mental health settings and is associated with poorer outcomes for nurses, patients, and organizations. Research is urgently needed to develop and test evidence-based interventions to address moral distress among mental health nurses and to evaluate individual and system-level intervention effects on nurses, clinical care, and patient outcomes.

Background: Research shows that undocumented migrants have difficulties in accessing healthcare. Act 2013:407 came into force in 2013 and entitled undocumented migrants to healthcare that cannot be deferred. To date, studies about undocumented migrants' access to care in Sweden and the impact of Act 2013:407 are sparse. Hence, the aim of this study was to describe professionals' experiences of access to healthcare for undocumented migrants in Sweden and the impact of Act 2013:407.

Methods: A qualitative design with semi-structured interviews was employed. Nine interviews were carried out in 2015 with nurses at two NGO healthcare centres for undocumented migrants - and an additional seven interviews in 2022 with staff at an NGO healthcare centre for undocumented migrants and personnel at a regional health and medical care administration. Interpretive description was used for the analyses.

Ethical considerations: Permission to carry out the study was obtained from managers at the participating NGOs and the regional health and medical care administration. Participants received verbal and written information about the study, and informed consent was obtained from all participants.

Findings: Six categories emerged from the analysis: Changes since the Act was introduced, General problems with healthcare access, Care for undocumented migrants - politics and social economy, Lack of knowledge, 'Healthcare that cannot be deferred' and Being an undocumented migrant.

Conclusion: Undocumented migrants' social needs are as great as their needs for healthcare. Healthcare staff are burdened with healthcare cost considerations which affect their judgement of care provision and prioritization. Healthcare staff attitudes towards undocumented migrants affect their access to healthcare. Undocumented migrants in need of healthcare are especially vulnerable due to their legal status, being ill and the fear of being reported and deported. To assure undocumented migrants' access to healthcare and maintain healthcare ethics, the only possible solution is to provide healthcare based on needs.

Background: Developing a framework that illustrates causal relationships and an in-depth comprehension of contextual elements is essential for steering the development of ethical interventions to enhance nurses' ethical decision-making.

Research aim: To examine the relationship between cultural competence, professional nursing values, and moral sensitivities of surgical nurses with a mediation analysis and structural equation model.

Research design: This study is descriptive and correlational.

Participants: and research context: This study was conducted with a total of 201 surgical nurses from two university hospitals in Konya, Türkiye. Data were gathered face-to-face between June and October 2023 with the Moral Sensitivity Questionnaire (MSQ), Nurses Professional Values Scale-Revised (NPVS-R), and Nurse Cultural Competence Scale (NCCS).

Ethical considerations: Ethical approval from Necmettin Erbakan University Ethics Committee was obtained (Number: 2023/419).

Results: In this study, the mean scores for the surgical nurses were as follows: 89.3 ± 19.33 on the MSQ, 113.1 ± 20.74 on the NPVS-R, and 72.06 ± 18.61 on the NCCS. Nurses' cultural competence level significantly affected their professional nursing values (β = 0.192; p = .007; R² = 0.04), and their professional nursing values, in turn, had a significant effect on their moral sensitivities (β = -0.363; p < .001; R² = 0.16). However, it was determined that the direct effect of nurses' cultural competence level on their moral sensitivity was not statistically significant. In contrast, the indirect effect of nurses' cultural competence level on their moral sensitivity, mediated by their professional nursing values was seen to be statistically significant (B = -0.070; p = .008).

Conclusions: This study showed that there is a significant positive relationship between the professional nursing values and cultural competence levels of surgical nurses and that as professional nursing values increase, their moral sensitivity also rises. Sensitivity with higher professional nursing values. Additionally, it was found that nurses' professional values served as a mediating factor between their levels of cultural competence and moral sensitivity. Therefore, it is crucial to enhance the cultural competence, professional nursing values, and moral sensitivity of nursing students and registered surgical nurses and to improve their reasoning and decision-making skills in ethical dilemmas.

Texts from various areas of the world highlight the importance of moral values like compassion and integrity in healthcare. Such values are held in high esteem by healthcare organisations and are actively 'taught' within nursing ethics education to ensure their presence within the future workforce. With such an emphasis, it is easy to overlook that moral values are not the only values that people, including nurses, hold. Other personal values - which may or may not conflict with moral values - are simultaneously present within individuals. Therefore, moral behaviour cannot be predicted solely by the presence/absence of certain moral values. Instead, it depends on how these integrate into an individual's broader values system.Using Schwartz's axiological Theory of Basic Human Values as a framework, I argue that moral values are but one part of an individual's greater personal values spectrum, which also includes, for instance, hedonism, achievement, and power. Within this spectrum, values are ordered hierarchically, influencing behaviour based on relative priority. When a conflict arises between moral and other personal values, the prioritisation of moral values is a requirement for moral behaviour.I discuss how socialisation in suboptimal clinical practice environments can cause moral values to be deprioritised and argue that the development of practical reasoning skills is paramount to learning to balance one's values and guide decision-making. I advocate for the integration of (meta-)axiological reflection - characterised by introspection and aimed at developing a deeper understanding of one's personal values spectrum - within nursing ethics education. This involves exploring the origin, meaning, and perceived relative importance of one's different personal values. By incorporating specific reflective exercises, students can increase self-awareness/insight and enhance their ability to recognise situations where conflicts between their moral values and other personal values may occur, which is likely to benefit moral decision-making in clinical practice.

Background: People living with advanced dementia risk being seen as someone without personhood in contemporary societies, an understanding that has been described and challenged for decades in dementia scholarly literature. Such perception can be characterised as forms of existential dehumanisation, which still asserts itself in dementia care practices, adversely affecting the ethical and caring aspects of such care.Aim: To challenge dehumanisation in dementia care, we must first learn to recognise what foster it in caring relations. Thus, the aim of our study is to identify existing perceptions of care recipients living with advanced dementia, which elicit dehumanising attitudes among formal caregivers.Research design: We conducted an integrative review based on Whittemore and Knafl's updated methodology. This allowed us to identify and analyse 26 articles incorporating both qualitative- and quantitative studies as well as theoretical- and grey literature all describing perceptions of care recipients living with dementia that lead to dehumanisation.Ethical considerations: Studying the darker sides in caring relations was to be beneficial in improving dementia care practices.Findings: Through an analytical process five themes that can sprout dehumanising attitudes in caring relations were identified, which include perceiving people living with advanced dementia as (1) absurd, (2) shadow, (3) perilous, (4) void, or (5) repugnant. We argue that these perceptions can be seen as unintentional and stem from a misled embodied perception, which caregivers should learn to recognise and consequently be able to resist through virtue ethics.Conclusion: Our study indicates that challenging dehumanisation is a practical matter of identifying and reacting in a timely way to ones misled embodied perceptions. We suggest the five themes offer a potential means to warn formal caregivers of impending dehumanising attitudes and help them to review how they ethically are thinking and perceiving the person living with advanced dementia.

Background: The quality of care in maternity facilities significantly influences women's autonomy and their right to make decisions about their bodies. Obstetric violence, a form of gender-based violence during childbirth, poses serious threats to women's rights and health worldwide. Aim: The research aimed to examine women's experiences and perceptions of obstetric violence using the micro-level constructivist grounded theory strategies of Mena-Tudela et al. (2023). Research design and methods: This study used a phenomenological qualitative research design. Data were collected from 17 eligible women using a Participant Information Form and a Semi-Structured Interview Form, applying maximum variation sampling to ensure a wide range of sociodemographic characteristics and diverse views and experiences. The data were analyzed using the seven-step phenomenological analysis method. Participants and research context: A total of 17 women who had vaginal labor at least 6 months ago were interviewed. Ethical considerations: The study was approved by the University Ethics Board for Non-Interventional Clinical Studies. Ethical considerations were closely aligned with the principles of respecting women's rights, ensuring that participants' autonomy and consent were central throughout the research process. Results: Five themes and 13 subthemes were extracted from the data analysis, including "Ignoring women in care," "The commodification of women," "Are the healthcare professionals the only authority?", "Ineffective childbirth management and its effects on women's health-seeking behavior," and "Types of obstetric violence." Conclusions: This study underscores the urgent need to address obstetric violence, recognizing its detrimental impact on women's rights, and well-being during childbirth. Protecting women's rights by prioritizing individual-centered care, informed consent, and respectful treatment is essential to uphold ethical standards and ensure dignified childbirth experiences for all women.

Background: Health advocacy is crucial for both patients and healthcare professionals. However, nurses who recognize the importance of health advocacy may experience heightened moral distress, particularly in complex donation and transplantation cases where patient autonomy, respect, and advocacy are paramount.

Aim: To identify the factors contributing to moral distress among nurses working in solid organ transplant units at a university hospital in São Paulo, with a focus on health advocacy.

Research design: This descriptive, cross-sectional study employs both quantitative and qualitative methods. For this, the quantitative phase of the study was conducted utilizing the Moral Distress Scale, while the qualitative phase was executed through focus group discussions.

Participants and research context: The quantitative phase involved 15 nurses using the Moral Distress Scale. The qualitative phase consisted of a focus group with 5 nurse managers/coordinators from the transplant units. Quantitative data were analyzed using R® software, while qualitative data were analyzed using Bardin's Content Analysis.

Ethical considerations: The study was approved by the Research Ethics Committee of the Ribeirão Preto College of Nursing, University of São Paulo. Participation was voluntary and confidentiality was ensured.

Results: A significant correlation was found between moral distress and the factors of "disregard for patient autonomy" (p = .0100) and "therapeutic obstinacy" (p = .0492).

Conclusion: The primary determinants associated with moral distress in the context of health advocacy were identified as "disregard for patient autonomy" and "therapeutic obstinacy."