Nursing Ethics最新文献

BackgroundEthical decision-making ability is critical for senior nursing interns in addressing complex clinical dilemmas. However, the mediating role of hospital ethical climate in the relationship between moral sensitivity and ethical decision-making remains unexamined. This gap limits evidence-based strategies for enhancing interns' ethical decision-making and the delivery of high-quality care.Research AimsTo examine the mediating role of hospital ethical climate in the relationship between moral sensitivity and ethical decision-making among senior nursing interns, and to determine the relationship among these three variables.Research DesignThe study is a cross-sectional correlational design.Participants and Research ContextBetween August 2023 and January 2024, 1096 senior nursing interns from 44 universities across seven Chinese regions participated. The general information questionnaire, Judgement About Nursing Decision scale, Chinese Moral Sensitivity Questionnaire-Revised Version, and Hospital Ethical Climate Survey were distributed online. SPSS 27.0 was used for descriptive statistics and Pearson correlation analysis, while PROCESS macro handled mediation analysis.Ethical ConsiderationsThis study was approved by the Ethical Review Board of Xiangya School of Nursing, Central South University (No. E2023125).FindingsA total of 935 valid questionnaires were collected, with a response rate of 85.3%. Participants demonstrated moderate levels in ethical decision-making ability (276.41 ± 18.51), moral sensitivity (42.01 ± 7.61), and perceived hospital ethical climate (102.17 ± 14.63). There were significant positive correlations between each pair of these three variables (r = 0.248-0.474, p < 0.05). Moral sensitivity was associated with hospital ethical climate and ethical decision-making; hospital ethical climate mediated the relationship between moral sensitivity and ethical decision-making (β = 0.252-0.580, p < 0.05).DiscussionsComparing our findings with international research, this study highlights the influence of hospital ethical climate and moral sensitivity on ethical decision-making, emphasizing the mediating role of ethical climate and its implications.ConclusionsHospital ethical climate played a mediating role between moral sensitivity and ethical decision-making among senior nursing interns. Interventions targeting both are recommended to enhance ethical decision-making ability. Future research should explore specific measures for this population.

Nurses encountered a myriad of ethical challenges during the height of the COVID-19 pandemic, such as allocation of scarce resources, the need to balance duty of care with safety of self as well as visitation restrictions. The impact of these challenges on the nursing workforce requires investigation. The aim of this review was to scope and describe the reported literature on ethical challenges faced by nurses during the COVID-19 pandemic, including contextual characteristics and strategies reported to address these challenges. The review was conducted in accordance with JBI methods for scoping reviews and reported using PRISMA-ScR guidance. A published protocol guided conduct of the review. The following databases were searched for eligible studies from November 2019 to January 2023: PubMed, CINAHL, Ovid, PsycINFO, the Cochrane Library, and Scopus. No language restrictions were applied. Studies were reviewed for inclusion by two independent reviewers, and a data extraction form was developed to extract data relevant to the review questions. Results were analyzed and presented according to the concepts of interest, using tables, figures, and supporting narrative synthesis. After searching the databases, 2150 citations were retrieved with 47 studies included in the review. Studies represented 23 countries across five continents. Most of the studies used qualitative designs. Ethical challenges were described in several ways, often without appealing to common ethics language or terms. Few studies reported on strategies to address the specific challenges, which may reflect the dynamic nature of the pandemic. The scoping review highlights the complex and, at times, overwhelming impact of ethical challenges faced by nurses across the globe during the COVID-19 pandemic. Findings from the review can be used as a basis for further research to explore, develop, and implement strategies to address ethical challenges faced by nurses during future public health crises.

BackgroundEthically challenging situations often arise in interactions between healthcare professionals (HCPs) and families. Although the Calgary models offer guidance for practical work and are beneficial in various challenging situations, explicit awareness and recognition of the ethical concepts and theories underlying Family Systems Care (FSC) is generally lacking.Method - Research aimThis study examined the basis of FSC in virtue ethics, deontology, and teleology.Research designUtilizing a qualitative design, an expert consensus was conducted through two focus group interviews, a Delphi group, and an expert panel.Participants and research contextThe expert consensus consisted of 23 professionals in FSC from various specialities, including nurses (n = 18), midwives (n = 4), and a general practitioner, who explored ethical considerations in clinical practice.Ethical considerationsThe research project was conducted in accordance with the ethical principles of participants' informed consent and the Declaration of Helsinki.FindingsParticipants recognized the significance of classical virtues such as faith, fortitude, hope, and caritas in FSC. They emphasized that these virtues not only guide HCPs in their practice but also empower families to rediscover their strengths amid suffering. Additionally, the integration of deontological principles and teleological perspectives highlighted the importance of balancing individual and collective well-being, and fostering compassionate relationships while navigating ethical complexities in therapeutic conversations.ConclusionThis study highlights the importance of virtue ethics, deontology, and teleology in guiding HCPs' moral reasoning within FSC. Participants emphasized respect and appreciation as essential values for maintaining trust with families during ethical challenges. By integrating ethical theories into practice, HCPs can navigate complex situations effectively, fostering compassionate and dignified care.

BackgroundMoral distress is a pervasive challenge in nursing practice, adversely impacting nurses' well-being, career development, patient safety, and organizational performance. Ethical climate, as a modifiable organizational factor, plays a pivotal role in mitigating moral distress. Understanding the association between nurses' moral distress and ethical climate is critical for clinical practice, management, and policymaking.AimThe aim was to systematically assess the association between nurses' moral distress and ethical climate.MethodsA systematic review and meta-analysis was conducted based on a comprehensive search of ten databases (PubMed, Cochrane Library, Embase, Web of Science, CINAHL, PsycINFO, Scopus, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG) from inception to December 27, 2024. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Correlation coefficients were synthesized using random or fixed-effects models. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity.Ethical considerationsEthical approval was not required as the review synthesized publicly available data.ResultsThirty-one studies involving 7635 nurses were included. Meta-analysis identified a moderate negative association between overall moral distress and ethical climate (r = -0.49, 95% CI: -0.59 to -0.38), and between moral distress frequency and ethical climate (r = -0.37, 95% CI: -0.45 to -0.28). Moderator analyses indicated that participant characteristics (gender composition, age, and work experience), study characteristics (sampling methods and ethical climate measurement tools), and working settings contributed to heterogeneity.ConclusionThis systematic review and meta-analysis demonstrated a moderate negative association between nurses' moral distress and ethical climate. Variations in participant demographics, study methodologies, and working settings partially accounted for the observed heterogeneity. Future research should employ larger, more diverse samples and longitudinal designs. Strengthening the ethical climate is essential for alleviating nurses' moral distress and enhancing organizational effectiveness.

BackgroundMoralization, or the application of moral value onto individuals' actions or identities, has broad impact in the context of health and healthcare. In particular, moralization may result in interpersonal and institutional consequences for certain groups of individuals such as people who use substances during pregnancy or while feeding human milk. Reflexive moralization is an underexplored phenomenon that represents the reflex-like nature of some instances of moralization. Objectives: The purpose of this study was to explore and explain how reflexive moralization impacts the perinatal care of substance-exposed dyads.Research DesignIn this targeted sub-analysis, dimensional analysis was used in the mode of emergent fit to analyze qualitative interviews conducted for a parent study investigating the circumstances under which clinicians bring moral considerations into the care of substance-exposed dyads.Participants and Research ContextInterviews with fifteen perinatal health clinician providing health or social care to substance-exposed dyads were included in this analysis.Ethical ConsiderationsThe X IRB determined this study exempt. All participants provided informed consent prior to enrolling in the study.ResultsFindings revealed novel dimensions of reflexive moralization, including the process of sympathization, which occurs when clinicians demoralize and transform their reflexive moralization into a tool for care. In order for the transformative process of sympathization to occur, clinician moral well-being must be assessed as sufficient, meaning clinicians must feel they have the capacity and competence to provide adequate care to patients. Discussion: Future research should further investigate the nature of clinician moral well-being in order to measure and develop interventions to support it.ConclusionsClinician moral well-being plays a pivotal role in clinical care delivery for substance-exposed dyads, in the context of reflexive moralization.

BackgroundAustralia faces a critical shortage of nurses, yet international nursing graduates (INGs) encounter significant barriers to securing employment after graduation. Current policies often prioritize domestic graduates, creating systemic disadvantages for INGs, particularly those on temporary visas. This inequity raises ethical concerns and undermines Australia's ability to fully utilize its nursing workforce, potentially compromising the quality of healthcare services.AimThis study explores the lived experiences of INGs regarding employment challenges in Australia, critically examining the ethical and equity implications of existing practices.Research Design A qualitative study employing a combined phenomenological and exploratory approach was conducted. Data were analyzed using a thematic analysis framework.Participants and Research ContextTwelve international nursing students in their final semester of the Bachelor of Nursing program at two metropolitan universities in Australia participated in semi-structured interviews.Ethical ConsiderationsEthical approval was obtained from the Monash University Human Research Ethics Committee (MUHREC-44400) and the University of Technology Sydney (ETH24-10028). Informed consent was obtained from all participants, who were assured of their right to confidentiality and to withdraw from the study at any time.ResultsFive overarching themes emerged: (1) Economic Disparity and Ethical Considerations, (2) Systemic Discrimination and Inequality, (3) Mental Health and Well-being, (4) Policy and Regulatory Barriers, and (5) Lack of Cultural Inclusion and a Sense of (Un)Belongingness.ConclusionsThe findings highlight urgent ethical concerns and equity challenges that demand comprehensive reforms to create a more inclusive and ethically sound environment for INGs in Australia. These reforms necessitate policy changes to address discriminatory practices and visa restrictions, enhanced institutional support to facilitate INGs' transition into the workforce, and a commitment to cultural competence and inclusion at all levels of the healthcare system. Addressing these systemic barriers is not only a matter of fairness and justice but is also crucial for ensuring a robust and ethically sustainable healthcare workforce in Australia.

BackgroundSpain's Euthanasia Law came into force in 2021. Nurses are involved throughout the entire process and yet the law only recognizes their role in the final administration of the drug.ObjectiveTo understand the practice and experience of nurses involved in the euthanasia process.Research designQualitative study with a phenomenological approach. An interpretative phenomenological analysis was conducted using ATLAS-ti.Participants and research contextThis study is part of a larger project for which the study population comprised professionals who have participated in the euthanasia process in Catalonia since the law came into force. This study is based on data collected from nurses through 6 in-depth interviews and 3 focus groups.Ethical considerationsThis study was approved by the Ethics Committee (22/094-P). All participants granted their informed consent. Interviews and focus groups were anonymized.FindingsThe results revolve around two themes: (1) Plasticity of nursing care in the face of regulatory gaps and (2) managing emotions while providing assisted dying. Nurses respond to patients and families by adapting to the demands of the process and self-managing any emotions that arise from participating in this practice. Nurses use rationalization to manage the range of emotions they experience resulting from the tension between respecting a person's autonomous decision to request euthanasia and upholding their professional duty to prevent harm. The team stands out as a crucial element in managing these emotions.ConclusionsSpanish nurses are involved throughout the entire euthanasia process, demonstrating great plasticity of care. Euthanasia care is complex and the relational context between professionals and the patient/family and between team members is key. The law should define and envisage the role of nurses, as it does for other professions.

BackgroundPatients with intellectual developmental disabilities (IDDs), as members of a vulnerable population, require specialized care that many ICU nurses feel inadequately prepared to provide. The complexity of caring for IDD patients often leads to feelings of moral distress, self-doubt, and a struggle to maintain resilience among ICU nurses.Research question/aim/objectivesThis study aims to explore ICU nurses' lived experiences caring for patients with IDD.Research designA descriptive, phenomenological qualitative approach was used along with inductive analysis to explore the meanings ICU nurses attribute to experiences caring for IDD patients.Participants and research contextICU nurses (N = 20) who met inclusion criteria were purposively sampled.Ethical considerationsThe study received ethical approval from an institutional review board. Informed consent was obtained from all participants.Findings/resultsThree main themes emerged from the analysis. First, in main theme 1, If Only I Had Known More, nurses reported insufficient training specific to IDD care, expressing shame about their knowledge gaps. Second, in main theme 2, They Deserve Better, nurses highlighted the lack of resources and institutional support, complicating efforts to deliver appropriate care. Finally, in main theme 3, It Weighs on My Soul, nurses reflected on the emotional toll of caring for IDD patients, discussing subthemes such as self-doubt, emotional detachment, coping efforts, witnessing isolation, and moral distress.DiscussionThese findings highlight personal, educational, and systemic gaps shaping ICU nurses' experiences with IDD patients. Limited training and insufficient resources intensified moral distress. There is an urgent need for IDD-oriented education, institutional support, and policies that promote compassionate, tailored care.ConclusionsFindings suggest there is a strong alignment with the ethics of care framework. Such a connection emphasizes the need for systemic changes to empower ICU nurses to deliver compassionate, individualized care to IDD patients and enhance professional resilience and patient outcomes.

Background: Ambulance staff face ethical demands to safeguard patient dignity and autonomy in situations where these values may be threatened. However, influences on how patients are understood can undermine this safeguarding, potentially impacting health outcomes. To address this, increased knowledge of these influences is needed as well as how they may form the ability to protect ethical values.Aim: The aim was to explore ambulance staff's view of what influences their understandings of encounters with persons living in stigmatized neighborhoods.Research Design: Transcripts from semi-structured interviews with ambulance staff were analyzed with content analysis.Participant and Research Context: Twenty-seven ambulance staff members were included from two different Swedish ambulance districts.Ethical Considerations: The study was conducted based on the Declaration of Helsinki and approved by the Swedish Ethical Review Authority.Findings: Six categories emerged; Individual values; Colleagues; Associated organizations; Societal information; Professional experiences; and Management.Conclusion: Ambulance staff's understandings are influenced in a multifaceted way that can produce processes of othering toward persons tied to specific neighborhoods, ethnicities, or cultures. This process endangers the safeguarding of dignity and autonomy due to understandings of the patient as of less value. However, critical reflection and exposure to diverse perspectives can counteract this and protect these ethical values.

BackgroundAddressing drug use among pregnant and postpartum women is complicated by the social, ethical, and legal interplay between maternal and child needs. The moral experiences of providers as they care for this population are poorly understood. The purpose of this review is to synthesize the qualitative literature on the moral experiences of prescribing maternity providers managing the care of pregnant and postpartum women who use drugs (PPWUD), specifically focused on drug testing and child welfare reporting decisions.MethodsThe Hunt and Carnevale (2011) bioethics framework was used to define moral experience as "a person's sense that values that he or she deem important are being realized or thwarted in everyday life." A systematic search of PubMed, PsycINFO, and CINAHL resulted in 31 eligible articles. Study quality was assessed using the Critical Appraisal Checklist for Qualitative Research from the Joanna Briggs Institute (2015). Thematic narrative analysis was used to synthesize results and identify themes.FindingsOverall, maternity providers' experiences were characterized by ethical conflicts influenced by provider-level and policy-level factors. Even when endorsing patient autonomy and parental rights, no maternity providers endorsed continued maternal substance use that placed the fetus or child at significant risk. Structural constraints within healthcare systems and punitive laws were cited as significant barriers to providing optimal care to PPWUD. Biased drug testing protocols and some child welfare reporting policies created ethical conflict by placing maternity providers' relationship with their patients in opposition to their legal and ethical responsibility to report child maltreatment.ImplicationsMore rigorous characterization of these moral experiences is needed to support the development of provider-level interventions and policy-level changes as maternity providers care for both mothers and children impacted by drug use.