Nursing Ethics最新文献

Ethical culture and climate are key factors that shape the quality of nursing care in healthcare settings. Together, these constructs provide a framework for tackling moral dilemmas and supporting nurses as they navigate ethical challenges in patient care. Despite progress in understanding these concepts, systemic issues remain. The increasing number of studies on this topic in recent years highlights the importance of issues related to ethical culture and climate in healthcare settings. The present study employs a bibliometric method to analyze and examine 251 documents published in the Web of Science database, aiming to provide a comprehensive review of the literature and science mapping of the field of ethical culture. It also seeks to identify historical and contemporary research streams and analyze the evolutionary trends in this domain. The results indicate that two historical research streams in the field of ethical culture have evolved into four contemporary streams, with topics such as ethical leadership, professional ethics, and resilience gaining increased significance. We have also identified and introduced the most influential authors, documents, and sources in the field of ethical culture. Finally, the study examines potential future research directions in this domain. Recommendations include strengthening ethical leadership, using reflective practices such as ethics rounds, and encouraging cross-cultural research to address diverse healthcare environments. By addressing moral distress and improving organizational support, healthcare facilities can retain nurses, enhance patient care, and advance ethical nursing practices.

BackgroundStorytelling is a frequent practice within nursing education. Stories are thought to be helpful for student learning, engagement, professional role development, and transmission of ethical values. Despite its common use, little is known about the stories told by nurse educators and the implicit ethical values within those stories.AimsTo describe the reasons nurse educators tell stories to undergraduate students and examine implicit ethical values within these stories.Research designA qualitative descriptive study with Rubin and Rubin's responsive interviewing method. Interview transcripts and written stories were analyzed thematically with constant comparison.Participants and research contextParticipants included 15 nurse educators, primarily from the northeastern United States.Ethical considerationsInstitutional Review Board (IRB) approval for protection of human subjects was received prior to conducting the study. Informed consent was obtained from all participants.FindingsNurse educators use storytelling to help students understand what it means to be a nurse, to improve student learning, because we are all human, and because the art and science of nursing requires storytelling. Ethical values from these stories were organized into the following themes: advocacy, nurse attributes, importance of the nurse-patient relationship, and reflection.ConclusionsFindings suggest that that storytelling in nursing education is used for role development and communicating ethical values. Additional studies are needed to determine the effectiveness of storytelling and how it can be used to improve nursing practice.

BackgroundHealthcare organizations are driven by mission-driven values, yet these values can be compromised in employee-organization relationships. Hospitals present psychologically challenging environments for their nurses, potentially causing breaches of psychological contracts. Despite extensive research on ethical climates, their impact on mitigating interpersonal deviance in healthcare remains understudied. This warrants investigation into how ethical workplace climates and breaches of psychological contracts affect interpersonal deviance in nurses.Research Objective/Purpose/AimThis study investigates how psychological contract breaches mediate the relationship between ethical climates and interpersonal deviance.Research Design/MethodThe study employs a cross-sectional design, collecting data from 230 nurses across five hospitals in India. Standard scales are used to measure the constructs in the study, with established reliability and validity. Structural equation modeling (SEM) was utilized to examine the hypotheses outlined in the study. We also tested the moderating effect of work experience in the moderated mediation model.Ethical considerationsThis study received ethical approval (#ERB-ASBC-2024-027) from the University Ethical Review Board, constituted at Amrita School of Business, Coimbatore.Participants and proceduresPermission to conduct the study was obtained from the hospital administration. Nursing staff participated voluntarily. They were informed about the survey's purpose and their right to withdraw at any time. Consent was obtained on the survey form before recording their responses, and no personal identifiers were collected.FindingsAn ethical workplace climate reduces nurses' interpersonal deviance, mediated by psychological contract breach. This mediation is moderated by work experience, with a stronger effect on less-experienced nurses.ConclusionThe study suggests that regular assessments of ethical workplace climate can aid in planning effective reinforcements at individual, leadership, or organizational level to reduce interpersonal deviance and perceptions of psychological contract breach.

Debates on assisted dying remain controversial and call out for conceptual clarification. What is the moral basis for assessing competing arguments, and what is the best way to frame these arguments in terms of actual and potential human rights? This article aims to investigate whether autonomy alone suffices as a moral source for human rights and whether, on this basis, there should be a positive human right to assisted dying, and a negative human right to assist others in dying. Drawing upon discussions in political theory, medical ethics, and human rights scholarship, the article develops an account of autonomy as multidimensional and subject to trade-offs. Autonomy is divided into the dimensions of liberty, opportunity, capacity, and authenticity. Furthermore, there is a common intuition that human beings ought to be endowed with a domain of core autonomy that must never be compromised in any trade-off. This analytical framework is used to map conflicts and trade-offs concerning assisted dying. By way of conclusion, it is argued that autonomy suffices to describe what human rights protect, but not why they do so. Furthermore, it is argued that the terminology of rights used in debates on assisted dying risks misrepresenting what the debate is actually about, and that the debate should be framed in terms of the right to health and exceptions to the right to life, rather than general rights related to assisted dying. Thus, assisted dying should be seen as an extreme option, where death is not the end, but the means, and ought to be considered alongside other means, as a last resort, already in the legislative process.

BackgroundNurses in long-term care often experience moral distress. While moral distress has been reported to negatively impact nursing competence and patient outcomes, some studies suggest that it may contribute positively to nursing competence. Thus, knowledge regarding the impact of moral distress on nursing competence remains limited and inconsistent.Research aimThis study aimed to identify the mediating effects of moral sensitivity and ethical climate on the relationship between moral distress and nursing competence.Research designThis was a quantitative study with a cross-sectional descriptive correlational design.Participants and research contextA survey was conducted with 175 registered nurses working in long-term care hospitals in Korea. Data were collected in September and October 2023. The survey measured moral distress, moral sensitivity, ethical climate, and nursing competence using the Moral Distress Scale, the Moral Sensitivity Questionnaire, the Hospital Ethical Climate Survey, and an instrument for measuring nursing competence in long-term care hospitals, respectively. The collected data were analyzed using SPSS Statistics version 27.0 and the PROCESS macro program.Ethical considerationThis study was approved by the Institutional Review Board. Informed consent was obtained from participants prior to data collection.FindingsMoral distress did not have a significant direct effect on nursing competence; however, it had a positive impact on nursing competence through the mediation of moral sensitivity and ethical climate. Moral sensitivity and ethical climate demonstrated a dual mediating effect in the relationship between moral distress and nursing competence.ConclusionThe findings of this study provide insights into how moral distress can positively contribute to nursing competence. Ensuring that nurses have high moral sensitivity and that organizations foster a positive ethical climate may help moral distress enhance nursing competence.

Research indicates that conscience is an asset to healthcare professional's personal and professional practice. However, little work has been done to support healthcare professionals to use and understand their conscience for moral decision-making. Disparity exists between international and national bodies that value conscience for healthcare professionals and the paucity of practice supports available to formally assist healthcare professionals to openly discuss and then navigate their moral decisions arising from their conscience. Therefore, the purpose of this systematic review was to examine the effectiveness of existing interventions aimed at supporting healthcare professionals to understand and use their conscience for healthcare practice. This review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Metanalyses. International, interdisciplinary databases including Medline, Embase, PsycINFO, CINAHL, Academic Search Complete, ATLA Religion, Religion and Philosophy Collection, PhilPapers, Scopus and Cochrane Controlled Register of Trials were searched and quantitative as well as qualitative outcomes were reported. We found 11 studies that met the inclusion criteria and underwent data extraction and synthesis. Five interventions were identified that aimed to address aspects of HCP's conscience. No interventions were identified that aim to support healthcare professionals to understand or use their conscience for moral decision-making in practice. Empirical and humanities research indicates that conscience is essential to healthcare practice, but issues of conscience remain a polarizing experience for many HCPs. Intervention and education-based research are therefore needed to support HCP's understanding and use of conscience for practice.

BackgroundThis discussion paper provides a reflection on ethical aspects of participant recruitment experiences during one research (PhD) project in the Republic of Ireland (ROI). Using Gibbs' framework for reflection, this paper examines these experiences. The research (PhD) project that informed this reflection aimed to understand the experiences of family caregivers when caring for family members at the end of their life, through recorded interviews in the home, within the context of palliative care provision. Ethical approval had been granted for the main study; however, this paper does not draw on empirical data from the study.AimThis discussion paper aims to provide a reflection on some challenges faced whenrecruiting family caregivers at end of life during the research (PhD) project.MethodsGibbs' framework for reflection was used to reflect on experiences of recruitment of 10 family caregivers, whose relatives were receiving palliative care, and who were interviewed in their home environments.FindingsOur reflections revealed that the recruitment process was protracted and challenging. When attempting to recruit family caregivers for the study, recruitment extended over a longer period than originally planned. Our reflections suggest that while gatekeeper workload was an influencing factor, a concern arose that they may have applied their own additional and personal ethical measures to determine participant suitability.ConclusionMore education and supportive collaboration with gatekeepers may be required to ensure that they develop a more comprehensive understanding of the gatekeeper role and are assured and informed of the ethical benchmarks that preceded their involvement. Enhanced understanding may highlight the benefits of families taking part in healthcare research.

BackgroundMost patients in need of palliative care remain in their homes, thus great focus should be placed on the creation of functional palliative homecare. Suffering through an often multifaceted illness and contemplating one's death can contribute to the loss of one's sense of dignity, and the preservation of patient dignity is a major challenge for health professionals worldwide.AimThe aim of the study was to explore and describe nurses' experiences of caring qualities alleviating suffering and preserving the dignity of patients in need of palliative homecare.Research designA qualitative exploratory study. In-depth semi-structured interviews as data collection method, and the qualitative content analysis of Graneheim and Lundman for data analysis. The theoretical perspective was based on Eriksson's caritative caring theory.Participants and research contextA total of nine nurses with extensive work experience from a palliative homecare context participated in the study.Ethical considerationsThe study was conducted in accordance with the criteria set forth by the Finnish National Board on Research Integrity TENK. Research permission was granted and participants gave their written informed consent to participate in the study.FindingsOne main theme and three subthemes were found. The main theme was: Being there for the other alleviates suffering while shaping and reshaping dignity preservation in a process. The three subthemes were: (1) Being a sensitive and compassionate witness who becomes responsible, (2) Having compliance, courage, and perception in a deep presence, (3) Being calm and patient while having time for conducting skilled practical knowledge.ConclusionsCertain caring qualities are important in the dignity-preserving care of people in need of palliative homecare, and person-centeredness plays a central role in alleviating suffering. Deep and trusting caring relationships and nurses' ability to customize the care being provided are significant in alleviating patient suffering and preserving dignity.

Background Medical gaslighting refers to the mistreatment that patients experience following interactions with clinicians when their medical complaints and suffering are discounted, doubted, questioned, second-guessed, or denied, resulting in self-doubts of patients and psychological ramifications. This research focuses on the ethical aspects of medical gaslighting among hospitalized patients by nurses.Research QuestionWhat are the nursing care and nursing ethics perspectives concerning medical gaslighting? Research DesignA narrative review.Research MethodInterpretation of two narrative interviews with each participant through the lenses of nursing ethics.Participants14 hospitalized patients, males and females, ages 30-81, from the majority group in the population.ContextLengthy hospitalizations.Ethical considerationsEthical approval was granted; all participants signed an informed consent form for participation and publication.FindingsPatient experiences demonstrate medical gaslighting by nurses, violating relational autonomy and resulting in delayed care.DiscussionMedical gaslighting contradicts ethics of care, the professional values of nursing, and patient-centered care constituting obstacles to respectful patient-nurse relationships and to relational autonomy.ConclusionsMedical gaslighting is a profoundly concerning ethical phenomenon that adversely affects patient well-being and trust in nursing as a significant profession in a just society.

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.