Nursing Ethics current issue

Editorial

Gallagher, A. — Wed, 04 Nov 2009 08:57:45 PST

Editorial Comment

Arries, E. J — Wed, 04 Nov 2009 08:57:45 PST

Patients' Transcultural Needs and Carers' Ethical Responses

Dogan, H., Tschudin, V., Hot, I., Ozkan, I. — Wed, 04 Nov 2009 08:57:45 PST

Many Turkish people migrated to Germany between 1955 and 1975. This study was carried out in Göttingen, Germany. Fifty Turkish people (described as patients) were asked about the care they had received from German health care personnel, and 50 German nurses and 50 German physiotherapists were questioned about care they had given to Turkish patients. Significant findings were the needs of the Turkish patients for good communication, physical contact and understanding of their culture-based expressions of illness. The German nurses and physiotherapists expressed the need for language barriers to be minimized and for education in the specific culture of Turkish patients. Our findings are discussed from an ethical viewpoint. The International Council of Nurses’ code of ethics is used to guide the ethical debate about the findings within the context of transcultural and multicultural care. Suggestions for better transcultural health care paradigms are made for relating to patients from different cultures when patients and care providers have little understanding of each other’s needs and expectations.

Ethical Considerations of Teaching Spirituality in the Academy

Becker, A. L — Wed, 04 Nov 2009 08:57:45 PST

Despite evidence in college students indicating a hunger for spiritual insight and spirituality’s application in health care, there continues to be guardedness within the academy towards inclusion of curricula that address spirituality. The purpose of this article is to examine the ethical considerations of teaching spirituality in the academy by describing current trends, issues relevant to nursing education and practice, legitimate concerns of the academy, and the importance of an ethical instructional response when teaching about spirituality. Data supporting the interest and desire by students to explore meaning and purpose in the context of spirituality will be presented. Challenges and barriers inherent in teaching this topic will be described, including the affective response, the lack of a universally accepted definition of spirituality, and spirituality’s relationship to religion. Pedagogical strategies consistent with an ethical instructional response will be discussed as the key to eliciting trust within the academy. A model of teaching spirituality and health will be offered to illustrate these possibilities.

Nursing Ethics in the Seventh-Day Adventist Religious Tradition

Johnston Taylor, E., Carr, M. F — Wed, 04 Nov 2009 08:57:45 PST

Nurses’ religious beliefs influence their motivations and perspectives, including their practice of ethics in nursing care. When the impact of these beliefs is not recognized, great potential for unethical nursing care exists. Thus, this article examines how the theology of one religious tradition, Seventh-day Adventism (SDA), could affect nurses. An overview of SDA history and beliefs is presented, which explains why ‘medical missionary’ work is central to SDAs. Theological foundations that would permeate an SDA nurse’s view of the nursing metaparadigm concepts of person, health, environment (i.e. community), and nursing (i.e. service) are presented. The ethical principles guiding SDA nurses (i.e. principled, case-based, and care ethics) and the implications of these theological foundations for nurses are noted in a case study.

Culture and Organizational Climate: Nurses' Insights Into Their Relationship With Physicians

Wed, 04 Nov 2009 08:57:45 PST

Within any organization (e.g. a hospital or clinic) the perception of the way things operate may vary dramatically as a function of one’s location in the organizational hierarchy as well as one’s professional discipline. Interorganizational variability depends on organizational coherence, safety, and stability. In this four-nation (Canada, Ireland, Australia, and Korea) qualitative study of 42 nurses, we explored their perception of how ethical decisions are made, the nurses’ hospital role, and the extent to which their voices were heard. These nurses suggested that their voices were silenced (often voluntarily) or were not expressed in terms of ethical decision making. Finally, they perceived that their approach to ethical decision making differed from physicians.

Moral Distress: Inability to Act or Discomfort with Moral Subjectivity?

Repenshek, M. — Wed, 04 Nov 2009 08:57:45 PST

Amidst the wealth of literature on the topic of moral distress in nursing, a single citation is ubiquitous, Andrew Jameton’s 1984 book Nursing practice. The definition Jameton formulated reads ‘... moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. Unfortunately, it appears that, despite the frequent use of Jameton’s definition of moral distress, the definition itself remains uncritically examined. It seems as if the context of how moral distress arises (i.e. anger, frustration etc.) has been co-opted as its definition. This current work suggests that the current definition is not moral distress as defined by Jameton, but rather, in large part, nursing’s discomfort with moral subjectivity in end-of-life decision making. A critical examination of how the Catholic tradition’s normative ethical framework accounts for moral subjectivity in end-of-life decision making serves to aid nursing’s discomfort and as a starting point to recontextualize moral distress.

Working with Children in End-of-Life Decision Making

Whitty-Rogers, J., Alex, M., MacDonald, C., Pierrynowski Gallant, D., Austin, W. — Wed, 04 Nov 2009 08:57:46 PST

Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.

Ethical Values in Personal Assistance: Narratives of People with Disabilities

Wadensten, B., Ahlstrom, G. — Wed, 04 Nov 2009 08:57:46 PST

The aim of this study was to investigate the experiences of persons with severe functional disabilities who receive personal assistance in their homes, the focus being on their daily life in relation to the ethical principles represented in the Swedish Disability Act: autonomy, integrity, influence and participation. Qualitative interviews were performed with 26 persons and thereafter subjected to qualitative latent content analysis. The experiences of personal assistance were very much in accordance with the said principles, the most important factor being that one is met with understanding. The participants described situations in which their integrity was violated in that they were not treated as competent adults. This indicates the importance of future efforts in nursing to support personal assistants with ethical knowledge and supervision so that they can empower people with disabilities and thereby enable them to maintain their self-esteem and dignity.

Generosity and the Moral Imagination in the Practice of Teamwork

Arber, A., Gallagher, A. — Wed, 04 Nov 2009 08:57:46 PST

In this article we discuss generosity, a virtue that has received little attention in relation to nursing practice. We make a distinction between material generosity and generosity of spirit. The moral imagination is central to our analysis of generosity of spirit. We discuss data taken from a team meeting and identify the components of generosity, for example, the role of the moral imagination in interrupting value judgements, protecting the identity of the chronically ill patient through use of the psychosocial format, and displaying empathetic maturity. The talk of the team enables us to understand and make visible the link between generosity, moral imagination and identity construction. The topic of generosity, although contextualized in a UK setting, has relevance to other cultural contexts.

Technologically-Mediated Nursing Care: the Impact on Moral Agency

O'Keefe-McCarthy, S. — Wed, 04 Nov 2009 08:57:46 PST

Technology is pervasive and overwhelming in the intensive care setting. It has the power to inform and direct the nursing care of critically ill patients. Technology changes the moral and social dynamics within nurse—patient encounters. Nurses use technology as the main reference point to interpret and evaluate clinical patient outcomes. This shapes nurses’ understanding and the kind of care provided. Technology inserts itself between patients and nurses, thus distancing nurses from patients. This situates nurses into positions of power, granting them epistemic authority, which constrains them as moral agents. Technology serves to categorize and marginalize patients’ illness experience. In this article, moral agency is examined within the technologically-mediated context of the intensive care unit. Uncritical use of technology has a negative impact on patient care and nurses’ view of patients, thus limiting moral agency. Through examination of technology as it frames cardiac patients, it is demonstrated how technology changes the way nurses understand and conceptualize moral agency. This article offers a new perspective on the ethical discussion of technology and its impact on nurses’ moral agency. Employing reflective analysis using the technique of embodied reflection may help to ensure that patients remain at the centre of nurses’ moral practice. Embodied reflection invites nurses critically to examine how technology has reshaped conceptualization, understanding, and the underlying motivation governing nurses’ moral agency.

Applying a Sociolinguistic Model to the Analysis of Informed Consent Documents

Granero-Molina, J., Fernandez-Sola, C., Aguilera-Manrique, G. — Wed, 04 Nov 2009 08:57:46 PST

Information on the risks and benefits related to surgical procedures is essential for patients in order to obtain their informed consent. Some disciplines, such as sociolinguistics, offer insights that are helpful for patient—professional communication in both written and oral consent. Communication difficulties become more acute when patients make decisions through an informed consent document because they may sign this with a lack of understanding and information, and consequently feel deprived of their freedom to make their choice about different treatments or surgery. This article discusses findings from documentary analysis using the sociolinguistic SPEAKING model, which was applied to the general and specific informed consent documents required for laparoscopic surgery of the bile duct at Torrecárdenas Hospital, Almería, Spain. The objective of this procedure was to identify flaws when information was provided, together with its readability, its voluntary basis, and patients’ consent. The results suggest potential linguistic communication difficulties, different languages being used, cultural clashes, asymmetry of communication between professionals and patients, assignment of rights on the part of patients, and overprotection of professionals and institutions.

Ethical Considerations in Cross-Linguistic Nursing

Carnevale, F. A, Vissandjee, B., Nyland, A., Vinet-Bonin, A. — Wed, 04 Nov 2009 08:57:46 PST

This article reviews empirical evidence and ethical norms in cross-linguistic nursing. Empirical evidence highlights that linguistic barriers between nurses and patients can perpetuate discrimination and compromise nursing care. There are significant organizational and relational challenges involved in ensuring adequate use of interpreters by nurses. Some evidence suggests that linguistic barriers are particularly problematic for nurses when compared with physicians. A comparative analysis of nursing ethical norms for cross-linguistic nursing was conducted using the codes of ethics of the American Nurses Association, the Canadian Nurses Association, and the International Council of Nurses. Five principal ethical norms for cross-linguistic nursing were identified: (1) respect for the patient as a unique person; (2) respect for the patient’s right to self-determination; (3) respect for patient privacy and confidentiality; (4) responsibility for one’s own competence, judgment, and action; and (5) responsibility to promote action better to meet the needs of patients, families, and groups.

International Council of Nurses 24th Quadrennial Conference, Durban, South Africa, 27 June -- 4 July, 2009

Gallagher, A. — Wed, 04 Nov 2009 08:57:46 PST

News

Wed, 04 Nov 2009 08:57:46 PST

Book Review: Foster C 2009: Choosing life, choosing death: the tyranny of autonomy in medical ethics and law. Oxford: Hart. 216 pp. GBP22.50; USD45.00 (PB). ISBN: 978 1 84113 929 6

Mitchell, V. — Wed, 04 Nov 2009 08:57:45 PST

Book Review: Miles SH 2009: Oath betrayed: America's torture doctors, second edition. Berkeley, CA: University of California Press. 274 pp. GBP9.95 (PB). ISBN: 978 0 520 25968 3

Mohr, W. K — Wed, 04 Nov 2009 08:57:45 PST

Book Review: Kenney C 2008: The best practice: how the new quality movement is transforming medicine. New York: Public Affairs. 313 pp. USD26.95 (HB). ISBN: 978 1586486 198

Tangredi, C. — Wed, 04 Nov 2009 08:57:45 PST

Book Review: MacDonald TH 2009: Removing the barriers to global health equity. Oxford: Radcliffe Publishing. 319 pp. GBP29.95; USD49.95 (PB). ISBN: 978 1 84619 308 8

Tschudin, V. — Wed, 04 Nov 2009 08:57:45 PST

Book Review: Krueger G 2008: Hope and suffering: children, cancer, and the paradox of experimental medicine. Baltimore, MD: Johns Hopkins University Press. 216 pp. USD35.00 (HB). ISBN: 9780 8018 8831 1

Santacroce, S. J. — Wed, 04 Nov 2009 08:57:45 PST

Book Review: Buka P 2008: Patients' rights, law and ethics for nurses: a practical guide. London: Hodder Arnold. 175 pp. GBP10.99 (PB). ISBN: 978 0340 93881 2

Sparacio, C. — Wed, 04 Nov 2009 08:57:45 PST

Calendar of Events

Wed, 04 Nov 2009 08:57:46 PST

Reviewers of articles received and published in 2008--09

Wed, 04 Nov 2009 08:57:46 PST