http://nej.sagepub.com Nursing Ethics RSS feed -- recent issues Nursing Ethics 0969-7330 http://nej.sagepub.com:80/icons/banner/title.gif http://nej.sagepub.com http://nej.sagepub.com/cgi/reprint/16/6/679?rss=1 Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/0969733009343981 6 16 680 2009-11-01 679 Articles http://nej.sagepub.com/cgi/reprint/16/6/681?rss=1 Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/0969733009343138 6 16 682 2009-11-01 681 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/683?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/0969733009341396 6 16 696 2009-11-01 683 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/697?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/0969733009342639 6 16 706 2009-11-01 697 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/707?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/0969733009343135 6 16 718 2009-11-01 707 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/719?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/0969733009342636 6 16 733 2009-11-01 719 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/734?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/0969733009342138 6 16 742 2009-11-01 734 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/743?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:46 PST info:doi/10.1177/0969733009341910 6 16 758 2009-11-01 743 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/759?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:46 PST info:doi/10.1177/0969733009341913 6 16 774 2009-11-01 759 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/775?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:46 PST info:doi/10.1177/0969733009343134 6 16 785 2009-11-01 775 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/786?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:46 PST info:doi/10.1177/0969733009343249 6 16 796 2009-11-01 786 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/797?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:46 PST info:doi/10.1177/0969733009341908 6 16 812 2009-11-01 797 Articles http://nej.sagepub.com/cgi/content/abstract/16/6/813?rss=1 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.

]]> Wed, 04 Nov 2009 08:57:46 PST info:doi/10.1177/0969733009343622 6 16 826 2009-11-01 813 Articles http://nej.sagepub.com/cgi/reprint/16/6/827?rss=1 Wed, 04 Nov 2009 08:57:46 PST info:doi/10.1177/0969733009343977 6 16 829 2009-11-01 827 Articles http://nej.sagepub.com/cgi/reprint/16/6/830?rss=1 Wed, 04 Nov 2009 08:57:46 PST info:doi/10.1177/0969733009350353 6 16 832 2009-11-01 830 Articles http://nej.sagepub.com/cgi/reprint/16/6/833?rss=1 Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/0969733009344256 6 16 834 2009-07-01 833 Articles http://nej.sagepub.com/cgi/reprint/16/6/834?rss=1 Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/09697330090160040102 6 16 835 2009-07-01 834 Articles http://nej.sagepub.com/cgi/reprint/16/6/835?rss=1 Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/09697330090160040103 6 16 836 2009-07-01 835 Articles http://nej.sagepub.com/cgi/reprint/16/6/836?rss=1 Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/09697330090160040104 6 16 837 2009-07-01 836 Articles http://nej.sagepub.com/cgi/reprint/16/6/837?rss=1 Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/09697330090160040105 6 16 838 2009-07-01 837 Articles http://nej.sagepub.com/cgi/reprint/16/6/838?rss=1 Wed, 04 Nov 2009 08:57:45 PST info:doi/10.1177/09697330090160040106 6 16 839 2009-07-01 838 Articles http://nej.sagepub.com/cgi/reprint/16/6/840?rss=1 Wed, 04 Nov 2009 08:57:46 PST info:doi/10.1177/0969733009350354 6 16 840 2009-11-01 840 Articles http://nej.sagepub.com/cgi/reprint/16/6/841?rss=1 Wed, 04 Nov 2009 08:57:46 PST info:doi/10.1177/0969733009343998 6 16 841 2009-11-01 841 Articles http://nej.sagepub.com/cgi/reprint/16/5/521?rss=1 Tue, 11 Aug 2009 06:35:48 PDT info:doi/10.1177/0969733009106644 5 16 522 2009-09-01 521 Article http://nej.sagepub.com/cgi/reprint/16/5/523?rss=1 Tue, 11 Aug 2009 06:35:48 PDT info:doi/10.1177/0969733009106645 5 16 524 2009-09-01 523 Article http://nej.sagepub.com/cgi/reprint/16/5/525?rss=1 Tue, 11 Aug 2009 06:35:48 PDT info:doi/10.1177/0969733009106646 5 16 527 2009-09-01 525 Article http://nej.sagepub.com/cgi/content/abstract/16/5/528?rss=1 This article discusses findings from a mixed method literature review that investigated cancer patients’ perceptions of what constitutes a good nurse. To find pertinent articles, we conducted a systematic key word search of five journal databases (1998—2008). The application of carefully constructed inclusion criteria and critical appraisal identified 12 relevant articles. According to the patients, good nurses were shown to be characterized by specific, but inter-related, attitudes, skills and knowledge; they engage in person-to-person relationships, respect the uniqueness of patients, and provide support. Professional and trained skills as well as broad and specific nursing and non-nursing knowledge are important. The analysis revealed that these characteristics nurtured patient well-being, which manifests as optimism, trust, hope, support, confirmation, safety and comfort. Cancer patients’ perceptions of what constitutes a good nurse represent an important source of knowledge that will enable the development of more comprehensive and practice-based views on good nursing care for such patients. These perceptions help us to understand how nurses effectively make a difference in cancer patient care.

]]> Tue, 11 Aug 2009 06:35:48 PDT info:doi/10.1177/0969733009106647 5 16 542 2009-09-01 528 Article http://nej.sagepub.com/cgi/content/abstract/16/5/543?rss=1 Research relating to patients’ views of the good nurse has mainly focused on the perspectives of adult patients, with little exploring the perceptions of children. This article presents findings from a qualitative study that explored views of the good nurse from the perspective of hospitalized children. The aims of the study were threefold: to remedy a gap in the literature; to identify characteristics of the good nurse from the perspective of children in hospital; and to inform children’s nursing practice. Twenty-two children were interviewed using an adapted ‘draw and write’ technique. Five themes relating to children’s views of the good nurse emerged from the analysis: communication; professional competence; safety; professional appearance; and virtues. Each of these will be discussed in relation to good nurse literature and recommendations made for children’s nursing practice.

]]> Tue, 11 Aug 2009 06:35:48 PDT info:doi/10.1177/0969733009106648 5 16 560 2009-09-01 543 Article http://nej.sagepub.com/cgi/content/abstract/16/5/561?rss=1 Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients.

]]> Tue, 11 Aug 2009 06:35:48 PDT info:doi/10.1177/0969733009106649 5 16 573 2009-09-01 561 Article http://nej.sagepub.com/cgi/content/abstract/16/5/574?rss=1 This study examines the presence of ethical climates in skilled nursing facilities and identifies their antecedents (work group, job position, tenure). A cross-sectional survey design was implemented. A total of 359 facilities were selected in the Midwestern United States. Responses were received from nurses representing 100 of those facilities (28%). A total of 656 usable questionnaires were returned of the 3060 distributed (21.4% response rate). Descriptive statistics, confirmatory factor analysis, and multivariate and univariate analyses of variance were used. The results confirmed the presence of five ethical climates. Significant differences between registered and licensed practical nurses with regard to egoistic and independence ethical climates were found. Furthermore, nurses in management and non-management positions differed significantly in their perceptions of caring and egoistic climates. The results suggest incongruence in value perceptions and imply that researchers and practitioners have to direct efforts towards preventing and identifying reasons behind this.

]]> Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106650 5 16 588 2009-09-01 574 Article http://nej.sagepub.com/cgi/content/abstract/16/5/589?rss=1 This descriptive study was conducted to determine nursing students’ observation of ethical problems encountered in their clinical practice. Data were collected through a questionnaire from 153 volunteer nursing students at a university-based nursing school in Ankara, Turkey. The students reported that some patients are either physically or psychologically mistreated by doctors and nurses; they were not given appropriate information; they were subjected to discrimination according to their socio-economic situation; and their privacy was ignored. The findings reveal that nurses’ own unethical behaviors contribute to a rise in ethical problems. It is argued that nurses should internalize their professional and ethical roles in order to provide safe and ethical care and be good role models for students.

]]> Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106651 5 16 598 2009-09-01 589 Article http://nej.sagepub.com/cgi/content/abstract/16/5/599?rss=1 The aim of this study was to elucidate municipal night registered nurses’ (RNs) experiences of the meaning of caring in nursing. The research context involved all night duty RNs working in municipal care of older people in a medium-sized municipality located in central Sweden. The meaning of caring in nursing was experienced as: caring for by advocacy, superior responsibility in caring, and consultative nursing service. The municipal night RNs’ experience of caring is interpreted as meanings in paradoxes: ‘being close at distance’, the condition of ‘being responsible with insignificant control’, and ‘being interdependently independent’. The RNs’ experience of the meaning of caring involves focusing on the care recipient by advocating their perspectives. The meaning of caring in this context is an endeavour to grasp an overall caring responsibility by responding to vocational and personal demands regarding the issue of being a RN, in guaranteeing ethical, qualitative and competent care for older people.

]]> Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106652 5 16 612 2009-09-01 599 Article http://nej.sagepub.com/cgi/content/abstract/16/5/613?rss=1 Departing from a contemporary novel about a boy who is going to die from leukaemia, this article shows how the dimension of time can be seen as a morally relevant category that bridges both ‘dramatic’ issues, which constitute the dominant focus of bioethical decision making, and ‘undramatic’ issues, which characterize the lived experience of patients, relatives and health care workers. The moral task of comparing the various time dimensions of a given situation is explained as an act of ‘synchronizing’ the clocks. Ethical sensitivity and competence are presented as core skills that allow a continuity of care in situations where dramatic issues seem to be resolved, but undramatic ones are still not addressed. A nine-step model of shared decision making is proposed as an approach to identifying critical junctures within an illness trajectory and synchronizing the clocks of the involved actors.

]]> Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106653 5 16 624 2009-09-01 613 Article http://nej.sagepub.com/cgi/content/abstract/16/5/625?rss=1 Harmony is one of the most fundamental Japanese values. It is derived from Confucianism and encompasses a state of mind, an action process and outcomes of the action. This article draws on research data and discusses Japanese nurses’ perceptions of harmony as reflected in their everyday practice. The most important virtues for these nurses were reported as politeness and respect for other persons. The outcome from the nurses’ harmonious practice, it is claimed, benefited patients and created peaceful, harmonious relationships for all. Because of the unique link between harmony and the location of interaction, the ideal ‘workplace harmony’ threatened some nurses’ professional decision making. These nurses confused harmony with conformity by superficial agreement. The Japanese seniority system could be a major factor contributing to this problem. Ethics education that includes traditional values and concepts in Japanese culture is strongly urged.

]]> Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106654 5 16 636 2009-09-01 625 Article http://nej.sagepub.com/cgi/content/abstract/16/5/637?rss=1 Obstetric ultrasound is the well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses have started promoting the use of fetal ultrasound machines for nonmedical reasons. Non-medical fetal ultrasound (also known as ‘keepsake’ ultrasound) is defined as using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication. Notwithstanding the guidelines and warnings regarding ultrasound safety issued by governments and professional bodies, the absence of scientifically proven physical harm to fetuses from this procedure seems to provide these businesses with grounds for rapid expansion. However, this argument is too simplistic because current epidemiological evidence is not synchronous with advancing ultrasound technology. As non-medical fetal ultrasound has aroused very significant public attention, a thorough ethical analysis of this topic is essential. Using a multifaceted approach, we analyse the ethical perspective of non-medical fetal ultrasound in terms of the expectant mother, the fetus and health professionals. After applying four major theories of ethics and principles (the precautionary principle; theories of consequentialism and impartiality; duty-based theory; and rights-based theories), we conclude that obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Non-medical fetal ultrasound can be considered ethically unjustifiable. Nevertheless, the ethical analysis of this issue is time dependent owing to rapid advancements in ultrasound technology and the safety issue. The role of health professionals in ensuring that obstetric ultrasound is an ethically justifiable practice is also discussed.

]]> Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106655 5 16 646 2009-09-01 637 Article http://nej.sagepub.com/cgi/content/abstract/16/5/647?rss=1 Trust in the nurse—patient relationship is maintained not by how professionals perceive their actions but rather by how the public perceives them. However, little is known about the public's view of nurses and other health care professionals who participate in pharmaceutical marketing. Our study describes public perceptions of health care providers' role in pharmaceutical marketing and compares their responses with those of a random sample of licensed family nurse practitioners. The family nurse practitioners perceived their participation in marketing activities as significantly more ethically appropriate than did the public responders. Further research is warranted before conclusions can be drawn, but these early findings suggest that nurse practitioners should consider a conservative approach to participating in pharmaceutical marketing.

]]> Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106656 5 16 658 2009-09-01 647 Article http://nej.sagepub.com/cgi/reprint/16/5/659?rss=1 Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106658 5 16 661 2009-09-01 659 Article http://nej.sagepub.com/cgi/reprint/16/5/662?rss=1 Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106659 5 16 664 2009-09-01 662 Article http://nej.sagepub.com/cgi/reprint/16/5/665?rss=1 Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106661 5 16 668 2009-09-01 665 Article http://nej.sagepub.com/cgi/reprint/16/5/669?rss=1 Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106660 5 16 670 2009-09-01 669 Article http://nej.sagepub.com/cgi/reprint/16/5/670?rss=1 Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/09697330090160051702 5 16 671 2009-09-01 670 Article http://nej.sagepub.com/cgi/reprint/16/5/671?rss=1 Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/09697330090160051703 5 16 672 2009-09-01 671 Article http://nej.sagepub.com/cgi/reprint/16/5/672?rss=1 Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/09697330090160051704 5 16 673 2009-09-01 672 Article http://nej.sagepub.com/cgi/reprint/16/5/673?rss=1 Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/09697330090160051705 5 16 674 2009-09-01 673 Article http://nej.sagepub.com/cgi/reprint/16/5/675?rss=1 Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009106662 5 16 675 2009-09-01 675 Article http://nej.sagepub.com/cgi/reprint/16/5/676?rss=1 Tue, 11 Aug 2009 06:35:49 PDT info:doi/10.1177/0969733009107030 5 16 676 2009-09-01 676 Article http://nej.sagepub.com/cgi/reprint/16/4/387?rss=1 Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104601 4 16 388 2009-07-01 387 Article http://nej.sagepub.com/cgi/reprint/16/4/389?rss=1 Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104602 4 16 390 2009-07-01 389 Article http://nej.sagepub.com/cgi/reprint/16/4/391?rss=1 Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104603 4 16 392 2009-07-01 391 Article http://nej.sagepub.com/cgi/content/abstract/16/4/393?rss=1 This article calls nursing to engage in the study of religions and identifies six considerations that arise in religious studies and the ways in which religious faith is expressed. It argues that whole-person care cannot be realized, neither can there be a complete understanding of bioethics theory and decision making, without a rigorous understanding of religious-ethical systems. Because religious traditions differ in their cosmology, ontology, epistemology, aesthetic, and ethical methods, and because religious subtraditions interact with specific cultures, each religion and subtradition has something distinctive to offer to ethical discourse. A brief example is drawn from Native American religions, specifically their view of `speech' and `words'. Although the example is particular to an American context, it is intended to demonstrate a more general principle that an understanding of religion per se can yield new insights for bioethics.

]]> Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104604 4 16 405 2009-07-01 393 Article http://nej.sagepub.com/cgi/content/abstract/16/4/406?rss=1 This article explores how ethics and religion interface in everyday life by drawing on a study examining the negotiation of religious and spiritual plurality in health care. Employing methods of critical ethnography, namely, interviews and participant observation, data were collected from patients, health care providers, administrators and spiritual care providers. The findings revealed the degree to which `lived religion' was intertwined with `lived ethics' for many participants; particularly for people from the Sikh faith. For these participants, religion was woven into everyday life, making distinctions between public and private, secular and sacred spaces improbable. Individual interactions, institutional resource allocation, and social discourses are all embedded in social relationships of power that prevent religion from being a solely personal or private matter. Strategies for the reintegration of religion into nursing ethics are: adjusting professional codes and theories of ethics to reflect the influence of religion; and the contribution of critical perspectives, such as postcolonial feminism, to the understanding of lived ethics.

]]> Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104605 4 16 417 2009-07-01 406 Article http://nej.sagepub.com/cgi/content/abstract/16/4/418?rss=1 Incorporating patients' spiritual beliefs into health care decision making is essential for ethically good care. Gadow's three-level ethical framework of ethical immediacy, ethical universalism, and relational narrative is presented as a tool for enhancing nurses' ability to explore and deepen understandings of patients' spiritual beliefs, given that these and their experiences are often expressed in a language that seems foreign to nurses. The demographic and cultural shifts that lead to the necessity to understand patients who use principles and metaphors that, while commonly understood within their spiritual tradition, may seem incomprehensible to outsiders, are here set in the Canadian context. A case study on palliative sedation is used to illustrate how the ethical framework can help to reveal the spiritual certainties, principles and narratives patients bring to their health care experiences.

]]> Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104606 4 16 428 2009-07-01 418 Article http://nej.sagepub.com/cgi/content/abstract/16/4/429?rss=1 This article portrays the unique aspects of ethics education in a multicultural, multireligious and conflict-based atmosphere among Jewish and Arab nursing students in Jerusalem, Israel. It discusses the principles and the methods used for rising above this tension and dealing with this complicated situation, based on Yoder's `bridging' method. An example is used of Jewish and Arab students together implementing two projects in 2008, when the faculty decided to co-operate with communities in East Jerusalem, the Arab side of the city. The students took it upon themselves to chaperon the teachers who came to watch them at work, translate, and facilitate interaction with a guarded and suspicious community. This approach could also be relevant to less extreme conditions in any inter-religious environment when trying to produce graduates with a strong ethical awareness.

]]> Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104607 4 16 435 2009-07-01 429 Article http://nej.sagepub.com/cgi/content/abstract/16/4/436?rss=1 The aim of this thematic literature review is to explore nurses' perceptions of ethical issues in the care of older people. Electronic databases were searched from September 1997 to September 2007 using specific key words with tight inclusion criteria, which revealed 17 primary research reports. The data analysis involved repeated reading of the findings and sorting of those findings into four themes. These themes are: sources of ethical issues for nurses; differences in perceptions between nurses and patients/relatives; nurses' personal responses to ethical issues; and the patient—nurse relationship. The findings reveal that ageism is one of the major sources of the ethical issues that arise for nurses caring for older people. Education and organizational change can combat ageist attitudes. Wider training is required in the care of older people, workplace skills, palliative care and pain management for older people. The demands of a changing global demography will necessitate further research in this field.

]]> Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104608 4 16 452 2009-07-01 436 Article http://nej.sagepub.com/cgi/content/abstract/16/4/453?rss=1 The purpose of this study was to investigate what strategies people with severe functional disabilities who receive personal assistance in their homes use in their daily life to achieve autonomy, integrity, influence and participation. Qualitative interviews were carried out and subjected to qualitative latent content analysis. The main finding was expressed in terms of six subthemes: trying to keep a private sphere; striving to communicate; searching for possibilities; taking the initiative; striving to gain insight; and using one's temperament. These generated the overall theme: maintaining dignity in close relationships. This study contributes an understanding of the strategies used by people who are dependent on personal assistance. Future efforts in nursing must focus on supporting personal assistants with ethical knowledge and guidance in order that people with severe functional disabilities are empowered to achieve autonomy, integrity, influence and participation in their daily lives.

]]> Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104609 4 16 465 2009-07-01 453 Article http://nej.sagepub.com/cgi/content/abstract/16/4/466?rss=1 This article gives an overview of the nursing ethics arguments on euthanasia in general, and on nurses' involvement in euthanasia in particular, through an argument-based literature review. An in-depth study of these arguments in this literature will enable nurses to engage in the euthanasia debate. We critically appraised 41 publications published between January 1987 and June 2007. Nursing ethics arguments on (nurses' involvement in) euthanasia are guided primarily by the principles of respect for autonomy, nonmaleficence, beneficence and justice. Ethical arguments related to the nursing profession are described. From a care perspective, we discuss arguments that evaluate to what degree euthanasia can be considered positively or negatively as a form of good nursing care. Most arguments in the principle-, profession- and care-orientated approaches to nursing ethics are used both pro and contra euthanasia in general, and nurses' involvement in euthanasia in particular.

]]> Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104610 4 16 486 2009-07-01 466 Article http://nej.sagepub.com/cgi/content/abstract/16/4/487?rss=1 This article describes the results of research that investigated whether student nurses identified the moral aspects of everyday nursing care situations and, if so, how they dealt with them. We intended to elucidate the role of mentoring situations in moral development. Student written documents reflecting discussions during mentoring situations were analysed quantitatively and qualitatively. The students studied in one of the three nursing schools involved in the research. In only a small proportion of cases (<13%) did the students identify the ethical questions in those situations. The results indicate that the nursing students rarely identified moral issues, implying that there was little conscious moral reflection and deliberation in their mentoring situations dealing with their problematic experiences during their internship. Additional competences will be required for session leaders in order to allow mentoring situations to play a more prominent role in moral development.

]]> Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104611 4 16 498 2009-07-01 487 Article http://nej.sagepub.com/cgi/content/abstract/16/4/499?rss=1 Nurses are encountering an increasing number of ethical dilemmas in clinical practice. Ethics courses for baccalaureate nursing students provide the opportunity for the development of critical thinking skills in order to deal with these effectively. The purpose of this descriptive qualitative study was to describe ethical reasoning in 70 baccalaureate nursing students enrolled in a nursing ethics course. Reflective clinical journals were analyzed as appropriate for qualitative inquiry. The overriding theme emerging from the data was `in the process of becoming', which includes: practicing as a professional, lacking the confidence as a student nurse to take an ethical stand, advocating for patients, being just in the provision of care, identifying the spiritual dimensions of nursing practice, confronting the `real world' of health care, making a commitment to practice with integrity, and caring enough to care. The development of critical thinking and ethical reasoning within the framework of knowing and connecting is essential in nursing education.

]]> Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104612 4 16 510 2009-07-01 499 Article http://nej.sagepub.com/cgi/reprint/16/4/511?rss=1 Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104614 4 16 513 2009-07-01 511 Article http://nej.sagepub.com/cgi/reprint/16/4/514?rss=1 Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104613 4 16 514 2009-07-01 514 Article http://nej.sagepub.com/cgi/reprint/16/4/515?rss=1 Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/09697330090160041402 4 16 515 2009-07-01 515 Article http://nej.sagepub.com/cgi/reprint/16/4/516?rss=1 Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/09697330090160041403 4 16 516 2009-07-01 516 Article http://nej.sagepub.com/cgi/reprint/16/4/517?rss=1 Mon, 15 Jun 2009 03:15:57 PDT info:doi/10.1177/0969733009104615 4 16 517 2009-07-01 517 Article http://nej.sagepub.com/cgi/reprint/16/3/261?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102853 3 16 262 2009-05-01 261 Article http://nej.sagepub.com/cgi/reprint/16/3/263?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102854 3 16 264 2009-05-01 263 Article http://nej.sagepub.com/cgi/reprint/16/3/265?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009105652 3 16 266 2009-05-01 265 Article http://nej.sagepub.com/cgi/content/abstract/16/3/267?rss=1 United Kingdom Transplant reported that, during 2007—2008, a total of 7655 people were awaiting a transplant; however, only 3235 organs were available via the current `opt in' approach. To address this shortfall, new UK legislation sought to increase the number of organs available for donation. The Chief Medical Officer for England and Wales supports the adoption of `presumed consent' legislation, that is, an `opt out' approach, as used in much of Europe. Little research, however, has explored the impact on bereaved relatives, nurses and medical staff of introducing presumed consent legislation. Adopting a phenomenological approach, this study used responses to an initial questionnaire combined with selected interviews with health care professionals to capture their direct experience of presumed consent legislation in three European countries: Portugal, Norway and Belgium.

]]> Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102687 3 16 282 2009-05-01 267 Article http://nej.sagepub.com/cgi/content/abstract/16/3/283?rss=1 When forced treatment in mental health care is under consideration, two approaches guide clinicians in their actions: the dominant rights-based approach and the relational ethical approach. We hypothesized that nurses with bachelor's degrees differentiate better between the two approaches than nurses without a degree. To test this hypothesis a survey was performed in major Slovenian health institutions. We found that nurses emphasize the importance of ethics and personal values, but 55.4% of all the nurse participants confused the two approaches. The results confirmed our hypothesis and indicate the importance of nurses' formal education, especially when caring for patients with mental illness.

]]> Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102689 3 16 291 2009-05-01 283 Article http://nej.sagepub.com/cgi/content/abstract/16/3/292?rss=1 Medical futility is often defined as providing inappropriate treatments that will not improve disease prognosis, alleviate physiological symptoms, or prolong survival. This understanding of medical futility is problematic because it rests on the final outcomes of procedures that are narrow and medically defined. In this article, Walker's `expressivecollaborative' model of morality is used to examine how certain critical care interventions that are considered futile actually have broader social functions surrounding death and dying. By examining cardiopulmonary resuscitation and life-sustaining intensive care measures as moral practices, we show how so-called futile interventions offer ritualistic benefit to patients, families, and health care providers, helping to facilitate the process of dying. This work offers a new perspective on the ethical debate concerning medical futility and provides a means to explore how the social value of treatments may be as important in determining futility as medical scientific criteria.

]]> Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102691 3 16 302 2009-05-01 292 Article http://nej.sagepub.com/cgi/content/abstract/16/3/303?rss=1 In this review of empirical studies we aimed to assess the influence of religion and world view on nurses' attitudes towards euthanasia and physician assisted suicide. We searched PubMed for articles published before August 2008 using combinations of search terms. Most identified studies showed a clear relationship between religion or world view and nurses' attitudes towards euthanasia or physician assisted suicide. Differences in attitude were found to be influenced by religious or ideological affiliation, observance of religious practices, religious doctrines, and personal importance attributed to religion or world view. Nevertheless, a coherent comparative interpretation of the results of the identified studies was difficult. We concluded that no study has so far exhaustively investigated the relationship between religion or world view and nurses' attitudes towards euthanasia or physician assisted suicide and that further research is required.

]]> Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102692 3 16 318 2009-05-01 303 Article http://nej.sagepub.com/cgi/content/abstract/16/3/319?rss=1 The aim of this study was to reveal doctors' and nurses' attitudes to euthanasia in intensive care units and surgical, internal medicine and paediatric units in Turkey. A total of 205 doctors and 206 nurses working in several hospitals in Istanbul participated. Data were collected by questionnaire and analysed using SPSS v. 12.0. Significantly higher percentages of doctors (35.3%) and nurses (26.6%) working in intensive care units encountered euthanasia requests than those working in other units. Doctors and nurses caring for terminally ill patients in intensive care units differed considerably in their attitudes to euthanasia and patient rights from other health care staff. Euthanasia should be investigated and put on the agenda for discussion in Turkey.

]]> Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102693 3 16 327 2009-05-01 319 Article http://nej.sagepub.com/cgi/content/abstract/16/3/328?rss=1 Our self-concept is how we see ourselves in our minds. The goal of this research was to discover any significant differences in the dimensions of self-concept between clinical nurses employed in an intensive care unit in Slovenia and Slovenian women from the general population, who represented the control group. The research included 603 women aged 20—40 years (mean 29.94; standard deviation ±6.0) who had a high-school education. To determine the differences between the groups statistically we used one-way analysis of variance. The results revealed that clinical nurses had a more positive self-concept than members of the control group. Self-concept is very important in nursing because it is closely connected to the existing value system of individuals and their behaviour. Self-concept gives nurses a sense of how they use their abilities and how they perform in relation to patients.

]]> Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102696 3 16 339 2009-05-01 328 Article http://nej.sagepub.com/cgi/content/abstract/16/3/340?rss=1 In nursing, the concept of advocacy is often understood in terms of reactive or proactive action aimed at protecting patients' legal or moral rights. However, advocacy activities have not often been researched in the context of everyday clinical nursing practice, at least from patients' point of view. This study investigated the implementation of nursing advocacy in the context of procedural pain care from the perspectives of both patients and nurses. The cross-sectional study was conducted on a cluster sample of surgical otolaryngology patients (n = 405) and nurses (n = 118) from 12 hospital units in Finland. The data were obtained using an instrument specially designed for this purpose, and analysed statistically by descriptive and non-parametric methods. According to the results, patients and nurses have slightly different views about which dimensions of advocacy are implemented in procedural pain care. It seems that advocacy acts are chosen and implemented rather haphazardly, depending partly on how active patients are in expressing their wishes and interests and partly on nurses' empowerment.

]]> Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009097992 3 16 362 2009-05-01 340 Article http://nej.sagepub.com/cgi/reprint/16/3/363?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102703 3 16 367 2009-05-01 363 Article http://nej.sagepub.com/cgi/reprint/16/3/368?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102705 3 16 372 2009-05-01 368 Article http://nej.sagepub.com/cgi/reprint/16/3/373?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102706 3 16 375 2009-05-01 373 Article http://nej.sagepub.com/cgi/reprint/16/3/376?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102707 3 16 376 2009-05-01 376 Article http://nej.sagepub.com/cgi/reprint/16/3/377?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/09697330090160031102 3 16 377 2009-05-01 377 Article http://nej.sagepub.com/cgi/reprint/16/3/378?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/09697330090160031103 3 16 378 2009-05-01 378 Article http://nej.sagepub.com/cgi/reprint/16/3/378-a?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/09697330090160031104 3 16 380 2009-05-01 378 Article http://nej.sagepub.com/cgi/reprint/16/3/380?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/09697330090160031105 3 16 380 2009-05-01 380 Article http://nej.sagepub.com/cgi/reprint/16/3/381?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/09697330090160031106 3 16 381 2009-05-01 381 Article http://nej.sagepub.com/cgi/reprint/16/3/382?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/09697330090160031107 3 16 382 2009-05-01 382 Article http://nej.sagepub.com/cgi/reprint/16/3/383?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/09697330090160031108 3 16 383 2009-05-01 383 Article http://nej.sagepub.com/cgi/reprint/16/3/384?rss=1 Thu, 16 Apr 2009 03:10:47 PDT info:doi/10.1177/0969733009102708 3 16 385 2009-05-01 384 Article