Health Care Ethics Consortium of Georgia ...ethics in action

This article aims to deepen the understanding of courage through a theoretical analysis of classical philosophers’ work and a review of published and unpublished empirical research on courage in nursing. The authors sought answers to questions regarding how courage is understood from a philosophical viewpoint and how it is expressed in nursing actions. Four aspects were identified as relevant to a deeper understanding of courage in nursing practice: courage as an ontological concept, a moral virtue, a property of an ethical act, and a creative capacity. The literature review shed light on the complexity of the concept of courage and revealed some lack of clarity in its use. Consequently, if courage is to be used consciously to influence nurses’ ethical actions it seems important to recognize its specific features. The results suggest it is imperative to foster courage among nurses and student nurses to prepare them for ethical, creative action and further the development of professional nursing practices.

There is increasing emphasis on the need for collaboration between practice and academic leaders in health care research. However, many problems can arise owing to differences between academic and clinical goals and timelines. In order for research to move forward it is important to name and address these issues early in a project. In this article we use an example of a participatory action research study of ethical practice in nursing to highlight some of the issues that are not frequently discussed and we identify the impact of things not-named. Further, we offer our insights to others who wish to be partners in research between academic and practice settings. These findings have wide implications for ameliorating misunderstandings that may develop between nurse leaders in light of collaborative research, as well as for participatory action research.

The aim of this study was to explore the obligations of nurses and physicians in providing end-of-life care. Nineteen nurses and 11 physicians from a single newborn intensive care unit participated. Using content analysis, an overarching obligation of creating the best possible experience for infants and parents was identified, within which two categories of obligations (decision making and the end of life itself) emerged. Obligations in decision making included talking to parents and timing withdrawal. End-of-life obligations included providing options, preparing parents, being with, advocating, creating peace and normalcy, and providing comfort. Nurses and physicians perceived obligations in both categories, although nurse obligations centered on the end of life while physician obligations focused on decision making. The findings demonstrate that, although the ultimate goal is shared by both disciplines, the paths to achieving that goal are often different. This has important implications for collaboration, communication, and improving the end of life.

The purpose of this article is to explore enduring ethical vulnerabilities of the nursing profession as illustrated in historical chapters of nursing’s past. It describes these events, then explores two ethical vulnerabilities in depth: conflicting loyalties and duties, and relationships with patients as ‘other’. The article concludes with suggestions for more ethical approaches to the other in current nursing practice. The past may be one of the most fruitful sites for examining enduring ethical vulnerabilities of the nursing profession. First of all, professional identity, which includes moral identity, comes in part from knowledge of the nursing profession’s past. Second, looking to the past to understand better how events and ideologies have brought vulnerabilities to the fore raises questions about ethical nursing practice today

In this article it is argued that there are barriers to effective and non-discriminatory practice when mentoring overseas nurses within the National Health Service (NHS) and the care home sector. These include a lack of awareness about how cultural differences affect mentoring and learning for overseas nurses during their period of supervised practice prior to registration with the UK Nursing and Midwifery Council. These barriers may demonstrate a lack of effective teaching of ethical practice in the context of cultural diversity in health care. This argument is supported by empirical data from a national study. Interviews were undertaken with 93 overseas nurses and 24 national and 13 local managers and mentors from six research sites involving UK health care employers in the NHS and independent sectors in different regions of the UK. The data collected showed that overseas nurses are discriminated against in their learning by poor mentoring practices; equally, from these data, it appears that mentors are ill-equipped by existing mentor preparation programmes to mentor overseas-trained nurses from culturally diverse backgrounds. Recommendations are made for improving mentoring programmes to address mentors’ ability to facilitate learning in a culturally diverse workplace and thereby improve overseas nurses’ experiences of their supervised practice.

Nurses are exposed to bullying for various reasons. It has been argued that the reason for bullying can be political, meaning that the behavior occurs to serve the self-interests of the perpetrators. This study aims to identify how nurses perceive the relevance of individual and political reasons for bullying behaviors. In February 2009 a survey was conducted with nurses working in a research and training hospital located in Turkey. The results showed that the aim of influencing promotion, task assignments, performance appraisal, recruitment, dismissal, allocation of equipment and operational means, together with allocation of personal benefits and organizational structure decisions, were perceived as potential political reasons for bullying by nurses. Moreover, the reasons for the various bullying behaviors were perceived as relevant to individual characteristics, namely, the perpetrators’ need for power, and their psychological and private life problems.

Nurses’ duties and patients’ rights have been important foci in nursing. Nurses’ rights legitimate the power and responsibility of the profession. There are few published articles on this subject in the nursing science literature. This article is a theoretical examination of nurses’ rights that aims to structure (i.e. show the internal logic of) those that have been little studied. It is based on the philosophical literature and published research. Nurses’ rights can be divided into: human and civil rights, rights based on health care legislation, professional rights, and earned rights. In this context, professional rights relate to nursing and also to tasks shared with other health care professions. Analyzing nurses’ rights will help to promote these rights, improve nurses’ position both nationally and internationally, and provide possibilities for enhancing patient care.

Using an interpretative research approach to ethical and legal literature, it is argued that nursing in the battlefield is distinctly different to civilian nursing, even in an emergency, and that the environment is so different that a duty of care owed by military nurses to wounded soldiers should not apply. Such distinct differences in wartime can override normal peacetime professional ethics to the extent that the duty of care owed by military nurses to their patients on the battlefield should not exist. It is also argued that as military nurses have legal and professional obligations to care for wounded soldiers on the battlefield, this obligation conflicts with following military orders, causing a dual loyalty conflict. This is because soldiers are part of the ‘fighting force’ and must be fit to fight and win the battle. This makes them more of a commodity rather than individual persons with distinct health care needs.

Professional values are standards for action and provide a framework for evaluating behavior. This study examined changes in the professional values of nursing students between their entrance to and graduation from an undergraduate nursing program. A pre- and post-test design was employed. A convenience sample of 94 students from a university in Taiwan was surveyed. Data were collected from students during the sophomore and senior years. Total scores obtained for the revised Nurses Professional Values Scale during the senior year of the nursing program were significantly higher than upon program entry. The ‘caring’ subscale was scored highest at both program entry and graduation, but the pre- and post-test scores were not significantly different from each other. The students scored significantly higher on the ‘professionalism’ and ‘activism’ subscales at post-test than they did at pre-test. Professional values changed in a positive direction between the beginning of the student nurses’ educational experience and their graduation. The results supported the premise that education had a positive effect on these students’ professional values but causality could not be assumed.

Understanding how a nurse acts in a particular situation reveals how nurses enact their ethics in day-to-day nursing. Our ethical frameworks assist us when we experience serious ethical dilemmas. Yet how a nurse responds in situations of daily practice is contingent upon all the presenting cues that build the current moment. In this article, we look at how a home care nurse responds to the ethical opening that arises when the nurse enters a person’s home. We discuss how the home presents the nurse with knowledge that informs the provision of ethical nursing care. The analysis is based on findings from an interpretive research study in palliative home care in Canada. Through interpretive analysis of a nursing situation we delineate how the nurse engages with the whole and acts inside the moment. The analysis shows how home care nurses are ethically determined to engage with whatever is going on in a patient’s home.