The nurse's role in a patient-centered approach for reducing COVID-19 vaccine hesitancy during pregnancy: An American Academy of Nursing consensus paper.

The evidence shows that COVID-19 vaccines can reduce the risks of poor pregnancy outcomes. Yet, reluctance to vaccinate remains high in pregnant populations. In this paper, we take a precision health and patient-centered approach to vaccine hesitancy. We adopted the society-to-cells vaccine hesitancy framework to identify society, community, family, individual, and physiologic factors contributing to COVID-19 vaccine hesitancy in pregnancy. Nurses are particularly well-suited to impact the factors associated with vaccine hesitancy. Because of their proximity to the patient, nurses are positioned to provide individualized, timely health information, and clinical guidelines to assist patients with decision-making related to vaccinations. Recommendations are provided to bolster nurses' engagement in precision health and patient-centered models of care to mitigate COVID-19 vaccine hesitancy in pregnancy.

Emergency department crowding: An examination of older adults and vulnerability.

Emergency departments in many nations worldwide have been struggling for many years with crowding and the subsequent provision of care in hallways and other unconventional spaces. While this issue has been investigated and analyzed from multiple perspectives, the ethical dimensions of the place of emergency department care have been underexamined. Specifically, the impacts of the place of care on patients and their caregivers have not been robustly explored in the literature. In this article, a feminist ethics and human geography framing is utilized to argue that care provision in open and unconventional spaces in the emergency department can be unethical, as vulnerability can be amplified by the place of care for patients and their caregivers. The situational and pathogenic vulnerability of patients can be heightened by the place of the emergency department and by the constraints to healthcare providers' capacity to promote patient comfort, privacy, communication, and autonomy in this setting. The arrangements of care in the emergency department are of particular concern for older adults given the potential increased risks for vulnerability in this population. As such, hallway healthcare can reflect the normalized inequities of structural ageism. Recommendations are provided to address this complicated ethical issue, including making visible the moral experiences of patients and their caregivers, as well as those of healthcare providers in the emergency department, advocating for a systems-level accounting for the needs of older adults in the emergency department and more broadly in healthcare, as well as highlighting the need for further research to examine how to foster autonomy and care in the emergency department to reduce the risk for vulnerabilities.

Compassionate nursing in challenging contexts: The importance of judgments.

BACKGROUND: Nurses' demonstration of compassion is an ethical and often regulatory expectation. While research has been conducted to examine the barriers and facilitators of compassion in nurses, little is known about how nurses develop and express compassion for patients who may be blamed for their health condition. Unvaccinated COVID-19 patients are an example of such patients. RESEARCH QUESTIONS: How do nurses provide compassionate care for unvaccinated adults infected with COVID-19? How did the context of COVID-19 vaccination in Canada shape nurses' relationships with unvaccinated patients? RESEARCH DESIGN: A generic qualitative approach using interviews to gather data was used. Martha Nussbaum's conceptualization of compassion and its cognitive requirements was employed to add depth to the analysis. PARTICIPANTS AND RESEARCH CONTEXT: Seventeen Registered Nurses, from a range of practice settings, who had cared for unvaccinated patients with COVID-19 participated. ETHICAL CONSIDERATIONS: Ethics approval was received, and signed informed consent was obtained. Participants who were the current students of the researchers were excluded. FINDINGS: Three themes were identified:1) Encountering Extreme Workplace Impediments to Compassion.2) Managing Emotions to Provide "Nonjudgmental Care."3) Practicing Narrative Imagination. DISCUSSION: The difficult working conditions during the pandemic impeded nurses' capacity to be compassionate. Yet, none judged their patients' suffering as trivial, and all provided necessary nursing care. Some initially blamed these patients for the severity of their illness and suppressed their emotions to provide what they called "nonjudgmental care." Upon reflection, participants recognized that these patients' life circumstances may have been barriers to vaccination which, in the end, facilitated the development of compassion. CONCLUSION: This research has implications that go beyond that of caring for patients with COVID-19. The ideal of "nonjudgmental care" requires critical re-examination because judgments and emotions are required for compassion.

How Should Focus Be Shifted From Individual Preference to Collective Wisdom for Patients at the End of Life With Antimicrobial-Resistant Infections?

Despite growth in numbers of organizational antimicrobial stewardship programs, antimicrobial resistance continues to escalate. Interprofessional education and collaboration are needed to make these programs appropriately responsive to the ethically and clinically complex needs of patients at the end of life whose care plans still require antimicrobial management.

Surgical safety checklist compliance process as a moral hazard: An institutional ethnography.

BACKGROUND: Charting is an essential component of professional nursing practice and is arguably a key element of patient safety in surgery: without proper, objective, and timely documentation, both benign and tragical errors can occur. From surgery on wrong patients to wrong limbs, to the omission of antibiotics administration, many harms can happen in the operating room. Documentation has thus served as a safeguard for patient safety, professional responsibility, and professional accountability. In this context, we were puzzled by the practices we observed with respect to charting compliance with the surgical safety checklist (SSC) during a study of surgical teams in a large, urban teaching hospital in Canada (pseudonym 'C&C'). METHODS: This article leverages institutional ethnography and a subset of data from a larger study to describe and explain the social organisation of the system that monitored surgical safety compliance at C&C from the standpoint of operating room nurses. This data included fieldnotes from observations of 51 surgical cases, on-the-spot interviews with nurses, formal interviews with individuals who were involved in the design and implementation of the SSC, and open-ended questions from two rounds of survey of OR teams. FINDINGS: We found that the compliance form and not the SSC itself formed the basis for reporting. To meet hospital accuracy in charting goals and legislated compliance documentation reporting requirements nurses 'pre-charted' compliance with the surgical checklist. The adoption of this workaround technically violated nursing charting principles and put them in ethically untenable positions. CONCLUSIONS: Documenting compliance of the SSC constituted a moral hazard, constrained nurses' autonomy and moral agency, and obscured poor checklist adherence. The findings highlight how local and extra local texts, technologies and relations create ethical issues, raise questions about the effectiveness of resulting data for decision-making and contribute to ongoing conversations about nursing workarounds.

Type 2 Diabetes Mellitus in Tanzania. A Narrative Review of Epidemiology and Disease Trend.

INTRODUCTION: The prevalence of type 2 diabetes is on a rapid rise in Tanzania, driven by lifestyle modifications, nutritional changes, and increased obesity rates. This article reviews the epidemiology, and disease trends of type 2 diabetes in Tanzania and explores the economic implications and challenges in care, including policy, education, and healthcare systems. METHODOLOGY: The study employs a narrative literature review from research articles, local healthcare reports, surveys, and public health records. It evaluates the economic impacts, healthcare capabilities, and patient behaviors in managing type 2 diabetes in Tanzania. RESULTS: The economic burden of diabetes in Tanzania is increasing due to direct healthcare costs, lost productivity, and reduced quality of life, placing significant pressure on the already resourcelimited healthcare system. Treatment dropout rates are alarmingly high, and healthcare providers' knowledge of diabetes is insufficient. Insulin and metformin availability are critically low. Cultural norms and dietary habits pose substantial barriers to effective disease management. CONCLUSION: The growing prevalence of type 2 diabetes in Tanzania presents a significant public health crisis, necessitating comprehensive strategies for prevention, early detection, and effective disease management. Priorities should include enhancing healthcare infrastructure, increasing public investment, improving healthcare education, and tackling socio-cultural barriers to disease management.

Digital Interventions for Stress Among Frontline Health Care Workers: Results From a Pilot Feasibility Cohort Trial.

BACKGROUND: The COVID-19 pandemic has challenged the mental health of health care workers, increasing the rates of stress, moral distress (MD), and moral injury (MI). Virtual reality (VR) is a useful tool for studying MD and MI because it can effectively elicit psychophysiological responses, is customizable, and permits the controlled study of participants in real time. OBJECTIVE: This study aims to investigate the feasibility of using an intervention comprising a VR scenario and an educational video to examine MD among health care workers during the COVID-19 pandemic and to use our mobile app for longitudinal monitoring of stress, MD, and MI after the intervention. METHODS: We recruited 15 participants for a compound intervention consisting of a VR scenario followed by an educational video and a repetition of the VR scenario. The scenario portrayed a morally challenging situation related to a shortage of life-saving equipment. Physiological signals and scores of the Moral Injury Outcome Scale (MIOS) and Perceived Stress Scale (PSS) were collected. Participants underwent a debriefing session to provide their impressions of the intervention, and content analysis was performed on the sessions. Participants were also instructed to use a mobile app for 8 weeks after the intervention to monitor stress, MD, and mental health symptoms. We conducted Wilcoxon signed rank tests on the PSS and MIOS scores to investigate whether the VR scenario could induce stress and MD. We also evaluated user experience and the sense of presence after the intervention through semi-open-ended feedback and the Igroup Presence Questionnaire, respectively. Qualitative feedback was summarized and categorized to offer an experiential perspective. RESULTS: All participants completed the intervention. Mean pre- and postintervention scores were respectively 10.4 (SD 9.9) and 13.5 (SD 9.1) for the MIOS and 17.3 (SD 7.5) and 19.1 (SD 8.1) for the PSS. Statistical analyses revealed no significant pre- to postintervention difference in the MIOS and PSS scores (P=.11 and P=.22, respectively), suggesting that the experiment did not acutely induce significant levels of stress or MD. However, content analysis revealed feelings of guilt, shame, and betrayal, which relate to the experience of MD. On the basis of the Igroup Presence Questionnaire results, the VR scenario achieved an above-average degree of overall presence, spatial presence, and involvement, and slightly below-average realism. Of the 15 participants, 8 (53%) did not answer symptom surveys on the mobile app. CONCLUSIONS: Our study demonstrated VR to be a feasible method to simulate morally challenging situations and elicit genuine responses associated with MD with high acceptability and tolerability. Future research could better define the efficacy of VR in examining stress, MD, and MI both acutely and in the longer term. An improved participant strategy for mobile data capture is needed for future studies. TRIAL REGISTRATION: ClinicalTrails.gov NCT05001542; https://clinicaltrials.gov/study/NCT05001542. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/32240.

Risk Factors for Hospital Readmission Following Noncardiac Surgery: International Cohort Study.

Objective: To determine timing and risk factors associated with readmission within 30 days of discharge following noncardiac surgery. Background: Hospital readmission after noncardiac surgery is costly. Data on the drivers of readmission have largely been derived from single-center studies focused on a single surgical procedure with uncertainty regarding generalizability. Methods: We undertook an international (28 centers, 14 countries) prospective cohort study of a representative sample of adults ≥45 years of age who underwent noncardiac surgery. Risk factors for readmission were assessed using Cox regression (ClinicalTrials.gov, NCT00512109). Results: Of 36,657 eligible participants, 2744 (7.5%; 95% confidence interval [CI], 7.2-7.8) were readmitted within 30 days of discharge. Rates of readmission were highest in the first 7 days after discharge and declined over the follow-up period. Multivariable analyses demonstrated that 9 baseline characteristics (eg, cancer treatment in past 6 months; adjusted hazard ratio [HR], 1.44; 95% CI, 1.30-1.59), 5 baseline laboratory and physical measures (eg, estimated glomerular filtration rate or on dialysis; HR, 1.47; 95% CI, 1.24-1.75), 7 surgery types (eg, general surgery; HR, 1.86; 95% CI, 1.61-2.16), 5 index hospitalization events (eg, stroke; HR, 2.21; 95% CI, 1.24-3.94), and 3 other factors (eg, discharge to nursing home; HR, 1.61; 95% CI, 1.33-1.95) were associated with readmission. Conclusions: Readmission following noncardiac surgery is common (1 in 13 patients). We identified perioperative risk factors associated with 30-day readmission that can help frontline clinicians identify which patients are at the highest risk of readmission and target them for preventive measures.

Advocacia do paciente na valorização do ser social e da família em tempos de COVID-19 / Defensa del paciente en la valoración del ser social y la familia en tiempos de COVID-19 / Patient advocacy in valuing social and family being in times of COVID-19

Resumo Objetivo compreender as estratégias utilizadas pelos enfermeiros intensivistas diante das situações que demandaram a advocacia do paciente, envolvendo a valorização do ser social e familiar no cenário da pandemia de COVID-19. Método estudo qualitativo, descritivo e exploratório, realizado nas cinco regiões do Brasil. Participaram do estudo 25 enfermeiros intensivistas. Os dados foram coletados por meio de uma entrevista semiestruturada e, posteriormente, submetidos à análise textual discursiva. Resultados os enfermeiros advogaram perante a equipe de saúde e pela presença da família dentro da Unidade de Terapia Intensiva. Com a pandemia de COVID-19, foram estabelecidas novas estratégias para advogar, promovendo a aproximação, de forma virtual, entre enfermeiros, pacientes e familiares, bem como a permanência dos familiares no ambiente de terapia intensiva, quando necessário, para que os enfermeiros conhecessem melhor o paciente e integrassem a família ao cuidado. Considerações finais e implicações para a prática as estratégias utilizadas para agir em prol do paciente se deram por meio da aproximação entre enfermeiros e familiares; por meio da instrução de familiares para que advoguem pelo paciente; e pela defesa da presença familiar dentro da Unidade de Terapia Intensiva.

Resumen Objetivo comprender las estrategias utilizadas por los enfermeros de cuidados intensivos frente a situaciones que exigían la defensa del paciente, involucrando la valorización del ser social y familiar en el escenario de la pandemia de COVID-19. Método estudio cualitativo, descriptivo y exploratorio, realizado en las cinco regiones de Brasil. 25 enfermeras de cuidados intensivos participaron en el estudio. Los datos fueron recolectados a través de una entrevista semiestructurada y posteriormente sometidos al análisis textual discursivo. Resultados los enfermeros abogaron ante el equipo de salud y por la presencia de la familia en la Unidad de Cuidados Intensivos. Con la pandemia del COVID-19, se establecieron nuevas estrategias para abogar, promoviendo el acercamiento virtual entre enfermeros, pacientes y familiares, así como la permanencia de los familiares en el ambiente de cuidados intensivos cuando sea necesario, para que los enfermeros puedan conocerse entre sí. mejorar al paciente e integrar a la familia en el cuidado. Conclusión e implicaciones para la práctica las estrategias utilizadas para actuar en nombre del paciente se llevaron a cabo a través del acercamiento entre enfermeras y familiares; instruyendo a los familiares para que defiendan al paciente; y por la defensa de la presencia familiar dentro de la Unidad de Cuidados Intensivos.

Abstract Objective to understand the strategies used by intensive care nurses in the face of situations that required patient advocacy, involving the appreciation of social and family being during the COVID-19 pandemic. Method this is a qualitative, descriptive and exploratory study, carried out in the five regions of Brazil. A total of 25 intensive care nurses participated in the study. Data were collected through a semi-structured interview and subsequently subjected to discursive textual analysis. Results nurses advocated before the health team and for the family's presence within the Intensive Care Unit. With the COVID-19 pandemic, new strategies were established to advocate, promoting virtual rapprochement between nurses, patients and family members as well as the permanence of family members in intensive care environments when necessary so that nurses could know patients better and integrate the family into care. Conclusion and implications for practice the strategies used to act on behalf of patients were carried out for rapprochement between nurses and family members; for instructing family members to advocate for patients; and for the defense of family presence within the Intensive Care Unit.

Management of bed availability in intensive care in the context of hospitalization by court order / Gestão da disponibilidade de leitos na terapia intensiva no contexto da internação por ordem judicial / Gestión de disponibilidad de camas en terapia intensiva en el contexto de internación por orden judicial

Abstract Objective: to identify, from the nurse perspective, situations that interfere with the availability of beds in the intensive care unit in the context of hospitalization by court order. Method: qualitative exploratory, analytical research carried out with 42 nurses working in adult intensive care. The selection took place by non-probabilistic snowball sampling. Data collected by interview and analyzed using the Discursive Textual Analysis technique. Results: three categories were analyzed, entitled deficiency of physical structure and human resources; Lack of clear policies and criteria for patient admission and inadequate discharge from the intensive care unit. In situations of hospitalization by court order, there is a change in the criteria for the allocation of intensive care beds, due to the credibility of professionals, threats of medico-legal processes by family members and judicial imposition on institutions and health professionals. Conclusion: nurses defend the needs of the patients, too, with actions that can positively impact the availability of intensive care beds and adequate care infrastructure.

Resumo Objetivo: identificar, a partir da perspectiva de enfermeiros, situações que interferem na disponibilidade de leitos em unidade de terapia intensiva no contexto de internação por ordem judicial. Método: pesquisa qualitativa exploratória, analítica, realizada com 42 enfermeiros atuantes em terapia intensiva adulto. A seleção aconteceu por amostragem não probabilística, do tipo bola de neve. Dados coletados por entrevista e analisados pela técnica de Análise Textual Discursiva. Resultados: analisaram-se três categorias, intituladas deficiência de estrutura física e de recursos humanos; falta de políticas e critérios claros para admissão de paciente e alta inadequada da unidade de terapia intensiva. Nas situações de internação por ordem judicial há alteração nos critérios de alocação de leito de terapia intensiva, mediante a credibilidade dos profissionais, ameaças de processos médico-legais por parte de familiares e imposição judicial às instituições e aos profissionais de saúde. Conclusão: enfermeiros defendem as necessidades dos pacientes, também, com ações que possam impactar positivamente na disponibilidade de leitos de terapia intensiva e de infraestrutura adequada de atendimento.

Resumo Objetivo: identificar, desde la perspectiva de los enfermeros, situaciones que interfieren en la disponibilidad de camas en unidad de terapia intensiva en contexto de internación por orden judicial. Método: investigación cualitativa exploratoria, analítica realizada con 42 enfermeros que prestan servicios en terapia intensiva de adultos. La selección se realizó por muestreo no probabilístico de bola de nieve. Recolección de datos por medio de entrevistas y análisis mediante la Técnica de Análisis de Texto Discursivo. Resultados: se analizaron 3 categorías a saber: deficiencia de infraestructura y de recursos humanos; falta de políticas y criterios claros para admisión de pacientes y alta inadecuada en unidades de terapia intensiva. En situaciones de internación por orden judicial, se advierten alteraciones respecto de los criterios de asignación de camas de terapia intensiva, mediante la credibilidad de los profesionales, amenazas de interposición de acciones médico-legales por parte de los familiares e imposiciones judiciales a instituciones y a profesionales de la salud. Conclusión: los enfermeros abogan por las necesidades de los pacientes mediante acciones que puedan impactar de manera positiva en la disponibilidad de lechos de terapia intensiva y de una infraestructura adecuada de atención.

Advocacy in intensive care and hospitalization by court order: what are the perspectives of nurses? / Abogacia en atención intensiva y hospitalización por orden judicial: ¿cuáles son las perspectivas de los enfermeros? / Advocacia na terapia intensiva diante da internação por ordem judicial: qual a perspectiva dos enfermeiros?

ABSTRACT Objective: to analyze how intensive care nurses practice patient advocacy in view of the need for hospitalization by court order to an intensive care due to bed unviability. Method: analytical exploratory qualitative research. Data were obtained through interviews with 42 nurses, selected via snowball sampling, between January and December 2016. The interviews were analyzed using elements of the Discursive Textual Analysis. Results: two categories emerged: 1) Between obedience to the law and the ethical-moral duty of the intensive care nurse; 2) The position of nurses in the practice of patient advocacy for patients requiring intensive care beds. Conclusions: intensive care nurses exercise sensitivity and moral duty of the care process when defending their patients by informing them of their rights, guiding, acting and talking to and on behalf of patients and their families, valuing care free of judgment and harm to the patient hospitalized by court order.

RESUMEN Objetivo: analizar cómo los enfermeros de cuidados intensivos practican la defensa del paciente en vista de la necesidad de hospitalización por orden judicial a cuidados intensivos debido a la inviabilidad de la cama. Método: investigación exploratoria, analítica cualitativa. Los datos se obtuvieron a través de entrevistas con 42 enfermeros, seleccionados mediante muestreo de bola de nieve, entre enero y diciembre de 2016. Las entrevistas se analizaron utilizando elementos del Análisis textual discursivo. Resultados: surgieron dos categorías: 1) Entre la obediencia a la ley y el deber ético-moral del enfermero de cuidados intensivos; 2) La posición de los enfermeros en la práctica de la defensa del paciente para pacientes que requieren camas de cuidados intensivos. Conclusiones: los enfermeros de cuidados intensivos ejercen la sensibilidad y el deber moral del proceso de atención cuando defienden a sus pacientes informándoles sobre sus derechos, guiándoles, actuando y hablando con y en nombre de los pacientes y sus familias, valorando la atención libre de juicio y daños al paciente hospitalizado por orden judicial.

RESUMO Objetivo: analisar como enfermeiros intensivistas têm exercido a advocacia do paciente diante da necessidade de internação em unidade de terapia intensiva por ordem judicial, perante in/viabilidade de leito. Método: pesquisa qualitativa exploratória, analítica. Os dados foram obtidos através da realização de entrevistas com 42 enfermeiros, selecionados mediante amostragem por bola de neve, entre janeiro e dezembro de 2016. As entrevistas foram analisadas mediante elementos da Análise Textual Discursiva. Resultados: emergiram duas categorias: 1) Entre a obediência à lei e o dever ético-moral do enfermeiro intensivista e; 2) A posição dos enfermeiros no exercício da advocacia do paciente que necessita de leito na terapia intensiva. Conclusões: enfermeiros intensivistas exercem a sensibilidade e dever moral do processo de cuidar quando defendem seus pacientes informando-os sobre seus direitos, orientando, agindo e falando sobre e em nome dos pacientes e seus familiares, prezando por um cuidado livre de julgamentos e prejuízos ao paciente que interna através da ordem judicial.

Acreditação hospitalar: a excelência como fonte de sofrimento moral para enfermeiros / Hospital accreditation: excellence as a source of moral distress for nurses

Objetivo: Analisar a prática profissional de enfermeiros em um hospital privado acreditado, sob o prisma da ética da virtude. Metodologia: Estudo de caso qualitativo, realizado em um Hospital Privado “Acreditado com Excelência” em Minas Gerais. Os participantes foram 13 enfermeiros. A coleta de dados foi realizada mediante entrevista individual seguindo roteiro semiestruturado e observação e submetidos à Análise Temática de Conteúdo. Resultados: Foram identificadas contradições entre os valores que norteiam a organização do trabalho na instituição, cujo enfoque é a acreditação e os valores dos enfermeiros, os quais são voltados para o cuidado. Conclusão: A contradição encontrada distancia o enfermeiro de sua prática, colocando-o em confronto com a sua profissão, provocando sofrimento moral.

Objective: To analyze the professional practice of nurses in an accredited private hospital, under the prism of virtue ethics. Methodology: Case study with a qualitative approach performed in a Private Hospital “Excelent in Accreditation” in Minas Gerais. The participants were 13 nurses. The data collection was performed through an individual interview following a semistructured script and observation and, submitted to the Thematic Content Analysis. Results: Contradictions were identified among the values that guide the organization of work in the institution, whose enforcement is the accreditation and values of nurses, which are focused on care. Conclusion: The contradiction found distances the nurses from their practice, putting them in confrontation with their profession, provoking the moral suffering.

Objetivo: Analizar la práctica profesional de enfermeros en un hospital privado acreditado, bajo el prisma de la ética de la virtud. Metodología: Estudio de caso cualitativo realizado en un Hospital Privado “Acreditado con Excelencia” en Minas Gerais. Participaron del estudio 13 enfermeros. La recolección de datos fue realizada mediante entrevista individual siguiendo itinerario semiestructurado y observación y sometidos al Análisis Temático de Contenido. Resultados: Se identificaron contradicciones entre los valores que orientan la organización del trabajo en la institución, cuyo ahorque es la acreditación y los valores de los enfermeros, los cuales se dirigen al cuidado. Conclusión: La contradicción encontró distancia al enfermero de su práctica, colocándolo en confrontación con su profesion, provocando el sufrimiento moral.

The ethics in qualitative health research: special considerations / A ética na pesquisa qualitativa em saúde: considerações especiais

AbstractA sound knowledge of the nature of qualitative research, along with an appreciation of some special ethical considerations, is needed for rigorous reviews to be conducted. The overall character of qualitative research is described with an emphasis on the tendency of qualitative researchers to explore sensitive topics using theoretically informed methods. A number of specific features of qualitative that require additional ethical attention and awareness are also examined including the following: 1) participants are frequently quite vulnerable and require protection because the data collection methods, such as in-depth interviews, can delve into personally and politically charged matters; 2) naturalistic observation can raise concerns regarding privacy and consent; 3) the potential for the identifiability of the results of this research may require extra efforts to maintain confidentiality. Ultimately, Reseach Ethics Committee members must be knowledgeable about qualitative approaches to be able to assess the potential harms and benefits in a protocol carefully. Without this knowledge gaining ethics approval can be overly difficult for researchers and the best practices for protecting human participants can be overlooked.

ResumoO caráter geral da pesquisa qualitativa é descrito com ênfase na tendência de pesquisadores qualitativos para explorar temas sensíveis, utilizando métodos teoricamente informados. Algumas características específicas de pesquisa qualitativa que requerem consciência e atenção ética adicional também são examinadas, incluindo as seguintes: 1) frequentemente os participantes são bastante vulneráveis e necessitam de proteção porque os métodos de coleta de dados, tais como entrevistas em profundidade, podem levar a uma profunda análise de questões repletas de aspectos pessoais e políticos; 2) a observação naturalística pode levantar questões específicas em matéria de privacidade e consentimento; 3) o potencial de que os resultados da pesquisa possibilitem a identificação dos participantes exige esforços adicionais para proteger a privacidade deles. Em última análise, os membros dos Comitês de Ética em Pesquisa (CEP) devem conhecer as abordagens qualitativas para avaliar cuidadosamente os potenciais danos e benefícios em um protocolo. Sem esse conhecimento, a aprovação ética pode ser excessivamente difícil para os pesquisadores e as melhores práticas para proteger os participantes podem ser negligenciadas.

A narrative approach to empirical nursing ethics research: uncovering the everyday moral knowledge of nurses

In this paper we explore the use of Margaret Urban Walker's metaethical perspective, particularly the use of narratives, to inform the development of a research approach to uncover the everyday moral knowledge of nurses. A method based on Walker's work makes it possible to analyze the power dimensions inherent in nurses' moral experience, to ground a narrative approach to nursing ethics with a robust moral epistemology, and to differentiate different types of narratives. A number of analytic questions, which have their basis in Walker's work, are presented and are used to analyze a practice narrative written to illustrate how narratives can be used to draw out the moral knowledge of nurses within the context of their actual work.

Neste artigo nós exploramos o uso da perspectiva metafísica de Margaret Urban Walker, particularmente o uso de narrativas, para informar o desenvolvimento de uma abordagem de pesquisa para revelar o conhecimento moral cotidiano de enfermeiras. Um método baseado no trabalho de Walker torna possível analisar as dimensões de poder intrínsecas na experiência moral das enfermeiras, fundamentar a abordagem narrativa à ética da enfermagem com uma moral epistemológica robusta e distinguir diferentes tipos de narrativas. Um número de questões analíticas que tem suas bases no trabalho Walker, são apresentadas e utilizadas para analisar a prática narrativa e ilustrar como as narrativas podem ser usadas para delinear o conhecimento moral de enfermeiras dentro do contexto de seu trabalho real.

En el presente artículo exploramos el uso de la perspectiva metafísica de Margaret Urban Walter, particularmente el uso de narrativas, para informar sobre el desarrollo de un abordaje de investigación que revela el conocimiento moral cotidiano de las enfermeras. Un método basado en el trabajo de Walter permite analizar las dimensiones de poder inherentes en la experiencia moral de las enfermeras, así como fundamentar con una moral epistemológica robusta, el abordaje narrativo ético de la enfermería, y distinguir los diferentes tipos de narrativas. Un número de cuestiones analíticas basadas en el trabajo de Walker son aquí presentadas y empleadas para analizar la práctica narrativa e ilustrar cómo las narrativas pueden ser usadas para delinear el conocimiento moral de las enfermeras dentro del contexto de su trabajo real.

Are submissive nurses ethical?: reflecting on power anorexia

We believe that the notion of power anorexia, which we define as a lack of desire to exercise power, is central to reflections about nursing ethical concerns. Questioning the assumption that nurses are powerless, we argue that nurses can and do exercise power and that their actions and inactions have consequences not only for themselves, but also for those for whom they care. We propose that a feminist ethics perspective be used both to understand and to overcome nurses' power anorexia. Feminist thinkers remind us not only of oppression's psychological impact, but that stereotypical views about women are socially constructed and, therefore, can be changed. Nurses using this framework should explore the implications of a centralized notion of caring to the way we conceive of power relations in health care. Perhaps deconstructing caring by focusing on how nurses exercise power could help us to re-conceptualize nursing and promote new agendas for health and health care.