Finding meaning in life: an exploration on the experiences with dependence on care of patients with advanced cancer and nurses caring for them.

PURPOSE: Patients with advanced cancer are likely to face increasing levels of care dependence. Adult patients who become care dependent on others can experience this condition as one of suffering and humiliation. The nurse-patient relationship plays a key role in the experience of dependence. Understanding patients' and nurses' perceptions of care dependence is crucial to addressing the impact it has on the lives of both. The aim of this study is to explore the experiences of patients with cancer and nurses caring for them. METHODS: A multicentre qualitative study was conducted in Italy using semi-structured interviews with patients with advanced cancer admitted to 3 hospitals, and 9 focus groups with nurses working in oncology wards of 2 hospitals. Data were analysed with inductive content analysis. RESULTS: Thirty-two patients and 44 nurses participated in the study. Three common themes were identified: within dependence, the relationship is a lifeline; dependence is influenced by internal and external factors and dependence generates changes. Dependence impacts on patients' and nurses' lives and implies a process of personal maturing for both. Patients learn the humility to ask for help by exposing their vulnerability. Nurses become aware that a trusting relationship helps patients to accept dependence, and they learn to self-transcend in order to build it. CONCLUSIONS: Striving to build positive relationships implies a change in nurses' and patients' lives. In this way, they come to understand important aspects of life and find meaning in difficult situations. Further studies should explore also homecare settings and patients' families.

Dignity: The Cornerstone of Nursing Care Among Hospitalized Mothers of Infants in Neonatal Intensive Care Unit.

: One of the most important areas of nursing care delivery is "dignity." Because of the increase in hospitalized infants in neonatal intensive care units in recent years, this has led to an increased focus on "family care and maternal dignity." Given the importance of understanding the phenomenon of maternal dignity in order to improve cooperation in the care of their infants and promote family-centered care, this study aims to describe the lived experience of hospitalized mothers of infants within the context of dignity. This is a descriptive phenomenological qualitative research study. Twenty mothers were invited to participate in this study using purposeful sampling. The data were generated through individual, semistructured interviews and field notes were developed during the interviews. Data were analyzed using the Colaizzi method.Findings of the study were presented in 3 themes: "privacy," "respecting individual identity," and "authority," and 7 additional subthemes. Mothers in this study needed to take care of their infants in an environment where their personal privacy is preserved, their individual identity is respected, and they have sufficient authority in obtaining medical decisions. It is essential that healthcare teams and policy makers of health organizations provide an appropriate supportive environment in terms of promoting mothers' dignity in different dimensions and subsequently improving family-centered care.

Ethical conflicts in patient relationships: Experiences of ambulance nursing students.

BACKGROUND: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts. AIM: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies. RESEARCH DESIGN: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses. PARTICIPANTS: The 69 participants attended a 1-year educational programme for ambulance nurses at a Swedish university. ETHICAL CONSIDERATIONS: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study. FINDINGS: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient's narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient's decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient's best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care. DISCUSSION: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient's best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient's communication and decision-making ability, the views of third parties, and the need for prioritisation. CONCLUSION: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient's best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient's decision-making ability.

During the COVID-19 pandemic, should nurses offer to pray with patients?

Patients hospitalized with COVID-19 are unable to visit with friends and family, and religious patients cannot see personal clergy or even hospital chaplains. These patients may be scared, possibly mechanically ventilated, and dying. In these situations, should their nurse ever initiate an offer of prayer? Weighing the pros and cons of this issue, this discussion will argue that when offered in an ethical, patient-centered manner, nurses offering prayer can be therapeutic for some patients.

Relationships and burden: An empirical-ethical investigation of lived experience in home nursing arrangements.

Quantitative research has called attention to the burden associated with informal caregiving in home nursing arrangements. Less emphasis has been placed, however, on care recipients' subjective feelings of being a burden and on caregivers' willingness to carry the burden in home care. This article uses empirical material from semi-structured interviews conducted with older people affected by multiple chronic conditions and in need of long-term home care, and with informal and professional caregivers, as two groups of relevant others. The high burden of home-care arrangements is unanimously stressed by all three groups involved in the triangle of care. An empirical-ethical investigation of what can be legitimately expected from family members and informal caregivers, informed by Frith's symbiotic empirical ethics approach, was undertaken. Key tenets from the special goods theory and nursing professionalism are used as analytical tools. The study concludes that the current situation may hinder professional development and can reinforce feelings of being a burden to relevant others.

An ethnographic study of human dignity in nursing practice.

BACKGROUND: The ethical values of nursing are crucial to the provision of humane care. Human dignity is a core value that must be preserved in order to deliver such care. No studies to date have compared the perceptions of nurses and/or patients regarding the components of dignified care embedded in actual clinical practice. PURPOSE: To explore the delivery of dignified care by professional nurses. This was an ethnographic qualitative study combining inductive and deductive methods to identify emergent themes. A multicenter study carried out in the internal medicine units of four hospitals in Barcelona (Spain). Convenience sampling was used to recruit nurses from the four units. SETTING AND SAMPLE: Multicenter study carried out in the internal medicine units of four hospitals in Barcelona (Spain). Convenience sampling was used to recruit nurses from the four units. METHOD: We conducted 158 hours of participant observation of 27 nurses. Semi-structured individual interviews were undertaken with 20 of these nurses, with data saturation being reached. Data were collected between September 2014 and May 2016 and were analysed using ATLAS.ti 7.2 for Windows. RESULTS: Two themes emerged from the analysis: Delivering dignified care and Factors influencing the delivery of dignified care. The nurses regarded human dignity as one of the key values of their profession. However, there was a discrepancy between their perceptions of the care they offered and what they actually did, due mainly to a lack of awareness about their own practice. Respect, confidentiality, privacy and communication were identified as the key elements underpinning dignified care. Institutional policies were seen as the major obstacle to the delivery of humane care, the key issues being frequent shift rotations, a high patient-nurse ratio and excessive paperwork. CONCLUSIONS: The results of this study underline the importance of delivering dignified care and the need to ensure that nurses' attitudes and behaviours are consistent with this goal. The ethnographic approach, combining participant observation with individual interviews, revealed discrepancies between nurses' perceptions of the care they offered, or should offer, and what they actually did. This suggests a need for professional forums in which nurses can become more aware of their own clinical practice.

Is it morally permissible for hospital nurses to access prisoner-patients' criminal histories?

In the United States, information about a person's criminal history is accessible with a name and date of birth. Ruth Crampton has studied nurses' care for prisoner-patients in hospital settings and found care to be perfunctory and reactive. This article examines whether it is morally permissible for nurses in hospital settings to access information about prisoner-patients' criminal histories. Nurses may argue for a right to such information based on the right to personal safety at work or the obligation to provide prisoner-patients with the care that they deserve. These two arguments are considered and rejected. It is further argued that accessing information about a prisoner-patient's criminal history violates nurses' duty to care. Care, understood through Sarah Ruddick's account as work and relationship, requires nurses to be open and unbiased in order to do their part in forming a caring relationship with patients. Knowledge of a prisoner-patient's criminal history inhibits the formation of this relationship and thus violates nurses' duty to care.

[Ethics and giving bad news to a patient with Alzheimer's]. / Éthique et mauvaise nouvelle à un patient Alzheimer.

Breaking bad news to a patient with Alzheimer's often raises ethical questions: should the person be informed or not when there is a risk he or she will not understand or retain the explanations provided? While on the face of it the truth seems desirable, it is important to carefully analyse what is at stake as this truth can potentially harm a vulnerable patient. The person making the disclosure can find themselves at the centre of a conflict: on the one hand loyalty and a moral duty to inform, on the other a compassionate lie to protect the patient from upsetting news. Being aware of the ethical issues at the heart of this dilemma can help to indicate the best path to take for the benefit of the patient, the family and the nurses.

Respectful care of human dignity: how is it perceived by patients and nurses?

OBJECTIVE: Dignified care protects the patient's rights and provides appropriate ethical care while improving the quality of nursing care. In this context, the opinions of nurses and patients who receive nursing care about dignified care are important. The aim of this study was to explore the opinions and experiences of Turkish patients and nurses about respectful care of human dignity. METHODS: This descriptive cross-sectional study was conducted in Turkey. Participants were inpatients at cardiology, neurology and neurosurgery clinics and nurses working in these clinics. The data for the study were collected from face-to-face interviews using questionnaires. The percentages of characteristics and preferences of the participants were calculated, and the results were analysed using statistical tests. RESULTS: A total of 150 patients and 78 nurses participated in the study. The patients stated that the protection of their rights was the most important factor for dignified nursing care. The nurses stated that being careful to not expose the patients' body and being respectful of the patients' privacy were important in dignified nursing care. The age of the patient, duration of the disease, number of hospitalisations and length of time the nurses had been working at the clinic caused significant changes in the factors considered important in dignified care. CONCLUSIONS: Our findings provide a perspective on dignified care in the Turkish healthcare setting. There were some differences between patients and nurses in the factors considered important for dignified care. The discussion with patients and nurses related to care and practices that protect or detract from human dignity can provide insights to ethics.

Responsibility and age-related dementia.

This article identifies the assumption of responsibility as a basic need of human beings and applies the concept specifically to older people with dementia or Alzheimer's disease. It suggests a two-level concept of responsibility, based on the approach of discourse ethicist Karl-Otto Apel, as a promising approach to recognizing human diversity while at the same time respecting people's equal rights to participate in discourse. This concept can serve as a theoretical starting point for the construction of individually adapted types of responsibility. Furthermore, the article describes practical ideas (primarily the practice of doll therapy) that can enable people with dementia or Alzheimer's disease to assume responsibility. Direct communication and a reflective, sensitive consideration of each individual case are identified as important prerequisites for the inclusion of elderly people with dementia.

Direct-to-consumer advertising effects on nurse-patient relationship, authority, and prescribing appropriateness.

BACKGROUND:: Discussing direct-to-consumer advertising of prescription drugs during a visit could affect prescribing practices and provider-patient relationship. RESEARCH OBJECTIVES:: The study examines advanced practice nurse prescribers' perceptions of direct-to-consumer advertising and its effects on nurse-patient relationship, prescriptive authority, and appropriateness of patient clinical requests. RESEARCH DESIGN:: A cross-sectional survey design was implemented. PARTICIPANTS AND RESEARCH CONTEXT:: The random sample consisted of 316 nurses (27.17% response rate) in one of the Midwestern states in the United States. Pearson's chi-square analysis and multiple/multinomial logistic regression analyses were used. ETHICAL CONSIDERATIONS:: Permission to conduct the study was obtained from the university's Institutional Review Board. Participation was voluntary, and measures were taken to protect the anonymity and confidentiality of consenting participants. FINDINGS:: Most nurses (69%) believed that patients were "poor or very poor" at assessing the relevance of drug advertisements, 61% reported that the increase in drugs advertisements directed at patient was "a bad or a very bad thing," and only 16% thought the advertisements were accurate to "a very or to a great extent." Improved nurse-patient relationship was associated with factors such as the patient not bringing printed material, seeking nurse's opinion only, taking responsibility for their health, and not challenging nurse's prescriptive authority. DISCUSSION:: Advertising discussion during a visit could improve as well as pose a challenge to a nurse-patient relationship and nurse's prescriptive authority. CONCLUSION:: The positives of discussing advertising information can be maximized and the negatives minimized through enhanced interpersonal nurse-patient communication.

Caring for elder patients: Mutual vulnerabilities in professional ethics.

BACKGROUND:: Neglect and abuse of elders in care institutions is a recurring issue in the media. Elders in care institutions are vulnerable due to their physical, cognitive, and verbal limitations. Such vulnerabilities may make them more susceptible to mistreatment by caregivers on whom they are heavily dependent. OBJECTIVES:: The goal was to understand caregivers' concerns about ensuring correct and proper treatment, as well as their experiences with neglect and abuse of older patients. This article examines resources and challenges of professional ethics within the care setting. RESEARCH DESIGN:: A study was conducted to explore the quality of care provided to older patients in nursing homes, geriatrics institutions, and ambulant care in the northwest region of Switzerland. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 23 semi-structured interviews were conducted with nursing staff of varying experience levels. ETHICAL CONSIDERATIONS:: Ethical approval was granted by the competent regional ethics commission, Ethikkomission Nordwest-und Zentralschweiz EKNZ [Ethics Commission Northwest and Central Switzerland] (2014-015). FINDINGS:: Three themes emerged from our data analysis: professional identity, professional context, and professional relationships. Our findings indicate mutual vulnerabilities within these three themes, characterizing the interactions between nursing staff and older patients. Study participants believe that incidences of error, neglect, and abuse are consequences of their own vulnerability since they are not able to meet the demands of an overstraining work situation. DISCUSSION:: Different aspects of this mutual vulnerability are described and critically discussed as challenges for professional ethics. CONCLUSION:: Early education, continuous training as well as better management and response from the institution are necessary to maintain professionalism while handling mutual vulnerabilities.

Heeding humanity in an age of electronic health records: Heidegger, Levinas, and Healthcare.

The American Recovery and Reinvestment Act of 2009 (ARRA) required healthcare providers in the United States to adopt and demonstrate meaningful use of electronic health records (EHRs) by January 1, 2014. In many ways, EHRs mark a notable improvement over paper medical records as they are more easily accessible and allow for electronic searching and sharing of medical history. However, as EHRs have become mandated by ARRA, many nurses now rely upon computers far more heavily during nurse-patient interactions, thereby decreasing the level of direct interpersonal communication between the two. There is evidence that eye contact between nurses and patients positively affects patient satisfaction. Above and beyond the issue of patient satisfaction is the more basic ethical issue of respecting the patient as a person. The author argues that the templates used in electronic health systems have the possibility of eroding the respect for humanity that is the hallmark of nurse-patient relationships, as signalled by the American Nurses Association's first principle in their Code of Ethics. Using concepts from philosophers Martin Heidegger and Emmanuel Levinas, the author provides guidance as to what an ethical interaction between nurse and patient should look like in an age of EHRs.

Empathy as an Ethical Imperative.

Empathy is an often-discussed topic among nurse scientists, educators, and professional practitioners. There is a small, but growing, body of research with a focus on empathy and its direct impact on clinical patient outcomes. However, nurses continue to place value on behavioral aspects of empathy, such as understanding the thoughts and feelings of others, caring, and perspective taking (Hojat, 2016; Kunyk & Olson, 2001). These empathic behaviors are foundational to establishing the nurse-patient relationship. The nurse-patient relationship is also central to the delivery of ethical patient care (American Nurses Association [ANA], 2015). Ethical care directly reflects elements of professional empathy, such as providing compassionate care, understanding the patient's perspective, and thoughtful consideration of the needs and values of each person (ANA, 2015). Empathy and ethics are connected, and both play a vital role in the decision-making process of nurses, particularly for decisions involving some level of uncertainty that require moral reasoning or values-based judgment (Barlow, Hargreaves, & Gillibrand, 2018).

[The reception, a prerequisite of the encounter: a political question]. / L'accueil, condition sine qua non de la rencontre : une question politique.

The reception of a patient in psychiatry is a stage which consists of more than a single initial contact between a person suffering psychologically and a caregiver. This time can open the way to an encounter, without which a care relationship cannot be established. The reception as a paradigm of psychiatric care questions the concept of this care, at a time when caregivers cannot avoid the question of their political engagement.

[Accessing the sensitive part of the Being before us]. / Accéder à la part sensible de l'Être qui nous fait face.

The acceleration of the standardisation of care and the dominance of the quality approach, since the 1990s, have brought significant changes to nursing practices, the different therapeutic approaches and the 'place' of caregivers with regard to the patient. In this context of modern psychiatry which must comply with all kinds of recommendations, what is the situation of the patient suffering from psychosis, who would previously have been supported over the long term in a psychopathological process? The encounter, envisaged as an opening, is placed at the heart of the therapeutic relationship.

When parents won't vaccinate their children: a qualitative investigation of australian primary care providers' experiences.

BACKGROUND: Increasingly, the experiences and perceptions of parents who decline vaccination are the subject of investigation. However, the experiences of clinicians who encounter these parents in the course of their work has received little academic attention to date. This study aimed to understand the challenges faced and strategies used when general practitioners and immunising nurses encounter parents who choose not to vaccinate their children. METHODS: Primary care providers were recruited from regions identified through the Australian Childhood Immunisation Register (ACIR) as having higher than national average rates of registered objection to childhood vaccination. Interviews began with an exploration of provider experiences with parents who accept, are hesitant towards, and who decline vaccination. Participants were asked specifically about how they addressed any difficulties they encountered in their interactions. Thematic analysis focused on encounters with parents - challenges and strategies. RESULTS: Twenty-six general practitioners (GPs), community and practice nurses (PNs) were interviewed across two regions in NSW, Australia. Providers' sense of professional identity as health advocates and experts became conflicted in their encounters with vaccine objecting parents. Providers were dissatisfied when such consultations resulted in a 'therapeutic roadblock' whereby provider-parent communication came to a standstill. There were mixed views about being asked to sign forms exempting parents from vaccinating their children. These ranged from a belief that completing the forms rewarded parents for non-conformity to seeing it as a positive opportunity for engagement. Three common strategies were employed by providers to navigate through these challenges; 1) to explore and inform, 2) to mobilise clinical rapport and 3) to adopt a general principle to first do no harm to the therapeutic relationship. CONCLUSIONS: Many healthcare providers find consultations with vaccine objecting parents challenging and some, particularly more experienced providers, employ successful strategies to address this. Primary care providers, especially those more junior, could benefit from additional communication guidance to better the outcome and increase the efficiency of their interactions with such parents.

Descriptive study of association between quality of care and empathy and burnout in primary care.

BACKGROUND: The doctor-patient relationship is a crucial aspect of primary-care practice Research on associations between quality of care provision and burnout and empathy in a primary care setting could improve this relationship. METHODS: Cross-sectional study of family physicians (108) and nurses (112) of twenty-two primary care centers in the health district of Lleida, Spain. Empathy and burnout were measured using the Jefferson Physician Empathy Scale and the Maslach Burnout Inventory, while quality of care delivery was evaluated using Quality Standard Indicator scores. JPSE and MBI results were grouped into low, medium, and high scores to analyze associations with QSI scores and sociodemographic variables. RESULTS: The mean QSI score recorded for the family physicians and nurses was 665 (out of a total of 1000). Higher, albeit insignificant, QSI scores were observed for practitioners with high burnout. No differences were observed according to level of empathy (p > 0.05). The differences with respect to sex, age, and area of practice (urban vs rural center) were not significant. Practitioners with low empathy had higher QSI scores than those with high empathy (672.8 vs. 654.4) while those with high burnout had higher scores than those with low burnout (702 vs. 671). CONCLUSIONS: Burnout and empathy did not significantly influence quality of care delivery scores in 22 primary care centers. More studies, however, are needed to investigate the unexpected trend observed that suggests that physicians and nurses with higher levels of burnout provide higher quality care.

Pediatric Inpatient Nurses' Perceptions of Child Maltreatment.

PURPOSE: The purpose of this study was to explore the perceptions of child maltreatment among inpatient pediatric nurses. DESIGN AND METHODS: A cross-sectional survey was used to obtain responses to an online survey designed to examine perceptions of child maltreatment from inpatient pediatric nurses. RESULTS: Many nurses surveyed (41.25%) indicated that they had not received adequate training or had never received training on child maltreatment identification and many (40%) also indicated they were not familiar with the applicable reporting laws. CONCLUSIONS: Due to the serious immediate and long term effects of child maltreatment, it is imperative that pediatric inpatient nurses have adequate training on how to identify potential abuse and neglect cases, as well as legal reporting requirements, since they are in a unique position to identify potential cases of maltreatment. PRACTICE IMPLICATIONS: There is a continuing need for training on child maltreatment identification and reporting laws for inpatient pediatric nurses.