Professional responsibility, nurses, and conscientious objection: A framework for ethical evaluation.

Conscientious objections (CO) can be disruptive in a variety of ways and may disadvantage patients and colleagues who must step-in to assume care. Nevertheless, nurses have a right and responsibility to object to participation in interventions that would seriously harm their sense of integrity. This is an ethical problem of balancing risks and responsibilities related to patient care. Here we explore the problem and propose a nonlinear framework for exploring the authenticity of a claim of CO from the perspective of the nurse and of those who must evaluate such claims. We synthesized the framework using Rest's Four Component Model of moral reasoning along with tenets of the International Council of Nursing's (ICN) Code of Ethics for Nurses and insights from relevant ethics and nursing ethics literature. The resulting framework facilitates evaluating potential consequences of a given CO for all involved. We propose that the framework can also serve as an aid for nurse educators as they prepare students for practice. Gaining clarity about the sense in which the concept of conscience provides a defensible foundation for objecting to legally, or otherwise ethically, permissible actions, in any given case is critical to arriving at an ethical and reasonable plan of action.

Moral Resilience: Managing and Preventing Moral Distress and Moral Residue.

Moral resilience is the ability to deal with an ethically adverse situation without lasting effects of moral distress and moral residue. This requires morally courageous action, activating needed supports and doing the right thing. Morally resilient people also have developed self-confidence by confronting such situations so they can maintain their self-esteem, no matter what life delivers. Finally, the ability to adapt to changing circumstances with a sense of humor is at the heart of their flexibility. Morally resilient nurses are not naïve about the price of moral integrity. They know it does not come without pain of dealing with adversity, but they believe the virtue of moral courage is necessary to meet the ethical obligations of their profession (ANA, 2015b).

The journey of women with breast cancer who engage in mindfulness-based stress reduction: a qualitative exploration.

This phenomenological study explores the "lived experience" of 8 women with stage I or II breast cancer who used mindfulness-based stress reduction (MBSR). The following 4 themes were identified: (1) the cancer journey: a shift in perception, (2) the treatment journey: the experience of MBSR, (3) the journey toward recovery, and (4) the journey toward self.

Palliative wound care: a concept analysis.

The concept of palliative wound care is in its infancy, with relevant literature emerging in the 1980s. Palliative wound care has evolved over time as new research and practice initiatives continue to explore its usefulness. We applied Rodgers' evolutionary concept analysis to a conceptual exploration of palliative wound care. The findings of this analysis identified reoccurring themes that were grouped into the concept's antecedents, attributes, and consequences. We found that palliative wound care is a holistic integrated approach to care that addresses symptom management and psychosocial well-being, is multidisciplinary, is driven by patient/family goals, and is integrated into wound healing principles and everyday practice. The integration of palliative wound care into the continuum of wound care, not just at the end of life, is the logical conclusion.

Clinical ethics committees: organizational support for ethical practice.

The tripartite functions of an ethics committee are case consultation, institutional policy review and development, and ethics education. Preparation before calling an ethics consultation is critical. In addition, serving on an ethics committee provides a personally and professionally rewarding experience because of the service performed for staff, patients, and families. This author encourages nurses to volunteer for this experience, as there is no better way to understand the perplexing ethical problems in health care today. As nurses become more active on ethics committees, health care will transition from the traditional demand-initiated consult to a process that will emphasize the prevention of ethical conflicts by fostering the development of ethical practice protocols or guidelines (Nelson et al., 2008).

Teaching innovation.

Innovation in healthcare is essential to solve the "wicked problems" currently facing healthcare. This article focuses on nature of innovation and how it operates, how innovators think and view problems, how the theory and practice of innovation can be taught in novel ways, and how organizational cultures foster or suppress innovation. Examples of teaching strategies and nurse-driven innovation illustrate the theory and practice of innovation.

Practical use of the nursing code of ethics: part I.

The Code (ANA, 2001) provides the nurse guidance for legal and ethical responsibilities to patients and, in the broader sense, to society. The first provision calls for honoring the human dignity in all patients and colleagues. It lays the groundwork for the importance of the essential ethical principle of autonomy, the right to self-determination. The second provision describes the importance of interdisciplinary collaboration and significance of appropriate nurse-patient boundaries. The importance of privacy and confidentiality in the nurse-patient relationship is the focus of the third provision. Without the nurse's honoring of privacy, the patient would be hesitant to share important information necessary to design an effective plan of care. The fourth provision primarily focuses on the importance of accountability for personal actions and for the actions of those to whom the nurse has delegated. By meeting these obligations, the nurse will remain the most trusted health care professional.

Practical use of the nursing Code of Ethics: part II.

The Code Provisions V through IX focus on a variety of responsibilities for the professional nurse. Provision V spotlights nurses' obligation to the same values and actions for themselves as are espoused in The Code for their patients. Provision VI addresses the responsibility of all nurses to maintain quality patient care, regardless of their roles in the health care system. Meeting professional obligations to maintain and forward the nursing profession can take a variety of forms, as indicated in Provision VII. Provision VIII reviews the macro level of professional nursing responsibility by centering on the issues of world hunger, pollution, and other violations of justice. Finally, Provision IX identifies the importance of involvement in professional associations and their efforts for social reform. The first two provisions of The Code address the boundaries of obligation and dependability (Lachman, 2009), and the last three address the duties outside individual patient experience.

Whistleblowers: troublemakers or virtuous nurses?

Whistleblowing is the action taken by a nurse who goes outside the organization for the public's best interest when it is unresponsive to reporting the danger through the organization's proper channels. As a professional, every nurse needs to champion whistleblowing rather than ostracizing nurses with the moral courage to speak out on unethical practices.

Whistleblowing: role of organizational culture in prevention and management.

An ethical culture is necessary to prevent and manage whistleblowing. Whistleblowing is often the result of an organizational culture that lacks the accountability for its espoused values.