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.

Abordagem familiar: uma teoria sobre a experiência de enfermeiros na Estratégia Saúde da Família / The Family Health Strategy: an approach

A família sempre esteve na base da abordagem em saúde, mesmo quando as políticas públicas não faziam essa recomendação. No Brasil, os primeiros apontamentos políticos nesse sentido iniciaram-se a partir da criação do Sistema Único de Saúde e, mais especificamente, da Estratégia Saúde da Família (ESF). Apesar do avanço inicial proporcionado por essa estratégia, o que se percebe,atualmente, é o distanciamento das diretrizes originais em relação ao cuidado familiar. Parte-se do pressuposto que a família, como unidade de cuidado e cuidadora, tanto pode ser promotora da saúde de seus integrantes, com ações que proporcionam uma vida saudável familiar, constituindo uma rede social de suporte às pessoas, como também pode contribuir para o processo de adoecimento de seus familiares, com imposição de normas limitantes culturalmente estabelecidas. Em contrapartida, cada família, por sua vez, também pode influenciar no processo saúde– doença. Diante do exposto, alguns questionamentos são apresentados: quais são as concepções de família construídas pelos enfermeiros? Como essas concepções influenciam em sua abordagem familiar? Como, de fato, a família tem sido utilizada como subsídio para a construção dos planos terapêuticos na Estratégia Saúde da Família? Como os enfermeiros percebem a inserção social das famílias assistidas e como esta interfere na abordagem familiar? Esses questionamentos embasam a tese defendida nesta pesquisa: a abordagem familiar pelo enfermeiro parte da sua concepção sobre o que é família, construída a partir de influências recebidas durante sua vida, que mantém relação direta com a sua forma de cuidar das famílias. Ainda,os fatores conjunturais aos quais as famílias estão socialmente submetidas conferem uma dinâmica específica ao conceito de família, que os profissionais inseridos na Estratégia Saúde da Família não têm conseguido acompanhar, não incorporando essas mudanças à sua forma de abordar as famílias...

The family has always been the basis for health care, even when public policies did not make that recommendation. In Brazil, the first political appointments for the family started up from the creation of the Public Health System and the Family Health Strategy. Currently, despite the initial break through provided by this strategy, what we see is the distance of the original guidelines in relation to family care. Thus, the objective of this research was to build theory about the family approach carried outby the nurse in the Family Health Strategy. It is a qualitative study, with theoretical framework in Symbolic Interaction and methodological framework on Grounded Theory. They interviewed 26 nurses working in the Family Health Strategy. The result was the creation of the Family Theory Approach for nurse in the Family Health Strategy, with four main categories. The first, called Family Conceptions, presents the concept of family originated from the nurses experiences. The second, named Social Conjuncture, defines the context where the family concepts are determined and the family approach occurs. The third, called Health Conjuncture, presents the situational elements in health that have influence on the family approach. And the last, the very Family Approach, presents the elements that involve the care provided by nurses in this scenario. The main contributions of this study are intended for Nursing and the Family Health Strategy, through the systematic theory about the family approach. This study also presents considerations about the use of familiar approach tools, the training of nurses for the work in the family health strategy and policy documents for family health in Brazil.

Applying ethical practice competencies to the prevention and management of unintended pregnancy.

Using a case study that incorporates patient, nurse practitioner, and student perspectives, we address ethical principles of respect for autonomy, beneficence, and fairness; professionals' right of conscience; and a social justice model for the discussion of prevention and management of unintended pregnancy. Through an ongoing process of self-reflection and values clarification, nurses can prepare for the challenge of applying ethical principles to the reproductive health care of women.

Ethics in independent nurse consulting: strategies for avoiding ethical quicksand.

Changes in health care have created a variety of new roles and opportunities for nurses in advanced practice. One of these changes is the increasing number of advanced practice nurses carrying out independent consultation. Differences in goals between business and health care may create ethical dilemmas for nurse consultants. The purpose of this article is to describe possible ethical pitfalls that nurse consultants may encounter and strategies to prevent or solve these dilemmas. Three themes related to nursing codes of ethics will be discussed: the duty to uphold human rights, the duty to fulfill commitments, and the duty to practice the profession competently.

Ethical problems in nursing management: the role of codes of ethics.

The aim of this study was to identify the ethical problems that nurse managers encounter in their work and the role of codes of ethics in the solutions to these difficulties. The data were collected using a structured questionnaire and analysed statistically. The target sample included all nurse managers in 21 specialized health care or primary health care organizations in two hospital districts in Finland (N = 501; response rate 41%). The most common ethical problems concerned resource allocation as well as providing and developing high quality care. This was the case in different managerial positions as well as in types of organization. Professional codes of ethics were used more often for problems related to patients' care compared with issues of resource allocation. Nurse managers at middle or strategic management levels used codes of ethics more often than those in charge of a ward. More research is required to investigate ethical decision making in nursing management, especially with regard to problem solving. In addition, new guidelines and continuing education in ethics are important for management personnel.