How nurse managers in Japanese hospital wards manage patient violence toward their staff.

AIM: This study explores nurse managers' experiences in dealing with patient/family violence toward their staff. BACKGROUND: Studies and guidelines have emphasised the responsibility of nurse managers to manage violence directed at their staff. Although studies on nursing staff have highlighted the ineffectiveness of strategies used by nurse managers, few have explored their perspectives on dealing with violence. METHODS: This qualitative study adopted a grounded theory approach to explore the experiences of 26 Japanese nurse managers. RESULTS: The nurse managers made decisions using internalised ethical values, which included maintaining organisational functioning, keeping staff safe, advocating for the patient/family and avoiding moral transgressions. They resolved internal conflicts among their ethical values by repeating a holistic assessment and simultaneous approach consisting of damage control and dialogue. They facilitated the involved persons' understanding, acceptance and sensemaking of the incident, which contributed to a resolution of the internal conflicts among their ethical values. CONCLUSIONS: Nurse managers adhere to their ethical values when dealing with patient violence toward nurses. Their ethical decision-making process should be acknowledged as an effective strategy to manage violence. IMPLICATIONS FOR NURSING MANAGEMENT: Organisational strategies that support and incorporate managers' ethical decision-making are needed to prevent and manage violence toward nurses.

Searching for ethical leadership in nursing.

BACKGROUND: Attention to ethical leadership in nursing has diminished over the past several decades. OBJECTIVES: The aim of our study was to investigate how frontline nurses and formal nurse leaders envision ethical nursing leadership. RESEARCH DESIGN: Meta-ethnography was used to guide our analysis and synthesis of four studies that explored the notion of ethical nursing leadership. PARTICIPANTS AND RESEARCH CONTEXT: These four original studies were conducted from 1999-2008 in Canada with 601 participants. ETHICAL CONSIDERATIONS: Ethical approval from the original studies covered future analysis. FINDINGS: Using the analytic strategy of lines-of-argument, we found that 1) ethical nursing leadership must be responsive to practitioners and to the contextual system in which they and formal nurse leaders work, and 2) ethical nursing leadership requires receiving and providing support to increase the capacity to practice and discuss ethics in the day-to-day. DISCUSSION AND CONCLUSION: Formal nurse leaders play a critical, yet often neglected role, in providing ethical leadership and supporting ethical nursing practice at the point of patient care.

Leadership styles in ethical dilemmas when head nurses make decisions.

BACKGROUND: The overlooked aspect in Lithuania is the dearth of leaders among head nurses, who bear the responsibility for decisions in ethical dilemmas. Understanding the application of leadership styles is fundamental to ensuring head nurses' abilities to influence outcomes for healthcare providers and patients. AIM: To identify the leadership styles applied by head nurses in decision making in ethical dilemmas on hospital wards. METHODS: The data were collected by questionnaires completed by head nurses (n = 278) working in five major state-funded hospitals in each of the five regions of Lithuania. The data were analysed using SPSS 16.0, calculating descriptive statistics and analysis of variance. FINDINGS: Head nurses apply democratic, affiliative, transformational and sustainable leadership styles when resolving ethical dilemmas. The application of leadership styles is associated not only with specific situations, but also with certain background factors, such as years of experience in a head nurse's position, ward specialization and the incidence of ethical dilemmas. Nurses having been in a head nurse's position over 10 years use primitive leadership styles, notably bureaucratic leadership, more often than do those head nurses with only a few years of experience in such a position. CONCLUSIONS: The results highlight the need for head nurses to reflect on their practices and to find new ways of learning from practice, colleagues and patients. Head nurses' managerial decisions due to their 'executive power' can turn into a new state-of-the-art leadership in nursing.

Nursing and conflict communication: avoidance as preferred strategy.

An exploratory study was conducted to examine nurses' (n = 57) selection of strategies to confront conflict in the workplace. Communication competence is the conceptual framework, defining competent conflict communication as joint problem-solving communication that is both effective and appropriate. Items were drawn from tools assessing nurses' conflict management strategies. Nurses reported a strong preference not to confront conflict directly; nurse managers were less likely to avoid direct communication. Nurses who do choose to confront conflict are more likely to use constructive than destructive strategies. The integration of the social science of health communication into nursing education and practice and other implications are discussed.

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.

Applying an ethical decision-making tool to a nurse management dilemma.

This article considers ethical dilemmas that nurse managers may confront and suggests an ethical decision-making model that could be used as a tool for resolving such dilemmas. The focus of the article is on the question: Can nurse managers choose the ethically right solution in conflicting situations when nurses' rights collide with patients' rights to quality care in a world of cost-effective and economic constraint? Managers' responsibility is to ensure and facilitate a safe and ethical working environment in which nurses are able to give quality care to their patients. In nursing it is frequently declared that managers' main obligations are to patients' needs and their rights to receive quality care. However, managers' ethical responsibilities are not only to patients but also to the nurses working in their institution. This article describes a real (but disguised) situation from an Israeli health care context to illustrate the dilemmas that may arise. The question is posed of whether nurse managers can maintain patients' and nurses' rights and, at the same time, fulfill their obligation to the conflicting demands of the organization. The article also offers a way to solve conflict by using an ethical decision-making model.

Factors impeding nurses from reporting adverse events.

AIM: To explore the reasons why Greek nurses are reluctant to report adverse events. BACKGROUND: This study provides an understanding of why nurses fail to report adverse events so that we can introduce systems and develop cultures, which make this easier. METHODS: An exploratory study using the Adverse Events Questionnaire, which was administered to 214 nurses in 14 major Athens hospitals, comprising university as well as tertiary hospitals. RESULTS: Five main reasons for not reporting were identified. They include the fear of the press, the licensing board, the difficulty in handling an adverse event, confidence about bringing up adverse events and the complaints by patients. Moreover, clustering variables into homogeneous sets, three latent variables were extracted. They include procedures, culture and dishonour, social control, workload and tradition. CONCLUSION: Nurses' impeding factors for bringing up adverse events may be projected not only by cultural aspects such as professional, national and organizational cultures but also by healthcare practice structural issues such as safety systems, rules and procedures, and relevant acts and regulations. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management should change management rules and establish systems so that nurses work in a blame-free culture, which examines system factors as causes of error rather than individuals.

Wicked spell or magic bullet? A review of the clinical supervision literature 2001-2007.

Clinical supervision has become an established part of nursing. Implemented in various different ways it has attracted attention from the research, educator and practice communities. The literature reported and analysed in this paper describes work that may benefit professional practice but there continue to be questions about application and method. Two new messages arise from the literature. The first underscores the responsibility of health care organisations to sustain and develop clinical supervision and the second points to the potential benefit that clinical supervision may have on patient outcomes.

Group clinical supervision for mental health nursing students.

Clinical supervision is recognized as important for developing safe professional practice in nursing. Although attention has been given to the development of training and education in clinical supervision for registered nurses, less discussion exists regarding these issues for pre-registration mental health nursing student to the theory and practice of group clinical supervision. In particular, this article raises awareness and promotes discussion of the practical issues involved in such an initiative.

Navigating uncharted water: research ethics and emotional engagement in human inquiry.

Sensitive research necessitates routine ethical practices of confidentiality, anonymity and worthiness. However, when co-constructing narratives with participants, the nurse researcher also faces unexplored ethical issues that arise out of the emotional intensity and professional responsibility inherent in the relationship. Such issues may be recognized and managed using clinical supervision in addition to academic supervision. Researcher vulnerability adds depth and complexity to human inquiry.

Improving research supervision in nursing.

In this paper, four experienced researchers from the UK, China and Australia offer guidance in research supervision based on their experiences and the recent document, Improving standards in postgraduate research degree programmes [Higher Education Funding Council for England, 2003. Improving standards in postgraduate research degree programmes. Formal consultation. Department for Employment and Learning, Northern Ireland, Higher Education Funding Council for England, Higher Education Funding Council for Wales, Scottish Higher Education Funding Council, HEFCE, London]. Supervision is an important aspect of not only the development of the neophyte researcher, but of academic staff and research activity in general. With increased academic accountability, good supervision should be an integral component of a quality research governance framework and resourced as such. Recommendations include: adoption of these standards; rigorous selection of research students and supervisors and development of projects; development of departmental procedures for monitoring, feedback and intellectual property; and transparency, rigour and fairness in examination procedures.

How do we withhold or withdraw life-sustaining therapy?

Nurse managers face many issues that concern withholding and withdrawing life-sustaining therapy in acute care. The author offers a framework for clinical decision making, an overview of the legal and ethical principles involved, and strategies to enrich communication between patients, families, and the health care team.

Thoughtful nursing practice: reflections on nurse delegation decision-making.

This article discusses delegation challenges and legal and regulatory oversight associated with delegation in the clinical practice setting. The authors address moral and legal attributes of the roles and responsibilities of health care providers regarding delegating health care interventions. The article also explores guiding principles and rules of delegation within professional standards, national practice guidelines, and state nurse practice acts. Nurse experts provide thoughtful reflection on nursing models and the role of delegation, emphasizing the critical role of delegation in extending the role of the health care professional in patient care services.

Dimensão ética do gerenciamento em enfermagem / Dimensión ética de la gestión en enfermería / The ethical dimension of nursing management

No gerenciamento de unidades de internação o enfermeiro se depara com a necessidade de tomada de decisões que envolvem osagentes dos ambientes interno e externo da instituição. Essas medidas carregam consigo um poder influenciador, independendo doseu grau de benefício. Logo, as questões éticas constituem dimensão importante na administração de enfermagem. O objetivo destetrabalho foi identificar medidas e/ou intervenções adotadas por enfermeiros gerentes de unidades de internação de um hospitaluniversitário, visando à observância da ética profissional. O estudo envolveu 20 enfermeiros que ocupavam cargos de supervisãotécnica nas seções ligadas à Divisão de Enfermagem. Estudo exploratório realizado por meio de entrevistas gravadas, com abordagemqualitativa, tendo como referencial o Discurso do Sujeito Coletivo. Evidenciou-se como maior preocupação dos enfermeiros, emrelação à prestação da assistência de enfermagem, o déficit de recursos humanos. Os gestores buscam o desenvolvimento dosrecursos humanos em enfermagem por meio de atividades educativas na própria unidade, ao mesmo tempo em que adotam as quesão oferecidas pela instituição hospitalar. Quando da ocorrência de infrações éticas, recorrem a estratégias individualizadas deorientação ao infrator, até as intervenções jurídicas. A resolução dos conflitos éticos, pelos gestores de enfermagem, geralmenteocorre de forma gradual, segundo o nível de comprometimento, seja do cliente ou da equipe multiprofissional. As atividadeseducativas têm foco no desenvolvimento de habilidades técnicas, visando prevenir danos físicos à pessoa. Porém, no estudo nãoforam mencionadas atividades educativas direcionadas ao desenvolvimento da consciência ética dos profissionais. O enfermeirodeve desempenhar atividades gerenciais com respeito à dignidade humana, salvaguardando os direitos pessoais por meio deprincípios éticos e preceitos universais.

In managing an Inpatient unit, nurses face the need to make decisions involving agents in the institution’s internal and externalenvironments. All these measures are influential, regardless of how beneficial they may be. Hence, ethical issues constitute animportant dimension of nursing management. This study aimed at identifying measures and/or interventions adopted by managingnurses at Inpatient Units in a University Hospital with the purpose to analyze professional ethics. The study involved nurses holdingtechnical-supervision positions in sectors related to the Nursing Division, comprising a total number of 20. Exploratory study carriedby means of taped interviews with a qualitative approach based on the Collective Subject Discourse. Human resources deficit wasobserved as nurses’ major concern in relation to nursing care provision. The managers seek the nursing staff’s development by meansof educational activities in their own unit at the same time that they adopt those offered by the hospital. When ethical violationsoccur, they resort to measures ranging from individual strategies for violators’ orientation to legal intervention. The resolution ofethical conflicts by nursing managers, usually occurs gradually, according to the level of commitment, either the client or themultidisciplinary team. The educational activities are focused on developing technical skills in order to prevent injury to the person.However, the study was not mentioned educational activities aimed at the development of ethical awareness of professionals. Thenurse must perform management activities with respect to human dignity, personal rights safeguarded by universal ethical principlesand precepts.

En la gestión de las unidades de hospitalización de la enfermera se enfrenta a la necesidad de tomar decisiones que involucran a losagentes de los entornos internos y externos de la institución. Estas medidas llevan consigo una poderosa influencia,independientemente de su nivel de beneficio. Por lo tanto, la dimensión ética es importante en la administración de enfermería. Elobjetivo de este estudio fue identificar las medidas y / o intervenciones adoptadas por las enfermeras gestoras de las unidades dehospitalización de un hospital universitario con el fin de mantener la ética profesional. En el estudio participaron 20 enfermeras queocupaban puestos de supervisión en las secciones técnicas relacionadas con la División de Enfermería. Estudio exploratorio llevadoa cabo por meio de entrevistas grabadas con un enfoque cualitativo basado en el Discurso del Sujeto Colectivo. Se hizo evidente quela mayor preocupación de las enfermeras en relación con la prestación de cuidados de enfermería, la escasez de recursos humanos.Los gestores tratan de desarrollar los recursos humanos en enfermería a través de actividades educativas en la propia unidad,mientras que la adopción de los ofrecidos por el hospital. Ante la ocurrencia de infracciones éticas, recurren a la orientaciónindividualizada a los delincuentes, a las intervenciones judiciales. La resolución de conflictos éticos por los gerentes de enfermeríageneralmente sucede de forma gradual, considerando el nivel de comprometimiento, sea del paciente sea del equipo multiprofesional.Las actividades educativas son enfocadas en el desarrollo de habilidades técnicas que procuran prevenir daños físicos al paciente. Sinembargo, no se han mencionado actividades educativas dirigidas al desarrollo de la conciencia ética de los profesionales.

The significance of nurse supervisors' different ethical decision-making styles.

BACKGROUND: The role of the nurse supervisor is very important, because of his/her ability to influence the atmosphere within the clinical nursing supervision group. AIM: To present and interpret nurse supervisors' different ethical decision-making styles. METHOD: A hermeneutic interpretation of three studies on nurse supervisors' different ethical decision-making styles. RESULTS: The significance of the nurse supervisor's ethical decision-making style is reflected in the awareness of their responsibility for creating a relationship with the supervisee. The supervisors focus on ensuring safety, integrating theoretical knowledge and clinical practice, willingness and preparedness to supervise on the substance of nursing, sharing the supervisees' feelings and challenging them, reflecting on the content of clinical nursing supervision as well as promoting justice and integrity in clinical nursing supervision. CONCLUSIONS: The interpretation highlights the importance of the nurse supervisor's style for the outcome of clinical nursing supervision, as they are role models for the supervisees. There is a need for further research to explore the advantages and disadvantages of nurse supervisors' different ethical decision-making styles, especially in relation to the influence of clinical nursing supervision on the quality of care and various support systems.