Inhibitors and facilitators of compliance with professional ethics standards: nurses' perspective.

INTRODUCTION: The clinical practices of nurses should be in accordance with the principles of professional ethics. Respecting professional ethics principles depends on several factors. The present study was conducted to investigate the effective inhibitors and facilitators in compliance with professional ethics and their importance from the nurses' perspective. METHODS: During this cross-sectional descriptive study, 452 nurses were included by the census sampling method. The data were collected via the "inhibitors of compliance with professional ethics standards by the nurses' perspective" and "facilitators of compliance with professional ethics standards by the nurses' perspective" questionnaires. Additionally, by designing the "open-ended question" section, other inhibiting and facilitating factors of professional ethics standards from the nurses' perspective were investigated. The data were analyzed using descriptive and inferential statistics (Wilcoxon signed ranks test). RESULTS: The individual care-related dimension as a facilitator had the highest mean score compared to the other dimensions (76.62 ± 4.92). Furthermore, seven items in the inhibitor section, 19 items in the facilitator section had higher scores. Among them, there were seven items in common. Strong or weak belief in compliance with ethical issues had the highest mean scores in the role of facilitator and inhibitor (90.54 ± 12.13 and 89.54 ± 14.88, respectively). CONCLUSION: Strong or weak belief in compliance with ethical issues was the most important inhibitor and facilitator from the nurses' perspective, which makes it necessary to examine individual beliefs about ethical issues among applicants to enter the nursing profession.

Use and impact of the ANA Code: a scoping review.

Adherence to professional ethics in nursing is fundamental for high-quality ethical care. However, analysis of the use and impact of nurses' codes of ethics as a part of professional ethics is limited. To fill this gap in knowledge, the aim of our review was to describe the use and impact of the Code of Ethics for Nurses with Interpretive Statements published by the American Nurses Association as an example of one of the earliest and most extensive codes of ethics for nurses with their interpretative statements and constituting a strong basis for the International Council of Nurses' Code of Ethics for Nurses. We based our review on previous literature using a scoping review method. We included both non-scientific and scientific publications to provide an analysis of codes of ethics which can be utilized in development and revision of other nurses' codes of ethics. In the searches, we used CINAHL and PubMed databases limiting publications to texts with a connection to the Code of Ethics for Nurses published from January 2001 to November 2022 and written in English. Searches yielded 1739 references, from which 785 non-scientific and 71 scientific publications were included for analysis of the data. Although non-scientific and scientific publications addressed different number of categories, the results indicated that in the both groups the use and impact focused on professional ethics, nursing practice, and work environment and less on education, research, or social health issues. Nurses' ethical standards were not addressed in non-scientific publications, and clinical issues and leadership were not in focus in scientific publications. To increase evidence-based knowledge of the impact of codes of ethics additional research is needed. Good scientific conduct was followed.

Nursing vaccine mandates: Ethically justified, an infringement on autonomy, or both?

After almost a year and a half of the COVID-19 pandemic, many healthcare institutions in the United States announced that they would mandate COVID-19 vaccination, with medical and religious exceptions, as a term of employment. The mandates resulted in widely publicized protests from hospital staff, including some nurses, who argued that these medical institutions violated the ethical principle of autonomy. As the world enters the "post-pandemic period," decisions such as these, made during times of crisis, must be reviewed to provide clarity for when the next pandemic occurs. In this paper, we support the argument that such mandates are ethically justifiable. We explore the framework of objections that were brought forward by dissenters of this vaccine mandate. Next, we provide an analysis of conflicting ethical principles present when such mandates were deployed. Utilizing the American Nurses Association's Code of Ethics for Nurses, notably provisions 2, 3, and 6 we argue that it is an ethical duty of the nurse to be vaccinated. Specifically, we turn to provision two, which most explicitly underscores the necessity of vaccination as a function of the nurse's primary commitment to the patient. Next, we highlight the International Council of Nurses Code of Ethics which provides similar guidance internationally. Finally, we examine the applicability of the principles of public health, care ethics, and the nursing role as frameworks to underpin such mandates both for the current and for potential future pandemics, arguing that the nurse's ethical duty to be vaccinated spans these contexts.

The promises and limitations of codes of medical ethics as instruments of policy change.

Codes of medical ethics (codes) are part of a longstanding tradition in which physicians publicly state their core values and commitments to patients, peers, and the public. However, codes are not static. Using the historical evolution of the Canadian Medical Association's Code of Ethics as an illustrative case, we argue that codes are living, socio-historically situated documents that comprise a mix of prescriptive and aspirational content. Reflecting their socio-historical situation, we can expect the upheaval of the COVID-19 pandemic to prompt calls to revise codes. Indeed, Alex John London has argued in favour of specific modifications to the World Medical Association's International Code of Medical Ethics (which has since been revised) in light of moral and scientific failures that occurred during the COVID-19 pandemic. Responding to London, we address the more general question: should codes be modified to reflect lessons drawn from the COVID-19 pandemic or future such upheavals? We caution that codes face limitations as instruments of policy change because they are inherently interpretive and 'multivocal', that is, they usually underdetermine or provide more than one answer to the question, 'What should I do now?' Nonetheless, as both prescriptive and aspirational documents, codes also serve as tools for reflection and deliberation-collective practices that are necessary to engaging with and addressing the moral and scientific uncertainties inherent to medicine.

The effect of flipped-jigsaw learning models on ethical decision-making.

BACKGROUND: Ethical decision-making education in nursing can be taught effectively by combining different teaching models that support the visualisation of taught concepts and integrating theory into practice. OBJECTIVES: The study aims to examine the effect of flipped and jigsaw learning models on ethical decision-making and ethical sensitivity in nursing. RESEARCH DESIGN: We used a nested mixed design. A pretest-posttest single-group quasi-experimental design was used in the quantitative part, and a case study method was used in the qualitative part. PARTICIPANTS AND RESEARCH CONTEXT: This study was conducted in fall semester with second-year nursing students who studied an ethics course for the first time, using two different collaborative learning models. In the quantitative part, ethical dilemma and ethical sensitivity scales were made as pre-test with 117 and post-test with 128 students. In the qualitative part, a semi-structured three focus group interviews was conducted with 16 students. ETHICAL CONSIDERATIONS: After obtaining the approval of the University's ethics committee, the study was carried out after obtaining participants' informed written and verbal consent. FINDINGS: Students' perspectives changed positively after training. This was related to six cases in section A of the Ethical Dilemma Scale. In part B, Practical Consideration (PC) and Principled Thinking (PT) mean scores were similar, showing no significant difference. For Familiarity in section C, it was determined that 68.4% of students in the pre-test and 77.3% in the post-test were familiar with similar dilemmas. The ethical sensitivity scale's total scores were in a similar range. In the qualitative stage, ethical decision-making, ethical sensitivity, ethical dilemma and the improvement process were obtained as a theme. CONCLUSIONS: There was an increase in the level of ethical sensitivity and familiarity with ethical dilemmas of nursing students after education. Flipped and jigsaw learning models can be used for nursing ethics courses.

Paramedic use and understanding of their professional code of conduct.

BACKGROUND: Paramedicine is a newly regulated profession in Australia and with the introduction of regulation in 2018 for this profession came increased responsibilities - including the introduction of a professional code of conduct. Several countries now have regulation of paramedicine and associated professional codes to guide ethical and professional behaviour. Despite this, there has been no published research into paramedic understanding and use of their professional codes. OBJECTIVES: To explore Australian paramedics' use and understanding of their professional code of conduct. Research design: This study used a qualitative descriptive design, underpinned by hermeneutic theory. Reflexive thematic analysis was used to analyse the interview data and identify Australian paramedic perceptions surrounding the use of their code of conduct. RESULTS: 11 Registered Paramedics from several states and territories were interviewed. Participants were invited to interview by advertisement on social media and the Australasian College of Paramedicine Web site. Participants had varied professional backgrounds including clinical work, education providers and policymakers/managers. Four themes were identified as follows: Theme 1 - 'You don't know, what you can't know'; Theme 2 - 'I don't need the code - the code is for others'; Theme 3 - 'It's about time'; Theme 4 - 'Navigating the new profession'. Ethical considerations: Ethics approval was granted by the Monash University Human Research Ethics Committee (MUHREC) Project ID: 28921. All participants provided informed consent. CONCLUSIONS: The results of this study suggest that paramedics' knowledge and use of their code is limited, and participants appeared to mostly rely instead on 'common sense' morals. Participants did appear to want to understand the broad concepts of the code more and have this better integrated into the profession. The code was also interpreted as important to the paramedic profession and its new professional status, helping to legitimise it as a health profession in Australia.

Professional values and nursing care quality: A descriptive study.

BACKGROUND: Professional values are important in promoting healthy work environments, patient satisfaction, and quality of care. Magnet® hospitals are recognized for excellence in nursing care and as such, understanding the relationship between nurses' values and Magnet status is essential as healthcare organizations seek to improve patient outcomes. RESEARCH QUESTION/AIM/OBJECTIVES: The research question is: are there differences in individual values, professional values, and nursing care quality for nurses and nurse managers practicing in Magnet, Magnet journey, and non-Magnet direct patient care settings? RESEARCH DESIGN: This descriptive cross-sectional study is guided and informed by the conceptual framework of the Professional Values Model including individual values, professional values, and nursing care quality. PARTICIPANTS AND RESEARCH CONTEXT: Convenience sampling of registered nurses and nurse managers, responsible for direct patient care, was utilized in a non-profit healthcare system in the Midwest region of the United States. ETHICAL CONSIDERATIONS: Institutional review board approval was obtained. Participants were informed about the right to self-determine participation and assurance of anonymity. FINDINGS: 827 (n = 827) nurses and nurse managers responded to the survey. Significant differences were identified in individual values sub-scale: self-enhancement (p = 0.38), professional values (p = 0.037), practice environment: participation in hospital affairs (p = 0.00), foundations for quality care (p = 0.016), and resources adequacy (p = 0.012) and in nurse sensitive HCAHPS questions: nurses explained things understandably (p = 0.00), got help as soon as wanted (p = 0.00), and treated with courtesy and respect (p = 0.00). DISCUSSION/CONCLUSIONS: Findings indicate that fostering individual and professional values may impact nursing practice, regardless of Magnet designation. Promoting professional values may contribute to improved work environments, enhancing patient satisfaction. Study results offer valuable insights for organizations striving to enhance nursing values, impacting quality of care provided to patients. MESH TERMS: Cross-Sectional Studies, Respect, Ethics Committees, Patient Satisfaction, Nurse Administrators, and Personal Satisfaction.

Two cases of nursing older nursing home residents during COVID-19.

INTRODUCTION: Two ethical challenges of nursing home nurses during the COVID-19 pandemic in Sweden are discussed in this paper. BACKGROUND: Historically, the nurse's primary concern is for the person who is ill, which is the core of nurses' moral responsibility and identity. In Sweden, person-centered care is generally deemed important in nursing older nursing home residents. OBJECTIVE: To chart moral responsibilities of nursing home nurses in two cases involving older residents during the COVID-19 pandemic in Sweden. METHODS: We used Margaret Urban Walker's framework for moral responsibilities and the International Council of Nurses (ICN) code of ethics for nurses (2021) for our normative analysis. ETHICAL CONSIDERATIONS: Written and verbal consent was obtained before the interviews, and information was given that participation was entirely voluntary and possible to cancel at any time before the work was published. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to this research project (Dnr. 2020-05649). FINDINGS: Case #1: a palliative older nursing home resident who was coercively tested for COVID-19, and case #2: a COVID-19-infected resident with dementia who was isolated using sedation. The decision that was finally made in the respective case was analyzed in the light of either consequentialist/utilitarian or non-consequentialist/deontological reasons. DISCUSSION: Empowerment of nurses as moral agents is required for the application of practical wisdom in the balancing of different care relationships (responsibilities), moral identities (professional virtues), and competing moral values. This requires resources and opens possibilities for profound ethical reflection in nursing education and at work. CONCLUSION: During the COVID-19 pandemic, the moral and professional responsibility of nursing home nurses to deliver person-centered care was sometimes problematically abandoned in favor of a more utilitarian manner of ethical decision-making.

A Hippocratic Oath for Mathematicians? Mapping the Landscape of Ethics in Mathematics.

While the consequences of mathematically-based software, algorithms and strategies have become ever wider and better appreciated, ethical reflection on mathematics has remained primitive. We review the somewhat disconnected suggestions of commentators in recent decades with a view to piecing together a coherent approach to ethics in mathematics. Calls for a Hippocratic Oath for mathematicians are examined and it is concluded that while lessons can be learned from the medical profession, the relation of mathematicians to those affected by their work is significantly different. There is something to be learned also from the codes of conduct of cognate but professionalised quantitative disciplines such as engineering and accountancy, as well as from legal principles bearing on professional work. We conclude with recommendations that professional societies in mathematics should sponsor an (international) code of ethics, institutional mission statements for mathematicians and syllabuses of ethics courses for incorporation into mathematics degrees.

Nurses' perception of workplace discrimination.

BACKGROUND: Discrimination and injustice are big obstacles in nurses' way to socialization and are among the major clinical challenges faced by nurses. Workplace discrimination is associated with such negative consequences as stress, fatigue, demoralization, loss of professional commitment, tension and conflicts at work, and resignation. A review of literature shows that not much research has been dedicated to workplace discrimination in nursing. OBJECTIVE: This study aims to investigate nurses' perception of workplace discrimination. METHOD: This cross-sectional study was conducted in the hospitals affiliated with a university of medical sciences in the largest city in the south of Iran in 2019. The participants consisted of 597 nurses who were selected through stratified random sampling. Data were collected using a researcher-made workplace discrimination questionnaire and analyzed in SPSS v. 21. FINDINGS: The mean of the nurses' workplace discrimination scores was found to be 102.57 ± 14.5, which is considered as moderate. The nurses' mean scores for the dimensions of vertical and horizontal discrimination (44.53 ± 6.8), consequences of discrimination (20.52 ± 5.55), and unfair promotion (12.38 ± 2.44) were moderate. As for the two other dimensions of workplace discrimination, namely, gender discrimination (14.41 ± 3.28) and cultural-organizational discrimination (11.88 ± 2.99), the participants' mean scores were low. There was a significant relationship between the nurses' workplace discrimination mean score on the one hand and their employment status (p = 0.016) and work experience (p = 0.002) on the other. However, the nurses' workplace discrimination mean score was not found to correlate with their level of education (p = 0.65), marital status (p = 0.274), and gender (p = 0.479). ETHICAL CONSIDERATION: This study has been approved by the ethics committee of the university. All the participants had signed the written informed consent form before participation. CONCLUSION: Hospital managers should take measures to reduce discrimination and establish organizational justice to raise nurses' morale and improve the quality of their performance as caregivers.

Professional codes of conduct: A scoping review.

BACKGROUND: Professional ethical codes are an important part of healthcare. They are part of the professionalisation of an occupation, are used for regulation of the professions and are intended to guide ethical behaviour in healthcare. However, so far, little is known about the practical use of professional codes in healthcare, particularly in paramedicine. OBJECTIVE: The aim of this scoping review was to determine what is known in the existing literature about health professionals' knowledge, awareness and use of their professional codes. METHOD: A scoping review was performed based on a six-stage framework as described by Levac et al. Six databases were searched: OVID Medline, EMBASE, EMCARE, CINAHL, ProQuest and Scopus, in September 2020. Google Scholar, Trove and Google using .gov and .org websites were also searched for grey literature. Two reviewers independently assessed study eligibility. RESULTS: The search yielded 1162 results after duplicate removal. Thirty-nine studies remained after title and abstract review. Twenty-five articles were included after full-text review. Sixteen examined nursing, eight examined medicine and one examined both nursing and medicine. No studies were identified that examined paramedicine. Twenty-one studies were of a cross-sectional design and four studies were of a qualitative design. CONCLUSION: Most health professionals know the codes exist, but do not think they know the content. Despite valuing professional codes highly, healthcare professionals do not use them regularly in clinical practice. Further research is needed, and professional codes should be made useful for practice and consideration given to how codes can be written, communicated and implemented to increase their actualisation in healthcare. Research should also begin in paramedicine to identify clinician's knowledge and use of codes in this profession. REVIEW REGISTRATION: Open Science Framework - doi:10.17605/OSF.IO/NKBY4. ETHICS STATEMENT: This article does not contain any studies involving human participants performed by any of the authors. The review followed good scientific conduct.

Guaranteeing dignity and decent work for migrant nurses and health care workers beyond the COVID-19 pandemic.

AIM(S): The main aim of this article is to outline the devastating aftereffects of COVID-19 in terms of ethical recruitment and the respect of dignity of nurses and health care professionals. BACKGROUND: Nations experience the ominous impacts of the COVID-19 pandemic in terms of an exacerbated shortage of nurses worldwide. In this situation, migration flows of nurses are skyrocketing and the respect of the migrant nurses' dignity as human beings should be guaranteed. EVALUATION: Data from reports elaborated by the International Centre on Nurse Migration (ICNM) were examined and outlined the central role of the respect of dignity of every nurse to prevent unethical exploitation of them. KEY ISSUE(S): The respect of human dignity is a complex concept. Human dignity denotes the inner nature of human beings but also their rights at work. CONCLUSION(S): In a post-COVID-19 world with increased flows of nurse migration, it is crucial to guarantee dignity at work for migrant nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should prioritize the ethical recruitment of health care workers and give a prominent role to the WHO 'Code of Practice on the International Recruitment of Health Personnel' which recognizes the ethical bedrocks of employment.

Involving people with type 2 diabetes in facilitating participation in a cardiovascular screening programme.

BACKGROUND: Knowledge is lacking about how to increase uptake among people with type 2 diabetes (T2D) invited to preventive initiatives like cardiovascular screening. AIM: To explore how to improve participation of people with T2D in cardiovascular screening using patient and public involvement (PPI). METHODS: Patient and public involvement was included in a qualitative research design. From April to October 2019, we invited 40- to 60-year-old people with T2D (n = 17) to individual consultative meetings, using an interviewing approach. Before the interviews, participants were asked to read a proposed invitation letter to be used in a cardiovascular screening programme. Inductive content analysis was undertaken. RESULTS: Participants considered cardiovascular screening important and beneficial from both a personal and social perspective. We found that the relational interaction between the person with T2D and the health-care professional was key to participation and that nudging captured through the design of the screening programme and the wording of the invitation letter was requested. CONCLUSION: In preventive initiatives perceived as meaningful by the invitee, a focus on recruitment is crucial to facilitate participation. This study contributed with knowledge about how to promote participation by involving health-care professionals in recruitment initiatives and through nudging. This knowledge may assist researchers, policymakers and ethicists' understanding and assessment of the ethical appropriateness and public acceptability of nudging in cardiovascular screening. PATIENT OR PUBLIC CONTRIBUTION: By consulting 17 people with T2D, we are now in a position to suggest how a screening initiative should be altered because tools to improve uptake have been identified.

Improving nurses' knowledge, attitude, and performance in relation to ethical codes through group reflection strategy.

BACKGROUND: The most basic responsibility of nurses that even precedes their therapeutic role is respect for professional ethics in providing clinical care. The present study was conducted to determine the effect of group reflection on the knowledge, attitude and performance of nurses in relation to ethical codes. METHODS: The present blinded, before-after, educational trial was conducted on 86 nurses working at a general hospital in the south of Iran who were randomly divided into a intervention (n = 44) and a control (n = 42) group. Data were collected before and after the intervention using three tools, including a knowledge test, an attitude rating scale and a performance questionnaire. In the intervention group, the intervention given consisted of four sessions of group reflection, and the control group received a single lecture on ethical codes. RESULTS: The mean changes in the nurses' score of knowledge after the intervention compared to before differed significantly in both intervention and control groups (P < 0.001), but there was no significant difference between the two groups in terms of the mean changes in the score of knowledge (2.73 ± 3.45 in intervention group vs. 2.57 ± 3.36 in control group, P = 0.83). Although the mean score of attitude differed significantly between the intervention and control groups in the posttest (34.7 ± 8.44 in intervention group vs. 29.95 ± 9.09 in control group, P < 0.014), the two groups were not significantly different in terms of the mean changes in the score of attitude in relation to ethical codes before and after the intervention (P < 0.14). Moreover, the two groups were significantly different in terms of the mean changes in the scores of performance in the two stages (9.07 ± 16.84 in intervention group vs. 0.67 ± 20.01 in control group, P < 0.001). CONCLUSION: Group reflection can improve the knowledge, attitude and performance of nurses in relation to ethical codes. Although lectures can help improve nurses' knowledge and attitude in this area, they have no significant effects on their performance. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (No: IRCT2016070317546N6, registration date: 10 October 2016), https://www.irct.ir/trial/16112.

Covid-19, ethical nursing management and codes of conduct: An analysis.

The conduct of nurse managers, and health service managers more widely, has been subject to scrutiny and critique because of high-profile organisational failures in healthcare. This raises concerns about the practice of nursing management and the use of codes of professional and managerial conduct. Some responses to such failures seem to assume that codes of conduct will ensure or at least increase the likelihood that ethical management will be practised. Codes of conduct are general principles and rules of normative standards, including ethical standards, and guides for action of agents in particular roles. Nurse managers seem to stride two roles. Contra some accounts of the roles of a professional (nurse) and that of a manager, it is claimed that there is no intrinsic incompatibility of the roles though there is always the possibility that it could become so and likewise for codes of conduct. Codes of conduct can be used to support nurse managers in making practical decisions via an 'outside in' approach with an emphasis on the use of principles and an 'inside out' approach with an emphasis on the agent's character. It is claimed that both approaches are necessary, especially as guides to ethical action. However, neither is sufficient for action because judgement and choice will always be required (principles always underdetermine action) as will a conducive environment that positively influences good judgement by being supportive of the basic principles and values of healthcare institutions. The response to the Covid-19 pandemic has created a unique set of circumstances in which the practical judgement, including ethical judgement, of nurse managers at all levels is being tested. However, the pandemic could be a turning point because staff and institutions (temporarily) freed from managerialism have demonstrated excellent practice supportive of ethical and other practical decision making. Organisations need to learn from this post pandemic.

The effect of education around ethical principles on nurses' perception to patient safety culture in an Iranian mental health inpatient unit: a pilot study.

BACKGROUND & OBJECTIVES: Patient safety is a crucial factor in the provision of quality healthcare and is therefore a global health concern. It is an area in which ethical concerns and high-quality clinical practice are inextricably linked. This study investigates the effect of education around ethical principles on nurses' perception of patient safety in a psychiatric unit. MATERIALS & METHODS: This pre- and post-test descriptive study was conducted in a mental health inpatient unit in a hospital in Tehran, capital of Iran, in 2018. A total of 33 nurses, selected by census sampling, participated in the study. Data was collected using a demographics questionnaire and Hospital Survey on Patient Safety Culture (HSOPSC), and was analyzed with SPSS21. RESULTS: The mean score of patient safety was 116.85 ± 9.98 before the educational intervention, 143.58 ± 7.21 immediately after intervention, and 153.12 ± 9.47 1 month after intervention. The rate of error report by most participants over the past 12 months was 3-5 and 6-10 events before intervention, and 6-10 events immediately after and 1 month after intervention. Also, 42.4% of the participants assessed patient safety after intervention as very good and 36.4% assessed it as acceptable and very good 1 month after intervention whereas most of the participants (45.5%) assessed patient safety as acceptable before intervention. CONCLUSION: Education on ethical principles exerts a positive effect on nurses' perception of patient safety culture. Thus, it is recommended as an effective method of promoting nurses' perception of this variable. In this way, healthcare quality and enhanced patient safety can be achieved.

Human rights and nursing codes of ethics in Canada 1953-2017.

Human rights are foundational to the health and well-being of all individuals and have remained a central tenet of nursing's ethical framework throughout history. The purpose of this study is to explore continuity and changes to human rights in nursing codes of ethics in the Canadian context. This study examines nursing codes of ethics between the years 1953 and 2017, which spans the very first code in Canada to the most recently adopted. The historical method is used to compare and contrast human rights language, positioning and descriptions between different code editions. The findings suggest there has been very little change in how human rights have been included within the Canadian nursing codes of ethics. Furthermore, we consider how changes within the nursing profession have influenced the authority of codes of ethics and their ability to support nurses in carrying out ethical obligations specific to human rights. Finally, the impacts and implications of these changes are discussed concerning the protection of human rights in today's healthcare landscape in Canada.

Do codes of ethics and position statements help guide ethical decision making in Australian immigration detention centres?

Australian immigration detention has been called state sanctioned abuse and a crime against humanity. The Australian healthcare community has been closely involved with these policies, calling for their reform and working within detention centres to provide healthcare. As well as having a devastating impact on health, immigration detention changes the scope and nature of healthcare, with its delivery described as a Sisyphean task. In this article I will explore the guidance that is available to clinicians who work within detention centres and argue that codes, guidelines and positions statements provide little help in relation to ethical decision making. First I will outline guidance that can be found in codes of ethics and position statements, focusing on particularly relevant principles, such as advocacy, clinical independence and the clinicians' relationship to human rights. I will then highlight the disparity between this guidance and the delivery of healthcare within detention by drawing on the testimony of clinicians who formerly worked in these environments. While this disparity should be cause for alarm and at a minimum call into question how codes and positions statements are being used (if at all), there are more fundamental reasons why codes and position statements fail to provide guidance in these circumstances. I will outline a more general criticism of codes of ethics and use this to suggest a way forward, including looking beyond codes and position statements to guide action within Australian immigration detention.

Nurses' professional values: Influences of experience and ethics education.

AIMS AND OBJECTIVES: To measure the professional values of registered nurses and determine whether these values are significantly related to postlicensure ethics education and years of experience. BACKGROUND: Nursing guilds in many countries reference the American Nurses Association's code of ethics to define expected professional nursing values. Strong professional values contribute to high-quality patient care and are influenced by complex practice environments. DESIGN: Causal-comparative design. METHODS: A convenience sample of actively licensed registered nurses in Washington State, United States of America, participated in an electronically administered survey (N = 2,439). Analyses were conducted using descriptive statistics, analysis of variance and correlation. Reporting utilised the STROBE checklist. RESULTS: Results suggested values of highest and lowest importance to nurses. Scores varied significantly based on years of nursing experience; a higher score indicated stronger orientation toward professional nursing values. Nurses with experience of 10 years or more had the highest scores. There was a modest, positive relationship between professional values and amount of time spent in postlicensure ethics education. CONCLUSIONS: Professional values of Washington State nurses are similar to other nurses in national and global workforces. Results suggest key areas of strength in nurses' professional values and areas needing additional focus and support. Professional values are highest among nurses with longer practice experience and among nurses who have had increased ethics education. RELEVANCE TO CLINICAL PRACTICE: Knowledge of nurses' priority values can assist leaders and educators to identify areas of needed support among nursing staff members. Organisational commitment to support of nurses' professional values through investment in ethics education may produce positive enduring consequences, such as workplace retention and high-quality patient care. Healthcare leaders and clinical educators who promote ethics education may help to mitigate negative effects of morally challenging situations, such as moral distress and work leaving.

Nurses' experiences of communicating respect to patients: Influences and challenges.

BACKGROUND: Respectful care is central to ethical codes of practice and optimal patient care, but little is known about the influences on and challenges in communicating respect. RESEARCH QUESTION: What are the intra- and inter-personal influences on nurses' communication of respect? RESEARCH DESIGN AND PARTICIPANTS: Semi-structured interviews with 12 hospital-based UK registered nurses were analysed using interpretative phenomenological analysis to explore their experiences of communicating respect to patients and associated influences. ETHICAL CONSIDERATIONS: The study was approved by the Institutional ethics board and National Health Service Trust. FINDINGS: Three interconnected superordinate themes were identified: 'private self: personal attitudes', 'outward self: showing respect' and 'reputational self: being perceived as respectful'. Respectful communication involved a complex set of influences, including attitudes of respect towards patients, needs and goals, beliefs around the nature of respectful communication, skills and influencing sociocultural factors. A tension between the outward self as intended and perceived presented challenges for nurses' reputational self as respectful, with negative implications for patient care. DISCUSSION: The study offers an in-depth understanding of intra- and inter-personal influences on communicating respect, and sheds light on challenges involved, helping provide practical insights to support respectful care. CONCLUSION: Findings stress the need for improved conceptualisations of respect in healthcare settings to formally recognise the complex attitudinal and socially constructed nature of respect and for appropriate professional training to improve its communication.