Barriers to nurses health advocacy role.

BACKGROUND: Speaking up to safeguard patients is a crucial ethical and moral obligation for nurses, but it is also a difficult and potentially dangerous component of nursing work. Health advocacy is gaining impetus in the medical literature, despite being hampered by barriers resulting in many nurses in Ghana remaining mute when faced with advocacy-required situations. We explored situations that thwart nurses from performing their health advocacy role. RESEARCH QUESTION: What would cause nurses to take no action when they witness situations that require them to act as health advocates for their clients or communities? RESEARCH DESIGN: An inductive, descriptive qualitative design was used to collect and analyse data on barriers that prevent nurses from practising their health advocacy role in Ghana. Individual one-on-one in-depth interviews were conducted using a semi-structured interview guide. The data were analysed using qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT: Twenty-four professional nurses and midwives registered with the Nursing and Midwifery Council were recruited from three regional hospitals in Ghana. These public hospitals were chosen from the upper, middle and coastal regions. ETHICAL CONSIDERATIONS: The UKZN Ethics Review Committee in South Africa and the GHS Ethics Review Committee in Ghana both gave their approval for this study. FINDINGS: Intrapersonal barriers, interpersonal barriers, and structural barriers emerged as major obstacles that nurses experience when performing their health advocacy role. CONCLUSIONS: Barriers to health advocacy have undermined nurses' ability to function as health advocates and are preventing them from utilising their health advocacy position in nursing practise. Giving nursing students positive role models in the classroom and in the clinic can help them become more effective health advocates.

Ethical and Moral Conflicts in the Nursing Care of Pediatric Patients With Cancer and Their Families.

BACKGROUND: Pediatric oncology nurses encounter ethical and moral dilemmas when providing comprehensive care to pediatric patients with cancer and their families. OBJECTIVE: The aim of this study was to explore ethical and moral conflicts arising in the field of pediatric oncology from the perspective of nursing professionals. METHOD: This qualitative secondary analysis was conducted with 10 nursing professionals from a pediatric cancer hospital through semistructured interviews and analyzed using thematic data analysis. RESULTS: Two themes emerged: (1) living with conflicts intrinsic to the relationships , which describes multiple sources of conflict in the relationships of nursing professionals with the team, with the family, and with seriously ill children, summarizing trigger-sensitive topics to be addressed for its mediation; (2) developing moral resilience , which represents how nurses reframe the conflicts and make use of strategies to avoid being personally harmful. CONCLUSIONS: The results highlight the challenging work environment of pediatric oncology, recognizing the multiple natures of sensitive topics to nursing professionals during clinical decision making and the incipient strategies in dealing with ethical and moral conflicts. IMPLICATIONS FOR PRACTICE: This study reveals self-reflection and intuitive strategies as protective factors, which could be applied as a step to support nurses encountering ethical and moral conflicts in pediatric oncology daily practice. Furthermore, because of the limited support services for nursing professionals, it is necessary to foresee institutional policies to embrace the development of moral resilience.

Educating ethics codes by lecture or role-play; which one improves nursing students' ethical sensitivity and ethical performance more? A quasi-experimental study.

BACKGROUND: Promoting ethical and professional principles through education is the major way to build and maintain people's trust in the nursing. However, despite remarkable efforts in this area, sensitivity to these principles and their application in clinical practice remain low. PURPOSE: This study aimed to compare the effect of educating codes of nursing ethics through methods of role-playing and lecture on the Ethical Sensitivity and Ethical Performance of nursing students. METHODS: A single-blinded quasi-experimental study conducted on 114 nursing students of Urmia University of medical sciences, which recruited using convenience sampling and assigned to two groups of intervention (role-paly and lecture) and one group of control, so that the sixth-, seventh- and eighth-semester nursing students were allocated to the control, role-play and lecture groups, respectively. Data were collected using the Nurses' Ethical Performance Questionnaire (EPQ) and the Lutzen's Moral Sensitivity Questionnaire (MSQ) at three time-points of before, immediately after, and two months after the intervention. The same educational content was provided for both intervention groups, so that the role-play group received the intervention over an eight-day period and the lecture group received it in five sessions. RESULTS: The results showed there was a significant difference in the mean scores of ethical sensitivity and ethical performance between the three groups immediately (p < .001) and two months after the intervention (p < .001), so the mean scores were significantly higher in the role-play and lecture groups compared to the control group after the intervention (p < .001). In addition, after the intervention, the mean scores of ethical sensitivity and ethical performance in the role-play group were higher than the lecture group (p < .001). CONCLUSION: Educating codes of ethics by role-playing method had a greater positive effect on the promotion of the ethical sensitivity and ethical performance compared to the lecture.

Reimagining relationality for reproductive care: Understanding obstetric violence as "separation".

Nursing Ethics has published several pleas for care ethics and/or relationality as the most promising ethical foundation for midwifery philosophy and practice. In this article, we stand by these calls, contributing to them with the identification of the structural form of violence that a care ethical relational approach to reproductive care is up against: that of "maternal separation". Confronted with reproductive and obstetric violence globally, we show that a hegemonic racialized, instrumentalized, and individualized conception of pregnancy is responsible for a severance of relationalities that are essential to safe reproductive care: (1) the relation between the person and their child or reproductive capabilities; and (2) the relation between the pregnant person and their community of care. We pinpoint a separation of the maternal relation in at least two discursive domains, namely, the juridical-political and the ethical-existential. Consequently, we plea for a radical re-imagination of maternal relationality, envisioning what care ethical midwifery, including abortion care, could be.

Compaixão e competência cultural de enfermeiros no cuidado de populações vulneráveis / Compassion and cultural competence of nurses in the care of vulnerable populations

ntrodução: O Brasil avança no processo para se aceitar como uma sociedade multicultural, acreditando na ampla presença da população preta, parda e indígena. Além disso, deve lidar com altos fluxos migratórios provenientes de todos os continentes e a crescente população em situação de rua, em nível nacional e local, que merece uma abordagem holística. Por meio do Sistema Único de Saúde (SUS), é garantido o acesso à saúde integral, universal e gratuita para toda a população, sem discriminação, sendo a Unidade de Pronto Atendimento (UPA) uma porta de entrada ao referido serviço para as populações mais vulneráveis. Portanto, os profissionais da saúde, em qualquer nível de atenção, e particularmente o enfermeiro, precisam compreender a diversidade cultural e, idealmente, terem a capacidade para responder à mesma. A competência cultural e compassiva remete à capacidade de prestar cuidados culturalmente adequados e congruentes, facilmente aceitos pela população com a finalidade de aliviar o sofrimento humano. Objetivo: Compreender o processo de construção da competência cultural e compassiva de enfermeiros que cuidam de populações vulneráveis numa Unidade de Pronto Atendimento em Belo Horizonte, Brasil. Metodologia: Trata-se de um estudo conduzido pela abordagem qualitativa, do tipo de estudo de caso único, ancorada no referencial teórico do Modelo do Desenvolvimento da Compaixão Culturalmente Competente da enfermeira Irena Papadopoulos. O estudo foi realizado em uma Unidade de Pronto Atendimento (UPA), localizada na cidade de Belo Horizonte (MG), Brasil. Participaram 18 enfermeiros que atuavam na UPA. Os dados foram coletados por meio de entrevista individual guiada por roteiro semiestruturado e observação da prática profissional, no período de outubro de 2020 a janeiro de 2021. Os dados foram submetidos à análise de conteúdo temática, proposta por Bardin, com auxílio do software ATLAS.ti, versão 9. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG, sob o parecer de número 4.249.999. Resultados: A análise dos dados permitiu compreender que o desenvolvimento da compaixão culturalmente competente é um processo subjetivo, contínuo e não linear. Além disso, possibilitou a construção de três categorias analíticas: A primeira foi "Construção da compaixão culturalmente competente em enfermeiros que cuidam de populações vulneráveis". Para a construção desta categoria, optou-se pela apresentação de três famílias: (a) Um olhar para dentro de si: o reconhecimento da identidade cultural; b) Caminhos a percorrer: da lacuna ao conhecimento cultural; c) A escuta atenta como cuidado essencial de enfermagem; e, d) competência cultural e compassiva como oportunidade infinita de crescimento). A segunda categoria foi "Compaixão Culturalmente Competente da enfermagem durante a pandemia por COVID-19 na Unidade de Pronto Atendimento", composta por três famílias: a) Processo de desconstrução pessoal e profissional; b) Fortalecimento dos laços profissionais baseado na compaixão; e, c) "Aproximações aos desafios da enfermagem para preservar o Cuidado Compassivo e Culturalmente Competente", composta por três famílias: a) Consolidação de habilidades compassivas no mundo globalizado; b) A formação profissional culturalmente competente como um processo incessante; e c) Alguns dilemas éticos no cuidado compassivo no início da vida.

Introduction: Brasil has been moving toward accepting itself as a multicultural society by acknowledging the vast presence of African American, Indigenous and Mestizo populations, while dealing with high migratory rates from every continent, and the increasing homeless population nationwide. All of these populations deserve an integral approach. Through the Unified Healthcare System (S.U.S. in portuguese), access, universality and free healthcare its guaranteed for all population, without discrimination. The Emergency Care Unit (UPA) is the main entrance to the referred healthcare system for the most vulnerable population. Nevertheless, healthcare practitioners in every level, especially nurses, need to comprehend and furthermost respect cultural diversity. Cultural competence is the capacity to provide cultural adequate and congruent care, easily accepted by the population. Aim: Understanding the process of construction of cultural competent compassion by nurses in main care of vulnerable population at the Emergency Care Unit (UPA) in Belo Horizonte, Brasil. Methods: Study conducted by qualitative approach, single case type, anchored in the theoretical framework of the Model for the Development of Culturally Competent Compassion by nurse Irena Papadopoulos. This study was carried out in an Emergency Care Unit (UPA), located in the city of Belo Horizonte (MG), Brazil. Eighteen nurses who worked at the UPA participated. Data was collected through individual online interviews guided by a semi-structured script and observation of the professional practice, from October 2020 to January 2021. The data were subjected to thematic content analysis, proposed by Bardin, with the help of ATLAS.ti software, version 9. The research was approved by the UFMG Research Ethics Committee, under the number 4,249,999. Results: Data analysis shows that the development of culturally competent compassion is a subjective, continuous and non-linear process. In addition, it enables the construction of three categories: "Building culturally competent compassion in nurses who care for vulnerable populations" is the first category. we opted for presenting three subcategories a) a look inside themselves: the recognition of cultural identity; b) Paths to be followed: from the gap to cultural knowledge; and c) Attentive listening as essential nursing care, cultural and compassionate competence as an endless opportunity for growth. The second category, "Cultural and compassionate competence of nursing during the COVID-19 pandemic in the Emergency Care Unit", is composed of three subcategories: a) Personal and professional deconstruction process; b) Strengthening professional ties based on compassion; and, c) Holistic care strategy for patients with COVID-19 and their families. Finally, "Approaches to the challenges of nursing to preserve Compassionate and Culturally Competent Care"", composed of three subcategories: a) Consolidation of compassionate skills in a globalized world; b) Culturally competent professional training as an incessant process; and c) Some ethical dilemmas in early-life compassionate care.

Being ethical and bioethical in daily life of primary health care: nurses' perceptions.

OBJECTIVES: to understand the perceptions of ethics and bioethics and how to be ethical and bioethical in daily life of Primary Health Care, from the perspective of nurses. METHODS: this is a Holistic-qualitative Multiple Case Study, based on Comprehensive Everyday Sociology, with 54 participants. RESULTS: two subcategories and the category Being ethical and bioethical in daily life of PHC: nurses' perceptions emerged. The ethical and bioethical being permeates a subjective and abstract self, whose fears, anxieties and concerns are intertwined with the human and professional dimensions in daily work and in personal-professional relationship. Ethics and bioethics perceptions emerge from subjectivity, established relationships, lived experiences and daily actions of nurses essential to the profession, professionals and individuals to be cared for. FINAL CONSIDERATIONS: ethical and bioethical perceptions and attitudes are essential to care, management and organizational actions, health care, and the safety of users and professionals.

The importance of moral sensitivity in nursing education: A comparative study.

BACKGROUND/AIM: This study aims to determine the importance of the "Ethics and Deontology in Nursing" course in nursing education for the purpose of revealing the level of moral sensitivity of nursing students. MATERIALS AND METHODS: In our research, which is a descriptive study, data were collected from 461 nursing students who studied at the Faculty of Health Sciences. In the study, the Personal Information Form and Moral Sensitivity Questionnaire (MSQ) were used as data collection forms. The findings from the study were evaluated with SPSS 22.00 package software, and the level of significance in all analyses was accepted as p < 0.05. RESULTS: The average age of the students participating in the study was 20.83 ± 1.55. Also, 51.8% of the students took the course "Ethics and Deontology in Nursing." The total mean score of the MSQ of students was determined as 83.32 ± 16.79. A statistically significant difference was found between the students' total scores of autonomy, benefit, holistic approach, conflict, practice, orientation, and moral sensitivity, depending on whether they took the course "Ethics and Deontology in Nursing." CONCLUSION: It was concluded that moral sensitivity in nursing students was positively influenced by the ethical education they received.

Essential components of midwifery ethics education: results of a Delphi study.

OBJECTIVE: Ethical dilemmas are an inevitable part of a midwife's experience in clinical care. Midwifery educational programs have an obligation to provide students the opportunities to acquire the skills and knowledge to recognize and negotiate ethical dilemmas. Implementation of strategies for imparting ethical competencies and clinical ethics decision-making skills in formal midwifery curricula have been challenging and inconsistent. The purpose of this study was to gather information and opinions from midwifery educators and clinical preceptors about the essential components of ethics education for midwifery students in the United States (U.S.), aiming for consensus on key content, competencies, learning outcomes, and teaching strategies. DESIGN: This is an online Delphi study conducted in three rounds. Round 1 consisted of open-ended questions to explore and identify key content, competencies, learning outcomes, and teaching strategies for midwifery ethics education. In Rounds 2 and 3, experts rated statements on a 1 to 7 Likert scale, with positive consensus defined as 70% or more of the experts scoring ≥6. PARTICIPANTS: The panel included midwifery educators (midwifery program directors, faculty, and clinical preceptors) from the United States. FINDINGS: Of the 12 statements on key content of ethics education, midwives emphasized that content promoting an understanding of shared decision-making is essential for inclusion. Of the statements regarding competencies, learning outcomes, and teaching strategies, 20 of 21 statements met consensus, including those related to shared decision-making and ethical decision-making, as well as attributes such as compassion and courage. Midwives did not agree that an essential teaching strategy includes a validated assessment tool for evaluating students on any component of ethics learning (knowledge, skills, behaviour). KEY CONCLUSIONS: This Delphi study reveals what midwifery educators consider essential components of ethics education for midwifery students, with a particular focus on the professional attributes of shared decision-making. IMPLICATIONS FOR PRACTICE: Initial insights about optimal ways to incorporate the essential ethics education components into midwifery program curricula are provided, and more research is needed.

A Public Health Ethics Analysis of the Criminalization of Direct Entry Midwifery.

Multiple types of midwives practice in the United States, but regulation of midwifery practice varies by state. In some states, direct entry midwifery practice is unregulated or criminalized. Because regulations are the most burdensome of the public health interventions, they require the most stringent ethical critique. This article uses the most recent Public Health Code of Ethics to analyze the ethics of regulations that criminalize direct entry midwifery practice. The Code establishes 8 criteria for ethical actions: (1) permissibility, (2) respect, (3) reciprocity, (4) effectiveness, (5) responsible use of scarce resources, (6) proportionality, (7) accountability and transparency, and (8) public participation. Laws that criminalize direct entry midwifery practice violate all of these criteria and therefore cannot be considered an ethical approach to the state's duty to safeguard public health. The remedy for this problem is for all states to license and regulate all types of midwives that meet international standards of education and training.

Perception of care quality and ethical sensitivity in surgical nurses.

BACKGROUND: It is stated that high ethical sensitivity positively affects the quality of nursing care. However, the relationship between nursing care quality and ethical sensitivity has not been clearly demonstrated in researches. AIM: This study was carried out to determine the relationship between surgical nurses' care behaviors and their ethical sensitivity. METHOD: The sample of this cross-sectional, descriptive-correlational study consists of 308 nurses who worked at the surgical departments in four Turkish hospitals. The data were collected using the "Nurse Description Form" developed by the researcher, "Caring Behaviours Inventory-24" and "Ethical Sensitivity Questionnaire." Data were evaluated by the Mann Whitney U test, Kruskal Wallis one-way analysis of variance and Spearman correlation analysis. ETHICAL CONSIDERATIONS: The study was approved by the ethics committee. Verbal and written consent was received from the nurses. RESULTS: It was found in the study that nurses' Caring Behaviours Inventory-24 total score median was 5.25 (4.83-5.58), nurses' perception level of caring quality was high, median of Ethical Sensitivity Questionnaire total score was 89.00 (75.00-101.00) and nurses' ethical sensitivity was moderate. A negative significant relation was found between nurses' Caring Behaviours Inventory-24 total score and Ethical Sensitivity Questionnaire total score (r = -0.162; p = 0.009). A negative relation was also detected between nurses' working period at the current clinic and providing benefit (r = -0.147; p = 0.012), holistic approach (r = -0.139; p = 0.018) and orientation (r = -0.175; p = 0.003) scores of Ethical Sensitivity Questionnaire sub-scales. CONCLUSION: Nurses' perception levels of caring quality were high and their ethical sensitivity levels were moderate. It was found out that nurses' ethical sensitivity increased together with their perception of caring quality, and as their working period at the current clinic increased, the ethical sensitivity also increased in terms of the sub-scales of providing benefit, holistic approach, and orientation. The factors that adversely affect the quality of nursing care and ethical sensitivity should be examined and attempts should be made to improve the working environment.

"I'm sure we talked about it": Midwives experiences of ethics education and ethical dilemmas, a qualitative study.

AIM: Midwives are expected to identify and help resolve ethics problems that arise in practice, skills that are presumed to be taught in midwifery educational programs. In this study, we explore how midwives recognize ethical dilemmas in clinical practice and examine the sources of their ethics education. METHODS: We conducted semi-structured, individual interviews with midwives from throughout the United States (U.S.) (n=15). Transcripts of the interviews were analysed using an iterative process to identify themes and subthemes. FINDINGS: Midwives described a range of professional ethical dilemmas, including challenges related to negotiating strained interprofessional relationships and protecting or promoting autonomy for women. Ethical dilemmas were identified by the theme of unease, a sense of distress that was expressed in three subthemes: uncertainty of action, compromise in action, and reflecting on action. Learning about ethics and ethical dilemmas occurred, for the most part, outside of the classroom, with the majority of participants reporting that their midwifery program did not confer the skills to identify and resolve ethical challenges. CONCLUSION: Midwives in this study reported a range of ethical challenges and minimal classroom education related to ethics. Midwifery educators should consider the purposeful and explicit inclusion of midwifery-specific ethics content in their curricula and in interprofessional ethics education. Reflection and self-awareness of bias were identified as key components of understanding ethical frameworks. As clinical preceptors were identified as a key source of ethics learning, midwifery educators should consider ways to support preceptors in building their skills as role models and ethics educators.

Nurses experiences of ethical dilemmas: A review.

BACKGROUND: Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today's hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual's dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses' options to act on the basis of ethical and moral grounds in the individual care situation. AIM: The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today. METHOD: The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas. ETHICAL CONSIDERATION: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. RESULTS: The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse-patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses. CONCLUSION: Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses' professional decision-making and forcing them to compromise basic nursing values.