Humanization practices in the parturitive course from the perspective of puerperae and nurse-midwives.

OBJECTIVE: to understand humanization practices in the parturitive course from the point of view of purperae and nurse-midwives. METHODS: an exploratory, descriptive, qualitative research carried out in a maternity hospital in Bahia State. Semi-structured interviews were carried out, with a structured script applied to 11 mothers and 5 nurse-midwives from March to June 2019. Analysis followed Bardin's content structure. RESULTS: this study unveiled the importance of using soft care technologies, respect for female role, active participation and women's autonomy as a positive impact on the parturition process. FINAL CONSIDERATIONS: nurse-midwives are qualified professionals to assist women in labor and birth. They can favor the implantation and implementation of care with humanization practices, respect for women's choices and incentive to the normal way of delivery with an expanded view of individual and multidisciplinary needs.

['Zero isolation', a care practice oriented towards recovery]. / "Zéro isolement", une pratique de soins orientée vers le rétablissement.

Some institutions do not have an isolation room. Agitation is managed otherwise, with the idea that restraint or isolation can only be a terrible experience. The care pathway is therefore designed to favour autonomy and to limit restrictions of freedom. In this context, professionals are in constant contact with the user. Example of a unit which advocates this concept of rehabilitation.

Strategies to Improve the Integration of Community Health Workers Into Health Care Teams: "A Little Fish in a Big Pond".

INTRODUCTION: The Patient Protection and Affordable Care Act acknowledges the value of community health workers (CHWs) as frontline public health workers. Consequently, growing attention has been placed on promoting CHWs as legitimate partners to provide support to health care teams and patients in the prevention, management, and control of chronic disease, particularly among diverse populations and high-need individuals. METHODS: Using a mixed-methods research approach, we investigated the integration of CHWs into health care teams from the CHW perspective. We conducted a survey of 265 CHWs and interviews with 23 CHWs to better understand and describe their experience and their perceived opportunities and challenges regarding their integration within the context of health care reform. RESULTS: Feelings of organizational support were positively correlated with the number of CHWs in the organization. CHWs reported the following facilitators to integration: having team meetings (73.7%), training inside (70.4%) and outside of the organization (81.6%), access to electronic health records, and ability for CHWs to stay connected to the community. CONCLUSION: The perspectives of CHWs on their positive and negative experiences offer useful and innovative insight into ways of maximizing their impact on the health care team, patients, and their role as key emissaries between clinical services and community resources.

In Cyprus, 'midwifery is dying...'. A qualitative exploration of midwives' perceptions of their role as advocates for normal childbirth.

BACKGROUND: advocacy has been identified as vital for improving maternal and newborn health. In many countries, midwives struggle to advocate for women; in Cyprus, there has been no research into perceptions of advocacy amongst midwives. AIM: this study provides an exploration of the perceptions of midwives as client advocates for normal childbirth in Cyprus. DESIGN: a qualitative approach was adopted, using participant observation and semi-structured interviews with a purposive sample of twenty experienced midwives. A thematic approach was taken for the analysis. FINDINGS: five main interconnected themes emerged, two of which, 'Lack of professional recognition' and 'Deficiencies in basic or continuing education' presented barriers to midwives' adoption of an advocacy role. Three themes reflected structural factors that also discouraged midwives from acting as advocates: these were 'physician dominance', 'medicalisation of childbirth' and 'lack of institutional support'. CONCLUSION: advocacy is a demanding and challenging role and midwives should be empowered to feel confident in undertaking this role through continuing professional education programmes and professional recognition. In order to be effective advocates, midwives needed to be recognised and valued by the public and by other health professionals as equal partners within the multidisciplinary team. However, midwives in Cyprus find themselves in difficult situations when advocating normal childbirth due to medical domination of the health services, medicalisation of childbirth and inadequate institutional support. IMPLICATIONS FOR PRACTICE: in this setting, midwives need to gain professional recognition, to have more effective basic and continuing education programmes and receive better support from managers and policy makers in order to become advocates for normal childbirth.

Nurses' ethical reflections on caring for people with malodorous exuding ulcers.

The aim of this study was to illuminate nurses' reflections on obstacles to and possibilities for providing care as desired by people with malodorous exuding ulcers. Six nurses who took part in a previous study were interviewed. The participants were shown an illustration with findings from a study that elucidated the meaning of living with malodorous exuding ulcers. They were asked to reflect on the obstacles to and possibilities of providing the care desired by the patients. Twelve audio-recorded transcribed interviews were analysed using qualitative content analysis. Our interpretations of participants' reflections on the obstacles and possibilities while caring for such patients revealed one theme: striving to 'do good' and 'be good'. The obstacles were formulated as subthemes: experiencing clinical competence constraints, experiencing organizational constraints, experiencing ineffective communication, fearing failure, and experiencing powerlessness. The possibilities were formulated by the subthemes: spreading knowledge about ulcer treatments, considering wholeness, and creating clear channels of communication. A multiprofessional team could overcome the identified obstacles and provide structure, competencies, commitment and support to 'do good' for patients and 'be good' nurses.

Healing during existential moments: the "art" of nursing presence.

This article addresses nursing presence, a phenomenon essential to holistic nursing care. The concept is introduced and explained, supporting background information is reviewed, barriers are identified, and successful applications are illustrated in different clinical settings. Avowing that metaphysical knowledge is the underpinning to the art of nursing presence, a Transformative Nursing Presence Model is offered as a distinctive framework for nurses and organizations interested in fostering enhanced nursing presence.

Nursing, religiosity, and end-of-life care: interconnections and implications.

The influence of religious beliefs and practices at the end of life is underinvestigated. Given nursing's advocacy role and the intimate and personal nature of the dimensions of religiosity and the end of life, exploring the multidimensional interplay of religiosity and end-of-life care is a significant aspect of the nurse-patient relationship and must be better understood. The question that must be faced is whether nurses' own belief systems impinge on or influence patient care, especially for patients who are at the end of life. When nurses understand their own beliefs and respect the religious practices and needs of patients and their families, it deepens the humanistic dimensions of the nurse-patient relationship.

Nurses perceptions of older patients integrity in long-term institutions.

AIM: This article reports on a study into nurses' perceptions of how the integrity of older patients is maintained in long-term care institutions in Finland. BACKGROUND: Patient integrity is an important aspect of ethical decision-making in nursing care and respect for integrity is central to good care. Problems may occur in the maintenance of older patients' integrity because of reduced communication skills and decision-making authority. Data collection was by means of a purpose-designed structured questionnaire in a sample of 222 nurses from four purposively selected long-term institutions in 2004. The response rate was 74%. The questionnaire consisted of a background data sheet and integrity items in three categories: psychological, physical and social integrity. RESULTS: The nurses gave the highest ratings for the maintenance of physical integrity, particularly for respectful and gentle touching. Nonetheless, according to nurses patients were often tied to their bed or chair. The second highest ratings were give to the maintenance of social integrity. Most nurses felt that the patients had good contact with the outside world, mainly family members. On the other hand loneliness was a more common problem for older people in institutions. The maintenance of psychological integrity received the lowest rating. Satisfaction with the job and with the quality of service provided correlated positively with the nurses' views on the maintenance of patient integrity. CONCLUSION: Nurses take the view that patient integrity is maintained reasonably well in long-term institutions. There are, however, some problematic areas that require special attention, particularly in the maintenance of psychological integrity. Future research needs to look at how patients and their relatives view the situation and to explore different training delivery options that can help raise the ethical quality of nursing care.

Respect in critical care: a foundational ethical principle.

Demonstrating respect is the hallmark of excellence in caring for critically ill patients and their families. Understanding the meaning of respect and the strategies that foster it are foundational for nurses as interdisciplinary healthcare professionals. Basically, respect is the act of esteeming another. Demonstrated by word and deed, it is fostered by attending to the whole person by involving the patient and family in decision making, providing family-centered care, bearing witness, and adopting a broader perspective marked by cultural humility. By creating processes that ensure everyone's views are heard, healthcare professionals as well as patients and their families are supported. One key process, known as the "Council Process," shifts dialogue from telling to discovering, from judging to inquiring; it neutralizes conjecture, fosters the acceptance of moral conflict, and protects the integrity of healthcare professionals and their organizations. Acknowledging respect as a foundational ethical principle is the first step toward relationally rich healthcare environments for patients, families, and professionals.

Making them more vulnerable: nursing insights on the irony of using questionnaires.

TOPIC: Nursing insights on the experience of using standardized questionnaires during hospice care. PURPOSE: To explore and describe the experience of hospice staff using questionnaires on hospice clients: whether such instruments help or hinder the holistic, compassionate hospice practice and to set this topic on the research agenda in the hope of generating critical reflection on this important aspect of hospice care. SOURCES: A cross-section of hospice staff interviewed about their experience with administering the questionnaires. (Findings from research conducted with hospice clients on their experience of questionnaires are published separately.) CONCLUSIONS: The initial findings indicate that staff perceive questionnaires as negatively impacting on their efforts to engage in holistic and compassionate hospice practice and point to a major irony that questionnaires, designed for the supportive care of the vulnerable, actually make the vulnerable more vulnerable.

Doing the right thing: nursing students, relational practice, and moral agency.

Registered nurses and nurse educators are often unaware of how nursing students experience the nursing profession. In the current practice climate of increased workloads, reduced funding, and higher patient acuity, nurse educators are likely to hear from colleagues how unprepared newly qualified nurses are for the needs of practice. It is difficult for many nursing students to see value in their practice because they become preoccupied with their perceived lack of knowledge and technical skills. Nurses and nurse educators should be aware of how this brands new graduates and informs their sense of developing professional identity. Despite their feelings of deficit in terms of skills and knowledge, it is clear that many nursing students are, in fact, effectively negotiating relational ethics. This article presents a collaborative account of the important relational work being undertaken by one group of nursing students in New Zealand.

A personal and ethical perspective on chronic wound pain.

Pain is a rarely acknowledged complication of chronic wounds, yet for those who live with it, it is often the over-riding preoccupation. In this article, the author--who herself has suffered for many years with wound pain--discusses why pain is not widely acknowledged by health professionals caring for wounds, and highlights why awareness of it is central to holistic care.

A pluralist view of nursing ethics.

This paper makes the case for a pluralist, contextualist view of nursing ethics. In defending this view, I briefly outline two current perspectives of nursing ethics - the Traditional View and the Theory View. I argue that the Traditional View, which casts nursing ethics as a subcategory of healthcare ethics, is problematic because it (1) fails to sufficiently acknowledge the unique nature of nursing practice; and (2) applies standard ethical frameworks such as principlism to moral problems which tend to alienate or undermine nursing ethical concerns. Alternatively, the Theory View, which aims to build an independent and comprehensive theory of nursing ethics, is also found wanting because it (1) fails to sufficiently acknowledge the heterogeneous nature of nursing practices; (2) overemphasizes the differences and undervalues the similarities between nurses and other health professionals; and (3) assumes that one ethical framework can be meaningfully applied across diverse moral problems and contexts. My alternative, is to argue that nursing ethics inquiry should take a pluralist and critical stance towards available ethical frameworks and the negotiation of the ethical realm. On this view, the search for moral consensus or a unique ethical framework for nursing is replaced by the task of working strategically with multiple frameworks in order to expand the moral agency of nurses and empower them to positively engage with moral uncertainty as an inevitable feature of living a moral life. I conclude by indicating some of the implications that this has for the teaching of nursing ethics.

Narrative ethics in nursing for persons with intellectual disabilities.

Both in The Netherlands and in Britain, practices of 'life story work' have emerged in nursing for persons with intellectual disabilities. The narrative approach to care and support may at the same time be considered as an attempt to compensate for the 'disabled authorship' of many persons with intellectual disabilities and as a sign of controversy with standard practices of diagnosis and treatment that tend to neglect the personal identities of both clients and care givers, their particular historical and relational contexts and their spiritual needs. This paper argues that narrative ethics not only offers an appropriate moral framework for practices of life story work, but that these practices are a narrative ethics in action. Starting with an account of the concept of 'life story work' as it has been introduced in nursing practices in the field of intellectual disability, the paper explains its relationship with key characteristics of narrative ethics. The teleological dimension in narrative ethics and in practices of life story work sparks off a dialectic process of understanding of the client and self-understanding of the care giver. It also invites a respect for life in its openness toward the future and presupposes an openness toward other possible versions of the life narrative. The phenomenological and hermeneutic-interpretative methodologies in narrative ethics aim at a 'sudden moment of intimacy' in relationships of nurses and clients. The 'epiphany' of this essential moment of recognition, insight and engagement cannot, however, be brought about by methodology.