Experiences of ethical issues when caring for children with cancer.

BACKGROUND: The treatment for pediatric cancer is often physically, socially, and psychologically demanding and often gives rise to ethical issues. OBJECTIVE: The purpose of this study was to describe healthcare professionals' experiences of ethical issues and ways to deal with these when caring for children with cancer. METHODS: A study-specific questionnaire was given to healthcare professionals at a pediatric hospital in Sweden. Qualitative content analysis was used to analyze answers to open-ended questions. The data were sorted into 2 domains based on the objective of the study. In the next step, the data in each domain were inductively coded, generating categories and subcategories. RESULTS: The main ethical issues included concerns of (1) infringing on autonomy, (2) deciding on treatment levels, and (3) conflicting perspectives that constituted a challenge to collaboration. Professionals desired teamwork and reflection to deal with ethical concerns, and they needed resources for dealing with ethics. IMPLICATIONS FOR PRACTICE: Interprofessional consideration needs to be improved. Forums and time for ethics reflections need to be offered to deal with ethical concerns in childhood cancer care. CONCLUSIONS: Experiences of ethical concerns and dealing with these in caring for children with cancer evoked strong feelings and moral perplexity among nursing staff. The study raises a challenging question: How can conflicting perspectives, lack of interprofessional consideration, and obstacles related to parents' involvement be "turned around," that is, contribute to a holistic perspective of ethics in cancer care of children?

Nursing research on religion and spirituality through a social justice lens.

Critical theories such as postcolonial feminism and intersectionality can provide new and vital perspectives on the interplay between social justice, religion, spirituality, health, and nursing. Criticality prompts us to examine taken-for-granted assumptions, such as the neutrality and universality of spirituality, while analyzing social relations of power, including the racialization of religion and religious patriarchy, that may result in oppressive conditions and social exclusion. The argument is made that when refracted through critical, intersectional lenses, religious and spiritual traditions can be rich sources of theoretical foundations and practical services that could inform nursing's recent re/turn toward social justice.

Spiritual care: evangelism at the bedside.

News media stories about Christian nurses sharing religious beliefs with patients raise questions about ethical spiritual care and the appropriateness of sharing one's faith at the bedside. The purpose of this article is to explore the ethics of faith sharing in the context of Christian nursing and offer guidance for ethical spiritual care.

The NMC code: conduct, performance and ethics.

The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives is a set of key principles that should underpin the practice of all nurses and midwives, and remind them of their professional responsibilities. It is not just a tool used in fitness-to-practise cases--it should be used to guide daily practice for all nurses and midwives. Alongside other standards, guidance and advice from the NMC, the code should be used to support professional development.

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.

Morality and moral conflicts in hospice care: results of a qualitative interview study.

Hospices consider themselves places that practise a holistic form of terminal care, encompassing physical and psychological symptoms, and also the social and spiritual support for a dying patient. So far, the underlying ethical principles have been treated predominantly in terms of a normative theoretical discussion. The interview study discussed in this paper is a qualitative investigation into general and hospice-related conceptions of morality among full-time and voluntary workers in German inpatient hospices. It examines moral conflicts and efforts leading to their solution. The main ideas identified include moral neutrality towards the patients and their requests, the capability of acceptance, the idea of self-restraint with respect to the dying patient and the principle of respect for the natural course of dying. Essential triggers for moral conflicts were the inadequate education of patients, problems of acceptance in view of incurable disease, and disagreements between members of patients' families. The interviewees expressed their scepticism towards formal institutions of ethical counselling. The study has shown a type of virtue ethics that forms an integral part of the overall concept of hospice care, which cannot be treated separately from a holistic idea of care at the end of life.

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.

Influencia del pensamiento humanista y filosófico en el modo de actuación profesional de enfermería / Influence of the humanistic and philosophical thinking on the nursing professional mode of acting

Se realizó una revisión bibliográfica con el objetivo de valorar la influencia del pensamiento humanista y filosófico en el modo de actuación profesional de enfermería. Es considerado en nuestro análisis el proceso de institucionalización de la enfermería profesional, así como la necesaria vinculación que se establece entre el pensamiento filosófico, los elementos más genuinos de la ética médica, la bioética y el Proceso de Atención de Enfermería, para establecer estrategias de cuidados profesionales en los que el proceso de humanizar en el arte de cuidar, conduzcan hacia unos servicios en salud de excelencia en el presente siglo, como respuesta a la creciente demanda de personalización de la asistencia sanitaria. Se concluye que es necesario vincular conocimientos de otras ciencias a la Enfermería para materializar su objeto de estudio de manera holística, pues la calidad en la formación de este profesional no depende exclusivamente de los conocimientos, habilidades intelectuales y hábitos profesionales contemplados en el currículo universitario, sino también de sus motivaciones, de los intereses personales y colectivos, así como el sistema de valores que regulan su ética profesional, pues no se puede desligar la buena praxis del cuidar de los valores humanistas, a partir de una propuesta de filosofía de la Enfermería que incluye con enfoque sistémico a los componentes: seres humanos, medio ambiente, salud, enfermero y enfermería(AU)

A bibliographic review was made to assess the influence of humanistic and philosophical thinking in Nursing professional thinking. In our analysis, the institutionalization process of professional nursing is considered, as well as the necessary linking established among philosophical thinking, the most genuine elements of medical ethics, bioethics, and the nursing care process, to lay down strategies of professional care where the humanizing process in the art of care leads to health services of excellence in this century, as an answer to the increasing demand of personalizing health care. It was concluded that it is necessary to link knowledges of other sciences with nursing to materialize its object of study in a holistic way, since the quality of training of this professional does not depend exclusively on knowledge, intellectual abilities, and professional habits registered in the university curriculum vitae, but also on his motivations, on his personal and collective interests, as well as on the system of values regulating his professional ethics, since it is impossible to separate the good praxis from taking care of the humanistic values, starting from a proposal of nursing philosophy that includes the following components with a systemic approach: human beings, environment, health, nurse, and nursing(AU)

Influencia del pensamiento humanista y filosófico en el modo de actuación profesional de enfermería / Influence of the humanistic and philosophical thinking on the nursing professional mode of acting

Se realizó una revisión bibliográfica con el objetivo de valorar la influencia del pensamiento humanista y filosófico en el modo de actuación profesional de enfermería. Es considerado en nuestro análisis el proceso de institucionalización de la enfermería profesional, así como la necesaria vinculación que se establece entre el pensamiento filosófico, los elementos más genuinos de la ética médica, la bioética y el Proceso de Atención de Enfermería, para establecer estrategias de cuidados profesionales en los que el proceso de humanizar en el arte de cuidar, conduzcan hacia unos servicios en salud de excelencia en el presente siglo, como respuesta a la creciente demanda de personalización de la asistencia sanitaria. Se concluye que es necesario vincular conocimientos de otras ciencias a la Enfermería para materializar su objeto de estudio de manera holística, pues la calidad en la formación de este profesional no depende exclusivamente de los conocimientos, habilidades intelectuales y hábitos profesionales contemplados en el currículo universitario, sino también de sus motivaciones, de los intereses personales y colectivos, así como el sistema de valores que regulan su ética profesional, pues no se puede desligar la buena praxis del cuidar de los valores humanistas, a partir de una propuesta de filosofía de la Enfermería que incluye con enfoque sistémico a los componentes: seres humanos, medio ambiente, salud, enfermero y enfermería.

A bibliographic review was made to assess the influence of humanistic and philosophical thinking in Nursing professional thinking. In our analysis, the institutionalization process of professional nursing is considered, as well as the necessary linking established among philosophical thinking, the most genuine elements of medical ethics, bioethics, and the nursing care process, to lay down strategies of professional care where the humanizing process in the art of care leads to health services of excellence in this century, as an answer to the increasing demand of personalizing health care. It was concluded that it is necessary to link knowledges of other sciences with nursing to materialize its object of study in a holistic way, since the quality of training of this professional does not depend exclusively on knowledge, intellectual abilities, and professional habits registered in the university curriculum vitae, but also on his motivations, on his personal and collective interests, as well as on the system of values regulating his professional ethics, since it is impossible to separate the good praxis from taking care of the humanistic values, starting from a proposal of nursing philosophy that includes the following components with a systemic approach: human beings, environment, health, nurse, and nursing.

Importancia de decir siempre la verdad al paciente / Importance of telling always the truth to patients

La Ética es la ciencia que se encarga del estudio de la moral, es la reflexión sistemática sobre normas o valores que deberían guiar la conducta humana. Se realizó este estudio descriptivo y prospectivo para valorar el criterio de pacientes, enfermeras y médicos sobre la importancia de decir siempre la verdad al paciente. El universo de estudio lo constituyeron el total de los pacientes ingresados en el período que se realizó el trabajo, 88 enfermeras y 48 médicos. La muestra quedó conformada, por muestreo aleatorio simple, por 80 pacientes, 40 enfermeras y 40 médicos. Se aplicó un cuestionario donde se incluyó, además de los indicadores que permitieron caracterizar la muestra, varias preguntas, diferentes para el paciente, la enfermera y el médico, sobre el aspecto esencial a averiguar. El mayor porcentaje de los involucrados respondieron afirmativamente a todas las preguntas formuladas en sus cuestionarios. Entre los pacientes, sólo una mujer opinó de otra forma en la pregunta relacionada con la malignidad de la enfermedad. Entre las enfermeras especializadas y los técnicos (as), un pequeño porcentaje marcó la pregunta sobre decir la verdad pero no en todas las enfermedades y pocos médicos opinaron sobre la necesidad de tener en cuenta la personalidad y el estado psicológico del paciente. Se puede concluir que los profesionales y personal de enfermería participantes, no violaron el principio ético de la verdad en la práctica de su profesión y que los pacientes están interesados, de una forma u otra, en conocer la verdad sobre su enfermedad(AU)

The Ethics is the science that takes charge of the study of the morals, it is the systematic reflection about norms or values that should guide the human behavior. He/she was carried out this descriptive and prospective study to value the approach of patients, nurses and doctors about the importance of always saying the truth to the patient. The study universe constituted it the total of the patients entered in the period that was carried out the work, 88 nurses and 48 doctors. The sample was conformed, for simple aleatory sampling, for 80 patients, 40 nurses and 40 doctors. A questionnaire was applied where it was included, besides the indicators that allowed to characterize the sample, several questions, different for the patient, the nurse and the doctor, on the essential aspect to discover. The biggest percentage of those involved responded affirmatively to all the questions formulated in its questionnaires. Among the patients, a woman only said in another way in the question related with the malignancy of the illness. Between the specialized nurses and the technicians (ace), a small percentage marked the question on saying the truth but not in all the illnesses and few doctors said about the necessity of keeping in mind the personality and the patient's psychological state. You can conclude that the professionals and personal of infirmary participants, they didn't violate the ethical principle of the truth in the practice of their profession and that the patients are interested, in a way or other, in knowing the truth on their illness(AU)

The lived experience of moral distress: nurses who assisted with elective abortions.

The concept of moral distress has been studied mainly as an occupational issue and has not been developed for use in clinical practice. This study was designed to bridge prior studies of occupational moral distress with future clinical investigations of moral distress. Study aims were to discover the essence, properties, and full content domain of the concept of moral distress in order to develop a universal definition of the concept. A modified phenomenological study of nurses' experience of a particular moral issue was conducted. A maximum variation sampling strategy was used to recruit a final sample of registered nurses (N = 10). Interior aversion is the essential act of moral distress. Five properties of the lived experience of moral distress were identified: perception, pain, valuing, altered participation, and perspective. Three types of moral distress identified in this study were: shocked, muted, and suppressed (persistent). Type of moral distress was related to situational conditions, recognition of moral ends, quality of coping processes, and temporal breadth. Negative outcomes of moral distress, which probably exist, were undetectable with this study design. The definition has been composed in universal terms, but remains tentative, since the full content domain of moral distress was largely but not definitively identified.