Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective.

BACKGROUND: Intensive care unit (ICU) nurses working in South Korea report experiencing uncertainty about how to care for patients undergoing withdrawal of life-sustaining treatments (WLT). A lack of consensus on care guidelines for patients with WLT contributes to uncertainty, ambiguity, and confusion on how to act appropriately within current law and social and ethical norms. To date, little has been discussed or described about how ICU nurses construct meaning about their roles in caring for dying patients in the context of wider social issues about end-of-life care and how this meaning interacts with the ICU system structure and national law. We aimed to better understand how ICU nurses view themselves professionally and how their perceived roles are enabled and/or limited by the current healthcare system in South Korea and by social and ethical norms. METHODS: This qualitative descriptive study was conducted using in-depth, semi-structured interviews and discourse analysis using Gee's Tools of Inquiry. Purposive sampling was used to recruit ICU nurses (n = 20) who could provide the most insightful information on caring for patients undergoing WLT in the ICU. The interviews were conducted between December 2021 and February 2022 in three university hospitals in South Korea. RESULTS: We identified four categories of discourses: (1) both "left hanging" or feeling abandoned ICU nurses and patients undergoing WLT; (2) socially underdeveloped conversations about death and dying management; (3) attitudes of legal guardians and physicians toward the dying process of patients with WLT; and (4) provision of end-of-life care according to individual nurses' beliefs in their nursing values. CONCLUSION: ICU nurses reported having feelings of ambiguity and confusion about their professional roles and identities in caring for dying patients undergoing WLT. This uncertainty may limit their positive contributions to a dignified dying process. We suggest that one way to move forward is for ICU administrators and physicians to respond more sensitively to ICU nurses' discourses. Additionally, social policy and healthcare system leaders should focus on issues that enable and limit the dignified end-of-life processes of patients undergoing WLT. Doing so may improve nurses' understanding of their professional roles and identities as caretakers for dying patients.

Effects of Communication Skills and Organisational Communication Satisfaction on Self-Efficacy for Handoffs among Nurses in South Korea.

(1) Background: Although numerous studies related to communication in a nursing context have been conducted, there is a lack of research considering the effects of personal and organisational communication factors on the self-efficacy for handoffs. This study aimed to identify the impact of communication competence and intra-organisational communication satisfaction on self-efficacy for handoffs among nurses. (2) Methods: This cross-sectional research was conducted between September and October 2018. In total, 203 registered nurses were invited to participate in the study by convenience sampling from five general hospitals in South Korea. Data were analysed using SPSS for t-test, one-way analysis of variance, Pearson's correlation coefficients, and multiple regression analysis. (3) Results: In the final regression model, the adjusted R square was significant, explaining 24.2% of the variance in self-efficacy for handoffs (F = 22.43, p = 0.001) when the variable horizontal communication (ß = 0.282, p < 0.001) was included in intra-organisational communication satisfaction. In addition, the longer the nurse's experience in the current unit and the higher the communication competence, the more statistically significant the self-efficacy for handoffs was found to be (ß = 0.215, p = 0.001 and ß = 0.180, p = 0.008). (4) Conclusions: To enhance the self-efficacy for handoffs, nurse managers should foster an atmosphere that allows their staff nurses to interact freely and establish specific guidelines for handoffs through mutual communication.

Ethical issues experienced by nurses during COVID-19 pandemic: Systematic review.

BACKGROUND: Frontline nurses who care for patients with COVID-19 work in stressful environments, and many inevitably struggle with unanticipated ethical issues. Little is known about the unique, ethically sensitive issues that nurses faced when caring for patients with COVID-19. AIM: To better understand how frontline nurses who care for patients with COVID-19 experience ethical issues towards others and themselves. METHODS: Systematic review of qualitative evidence carried out according to the Preferred Reporting Items for Systematic reviews and Meta-analyses on ethical literature (PRISMA-Ethics). The electronic databases PubMed, Embase, Cinahl, Web of Science, Philosopher's Index, and Scopus were queried to identify candidate articles. Articles appearing from March 1, 2020 to December 31, 2022 were considered if they met the following inclusion criteria: (1) Published qualitative and mixed method studies and (2) ethical issues experienced by nurses caring for patients with COVID-19. We appraised the quality of included studies, and data analysis was guided by QUAGOL principles. FINDINGS: Twenty-six studies meeting our inclusion criteria for how nurses experience ethical issues were characterised by two key themes: (1) the moral character of nurses as a willingness to respond to the vulnerability of human beings and (2) ethical issues nurses acted as barriers sometimes, impeding them from responding to requests of vulnerable human beings for dignified care. CONCLUSION: Our review provides a deeper understanding of nurses' experiences of ethically sensitive issues, while also highlighting the critical need for adjustments to be made at organisational and societal levels. Ethical issues that emerged in situations where organisational and situational constraints impeded nurses' ethical responses to patients' appeals suggests that early practical support should be made available to resolve ethical issues recognised by nurses. Such support contributes to protecting and promoting not only the dignity of patients with COVID-19 but also of fellow humans in need during crisis.

Aesthetic Attitude Based on Kant's Aesthetics of Caring Relationships in Nursing.

(1) Background: Although aesthetic attitude has been comprehended as one of the fundamental traits in nursing, there is a lack of discussion considering Kant's aesthetics of caring relationships. The purpose of this study was to illuminate aesthetic and moral characteristics of caring expressed in the caring relationship between a nurse and patient and suggest a new perspective of aesthetic attitude based on Kant's aesthetics of care ethics. (2) Methods: A theoretical reflection was contemplated regarding notions of aesthetic attitude in the caring relationship between a nurse and patient. (3) Results: human faculty of reflective aesthetic judgment to feel the beautiful and the sublime through imagination and free play in Kant's aesthetics could be applied to the aesthetic attitude in the field of nursing. (4) Conclusions: A nurse who has trained with this aesthetic attitude can act as a moral agent and contribute to the protection and promotion of human dignity in a caring relationship.

Job satisfaction and moral distress of nurses working as physician assistants: focusing on moderating role of moral distress in effects of professional identity and work environment on job satisfaction.

BACKGROUND: Physician assistant was created in response to a shortage of physicians. However, this profession is not officially recognized in Korea. Many nurses are working as physician assistants. Their job satisfaction was low due to role conflict. Job satisfaction plays a major role in providing high quality nursing. This study aimed to investigate effects of work environment and professional identity on job satisfaction and identify the mediating role of moral distress in such effects. METHODS: Participants were 112 nurses working as physician assistants. They were recruited from three General Hospitals. A questionnaire scale was used to collect data. Data were analyzed using frequency, descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation, and Macro Model 4 with SPSS Statistics. RESULTS: Job satisfaction of nurses working as physician assistants had a score of 3.08 out of 5. It showed significant associations with work environment and professional identity. Moral distress had a partial mediating role in relationships of job satisfaction with work environment and professional identity. CONCLUSION: Many nurses are working as physician assistants, although physician assistant as a profession is not officially recognized in Korea. Nurses working as physician assistants experience confusion about their professional identity and moral distress. For better nursing outcomes, physician assistant policy should be improved, and various strategies should be provided to improve their job satisfaction.

Impact of ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses: a cross-sectional study.

BACKGROUND: While several studies have been performed on turnover intention among nurses, limited studies have considered the ethical perspectives on turnover intention among haemodialysis nurses. The purpose of this study was to clarify the impact of ethical factors, namely ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses. METHODS: This cross-sectional research was conducted between July and August 2017. A total of 148 haemodialysis nurses were invited to participate in the study by convenience sampling from 11 general and university hospitals in South Korea. Data were analysed using SPSS for t-test, one-way analysis of variance, Pearson's correlation coefficients, and multiple regression analysis. RESULTS: In the final regression model, the adjusted R-squared significantly explained 34.6% of the variance in turnover intention (F = 22.534, p < .001) when moral distress related to physician practice (ß = 0.310, p = .001) and ethical climate related to the hospital climate (ß = - 0.253, p = .003) and manager (ß = - 0.191, p = .024) were included. Following the stepwise multiple regression process, all subdomains related to moral sensitivity were excluded due to no statistical significance in the final regression model. CONCLUSION: To reduce turnover intention among haemodialysis nurses, hospitals and managers should pay attention to haemodialysis nurses' moral distress originating from physicians' practice and improve their ethical climate. Additionally, it is required that the impact of moral sensitivity on turnover among nurses working in diverse care settings be examined further.

Validation of the Korean Version of Nurses' Moral Courage Scale.

(1) Background: Research that examines moral courage has received a great deal of attention from scholars and practitioners in recent years due to the impact of moral distress experienced by nurses. Although it needs to identify the phenomenon related to moral courage among nurses, there has been a lack of instrumentation to investigate the quantitative aspects of moral courage among Korean nurses. This study aimed to test the validity of the Korean version of the Nurses' Moral Courage Scale. (2) Methods: A cross-sectional study was conducted through convenience sampling of 243 nurses from two general hospitals in South Korea. (3) Results: The Korean version of the Nurses' Moral Courage Scale was developed from construct validity evidence, including 12 items in four domains: 'Compassion and true presence', 'Moral integrity', 'Moral responsibility', and 'Commitment to good care'. Concurrent validity was obtained according to the significant correlation coefficients among the variables: moral courage, moral sensitivity, and professional moral courage. (4) Discussion: Our research contributes to the knowledge and understanding of moral courage in the nursing context and encourages future researchers to conduct a quantitative analysis of moral courage among Korean nurses using the validated K-NMCS.

Internet-Delivered Cognitive Behavioral Therapy in Patients With Irritable Bowel Syndrome: Systematic Review and Meta-Analysis.

BACKGROUND: Irritable bowel syndrome is a common functional gastrointestinal disorder that negatively affects all aspects of life. With the widespread use of the internet, internet-delivered cognitive behavioral therapy has been developed and applied to control symptoms and improve the quality of life of those with irritable bowel syndrome. However, few studies have systematically reviewed the effectiveness of internet-delivered cognitive behavioral therapy on irritable bowel syndrome. OBJECTIVE: This study aimed to systematically review studies that examined the use of internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome and to evaluate the effects of internet-delivered cognitive behavioral therapy on the improvement of symptom severity, quality of life, psychological status, and cost-effectiveness. METHODS: This meta-analysis involved the search of 6 databases for relevant publications. From the 1224 publications identified through database searches, 9 randomized controlled trials were finally included in the analysis. RESULTS: The internet-delivered cognitive behavioral therapies including exposure-based cognitive behavioral therapy, cognitive behavioral therapy for self-management, and cognitive behavioral therapy for stress management were provided in 5 to 13 sessions for 5 to 10 weeks. Internet-delivered cognitive behavioral therapy had medium-to-large effects on symptom severity (standardized mean difference [SMD] -0.633; 95% CI -0.861 to -0.4304), quality of life (SMD 0.582; 95% CI 0.396-0.769), and cost-effectiveness (-0.372; 95% CI -0.704 to -0.039) at postintervention. The effects on symptom severity remained over time even after the intervention, short-term follow-up (SMD -0.391; 95% CI -0.560 to -0.221), and long-term follow-up (SMD -0.357; 95% CI -0.541 to -0.172). There was no significant difference in psychological status, including anxiety and depression, in those with irritable bowel syndrome compared to the controls during the postintervention period. CONCLUSIONS: This review demonstrates that internet-delivered cognitive behavioral therapy could be a cost-effective intervention for improving symptoms and the quality of life in patients with irritable bowel syndrome. However, studies are still insufficient regarding the use of internet-delivered cognitive behavioral therapy in these patients; therefore, more high-quality studies are required in the future.

Impact of Nurse-Physician Collaboration, Moral Distress, and Professional Autonomy on Job Satisfaction among Nurses Acting as Physician Assistants.

Although there is considerable literature on job satisfaction among nurses in various settings, there is little research about contributing factors, including moral distress to job satisfaction among a certain group of nurses, such as nurses acting as physician assistants. The purpose of this study was to verify the impact of nurse-physician collaboration, moral distress, and professional autonomy on job satisfaction among nurses acting as physician assistants. Descriptive and correlational research was conducted on a convenience sample of 130 nurses from five general hospitals in South Korea. In the final regression model, the adjusted R square was significant, explaining 38.2% of the variance of job satisfaction (F = 8.303, p < 0.001), where 'cooperativeness' (ß = 0.469, p = 0.001) from nurse-physician collaboration, 'institutional and contextual factor' from moral distress (ß = -0.292, p = 0.014), and professional autonomy (ß = 0.247, p = 0.015) were included. In hospital environments, a more cooperative inter-professional relationship between nurses and physicians led to less moral distress caused by organisational constraints. A higher level of professional autonomy among nurses acting as physician assistants is required to increase their job satisfaction.

A New Perspective on Human Rights in the Use of Physical Restraint on Psychiatric Patients-Based on Merleau-Ponty's Phenomenology of the Body.

(1) Background: Physical restraint in psychiatric settings must be determined by health care professionals for ensuring their patients' safety. However, when a patient cannot participate in the process of deciding what occurs in their own body, can they even be considered as a personal self who lives in and experiences the lifeworld? The purpose of this study is to review the existential capability of the body from Merleau-Ponty's phenomenology to explore ways of promoting human rights in physical restraint. (2) Methods: A philosophical reflection was contemplated regarding notions of the body's phenomenology. (3) Results: Merleau-Ponty's body phenomenology can explain bodily phenomena as a source of the personal subject, who perceives and acts in the world, and not as a body alienated from the subject in health and illness. Patients, when they are physically restrained, cannot be the self as a subject because their body loses its subjecthood. They are entirely objectified, becoming objects of diagnosis, protection, and control, according to the treatment principles of health care professionals. (4) Conclusions: The foundation of human rights, human being's dignity lies in the health professionals' genuine understanding and response to the existential crisis of the patient's body in relation to its surrounding environment.

The Effects of Group Art Therapy on the Primary Family Caregivers of Hospitalized Patients with Brain Injuries in South Korea.

This study examined the effects of group art therapy on depression, burden, and self-efficacy in primary family caregivers of patients with brain injuries. This was a quasi-experimental, nonequivalent control group and a pre- and post-test design. This study was carried out in one national rehabilitation hospital targeting 41 primary family caregivers of patients with brain injuries. Group art therapy intervention was carried out three days per week comprising 12 sessions over four consecutive weeks. The experimental group (n = 20) received group art therapy, whereas the control group (n = 21) did not. We used a time difference method to minimize the risk of contaminating the control group by sampling sequentially. For depression, although there was a significant difference after the intervention (t = 3.296, p = 0.004), the mean difference score was not statistically significant between the experimental group and the control group (t = 0.861, p = 0.395). The experimental group showed a significantly greater decrease in burden (t = 2.462, p = 0.020) and significantly greater improvement in self-efficacy (t = -6.270, p < 0.001) than the control group. Group art therapy may be an effective nursing intervention for primary family caregivers of patients with brain injuries.

Levels, antecedents, and consequences of critical thinking among clinical nurses: a quantitative literature review

The purpose of this study was to obtain a more comprehensive understanding of critical thinking within the clinical nursing context. In this review, we addressed the following specific research questions: what are the levels of critical thinking among clinical nurses?; what are the antecedents of critical thinking?; and what are the consequences of critical thinking? A narrative literature review was applied in this study. Thirteen articles published from July 2013 to December 2019 were appraised since the most recent scoping review on critical thinking among nurses was conducted from January 1999 to June 2013. The levels of critical thinking among clinical nurses were moderate or high. Regarding the antecedents of critical thinking, the influence of sociodemographic variables on critical thinking was inconsistent, with the exception that levels of critical thinking differed according to years of work experience. Finally, little research has been conducted on the consequences of critical thinking and related factors. The above findings highlight the levels, antecedents, and consequences of critical thinking among clinical nurses in various settings. Considering the significant association between years of work experience and critical thinking capability, it may be effective for organizations to deliver tailored education programs on critical thinking for nurses according to their years of work experience.

Ethical Conflicts Experienced by Nurses in Geriatric Hospitals in South Korea: "If You Can't Stand the Heat, Get Out of the Kitchen".

Ethical conflicts among nurses can undermine nurses' psychological comfort and compromise the quality of patient care. In the last decade, several empirical studies on the phenomena related to ethical conflicts, such as ethical dilemmas, issues, problems, difficulties, or challenges, have been reported; however, they have not always deeply explored the meaning of ethical conflicts experienced by nurses in geriatric care. This study aims to understand the lived experiences of ethical conflict of nurses in geriatric hospitals in South Korea. A phenomenological study was conducted. In-depth, face-to-face interviews were performed with nine registered nurses who cared for elderly patients in geriatric hospitals in South Korea between August 2015 and January 2016. Three main themes emerged from the analysis: (1) confusing values for good nursing, (2) distress resulting from not taking required action despite knowing about a problem, and (3) avoiding ethical conflicts as a last resort. It was found that for geriatric nurses to cope with ethical conflicts successfully, clear ethical guidance, continuing ethics education to improve ethical knowledge and moral behaviors, and a supportive system or program to resolve ethical conflicts involving nurses should be established.

Impact of ethical factors on job satisfaction among Korean nurses.

BACKGROUND: Although numerous studies on job satisfaction among nurses have been conducted, there is a lack of research considering the ethical perspectives of leadership and organizational climate in job satisfaction. OBJECTIVE: The purpose of this study was to clarify the impact of the ethical climate and ethical leadership as perceived by nurses on job satisfaction in South Korea. RESEARCH DESIGN: A descriptive and correlational study was conducted with a convenience sample of 263 nurses from four general hospitals in South Korea. ETHICAL CONSIDERATIONS: This study was approved by the Institute Review Board of Hallym University before data collection. RESULTS: Job satisfaction was positively correlated with ethical climate and ethical leadership. The ethical climate in relationship with hospitals and people orientation leadership were influential factors in the level of job satisfaction among nurses. DISCUSSION: Organizations in the nursing environment should pay attention to improving the ethical climate with acceptable ethical norms in the workplace and nurse leaders should respect, support and genuinely care about their nurses in ethical concerns.

The Association Between the Burden on Formal Caregivers and Behavioral and Psychological Symptoms of Dementia (BPSD) in Korean Elderly in Nursing Homes.

Behavioral and psychological symptoms of dementia (BPSD) are sources of psychological distress for caregivers who take care of people with dementia. The purpose of this study was to examine the association between BPSD and the burden on formal caregivers of nursing homes in South Korea. Results showed that the total severity score of BPSD had a statistically significant positive correlation with the total distress score. Agitation/Aggression was the most distressing symptom for registered nurses and care workers. These findings suggest that there is a need for improved treatments for BPSD, to help mitigate its burden on formal caregivers.

Moral distress experienced by nurses: a quantitative literature review.

Nurses are frequently confronted with ethical dilemmas in their nursing practice. As a consequence, nurses report experiencing moral distress. The aim of this review was to synthesize the available quantitative evidence in the literature on moral distress experienced by nurses. We appraised 19 articles published between January 1984 and December 2011. This review revealed that many nurses experience moral distress associated with difficult care situations and feel burnout, which can have an impact on their professional position. Further research is required to examine worksite strategies to support nurses in these situations and to develop coping strategies for dealing with moral distress.

Effect of domain-specific life satisfaction on depressive symptoms in late adulthood and old age: results of a cross-sectional descriptive survey.

PURPOSE: The aim of this study was to determine the effect of domain-specific life satisfaction on the risk of depressive symptoms in late adulthood and old age. METHODS: A cross-sectional descriptive survey was conducted using stratified data from the Korean Longitudinal Study of Aging (KLoSA). The respondents completed the Korean version CES-D and domain-specific life satisfaction. RESULTS: In both groups, satisfaction with health and economic status were significant predictors of depressive symptoms. In the old age group, depressive symptoms were also predicted by satisfaction with the relationships with one's spouse and with one's children. CONCLUSION: Life satisfaction was a crucial predictive factor for depressive symptoms in late adulthood and old age.

Concept analysis of nurses' identification of pain in demented patients in a nursing home: development of a hybrid model.

Pain is a subjective feeling, with no known biologic markers. Proof of its presence and measurement of intensity rely entirely on self-reporting by the patient. The hampered or abrogated ability of demented patients to report their pain is a major difficulty in pain assessment and management. The purpose of this study was to clarify and conceptualize pain identification in demented patients by nurses. The hybrid model of concept development was used in the development of a conceptual structure of pain in demented patients. Data were collected by literature review (theoretical phase) and among nurses caring for demented patients in three nursing homes in South Korea (fieldwork phase). The 13 nurses involved each reported >3 years' nursing home experience. In a hybrid model, pain identification in demented patients by nurses constituted an active daily process of integrating patient expressional cues during periods of pain and pain relief and involving three dimensions: identification schemes based on the stage and type of dementia, connecting assessments after each intervention, and cognitive efforts to establish the origin of pain. Identification of pain in demented patients by nurses is a complex process. More research is needed to formulate an assessment tool and pain management strategies for patients with dementia.