Moral Distress: One Unit's Recognition and Mitigation of This Problem.

Moral distress experienced by staff has been well documented in the intensive care work areas, but less described in oncology nursing. Factors that contribute to moral distress include ethical dilemmas, mismatched goals of care among patients and their families and providers, and perceptions of futility of care. This article describes recognizing the risk of moral distress in a newly formed medical-surgical oncology unit and steps taken to mitigate developing moral distress, illustrating that moral distress is present in oncology nursing and warrants further study.

Direct-to-consumer advertising effects on nurse-patient relationship, authority, and prescribing appropriateness.

BACKGROUND:: Discussing direct-to-consumer advertising of prescription drugs during a visit could affect prescribing practices and provider-patient relationship. RESEARCH OBJECTIVES:: The study examines advanced practice nurse prescribers' perceptions of direct-to-consumer advertising and its effects on nurse-patient relationship, prescriptive authority, and appropriateness of patient clinical requests. RESEARCH DESIGN:: A cross-sectional survey design was implemented. PARTICIPANTS AND RESEARCH CONTEXT:: The random sample consisted of 316 nurses (27.17% response rate) in one of the Midwestern states in the United States. Pearson's chi-square analysis and multiple/multinomial logistic regression analyses were used. ETHICAL CONSIDERATIONS:: Permission to conduct the study was obtained from the university's Institutional Review Board. Participation was voluntary, and measures were taken to protect the anonymity and confidentiality of consenting participants. FINDINGS:: Most nurses (69%) believed that patients were "poor or very poor" at assessing the relevance of drug advertisements, 61% reported that the increase in drugs advertisements directed at patient was "a bad or a very bad thing," and only 16% thought the advertisements were accurate to "a very or to a great extent." Improved nurse-patient relationship was associated with factors such as the patient not bringing printed material, seeking nurse's opinion only, taking responsibility for their health, and not challenging nurse's prescriptive authority. DISCUSSION:: Advertising discussion during a visit could improve as well as pose a challenge to a nurse-patient relationship and nurse's prescriptive authority. CONCLUSION:: The positives of discussing advertising information can be maximized and the negatives minimized through enhanced interpersonal nurse-patient communication.

Accidents and ethics: a visual-narrative approach.

Emergency department (ED) attendances are continuing to rise, and medical and nursing teams are working under considerable strain. ED clinicians are used to thinking on their feet and possess the skills to multitask, and juggle ever-changing and competing priorities against the clock. This article reports the findings of a study that enabled ED clinicians to take time out to reflect on some of the difficult decisions they make daily, and to ask whether they consider ethical principles in depth, and if they are of any practical help. Findings reveal that autonomy, beneficence, non-maleficence and distributive justice are evident in contemporary EDs, and clinicians need to be encouraged to incorporate ethical reasoning into their reflective practice. The term 'clinician' refers to doctors and nurses in this article.

The Gene Pool: The Ethics of Genetics in Primary Care.

AIM: The purpose of this integrative review is to critically analyze the research literature regarding ethical principles that surround the integration of genetics and genomics in primary care clinical practice. BACKGROUND: Advanced practice nurses (APRNs) play an important role in the provision of primary care services, in the areas of obstetrics, pediatrics, family practice, and internal medicine. Advances in genetic and genomic science are infiltrating these day-to-day health-care systems and becoming an integral part of health-care delivery. It is imperative for primary care providers to understand the ethical, legal, and social implications of genetics and genomics. METHODS: A comprehensive multistep search of CINAHL, MEDLINE, Academic Search Premier, PsycINFO, Web of Science, and Scopus databases was conducted to identify primary research articles published from 2003 to 2015 that evaluated ethical issues related to genetics and genomics in U. S. primary care practice. A sample of 26 primary research articles met the inclusion criteria. Whittemore and Knafl's (2005) revised framework for integrative reviews was used to guide the analysis and assess the quality of the studies. Key findings from the studies are discussed according to Beauchamp and Childress's (2009) ethical principles of autonomy, beneficence, nonmaleficence, and justice. RESULTS: Research conducted to date is mainly qualitative and descriptive and the analysis revealed several ethical challenges to implementing genetics and genomics in primary care settings. CONCLUSION: The review suggests that there are several implications for research, education, and the development of primary care practice that support APRNs delivering genetic and genomic care while incorporating knowledge of ethical principles. More research needs to be conducted that evaluates the actual genetic/genomic ethical issues encountered by primary care providers.

Palliative and End-of-Life Ethical Dilemmas in the Intensive Care Unit.

Critical care nurses and advanced practice registered nurses frequently face bioethical dilemmas in clinical practice that are related to palliative and end-of-life care. Many of these dilemmas are associated with decisions made concerning continuing, limiting, or withdrawing life-sustaining treatments. The purpose of this article is to describe common ethical challenges through case study presentations and discuss approaches that critical care nurses and advanced practice registered nurses in collaboration with the interdisciplinary team can use to address these challenges. Resources that may be helpful in managing ethical dilemmas are identified.

The 2014 Scope and Standards of Practice for Psychiatric Mental Health Nursing: Key Updates.

The 2014 Psychiatric-Mental Health Nursing: Scope and Standards of Practice is the specialty's description of competent nursing practice. The scope portion of this document identifies the focus of the specialty by defining nursing practice extents and limits. Standards are statements that identify the duties and obligations for which specialty nurses are held accountable, including general registered nurses and advanced practice nurses. This article begins with a brief overview of the revision process. The author describes key factors that influenced the revision, such as external documents and current priorities in healthcare, and synthesizes significant changes to the document, including commentary and comparisons to the generalist Scope and Standards of Practice. Implications for nursing education and a companion resource are discussed.

Advanced practice registered nurse intended actions toward patient-directed dying.

UNLABELLED: Patient-directed dying (PDD) (also known as physician-assisted suicide) has been a heavily debated issue in the United States since the passing of the Death With Dignity Act in Oregon in 1997. Previous research surrounding PDD has been limited to assessing the attitudes of physicians, nurses, and patients. The purpose of this study was to describe the intended actions of advanced practice registered nurses (APRNs) toward initiating PDD discussions and prescribing a lethal dose of medication under PDD legislation. A survey design was used to guide this pilot study. An investigator-developed questionnaire was disseminated electronically to APRNs on a free professional Listserve in a rural northeastern state. The final sample was composed of 16 APRNs whose area of certification were identified as 63% family, 31% adult, 6% psychiatric/mental health, and 13% other. Hospice and palliative care employment experience was reported by 75% of the sample. RESULTS: The APRN subjects were more willing to engage in PDD discussions than to prescribe under PDD legislation. The APRNs reported an increased willingness to initiate discussions and prescribe when patient pain and suffering were explicitly stated. Seventy-five percent of APRNs viewed their personal and professional opinions regarding PDD to be synonymous even though 50% were unsure as to whether PDD was consistent with the American Nurses Association (2001) Code of Ethics for Nurses. CONCLUSIONS: Advanced practice registered nurses reported increased intent to discuss than actively participate through means of prescriptive authority under PDD legislation. The depiction of pain and suffering may have an impact on APRN intention to act in cases of PDD. RECOMMENDATIONS: Increased awareness and education surrounding professional codes for APRNs, particularly regarding PDD, are needed.

[Quantitative methodology and experimental studies 2/2]. / Méthodologie quantitative et etudes expérimentales 2/2.

Experimental studies potentially produce scientific evidence. To achieve this goal, it is necessary to pay particular attention to three elements essential for the validity of the study: randomisation, manipulation and control.

Donation after cardiac death: ethical dilemmas and implications for advanced practice nurses.

Donation after cardiac death has always presented ethical concerns among health care providers. As advanced practice nurses and critical care nurses, it is our responsibility to ensure that health care providers and families are educated about the process and that we remain advocates for the potential donors. This article reviews the donation after cardiac death process, provides a donation after cardiac death hypothetical case report and its outcome, and addresses the ethical concerns associated with donation after cardiac death from both opponents' and proponents' points of view. It will also discuss the benefits of obtaining a palliative care consult and the roles of the advanced practice nurse in the care of the potential donor.

Confidence and knowledge regarding ethics among advanced practice nurses.

As the scope of advanced practice nursing expands and the educational requirements increase, so do the ethical responsibilities. How prepared are advanced practice nurses (APNs) to manage the ethical challenges in advanced practice? The purpose of this study was to determine APNs' ethics knowledge and perceived level of confidence in their ability to manage ethical problems in advanced practice. Assuming ethics knowledge and abilities of APNs are similar to those of medical residents, a survey instrument for medical residents was modified for use with APNs. Responses to the modified survey indicated a fairly high level of confidence but a fairly low level of knowledge. Studies show that ethics education can be effective in improving knowledge, confidence, and ethical behavior. Given the expanding role of APNs as doctors of nursing practice, research is needed to determine the ethics knowledge needs and teaching strategies to better prepare nurses for the challenges of advanced practice.

Ethics in independent nurse consulting: strategies for avoiding ethical quicksand.

Changes in health care have created a variety of new roles and opportunities for nurses in advanced practice. One of these changes is the increasing number of advanced practice nurses carrying out independent consultation. Differences in goals between business and health care may create ethical dilemmas for nurse consultants. The purpose of this article is to describe possible ethical pitfalls that nurse consultants may encounter and strategies to prevent or solve these dilemmas. Three themes related to nursing codes of ethics will be discussed: the duty to uphold human rights, the duty to fulfill commitments, and the duty to practice the profession competently.

A literature review: Advance directives and patients with implantable cardioverter defibrillators.

PURPOSE: The purpose of this literature review is to describe the severity of and susceptibility for negative outcomes in patients with implantable cardioverter defibrillators (ICDs) who lack advanced directives. DATA SOURCES: A comprehensive review of literature was conducted with articles selected from CINAHL, Pubmed, Ovid, Medline, evidence-based medicine, evidence-based nursing, and the Web of Science from 1990 to the present. Key words such as ICD, randomized controlled trials, case studies, advanced directives, end-of-life, living will, health care proxy, and durable power of attorney were used to identify specific studies. CONCLUSIONS: Advanced directives are becoming an essential part of care for the ICD population. The recommendations in the literature suggest that clinicians should initiate end-of-life discussions with their patients when they are healthy. The patients' preferences should be discussed often in patient care in case they would like changes made to their advance directive as their condition changes. IMPLICATIONS FOR PRACTICE: Implementation of advanced directives in patients' medical care will need to be encouraged in the event of illness. Advanced practice nurses can provide clear explanations of patients' treatment choices in outpatient and inpatient settings.

The essential role of the clinical research nurse (CRN).

In an age of increasing focus on expanding the opportunity of clinical research trial participation to broader patient populations, the clinical research nurse (CRN) has become an essential member of the clinical research team. The CRN is responsible for many roles and aspects of clinical trial management. Clarification of these roles and responsibilities will be provided in this article.

The development of the next generation of nurse leaders.

This article explains the development of a value-added leadership focus to a graduate nursing program. With the changes to and complexity within the health care system, advanced practice nurses need academic preparation in advanced care management of populations and leadership competencies. Strategic environmental scanning suggested that some revisions could better prepare future nurse leaders. Through literature review and focus groups, faculty's analysis provided evidence for development of a different kind of advanced practice nurse. This process led to a graduate program that prepares nurse leaders who are competent in the clinical settings and leadership roles of today's health care organizations. The 40-semester hour program allows flexibility for minimum career disruption and a choice of tracks to accommodate individuals' educational needs. Grounded in practicum experiences and guided by health care theory, policy, and research, graduates possess the knowledge and competencies to assume the advanced leadership roles required in future health care systems.