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.

Conflitos e dilemas éticos vivenciados pelo enfermeiro no cuidado perioperatório / Conflicts and ethical dilemmas experinced by the nurse in the perioperative care

O estudo objetivou compreender os conflitos e dilemas éticos vivenciados por enfermeiros no cuidado perioperatório de um hospital geral, em Salvador-Bahia. Optou pela abordagem fenomenologica de Edmund Husserl,por ter como objeto de estudo o fenômeno conflitos e dilemas éticos do enfermeiro no centro cirúrgico. A fonte de dados foi aentrevista fenomenológica. As análises ideográfica e nomotética possibilitaram a apreensão da estrutura do fenômeno com duas categorias: Compreendendo os conflitos e dilemas éticos vivenciados pelos enfermeiros no período perioperatório e os enfermeiros vivenciam conflitos e dilemas éticos no períodoperioperatório em contexto de deficiências de recursos humanos, físicos e materiais. Compreende-se que a escassez de recursos além da divergência de opiniões sobre uma mesma situação; dificuldade da equipe cirúrgica para chegar a um consenso; não atendimento das solicitações da equipe; ações realizadas sob tensão na unidade; desrespeito à autonomia dos enfermeiros durante a prática e escassez de recursos são os geradores deconflitos e dilemas no perioperatório. Recomenda-se às instituições investir em infraestrutura, recursos materiais e humanos no centro cirúrgico.

The study aimed to get to understand the conflicts and ethical dilemmas experienced nurses in the perioperative care of a general hospital in Salvador-Bahia. It was choose the phenomenological approach by Edmund Husserl, by having as object of study the phenomenon conflicts and ethical dilemmas of the nurse in surgical center. The data collected by phenomenological interview. Ideographic and nomothetic analyzes allowed the seizure of the phenomenological structure in two categories: Comprehending the conflicts and ethical dilemmas experienced by nurses in the perioperative period and Nurses experience conflicts and ethical dilemmas in perioperative period in the context of inadequate human resources, physical and material. It is understood that the shortage of resources and divergence of opinions on the same situation; difficulty of the surgical team to reach a consensus; not treatment of requests of the team; actions held under tension in the unit; disrespect for the autonomy of nurses during practice and scarcity of resources are the generators of conflicts and dilemmas in perioperative. It recommended to institutions to invest in infrastructure, material and human resources in surgical center.

A reflective study on abortions in theatre.

This article discusses the concept of conscientious objection in relation to surgical terminations of pregnancy. It explores a scrub nurse's duty of care not only to the patient but to themselves. It highlights the importance of being self-aware of one's moral and emotional attitude towards abortions in theatre. Doing so enables the nurse/ODP to practice professionally and autonomously, and to deliver the highest level of perioperative care whilst respecting their personal rights.

Do-not-resuscitate. Orders in surgery: decreasing the confusion.

Patients have the right to make decisions regarding their medical care, including the right to refuse treatment or to issue do-not-resuscitate orders as part of an advance directive. Health care providers must comply with the patient's wishes regarding care. Automatic suspension or continuation of a do-not-resuscitate order for a patient undergoing surgery cannot be justified. Surgical team members should consult with the patient and, if necessary, with an ethics expert or committee to determine whether the do-not-resuscitate order is to be maintained or completely or partially suspended during anesthesia and surgery. All surgical departments should have a written policy and procedure concerning the treatment of patients with do-not-resuscitate orders.

Significados atribuídos pelos enfermeiros às ações nas ocorrências éticas no bloco operatório / Meanings assigned by nurses to ethical events in the operating theater

Trata-se de um estudo com abordagem qualitativa sobre as ações dos enfermeiros atuantes no Bloco Operatório (centro cirúrgico, recuperação pós-anestésica e central de material e esterilização) diante das ocorrências éticas com o pessoal de enfermagem atuante nesse setor. Os sujeitos participantes da pesquisa são quatro enfermeiras que atuam há mais de cinco anos no Bloco Operatório de um hospital privado de grande porte do município de São Paulo. Os objetivos do estudo foram conhecer e compreender, com base nas vivências cotidianas das enfermeiras que atuam nesse setor, os significados que atribuem às suas ações diante das ocorrências éticas com o pessoal de enfermagem...

Estudio de satisfacción en cuidados de enfermería y opinión de los usuarios en CMA / No disponible

Objetivo: Como parte de los programas de garantía de calidad de la CMA, el objetivo del estudio fue conocer la calidad percibida a través del análisis del grado de satisfacción en los cuidados recibidos y opinión sobre la CMA. Material y método: Se realizó un estudio descriptivo-retrospectivo de 123 pacientes intervenidos en la unidad de CMA a través de un cuestionario de calidad percibida. La media de edad fue de 38,9 años y el periodo evaluado del 1 al 31 de diciembre de2005. El análisis de datos se hizo con el programa estadístico SPSS para Windows. Resultados: Un 58,3% fueron pacientes de Cirugía General y el 22,6% pertenecían a ORL. En un 50,5% el cuestionario fue cumplimentado por el paciente y en un 49,5% por el familiar. La valoración de la atención prestada por enfermería se consideró buena o muy buena en un 98,9%. Igualmente ocurrió con la variable resolución de problemas (96,4%). La información dada previa a la intervención se consideró mal o ni bien ni mal en un 17,3% y la proporcionada al alta un 4,5% la valoró igualmente mal o ni bien ni mal. El alta en el mismo día fue considerada como bien o muy bien en un 76,7%. Hubieran preferido pasar la noche en el hospital el 22% de los familiares, y el 8,9%de los pacientes. Un 97,8% de los pacientes volverían a operarse en nuestro hospital. Conclusiones: La CMA ofrece niveles altos de calidad percibida por el usuario. Se nos plantea la mejora en la información dada al usuario, pues la CMA supone mayor nivel de autocuidados y un mayor conocimiento de la CMA y sus beneficios. Conocerla calidad percibida del producto enfermero desde la dimensión de los resultados nos ha orientado a diseñar intervenciones de mejora (AU)

Objective: The purpose of the study was to know the quality perceived through the analysis of the degree of satisfaction in the cares received and the opinion about CMA, as a part of the quality assurance CMA programs. Material and method: A descriptive-retrospective study of123 patients, who have been operated on in a CMA unit through a perceived quality questionnaire, was taken up. The average age was 38.9 years old and the studied period was from 1st to 31st of December of 2005. The data analysis was done by the statistical software SPSS for Windows Results: The 58.3 per cent of the patients belong to General Surgery and the 22.6 per cent belong to ORL. In the 50.5 percent, the questionnaire was filled out by the patient and the 49.5per cent by a relative. The 98.9 per cent considered as good or very good the care attention from the nursing. Likewise happen with changeable problem resolution (96.4 per cent). The given information previous to the operation was considered as bad or regular in about 17.3 per cent and the one given to the discharge in about 4.5 per cent was assessed as bad or regular. The same day discharge was considered as good or very good in about 76.7 percent. About 22 per cent of relatives and about 8.9 per cent of the patient have would prefer to spend the night at the hospital. A97.8 per cent of the patients would come back to our hospital to be operated. Conclusions: CMA offers high levels of quality perceived by the patient. We are suggested to improve the information given to the user, since CMA means a greater level of self care and a greater knowledge of CMA and its benefits. We are determined to design interventions of improvement due to knowing the perceived quality of the nursing product from the results magnitude (AU)

The expression of caring within the perioperative dialogue: a hermeneutic study.

BACKGROUND AND AIM: This article, which is based on a study conducted in a perioperative context in Sweden, focuses on nurse anaesthetists' and theatre nurses' descriptions of caring and how caring becomes visible to patients in the perioperative dialogue. The perioperative dialogue is the pre-, intra- and postoperative meeting between the nurse and patient in connection with the latter's surgery. METHODS: Semi-structured interviews were conducted with 18 patients and 20 nurses, in which they described their experiences of perioperative dialogues. The interpretation process was based on Gadamer's philosophy of hermeneutics. FINDINGS: The findings indicate that, as a caring act, the vow involves: promising to allow the patient to be him/herself, promising to safeguard the welfare of the patient and promising to guide the patient through the operation as well as taking responsibility for that which I have promised. From the patient's perspective, the nurse was someone who: cares about me, takes me seriously, creates a calm atmosphere and to whom I can hand over responsibility. CONCLUSIONS: Four empirical assumptions were formulated in relation to the nurse's vow and how the nurse's caring became visible to the patients.

The role of the advanced scrub practitioner.

The roles of all healthcare professionals have changed considerably over the years and the nurse in particular has been affected. These changes have been influenced by the following guidance, Code of Professional Conduct (UKCC 1992) and Code of Professional Conduct (NMC 2004). Such changes involve the whole area of advancing roles in perioperative nursing, such as the nurse working as advanced scrub practitioner (ASP) (formally known as first assistant). Boss (2002) mentions that these new role developments are concerned with principles such as serving the interests of patients, providing holistic care, developing professional skills and knowledge and being accountable and responsible for your individual actions. Nurses acting as an ASP have many matters to contend with, such as autonomy, duty of care and other legal issues, and professional accountability. This paper explores these issues in more detail.

Informed consent.

Disclosure of information prior to consent is a very complex area of medical ethics. On the surface it would seem to be quite clear cut, but on closer inspection the scope for 'grey areas' is vast. In practice, however, it could be argued that the number of cases that result in complaint or litigation is comparatively small. However, this does not mean that wrong decisions or unethical scenarios do not occur. It would seem that in clinical practice these ethical grey areas concerning patients' full knowledge of their condition or treatment are quite common. One of the barometers for how much disclosure should be given prior to consent could be the feedback obtained from the patients. Are they asking relevant questions pertinent to their condition and do they show a good understanding of the options available? This should be seen as a positive trait and should be welcomed by the healthcare professionals. Ultimately it gives patients greater autonomy and the healthcare professional can expand and build on the patient's knowledge as well as allay fears perhaps based on wrongly held information. Greater communication with the patient would help the healthcare professional pitch their explanations at the right level. Every case and scenario is different and unique and deserves to be treated as such. Studies have shown that most patients can understand their medical condition and treatment provided communication has been thorough (Gillon 1996). It is in the patients' best interests to feel comfortable with the level of disclosure offered to them. It can only foster greater trust and respect between them and the healthcare profession which has to be mutually beneficial to both parties.

Young teenagers providing their own surgical consents: an ethical-legal dilemma for perioperative registered nurses.

During the delivery of health care, ethical-legal problems are not uncommon and can be defined as situations that have potential legal consequences when equally compelling ethical reasons for and against a particular course of action are recognized and a decision must be made. Ethical-legal repercussions may occur when obtaining surgical consent from a younger teenager (defined as dependant and/or under 18 years of age). An ethical-legal dilemma arising from the case of a 14-year-old, run away girl, who had signed her own surgical consent for a cholecystectomy is analyzed. The concept of consent is discussed and related to an actual case study. The elements of a valid informed consent are identified, discussed and related to the case study. Using the MORAL model for ethical decision-making the ethical implications of this case are analysed. Possible legal repercussions are addressed and a risk management strategy (suggested policy and documentation protocols for the consent process) is proposed and evaluated.

A Humanização no gerenciamento de novas tecnologias por enfermeiras de centro cirúrgico / The Humanization in the management of new technologies by perioperative nurses

O presente estudo, de natureza exploratório-descritiva, com abordagem quantitativa, objetivou avaliar a humanização que gerenciam as novas tecnologias de Centro Cirúrgico. A iniciativa ocorreu em hospitais de Feira de Santana (BA), no ano de 2002, e teve uma amostra constituída por 33 enfermeiras com experiência em Centro Cirúrgico....

Critical incident: a nurse's personal reflection.

This thought-provoking article describes how a perioperative nurse of twenty years' experience reflected on a critical incident that happened in the hospital where she works, and what she gained from the experience. She also provides us with a survey of the literature pertaining to the processes underlying critical analysis.

Anaesthesia care of older patients as experienced by nurse anaesthetists.

This article analyses problem situations in the context of anaesthesia care. It considers what it means for nurse anaesthetists to be in problematic situations in the anaesthesia care of older patients. Benner's interpretive phenomenological approach proved useful for this purpose. Paradigm cases are used to aid the analysis of individual nurses' experiences. Thirty narrated problematic anaesthesia care situations derived from seven interviews were studied. These show that experienced nurse anaesthetists perceive anaesthesia care as problematic and highly demanding when involving older patients. To be in problematic anaesthesia care situations means becoming morally distressed, which arises from the experience or from being prevented from acting according to one's legal and moral duty of care. An important issue that emerged from this study was the need for an ethical forum to discuss and articulate moral issues, so that moral stress of the kind experienced by these nurse anaesthetists can be dealt with and hopefully reduced.