Corroborating indicates nurses' ethical values in a geriatric ward.

The aim of the study was to identify nurses' ethical values, which become apparent through their behaviour in the interactions with older patients in caring encounters at a geriatric clinic.Descriptions of ethics in a caring practice are a problem since they are vague compared with the four principles of autonomy, beneficence, non-maleficence, and justice.A Grounded Theory methodology was used. In total, 65 observations and follow-up interviews with 20 nurses were conducted, and data were analysed by constant comparative analysis.THREE CATEGORIES WERE IDENTIFIED: showing consideration, connecting, and caring for. These categories formed the basis of the core category: "Corroborating." In corroborating, the focus is on the person in need of integrity and self-determination; that is, the autonomy principle. A similar concept was earlier described in regard to confirming. Corroborating deals more with support and interaction. It is not enough to be kind and show consideration (i.e., to benefit someone); nurses must also connect and care for the older person (i.e., demonstrate non-maleficence) in order to corroborate that person.The findings of this study can improve the ethics of nursing care. There is a need for research on development of a high standard of nursing care to corroborate the older patients in order to maintain their autonomy, beneficence, and non-maleficence. The principal of justice was not specifically identified as a visible nursing action. However, all older patients received treatment, care, and reception in an equivalent manner.

Empirical and normative ethics: a synthesis relating to the care of older patients.

The aim of this study was to synthesize the concepts from empirical studies and analyze, compare and interrelate them with normative ethics. The International Council of Nurses (ICN) and the Health and Medical Service Act are normative ethics. Five concepts were used in the analysis; three from the grounded theory studies and two from the theoretical framework on normative ethics. A simultaneous concept analysis resulted in five outcomes: interconnectedness, interdependence, corroboratedness, completeness and good care are all related to the empirical perspective of the nurse's interaction with the older patient, and the normative perspective, i.e. that found in ICN code and SFS law. Empirical ethics and normative ethics are intertwined according to the findings of this study. Normative ethics influence the nurse's practical performance and could be supporting documents for nurses as professionals.

Ethical values in caring encounters on a geriatric ward from the next of kin's perspective: an interview study.

The aim of this study was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Interviews with 14 next of kin were conducted and data were analysed by constant comparative analysis. Four categories were identified: receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: 'Being amenable', a concept identified in the next of kin's description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and the next of kin. Nurses' focusing on elderly patients' well-being as a final criterion affects the next of kin and their experience of this fundamental condition for high-quality care seems to be fulfilled.

Female patients report on health care staff's disobedience of ethical principles.

BACKGROUND: Earlier studies have shown a high prevalence of abuse in health care (AHC). We hypothesized that patients might easily feel abused when staff do not follow prevailing ethical principles. Therefore we developed the Violations of Ethical Principles Questionnaire (ViolEP), with 30 examples of situations in health care where four ethical principles are disobeyed (autonomy, nonmaleficence, justice, and integrity). Respondents reported whether or not they had ever experienced each of the situations, and whether or not they had perceived that event as a violation. RESEARCH QUESTIONS: 1. What proportion of female patients have ever experienced staff disobeying ethical principles in health care? 2. To what extent are such events perceived as violations? and 3. How well do perceived violations of ethical principles correspond to experiences of AHC? METHOD: Our sample was 661 consecutive female patients at the Department of Obstetrics and Gynecology in Linköping, Sweden. They completed ViolEP and NorVold Abuse Questionnaire (NorAQ) at home and returned them by post. RESULTS: 20/661 (64%) women answered the ViolEP and 426/661 (64%) returned the NorAQ. The majority (73%) (306/420) had experienced staff disobeying ethical principles. More than every second woman had perceived those events as violations (68%) (209/306). The prevalence of AHC was 23%. ViolEP had good sensitivity but low specificity when we used AHC according to NorAQ as the "gold standard". CONCLUSION: The majority of the patients had experienced health care staff disobeying prevailing ethical principles. These events were not always perceived as violations. The reason for this discrepancy needs to be explored.

Allocation of scarce resources in health care: values and concepts

In many countries, a gap exists between the population's need for health care and available resources. These nations have attempted to eliminate or reduce the gap through such activities as improving efficiency and narrowing responsibilities. Since these measures have proven insufficient, decisions must be made regarding how to best use the scarce resources. The priority-setting and rationing processes involve key decisions in the sense that they have consequences for people's health and quality of life and they should therefore be rational and based on solid grounds. This means that the decisions involve three issues: facts, concepts and values. In this presentation the focus is on the conceptual and value issues. A basic ethical platform as a guide for decision-making will be presented. The ethical principles that constitute the platform contain central concepts like health care need, cost-effectiveness, health and goal. A short presentation of these concepts will be carried out. This will end with the concept of a goal and its importance for decision-making.

Em muitos países existe uma lacuna entre a necessidade da população por cuidado de saúde e os recursos disponíveis. Estas nações têm tentado eliminar ou reduzir a lacuna por meio de atividades como, por exemplo, o melhoramento da eficiência e a atribuição de responsabilidades. Uma vez que estas medidas têm sido provadas como insuficientes, as decisões devem ser tomadas levando em consideração o melhor uso dos escassos recursos. O estabelecimento de prioridades e o processo de racionalização envolvem decisões chave no sentido de que elas têm conseqüências para a saúde e a qualidade de vida da população e devem, deste modo, ser racionais e baseadas em fundamentos sólidos. Isto significa que as decisões envolvem três questões: fatos, conceitos e valores. Neste artigo, o foco é sobre as questões conceituais e valorativas. É apresentada uma plataforma ética básica como guia para a tomada de decisão. Os princípios éticos que constituem a plataforma incluem conceitos centrais, tais como, necessidade de cuidado de saúde, custo-efetividade, saúde e objetivo. Uma curta apresentação destes conceitos é realizada e é finalizada com o conceito de objetivo e sua importância para a tomada de decisão.

En muchos países existe un vacío entre la necesidad de cuidados de salud de la población y los recursos disponibles para realizar esos cuidados. Esas naciones han procurado eliminar o reducir el vacío existente a través de la realización de actividades, como, por ejemplo: la mejoría de la eficacia y la atribución de responsabilidades. Puesto que esas medidas han probado que son insuficientes, las decisiones deben ser tomadas considerando el mejor uso de los escasos recursos. El establecimiento de prioridades y el proceso de racionalización implica decisiones claves, ya que ellas tienen consecuencias para la salud y la calidad de vida de la población, y por ello, deben ser racionales y basadas en argumentos sólidos. Eso significa que las decisiones a ser tomadas engloban tres cuestiones: hechos, conceptos y valores. En el presente artículo, el foco es sobre las cuestiones conceptuales y valorativas. Es presentada una plataforma ética básica que sirve como guía para la toma de decisiones. Los principios éticos que constituyen la plataforma contienen conceptos centrales, tales como: necesidad de cuidado de salud, costo-eficacia, salud y objetivo del cuidado de salud. Una breve presentación de esos conceptos es realizada, finalizando con el concepto de objetivo del cuidado de salud y su importancia para la toma de decisiones.

A noção de cuidado de si mesmo e o conceito de autocuidado na enfermagem / The notion of care of the self and the concept of self-care in nursing

Apesar das enfermeiras chamarem a si mesmas de profissionais do cuidado e acreditarem que a essência da enfermagem é o cuidado, nós sabemos que ainda não está suficientemente claro o que é cuidado, suas características e seus objetivos. Nesse sentido, muitas concepções de cuidado coexistem e têm influenciado as práticas de enfermagem. Essas concepções variam conforme perspectivas teóricofilosóficas e ambientes da prática. Uma dessas concepções que mais tem influenciado a prática de enfermagem brasileira é da teoria de autocuidado de Dorothea Orem. No entanto, mais recentemente, uma outra perspectiva vem emergindo no contexto da enfermagem brasileira; a noção de cuidado de si de Michel Foucault. O principal propósito desse trabalho é analisar criticamente e problematizar a noção de cuidado de si mesmo e o conceito de autocuidado para, num segundo momento, tentar fazer dialogar uma e outra concepção, colocando alguns elementos que consideramos significativos, a fim de estabelecer, se possível, algum tipo de complementaridade.

Although nurses call themselves care professionals and believe that the essence of nursing is care, we have noticed that it is not yet sufficiently clear what care means; what its characteristics are; its objectives and so on. Thus, many conceptions of care co-exist and have influenced current nursing practices, which vary according to their respective theoretic-philosophical perspectives and practice environments. Based on this, we can say that one of the most influential nursing theories within Brazilian nursing is Dorothea Orem's theory of self-care. However, more recently, another perspective has emerged within the context of Brazilian nursing; Michel Foucault's Care of the self. The main purpose of this paper is to critically examine the Foucault notion of Care of the self and Orem's concept of Self-care in order to establish, if possible, a dialogue between one and the other notion within the context of care practice in Nursing.

Aunque las enfermeras se denominen a sí mismas como las profesionales del cuidado y consideren este último como la esencia de la enfermería, sabemos que todavía no está suficientemente claro cuál es el significado del concepto de cuidado, cuáles son sus características y sus objetivos. Varias concepciones de cuidado coexisten y vienen influenciando cotidianamente las prácticas de enfermería, las cuales son distintas de acuerdo con la perspectiva teórico filosófica y con el contexto de la práctica. En relación a este punto, una de las teorías de enfermería más influyentes en Brasil es la teoría de autocuidado de Dorotea Orem. Recientemente, otra perspectiva fue surgiendo en el contexto de la enfermería brasileña a partir del concepto cuidado de sí mismo de Michel Foucault. El objetivo de este trabajo es examinar críticamente la noción foucaultiana del cuidado de sí mismo y el concepto de autocuidado de Orem en el contexto de las prácticas de cuidado en enfermería. El principal propósito de este trabajo es analizar críticamente y problematizar la noción de Cuidado de sí mismo y el concepto de Autocuidado para que en un momento se haga dialogar una y otra concepción, colocando algunos de los elementos que consideramos significativos con la finalidad de establecer, si posible, algún tipo de complementariedad.

Nurses' views of longitudinal genetic screening of and research on children.

There is a lack of empirical data exploring ethical issues of genetic screening and longitudinal research involving children. Therefore, this pilot interview study explored the perceptions of nurses and midwives in relation to their involvement in an ongoing genetic preventive screening process involving children - the All Babies in South-east Sweden (ABIS) study (n=17,005). Data were collected through semistructured interviews with 10 nurses involved in all information and sampling procedures. While providing the preliminary nature of this study, it supports the idea of the importance of further research, both from a nursing professional perspective and from other parties involved in clinical research. The findings made in this study suggest that for such studies it is vital that nurses and midwives are fully informed about aims, methods, and potential intervention/prevention since in many cases they have a central role in several areas of screening and clinical longitudinal research involving children, e.g. information to potential research participants, obtaining informed consent, and data collection. With a thorough understanding of the research, including both basic aims and methods as well as potential future prevention aims, the nursing staff involved will be better placed to help participants make an informed choice and to provide additional information to the participants. Further research may be needed that aims to develop effective methods in preparing data collectors. It is also suggested that the design of the information process, and especially in longitudinal research involving young children, is of utmost importance before such studies are commenced.

Information and informed consent in a longitudinal screening involving children: a questionnaire survey.

This empirical study explores participants' perceptions of information and understanding of their children's and their own involvement in a longitudinal screening, the ABIS Study. ABIS (All Babies In Southeast Sweden) is a multicentre, longitudinal research screening for Type 1 diabetes and multifactorial diseases involving 17 005 children and their families. For this study, a random selection of mothers was made, using perinatal questionnaire serial numbers from the ABIS study. In total, 293 of these mothers completed an anonymous questionnaire (response rate 73.3%). Our findings from the questionnaire indicate a marked difference between the reported satisfaction with and understanding of the information provided on the one hand and the significant lack of knowledge of some of the aims and methods of the ABIS screening on the other, namely concerning high-risk identification of involved children, potential prevention and future questionnaires. Two questions evoked by our results are: (1) what information is required for participants in longitudinal studies involving children? and (2) how do we ensure and sustain understanding, and thus in a prolonging, informed consent in these studies? This study underlines the importance of an increased understanding of the ethical issues that longitudinal research on children raise and the need to discuss how information and informed consent strategies should be analysed and designed in longitudinal studies.

Interpreting definitions: the problem of interpreting definitions of medical concepts.

During the last hundred years medical language has been influenced by scientific and technological progress. As a result uncertainty in medical communication is increasing. This may have serious consequences not only for health care delivery but also for medical science. Disease classification, assessment of the validity of epidemiological investigations and comparison of the results of various investigations are examples of what will become less secure. The purpose of the article is to emphasise a main source of uncertainty--the problem of interpreting definitions. Two issues of interpretation are explored. One concerns the logical status of a statement and the other the function of a statement. It is concluded that the security of medical language can be increased through the elucidation of the logical status and functions of statements making up medical concepts.

The significance of the goal of health care for the setting of priorities.

The purpose of the article is to argue for the significance of a clarified goal of health care for the setting of priorities. Three arguments are explored. First, assessment of needs becomes necessary in so far as the principle of need should guide the priority-setting. The concept of health care need includes a goal component. This component should for rational reasons be identical with the goal of health care. Second, in order to use resources efficiently it is necessary to assess the effects of health care. It is not, however, a question of assessing whether there is an effect but a question of assessing whether there is the right effect. And what constitutes the right effect can only be determined in relation to the goal of the enterprise. Third, the health sector involves several groups of actors such as politicians, administrators, doctors, nurses, physiotherapists, occupational therapists, educationists and patients. It is common knowledge that successful teamwork requires an understanding of a common goal. The article ends with an example of a goal chosen from ethics.

Terms used to describe urinary tract infections--the importance of conceptual clarification.

Inaccuracies in medical language are detrimental to communication and statistics in medicine, and thereby to clinical practice, medical science and public health. The purpose of this article is to explore inconsistencies in the use of some medical terms: urinary tract infection, bacteriuria and urethral syndrome. The investigated literature was collected from medical dictionaries, textbooks, and articles indexed in Medline(R). We found various practices regarding how the medical terms should be defined, and had great difficulty in interpreting the status of the statements under the heading of 'definition'. The lesson to be learned, besides a reminder of the importance of clearly defined medical concepts, is that it must be explicitly stated whether what is presented as a definition is to be considered as defining criterion, as recognising criterion or as characteristic of the disease entity.

Uncertainties in the identification of need for nursing care: conceptual obscurities

The way in which health care is allocated affects us in various important aspects, like for example the distribution of risk to become ill, the probability to be cured, and the way in which we are helped to satisfy our needs when we are injured or disfunctional in consequence of ill health. In this context, considerations about needs are central for health care professionals and especially for nurses, for these professionals must attend not only the medical needs of their patients, but their human needs as well. However, there are uncertainties concerning the identification of health care needs in nursing, principally those consequencial to conceptual obscurities. For this reason, our purpose is to examine the possibilities of bringing up nursing health care needs through conceptual clarification. In order to do this, concepts of need, health, health care need, nursing health care need, and finally, a model for raising the nursing health care needs are analyzed...

A forma pela qual o cuidado de saúde é alocado nos afeta em vários aspectos importantes, como por exemplo a distribuição do risco para ficar enfermo, a probabilidade de ser curado, e a forma pela qual somos ajudados a satisfazer nossas necessidades quando ficamos prejudicados ou disfuncionais em conseqüência de má-saúde. Neste contexto, considerações sobre necessidades são centrais para os profissionais de saúde e, especialmente para as enfermeiras e enfermeiros, pois esses profissionais devem atender não somente as necessidades médicas de seus pacientes, mas também suas necessidades humanas. No entanto, há incertezas acerca da identificação das necessidades por cuidado de enfermagem, principalmente conseqüentes à obscuridades conceituais. Por este motivo, nosso propósito é examinar as possibilidades de levantamento das necessidades para o cuidado de enfermagem através da clarificação conceitual. Para tanto, são analisados os conceitos de necessidade, saúde, necessidade de cuidado de saúde, necessidade de cuidado de enfermagem e, finalmente, um modelo para o levantamento de necessidade de cuidado de enfermagem...

La forma por el cual el cuidado de la salud es alocado nos afecta en varios aspectos importantes, como por ejemplo en la distribución del riesgo para quedar enfermo, la probabilidad de ser curado, y la forma por la cual somos ayudados a satisfacer nuestras necesidades cuando quedamos perjudicados o disfuncionales a consecuencia de una mala salud. En este contexto, consideraciones sobre necesidades son centrales, para los profesionales de la salud y, especialmente para las Enfermeras y Enfermeros, pues estos profesionales deben atender no solamente las necesidades médicas de sus pacientes, sino también sus necesidades humanas. Entre tanto, existe una incertidumbres sobre la identificación de las necesidades para el cuidado de Enfermería, principalmente consecuentes a las oscuridades conceptuales. Por este motivo, nuestro propósito es examinar las posibilidades del levantamiento de las necesidades para el cuidado de Enfermería a través de la clarificación conceptual. Para esto, son analisados los conceptos de necesidad, salud, necesidad del cuidado de la salud, necesidad del cuidado de Enfermería y, finalmente, un modelo para el levantamiento de la necesidad del cuidado de Enfermería...

Mothers of children in ABIS, a population-based screening for prediabetes, experience few ethical conflicts and have a positive attitude.

Screening is supposed to create less anxiety among first-degree relatives of diabetic patients where the risk of developing diabetes already is well known. It has also been argued that screening of a general child population should never be performed unless identified high-risk individuals can be offered intervention to prevent diabetes. However, the empirical data are scarce, especially regarding what opinions patients or their parents have of these matters/issues themselves. We have therefore tried to evaluate mothers' attitudes to and ethical views on participation in a research screening for prediabetes in an unselected birth cohort. All 21,700 mothers of children in southeast Sweden born between 1 October 1997 and 1 October 1999 were asked to participate in ABIS (All Babies in Southeast Sweden). They were given information about the design of the study and that HLA types and autoantibodies will be determined in order to predict diabetes, but that no prevention of diabetes will be offered unless future studies show effective methods. After informed consent, 78.6% of mothers let their babies participate (17,055 children) despite a quite laborious study protocol. Explorative in-depth semistructured interviews were performed in 21 mothers, of whom 15 were strategically selected to get as many various attitudes as possible and of whom 6 chose not to participate in ABIS. All interviewed mothers were positive to the ABIS project. We conclude that a well-designed screening program to detect individuals in the general population with high risk of developing diabetes does not evoke anxiety nor severe ethical conflicts.

The goal of nursing: its importance for the assessment of the need for nursing care / The goal of nursing: its importance for the assessment of the need for nursing care/O objetivo da Enfermagem: sua importância para o estabelecimento da necessidade para o cuidado de Enfermagem

Assesments of needs involve many difficult methodological issues. One such issue is on the conceptual level. What exactly is it that should be assessed when we are to assess a need or a need for nursing care? My purpose here is to present some fo the results of a philosophical investigation into the concept of need and need for nursing care. This means first of all an outlining of the logical structure of the general concept of need. The mos significant characteristic of this concept is the goal of need. Without a clear understanding of this goal it is pointless to claim that someone has a need. From this theoretical basis the concept of need for nursing care is analysed. It is suggested that satisfied medical needs and satisfied basic human needs of the patients are significant goals of a need for nursing care. Finally, I will end by outlining the basic structure of a model for the assessment of need for nursing care.