Hypervisible Nurses: Effects of Circulating Ignorance and Knowledge on Acts of Whistleblowing in Health.

Whistleblowing has been examined from various angles over the past 40 years, but not yet as a matter of epistemology. Whistleblowing can be understood as resulting from the improper transmission of critical knowledge in an organization (eg, knowledge about poor care or wrongdoing). Using the sociology of ignorance, we wish to rethink whistleblowing and the failures it brings to light. This article examines how nurses get caught in the strategic circulation of knowledge and ignorance, which can culminate in acts of whistleblowing. The sociology of ignorance helps understand how whistleblowing is borne out of the complex and strategic circulation of knowledge and ignorance that spells multiple and intersecting epistemic positions for nurses. In particular, various organizational blind spots position nurses as untrustworthy and illegitimate speakers in the "business" of the organization. Organizational failings therefore remain concealed while nurses become hypervisible, both as faulty care providers and as problematic information brokers.

The relevance of nurses and midwives code of conduct in Australia.

AIM: This study explores Australian clinical nurses' and midwives' familiarity with a new code of conduct and understanding in what ways the code is important for nurses as they carry out clinical practice. BACKGROUND: Codes specify the expectations of nurses' responsibilities, legal requirements, behaviour and conduct. Being familiar with the code is central to being a professional nurse or midwife. As nursing continues to advance, updating the code is crucial to maintain professional and safe practice. DESIGN: This project utilized a cross-sectional descriptive design. METHODS: A survey was developed incorporating Likert-type scale assessments of the 7 value statements from the 2018 Australian Nurses' Code of Conduct for familiarity and importance. The survey included open-ended questions to elicit clinical nurses' experiences of conduct breaches, opinions regarding usefulness and relevance of the code for current practice. Data were collected at an acute care hospital in Sydney during January 2018. RESULTS: Significant differences relating to cultural and patient-centred approaches were revealed in the study. The new value involving the role of research was least understood and ranked least important by nurses and midwives. Professional 'integrity' resonated with participants when considering the behaviour of nurses, and short, unambiguous values were the most popular. Additionally, a substantial number of participants had no knowledge of the code or were not aware of the recently revised version. CONCLUSION AND IMPLICATIONS FOR NURSING: A code of conduct provides structure and guidance for workplace values and principles. A respected code is important to the nursing profession to help prevent inappropriate and incompetent behaviour and as a guide for nursing performance. Nurses in this study claimed the code was highly relevant to their work as a nurse and was incorporated into their daily practice.

What 'Just Culture' doesn't understand about just punishment.

Recent years have seen the rise of 'Just Culture' as an ideal in the patient safety movement, with numerous hospitals and professional organisations adopting a Just Culture response to incidents ranging from non-culpable human error to intentional misconduct. This paper argues that there is a deep problem with the Just Culture model, resulting from its impoverished understanding of the value of punitive, fundamentally backward-looking, practices of holding people accountable. I show that the kind of 'accountability' and 'punishment' contemporary Just Culture advocates endorse disrespects both patients and providers. I claim, first, that punishment is good because it respects participants in the healthcare system by restoring an equilibrium of social and moral status that wrongdoing disturbs, and, second, that it only does so when it communicates a backward-looking message of resentful blame.

Vivendo entre a segurança e o risco: implicações à saúde do policial militar / Living in the midst of security and risk: implications on military police officers' health

This is a descriptive and exploratory study conducted in the first half of 2012 with 12 military police officers from a Military Police Brigade in a capital of southern Brazil, which aimed to investigate occupational hazards from the point of view ofworkers. Data was collected through interviews and analyzed by means of thematic analysis. The study complied with Resolution 466/12 of the National Health Council. Physical violence, disease transmission by contact with blood, and accidents were the mainrisks identified. Most of the participants reported wearing personal protective equipment to protect their health. The subjects perceive that their job interferes negatively with their personal life, and greater satisfaction with the activity involves thecommunity's acknowledgement for the services provided. Co-management of everyday problems and ongoing health education can be protagonism alternatives that may contribute to prevention of diseases and promotion of military police officers' health.

Trata-se de um estudo descritivo e exploratório, realizado no primeiro semestre de 2012, com 12 policiais militares de umBatalhão de Policia Militar de uma capital da região sul brasileira queteve como objetivo investigar os riscos ocupacionais, sob o ponto de vista dos trabalhadores. Os dados foram coletados mediante entrevistas e analisados por meio da análise temática. A pesquisa respeitou a Resolução 466/12do Conselho Nacional de Saúde. A violência física, a transmissão de doenças pelo contato com sangue e os acidentes foram os principais riscos identificados. A maioria referiu usar Equipamentos de Proteção Individual para a proteção à saúde. A maior satisfação da atividade envolve o reconhecimento da comunidade pelo serviço prestado. Cogestão dos problemas cotidianos e educação permanente em saúde podem ser alternativas de protagonismo que podem contribuir para a prevenção de agravos e promoção da saúde dos policiais militares.

Registros enfermeros. Contribución a la seguridad del paciente y a la visualización de la disciplina enfermera / Nursing records. Contribution to the security of patient and visualizing of the discipline of nursing

Los registros enfermeros conforman la historia de enfermería de un paciente con el objetivo de dejar constancia de la atención prestada y de la evolución de la persona desde la mirada holística que identifica la profesión. Estos registros tienen un contexto legal, profesional y de seguridad que deben cumplir. También a través de la escritura se puede inferir la visión que de la profesión tiene el profesional/escritor. En este artículo se analizan algunas expresiones extraídas de registros enfermeros de unidades de cuidados paliativos tomando como referencia los elementos contextuales nombrados. Se concluye que se debería prestar más atención a esta actividad, que es una obligación profesional y un derecho del paciente, para dotar a los registros enfermeros de información objetiva, clara, sin ambigüedades ni interpretaciones erróneas, y que refleje la aportación específica de la enfermería a la sociedad (AU)

The nursing records conform the clinical history of a patient with the aim to bring evidence of care provided by professional as well as to bring evidence of evolution of a person from a holistic point of view that identifies the profession. These records have a legal, professional and security contexts that ought to be fulfilled. In addition, with help of record keeping it is possible to infer a vision of the profession that was transmitted by the author. This article discusses the qualitative data based on various expressions extracted from the nursing records of palliative care units, taking as a reference the contextual elements that were named above. It concludes that it’s important to give more attention to this activity as it presents a professional obligation and belongs to patient’s rights. The current research stresses the importance to have the nursing records updated with the objective information, clear, without ambiguities or misinterpretations, and which can evidence the specific contribution of nursing to the society (AU)

Nursing under the influence: a relational ethics perspective.

When nurses have active and untreated addictions, patient safety may be compromised and nurse-health endangered. Genuine responses are required to fulfil nurses' moral obligations to their patients as well as to their nurse-colleagues. Guided by core elements of relational ethics, the influences of nursing organizational responses along with the practice environment in shaping the situation are contemplated. This approach identifies the importance of consistency with nursing values, acknowledges nurses interdependence, and addresses the role of nursing organization as moral agent. By examining the relational space, the tension between what appears to be opposing moral responsibilities may be healed. Ongoing discourse to identify authentic actions for the professional practice issue of nursing under the influence is called upon.

Filosofía y ciencia de la disciplina enfermera / Philosophy and science of the nursing

Para impulsar el desarrollo de la disciplina enfermera no solo es necesario estudiar el cuerpo de conocimientos de la Enfermería, sino también ser conscientes de la importancia de aumentar la autoestima profesional y valorar las acciones cuidadoras propias para avanzar hacia la humanización de la asistencia y el reconocimiento social merecido y estereconocimiento se debe generar desde dentro, desde el seno de la disciplina.En el presente artículo se presenta una breve reflexión acerca de la naturaleza de la filosofía de la Enfermería. En primer lugar se define el concepto de “filosofía de la Enfermería” y se analizan sus distintos enfoques. A continuación se describen la esencia y los valores de la Enfermería y, por último, se aborda el conocimiento y el desarrollo de la disciplina enfermera para explicar que no solo se deben valorar las cuestiones epistemológicas sobre el conocimiento sino también las preguntas ontológicas sobre el significado, el ser y la realidad (AU)

To promote the development of the nursing discipline it is not only necessary to acquire the body of nursing knowledge but it is also necessary to be aware of the importance of increasing professional self-esteem and to adequately value the care actions of individuals to make progress towards a more humanised care and the endowing social recognition. This recognition must be generated from with in, from the very core of the discipline.This paper depicts a brief reflexion on the nature of the philosophy of nursing. Firstly, the concept of “Philosophy of Nursing” is defined and the different approaches are analysed. Next, the essence and the values inherent to nursing are described. Lastly, a look into the knowledge and development of the nursing discipline is taken in order to explain that not only epistemological issues should be valued regarding knowledge but also ontological questions concerning the meaning, the being, and reality (AU)

[Survey in hospitals. Nursing errors, error culture and error management]. / Befragung in Krankenhäusern. Pflegefehler, Fehlerkultur und Fehlermanagement.

Knowledge on errors is important to design safe nursing practice and its framework. This article presents results of a survey on this topic, including data of a representative sample of 724 nurses from 30 German hospitals. Participants predominantly remembered medication errors. Structural and organizational factors were rated as most important causes of errors. Reporting rates were considered low; this was explained by organizational barriers. Nurses in large part expressed having suffered from mental problems after error events. Nurses' perception focussing on medication errors seems to be influenced by current discussions which are mainly medication-related. This priority should be revised. Hospitals' risk management should concentrate on organizational deficits and positive error cultures. Decision makers are requested to tackle structural problems such as staff shortage.

Battlefield conditions: different environment but the same duty of care.

Using an interpretative research approach to ethical and legal literature, it is argued that nursing in the battlefield is distinctly different to civilian nursing, even in an emergency, and that the environment is so different that a duty of care owed by military nurses to wounded soldiers should not apply. Such distinct differences in wartime can override normal peacetime professional ethics to the extent that the duty of care owed by military nurses to their patients on the battlefield should not exist. It is also argued that as military nurses have legal and professional obligations to care for wounded soldiers on the battlefield, this obligation conflicts with following military orders, causing a dual loyalty conflict. This is because soldiers are part of the 'fighting force' and must be fit to fight and win the battle. This makes them more of a commodity rather than individual persons with distinct health care needs.

Developing a modern standard to define and assess professionalism in trainees.

OBJECTIVE: Assessing professionalism in medical education poses many challenges. The authors discuss common themes and principles in managing professionalism in medical education. METHODS: The authors review the development of standards of professionalism in medical education. They define educational goals for professionalism and also discuss the practical problems with assessing professionalism and addressing it with the trainees. Strategies for remediation of unprofessional conduct are outlined. RESULTS: Given the importance of role models in the development of professional behavior, maintaining an environment that fosters professionalism is an implicit feature of teaching professionalism. Professionalism should be a part of the objectives for each course and clinical rotation, using clearly defined goals and objectives. Assessment of professionalism should begin early and be conducted frequently, giving trainees the opportunity to change. A formal mentoring system can be an effective mechanism to develop role models and teach professionalism. CONCLUSION: Teaching professionalism through formal curricula is paramount in helping develop new generations of compassionate and responsible physicians. Additional strategies such as consistent role modeling of professional behaviors are also needed to encourage the development of professional physicians.