Factors that impact on emergency nurses' ethical decision-making ability.

BACKGROUND:: Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered. RESEARCH PURPOSE:: Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability. RESEARCH DESIGN AND CONTEXT:: A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson's r was the statistical method used to analyze three primary and two secondary research questions. PARTICIPANTS:: A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected. ETHICAL CONSIDERATIONS:: Approval to conduct this study was obtained by the Adelphi University Institutional Review Board. FINDINGS:: A relationship between intuition and perceived ethical decision-making ability ( r = .252, p = .001) was a significant finding in this study. DISCUSSION:: This study is one of the first of this nature to make a connection between intuition and nurses' ethical decision-making ability. CONCLUSION:: This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions.

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.

Ethical and legal challenges associated with disaster nursing.

BACKGROUND: In disaster situations, nurses may face new and unfamiliar ethical and legal challenges not common in their everyday practice. RESEARCH QUESTION/OBJECTIVES/HYPOTHESIS: The aim of this study was to explore Iranian nurses' experience of disaster response and their perception of the competencies required by nurses in this environment. RESEARCH DESIGN: This article discusses the findings of a descriptive study conducted in Iran in 2012. PARTICIPANTS AND RESEARCH CONTEXT: This research was conducted in Iran in 2012. Participants included 35 nurses who had experience in healthcare delivery following a disaster event in the past 10 years, either in a hospital or out-of-hospital context. ETHICAL CONSIDERATIONS: This research study was approved by the Ethics Committee of the Isfahan University of Medical Sciences. FINDINGS: From this study, five themes emerged as areas that nurses require competence in to work effectively in the disaster setting. This article focusses on one theme, the ethical and legal issues that arise during disaster response. Within the theme of ethical and legal issues, two sub-themes emerged. (1) Professional ethics explores professional responsibility of nurses as well as sense of ethical obligation. (2) Adherence to law refers to nurses' familiarity with and observation of legal requirements. DISCUSSION: This article adds to a growing pool of literature which explores the role of nurses in disasters. The findings of this study emphasize the need for nurses working in the disaster setting to be aware of professional responsibilities and familiar with legal requirements and the challenges related to observing ethical responsibilities. CONCLUSION: In highlighting these issues, this article may provide a useful starting point for the development of an educational framework for preparing nurses and other health professionals to work in the disaster setting.

Some ethical conflicts in emergency care.

BACKGROUND: Decision-making and assessment in emergency situations are complex and result many times in ethical conflicts between different healthcare professionals. AIM: To analyse and describe situations that can generate ethical conflict among nurses working in emergency situations. METHODS: Qualitative analysis. A total of 16 emergency nurses took part in interviews and a focus group. ETHICAL CONSIDERATIONS: Organisational approval by the University Hospital, and informed consent and confidentiality were ensured before conducting the research. RESULT/CONCLUSION: Two categories emerged: one in 'ethical issues' and one in 'emotions and feelings in caring'. The four ethical subcategories are presented: Autonomy, the first sub category: first, the nurse's ability to practise care on an emergency ward and, second, to support the patient and/or relatives in terms of care and medical treatment. The conflicts arise when the nurse ends up in the middle between the patient and the physician responsible for the diagnosis and treatment from a nature scientific perspective. Reification of injured body: patient was often reified and fragmented, becoming just a leg or arm. Different factors contributed in this perspective. Pain: pain relief was often inadequate but more effectively treated in the emergency medical services than at the emergency department. The nurses highlighted the phenomenon of suffering because they felt that pain was only an object, forgetting the patients' care need, like separating mind from body. Death: the nurses felt that the emergency services are only prepared to save lives and not to take care of the needs of patients with 'end-of-life' care. Another issue was the lack of ethical guidelines during a cardiac arrest. Resuscitation often continues without asking about the patient's 'previous wishes' in terms of resuscitation or not. In these situations, the nurses describe an ethical conflict with the physician in performing their role as the patient's advocate. The nurses express feelings of distress, suffering, anger and helplessness.

Ethical issues in the response to Ebola virus disease in US emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine.

The 2014 outbreak of Ebola Virus Disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged US emergency departments to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to US acute care facilities, ethical questions have been raised in both the press and medical literature as to how US emergency departments, emergency physicians, emergency nurses and other stakeholders in the healthcare system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to US emergency physicians, emergency nurses and other stakeholders in the healthcare system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to US emergency departments in how they approach preparation for and management of potential patients with EVD.

Moral distress in emergency nurses.

INTRODUCTION: For nurses, moral distress leads to burnout, attrition, compassion fatigue, and patient avoidance. METHODS: Using a quantitative, cross-sectional, and descriptive design, we assessed the frequency, intensity, and type of moral distress in 51 emergency nurses in 1 community hospital using a 21-item, self-report, Likert-type questionnaire. RESULTS: Results showed a total mean moral distress level of 3.18, indicative of overall low moral distress. DISCUSSION: Situations with the highest levels of moral distress were related to the competency of health care providers and following family wishes to continue life support, also known as futile care. Moral distress was the reason given by 6.6% of registered nurses for leaving a previous position, 20% said that they had considered leaving a position but did not, and 13.3% stated that they are currently considering leaving their position because of moral distress.

Family violence assessment practices of pediatric ED nurses and physicians.

BACKGROUND: Recommendations by the ENA and other professional organizations have not resulted in widespread adoption of routine assessment for family violence such as child abuse and intimate partner violence. The aim of this qualitative study was to use a theory-driven approach to explore the salient beliefs and attitudes of nurses and physicians related to routine assessment of child abuse and intimate partner violence in the pediatric emergency department. METHODS: Nurse and physician participants from a large Midwestern pediatric trauma center responded to a series of open-ended questions designed to identify positive or negative attitudes toward family violence assessment, approving or disapproving beliefs about family violence assessment, and the perception of ease or difficulty in performing family violence assessment. RESULTS: Respondents valued early identification and the associated health benefits of keeping pediatric patients safe, as well as linking at-risk families to community resources. They believe that victims, health care organizations, and some providers approve of routine family violence assessment but also believe that some providers and families who value privacy disapprove. Previously identified barriers and facilitators to family violence assessment were confirmed by participants. A finding unique to this study was that participants expressed the belief that routine family violence assessment offers more complete health care to children. DISCUSSION: Participants viewed child abuse and intimate partner violence as an event in a child's life that affects the child's health. Participants valued the benefits of routine family violence assessment; however, translating these value beliefs into practice remains elusive. A theoretical framework may provide insight into yet unidentified aspects of known barriers and facilitators.

[Hospitalization by court order: ethical dilemmas experienced by nurses]. / Internação por ordem judicial: dilemas éticos vivenciados por enfermeiros.

A qualitative study aimed at describing the situations experienced and the ethical dilemmas of nurses in the process of referring and receiving hospitalized patients by court order who require admission to the Intensive Care Unit (ICU). A partially structured interview was conducted with 10 nurses who worked in the ICU and 10 who worked in the Emergency Room (ER) in public and private hospitals in the metropolitan area of Porto Alegre, Brazil. The data was analyzed following the Semantic Analysis. The results indicated that nurses experienced ethical dilemmas associated with problems of overcrowding in emergency rooms and ICUs, poor specialized technology and orientation as to the benefits provided by law. We concluded that it is essential for nurses to participate in discussions that allow the planning of the different instances that have been promoting this often chaotic situation.

Moral distress: an invisible challenge for trauma nurses.

It is not known how moral distress is experienced by trauma nurses and how it may affect their ability to provide care to their patients. In particular, how does moral distress affect trauma nurses' ability to perform specific duties when a patient is dying in the specialized trauma unit of the emergency department? This article highlights aspects of moral distress for nurses and proposes specific sources of moral distress in trauma nursing such as futile care. The experiences of trauma nurses are also discussed in relationship to a caring framework of enduring and suffering.

Exploring the ethics of prescribing medicines.

The delivery of holistic care should incorporate patient empowerment through the promotion of health and self-help measures, including pain relief. In this article, the author, a newly qualified independent prescriber, explains why she believes that encouraging patients to buy over-the-counter medication is morally acceptable and based on the principles of beneficence and non-malevolence. She also reflects on her prescribing decisions in the context of ethics, health economics and personal perspective for four patients with similar injuries. The author works in Wales, where prescriptions are free to residents.

Humanization in urgent and emergency services: contributions to nursing care. / Humanização nos serviços de urgência e emergência: contribuições para o cuidado de enfermagem.

OBJECTIVE: To analyze the evidence of researches carried out on humanization in urgent and emergency care, considering their contributions to nursing care. METHODS: Integrative review of LILACS, CINAHL, SciELO, Web of Science, SCOPUS, and BDENF databases, using the keywords: humanization of care, urgencies, emergencies, emergency medical services, and nursing. RESULTS: The search resulted in a total of 133 publications, of which 17 were included in the scope of this review. The analysis enabled the elaboration of the evidence units: 'Reception with Risk Classification: a device with good results' and 'Barriers and difficulties to use the guidelines of the National Humanization Policy'. CONCLUSION: The Reception with Risk Classification was evidenced as the main device for the effective implementation of the National Humanization Policy and there are barriers to its effectiveness related to the organization of health care networks, structural problems, and multi-professional work.

Ethical, legal and professional accountability in emergency nursing practice: An ethnographic observational study.

INTRODUCTION: Accountability in nursing practice is a concept that influences quality care, decision-making, safety standards and staff values. Therefore, understanding accountability and how it affects nursing practice could improve patient care and nurses' working conditions. AIM: The aim of this study was to find factors that influenced ethical, legal and professional accountability in emergency nursing practice. METHODS: A qualitative ethnographic approach using participant observation through convenience sampling was employed as the data collection method, while ethnographic content analysis was used for data analysis. RESULTS: The factors linked to nursing accountability found were classified into four main themes: daily dynamics, work environment evolution, customs and routines and bioethics principles' application. DISCUSSION: The long-term effect of chronic high workload and crowding, which affects nursing accountability, could promote burnout in a junior ED workforce. Changes in the nurses' working conditions need to be implemented to limit the workload to which an ED nurse is subjected to. CONCLUSION: ED nurses have to manage their accountability in difficult situations regularly, which followed patterns of four main themes across the majority of situations. Nonetheless, all those factors were influenced by nursing workload, an ever-present factor that was always considered by ED nurses during decision-making.

Exploring the Sexual Assault Response Team Perception of Interprofessional Collaboration: Implications for Emergency Department Nurses.

There is little research on the dynamics of the sexual assault response team (SART) members' interprofessional collaboration (IPC) practice. The study purposes were to (1) explore the perceptions of IPC among SART members; (2) evaluate the use of Perception of Interprofessional Collaboration Model Questionnaire with the SART; and (3) discuss the implications of the Interprofessional Core Competencies for emergency department nurses and sexual assault nurse examiners. This cross-sectional mixed-methods study (n = 49) was implemented using 4 SART teams in a mid-Atlantic state. There were no statistically significant differences in the subscales within the group level using analysis of variance but offered some valuable insight and content analysis. Emergency department nurses collaborate with different agencies and discipline within their working environment. Understanding the basics of IPC and the perception of IPC within the SART may open doors to further appreciate the dynamics of this team.

Exercising restraint: clinical, legal and ethical considerations for the patient with Alzheimer's disease.

The number of older people using emergency care is increasing steadily and older people account for over half of all emergency admissions. In the emergency setting, nurses caring for older people with Alzheimer's disease can be faced with many complex ethical and legal challenges. Moreover, challenges such as the use of physical restraint can precipitate conflict when the nurse is placed in the precarious position of doing good, respecting autonomy and avoiding paternalism. Although, there is no complete set of "rules" that can provide nurses with an answer to each dilemma, it is of significant value for nurses to have sound knowledge of ethical and legal positions in order to analyse the many complex situations that they may encounter.