Ethics of care in technology-mediated healthcare practices: A scoping review.

BACKGROUND: Introducing new technologies into healthcare practices may challenge professionals' traditional care cultures. The aim of this review was to map how the 'ethics of care' theoretical framework informs empirical studies of technology-mediated healthcare. METHOD: A scoping review was performed using eight electronic databases: CINAHL with full text, Academic Search Premier, MEDLINE, the Philosopher's Index, SocINDEX with Full Text, SCOPUS, APA PsycInfo and Web of Science. This was followed by citation tracking, and articles were assessed against the inclusion criteria. RESULTS: Of the 443 initial articles, 18 met the criteria and were included. We found that nine of the articles used the concept of 'ethics of care' (herein used interchangeably with the terms 'feminist ethics' or 'relational ethics') insubstantially. The remaining nine articles deployed care ethics (or its equivalent) substantially as an integrated theoretical framework and analytical tool. We found that several articles suggested an expansion of ethics of care to encompass technologies as part of contemporary care. Furthermore, ethics of care contributed to the empirical research by recognising both new relationships between patients and healthcare professionals as well as new ethical challenges. CONCLUSION: Ethics of care is sparsely used as a theoretical framework in empirical studies of technology-mediated healthcare practices. The use of ethics of care in technology-mediated care brings new dilemmas, relational tensions and vulnerabilities to the foreground. For ethics of care to be used more explicit in empirical studies, it is important that it is recognised by research community as an adequate, universal ethical theory.

Death and liminality: An ethnographic study of nursing home staff's experiences in an encounter with the dead body.

This paper investigates nursing home staff's experiences of the "final journey," when a resident's dead body is taken to the cold room. The account is based on data from ethnographic fieldwork in two nursing homes in Norway. Accompanying the dead body, staff found themselves "betwixt and between" - an anxious and ambiguous state, bordering on the uncanny. Liminality became a useful theoretical device in the data interpretation. The last offices - a rite of passage governing liminal states - provided a containing structure for this final journey but were not sufficient to banish the uncanny from the staff's experience.

Between the patient and the next of kin in end-of-life care: A critical study based on feminist theory.

BACKGROUND:: For the experience of end-of-life care to be 'good' many ethical challenges in various relationships have to be resolved. In this article, we focus on challenges in the nurse-next of kin relationship. Little is known about difficulties in this relationship, when the next of kin are seen as separate from the patient. RESEARCH PROBLEM:: From the perspective of nurses: What are the ethical challenges in relation to next of kin in end-of-life care? RESEARCH DESIGN:: A critical qualitative approach was used, based on four focus group interviews. PARTICIPANTS:: A total of 22 registered nurses enrolled on an Oncology nursing specialisation programme with experience from end-of-life care from various practice areas participated. ETHICAL CONSIDERATIONS:: The study was approved by the Norwegian Social Science Data Service, Bergen, Norway, project number 41109, and signed informed consent obtained from the participants before the focus groups began. FINDINGS AND DISCUSSION:: Two descriptive themes emerged from the inductive analysis: 'A feeling of mistrust, control and rejection' and 'Being between hope and denial of next of kin and the desire of the patient to die when the time is up'. Deductive reinterpretation of data (in the light of moral distress from a Feminist ethics perspective) has made visible the constraints that certain relations with next of kin in end-of-life care lay upon the nurses' moral identity, the relationship and their responsibility. We discuss how these constraints have political and societal dimensions, as well as personal and relational ones. CONCLUSION:: There is complex moral distress related to the nurse-next of kin relationship which calls for ethical reflections regarding these relationships within end-of-life care.

I am only a nurse: a biographical narrative study of a nurse's self-understanding and its implication for practice.

BACKGROUND: The personal is a vital part of professional nursing practice. From a psycho-social perspective, nurses produce and reproduce conceptions of the Self through experience. A literature search on nurses' self-understanding in a psycho-social perspective yields no results. Hence, the aim of this study was to investigate personal and professional experiences that may have formed the self-understanding of a nurse, and how this self-understanding may have influenced her professional practice. METHODS: Using a single case approach, I conducted a Biographical Narrative Interview with a 50-year-old experienced Norwegian nurse. I asked the nurse to tell me the story of her life and how her work has affected her and possibly changed the way she saw herself. The overall aim of the interpretation was to understand the historically situated subjectivity in terms of the nurse's personal, social and professional constraints and chosen options. RESULTS: The nurse's narrative of her life story made it possible to trace a common theme throughout her experiences, the experience of being "only a nurse". The nurse experienced a low status, as well as a downgrade in the competence needed to deliver quality care in professional relationships. She felt it difficult to identify with the experience of being on the bottom of the social ladder and to identify with the female, mothering ideal connected to nursing. She desired a better position, and wanted to identify with strong women. In contrast to reality, her self-understanding influenced her relationship with her patients, her professional pride and her further professional development. CONCLUSIONS: This study shows that the professional practice of a nurse was informed by her self-understanding. This study suggests that the individual nurse must be given the opportunity to explore her professional vulnerability based on the assumption that it is both personally and socially constituted. This study indicates that the exploration of a nurse's self-understanding is one way to contribute to professional development.

Theoretical Perspectives Underpinning Research on the Physician-Patient Relationship in a Digital Health Practice: Scoping Review.

BACKGROUND: The advent of digital health technologies has transformed the landscape of health care, influencing the dynamics of the physician-patient relationship. Although these technologies offer potential benefits, they also introduce challenges and complexities that require ethical consideration. OBJECTIVE: This scoping review aims to investigate the effects of digital health technologies, such as digital messaging, telemedicine, and electronic health records, on the physician-patient relationship. To understand the complex consequences of these tools within health care, it contrasts the findings of studies that use various theoretical frameworks and concepts with studies grounded in relational ethics. METHODS: Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review. Data were retrieved through keyword searches on MEDLINE/PubMed, Embase, IEEE Xplore, and Cochrane. We screened 427 original peer-reviewed research papers published in English-language journals between 2010 and 2021. A total of 73 papers were assessed for eligibility, and 10 of these were included in the review. The data were summarized through a narrative synthesis of the findings. RESULTS: Digital health technologies enhance communication, improve health care delivery efficiency, and empower patients, leading to shifts in power dynamics in the physician-patient relationship. They also potentially reinforce inequities in health care access due to variations in technology literacy among patients and lead to decreases in patient satisfaction due to the impersonal nature of digital interactions. Studies applying a relational ethics framework have revealed the nuanced impacts of digital health technologies on the physician-patient relationship, highlighting shifts toward more collaborative and reciprocal care. These studies have also explored transitions from traditional hierarchical relationships to mutual engagement, capturing the complexities of power dynamics and vulnerabilities. Other theoretical frameworks, such as patient-centered care, and concepts, such as patient empowerment, were also valuable for understanding these interactions in the context of digital health. CONCLUSIONS: The shift from hierarchical to collaborative models in the physician-patient relationship not only underscores the empowering potential of digital tools but also presents new challenges and reinforces existing ones. Along with applications for various theoretical frameworks and concepts, this review highlights the unique comprehensiveness of a relational ethics perspective, which could provide a more nuanced understanding of trust, empathy, and power dynamics in the context of digital health. The adoption of relational ethics in empirical research may offer richer insights into the real-life complexities of the physician-patient relationship, as mediated by digital technologies.

"They Stay With You": Nursing Home Staff's Emotional Experiences of Being in a Close Relationship With a Resident in Long-Term Care who Died.

Aim: To explore and develop understanding of nursing home staff's emotional experiences of being in a close relationship with a resident in long-term care who later died. Design: Ethnographic fieldwork. Methods: As part of fieldwork, narrative interviews were conducted with nursing home staff (n = 6) in two nursing homes in Norway and analyzed using interpretative phenomenological analysis. Findings: Through data analysis, we identified three superordinate themes: (1) wanting to be something good for the resident and their families, (2) striving to make sense of the resident's death, and (3) struggling to balance being personal and professional. Implications for holistic nursing and conclusion: Nursing home staff experience tensions between ideals of distanced professionalism and the emotional experience of proximity, evidenced by personal commitment and mutual recognition in relationships with "special residents" in long-term care. To support holistic practice, awareness is needed of the emotional impact of relationships on health professionals. Suppressing feelings puts staff at risk of moral distress, compassion fatigue, and burnout, as well as higher turnover and absenteeism. Managers should facilitate discussions on professionals' ideals of relationship-based practice, including processing of, and reflection on, emotional experiences in long-term care. Rituals to mark a resident's death can provide further emotional containment.

Experiences of women who have a vaginal birth after requesting a cesarean section due to a fear of birth: a biographical, narrative, interpretative study.

A fear of childbirth is a reason for a Cesarean section on request without a medical indication. The law for patients' rights in Norway does not give women the opportunity to choose a Cesarean section, only the potential to participate in the decision-making process. This requires cooperation between health professionals and patients. The present study explores the experience of women who had a vaginal birth after requesting a Cesarean section due to a fear of birth. A biographical, narrative, interpretative method was used. Through five women's stories, it is evident that the practice of decision-making constitutes a challenge for both the women and the health professionals. The importance of a woman's right to be taken seriously, even if she does not want to understand the reason behind her fear of birth, is emphasized. An open mind from midwives and physicians is required, although this seems difficult to achieve.

How Do Migrant Nursing Home Staff Relate to Religion in Their Work With Patients Who Are Approaching Death?

AIM: To investigate how migrant nursing home staff relate to religion in their care for patients who are approaching death. METHOD AND THEORY: Individual in-depth interviews were conducted with 16 migrant health care workers from five nursing homes in Norway. The overall analytic approach was hermeneutical. The parts and the whole were interpreted in light of each other to gain a "thick description" of the data material in order to show the ways in which experiential meaning-making draws on cultural webs of sign ificance. FINDINGS: Religion held various meanings for the migrant health care workers interviewed. Religious and cultural competence and knowledge of migrant nursing home staff was neither asked for by the management nor discussed in the staff group. The way our participants related to religion at work was therefore based on individual preferences and internalized practices. CONCLUSION AND IMPLICATION FOR PRACTICE: Organized reflection groups among staff are needed in order to integrate and develop religious literacy in the multicultural nursing home setting. Such reflection groups can help the individual staff member to perform holistic nursing, that is, to be attentive of the interconnectedness of biological, social, psychosocial, and spiritual aspects in a human being.

CARING FUTURES: a study protocol for transdisciplinary qualitative research on technology-mediated care practices and theory development for ethics of care.

INTRODUCTION: The world's population is ageing. As older persons live longer and increase in number, society faces a greater disease burden and, in public welfare, a corresponding resource deficit. New technology is one solution to this deficit but there is scarce knowledge about ethical aspects of such innovations in care practices. In CARING FUTURES, we address this scarcity by interrogating how new technology in care can become ethically sound and, correspondingly, how ethics of care can become more technology aware. Our concern is to protect quality care for the future. METHODS AND ANALYSIS: CARING FUTURES advances transdisciplinarity through knowledge exchange around technology-mediated care and ethics of care, involving key stakeholders. We rely on established and innovative methods to generate experience-near and practice-near knowledge. Through this empirical research, we seek to expand understanding of technology-mediated care and to enrich ethics of care theory. ETHICS AND DISSEMINATION: Empirical studies have been approved or await approval by national ethics committees. CARING FUTURES is designed to create societal impact through Knowledge Transfer Events targeting stakeholders in health, care and welfare, and Educational Packages for students of care-providing knowledge-exchange forums for future academics and practitioners of care. The project's societal impact is also ensured in that participating researchers are also practitioners and/or educators of care personnel for the future. Project findings will be disseminated through scientific publications and conference presentations. Through communication in both traditional and digital media platforms, we engage in dialogues between researchers, user groups, policy makers and the wider public.

Maximizing work integration in job placement of individuals facing mental health problems: Supervisor experiences.

BACKGROUND: Many people confronting mental health problems are excluded from participation in paid work. Supervisor engagement is essential for successful job placement. OBJECTIVE: To elicit supervisor perspectives on the challenges involved in fostering integration to support individuals with mental health problems (trainees) in their job placement at ordinary companies. METHODS: Explorative, qualitative designed study with a phenomenological approach, based on semi-structured interviews with 15 supervisors involved in job placements for a total of 105 trainees (mean 7, min-max. 1-30, SD 8). Data were analysed using qualitative content analysis. RESULTS: Superviors experience two interrelated dilemmas concerning knowledge of the trainee and degree of preferential treatment. Challenges to obtaining successful integration were; motivational: 1) Supervisors previous experience with trainees encourages future engagement, 2) Developing a realistic picture of the situation, and 3) Disclosure and knowledge of mental health problems, and continuity challenges: 4) Sustaining trainee cooperation throughout the placement process, 5) Building and maintaining a good relationship between supervisor and trainee, and 6) Ensuring continuous cooperation with the social security system and other stakeholders. CONCLUSIONS: Supervisors experience relational dilemmas regarding pre-judgment, privacy and equality. Job placement seem to be maximized when the stakeholders are motivated and recognize that cooperation must be a continuous process.