Shall I tell my mentor? Exploring the mentor-student relationship and its impact on students' raising concerns on clinical placement.

AIMS: To explore student nurses' and nurse mentors' perceptions and experiences of raising concerns on clinical placement and the influence (if any) of their relationship on this process. A secondary aim is to consider the above, from a regulatory perspective in light of current literature and policy developments. BACKGROUND: Raising concerns whilst on clinical placement has been shown to be challenging for student nurses internationally. Registered nurses in the UK (in this case called "nurse mentors") facilitate learning and assessment in practice. However, limited research exists on the influence of the relationship between the nurse mentor and student nurse on the raising concerns process. DESIGN: A qualitative approach was used to undertake secondary thematic analysis of interview data. The primary data set was generated during a PhD study, focusing on the mentor-student dynamic and the possible influence of this relationship on students' raising concerns. METHODS: 30 individual semi-structured interviews were subjected to concurrent and thematic analysis. Interviews were undertaken with student nurses (n = 16) and nurse mentors (n = 14) between April 2016-January 2018. The COREQ 32-item checklist was used during the preparation of this article. FINDINGS: The following three interrelated analytical themes were generated from the data, "developing a mentor-student relationship," "keeping your mentor sweet" and "the mentor role in the raising concerns process." CONCLUSION: Our analysis of participants' experiences and perceptions offers an original contribution to understanding the factors associated with student nurses raising concerns in practice. Student nurses and most mentors believed that students should be encouraged and supported to raise concerns, but students' decisions were strongly influenced by their perceptions of the immediate interpersonal and educational context. Similar barriers to raising concerns have been shown to exist regardless of geographical boundaries, therefore the findings of this study are nationally and internationally relevant. Relevance to clinical practice This study provides new insight into the role of the nurse mentor in supporting students who raise concerns on clinical placements. The majority of the mentor participants believed that students should be encouraged and supported to speak up if they witness poor care or unprofessional behaviour. Focusing on the compexities around raising concerns in mentorship training and updates would rovide a forum for open discussion amongst mentors and educators.

Whistle-blowing process in healthcare: From suspicion to action.

BACKGROUND:: Whistle-blowing is an ethical activity that tries to end wrongdoing. Wrongdoing in healthcare varies from inappropriate behaviour to illegal action. Whistle-blowing can have negative consequences for the whistle-blower, often in the form of bullying or retribution. Despite the wrongdoing and negative tone of whistle-blowing, there is limited literature exploring them in healthcare. OBJECTIVE:: The aim was to describe possible wrongdoing in Finnish healthcare and to examine whistle-blowing processes described on the basis of the existing literature in healthcare as perceived by healthcare professionals. RESEARCH DESIGN:: The study was a cross-sectional descriptive survey. The data were collected using the electronic questionnaire Whistle-blowing in Health Care and analysed statistically. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 397 Finnish healthcare professionals participated, 278 of whom had either suspected or observed wrongdoing in healthcare, which established the data for this article. ETHICAL CONSIDERATIONS:: Ethical approval was obtained from the Ethics Committee of the University (20/2015). Permission to conduct the study was received according to the organisation's policies. FINDINGS:: Wrongdoing occurs in healthcare, as 96% of the participants had suspected and 94% had observed wrongdoing. Regarding the frequency, wrongdoing was suspected (57%) and observed (52%) more than once a month. Organisation-related wrongdoing was the most common type of wrongdoing (suspected 70%, observed 66%). In total, two whistle-blowing processes were confirmed in healthcare: (1) from suspicion to consequences occurred to 27%, and (2) from observation to consequences occurred to 37% of the participants. DISCUSSION AND CONCLUSION:: Wrongdoing occurs in healthcare quite frequently. Whistle-blowing processes were described based on the existing literature, but two separate processes were confirmed by the empirical data. More research is needed on wrongdoing and whistle-blowing on it in healthcare.

Poor care and the professional duty of the registered nurse.

Concerns have been raised in recent years about standards of care in the UK. Notable failures have been identified in the care of vulnerable older adults. This article identifies and discusses some logical steps which might be taken to minimise the risk of individual and systemic care failure in settings for older adults. These steps include frank discussion about ageism to promote empowerment and respect for older people; ensuring robust policies are in place that support and encourage the reporting of poor care; and ensuring that registered practitioners are aware of their accountability for their actions and also their omissions should they witness poor care. In addition to reducing the risk of poor care, these steps could contribute to having a more confident, competent and empowered workforce.

Whistle-blowing in Medical School: A National Survey on Peer Accountability and Professional Misconduct in Medical Students.

OBJECTIVE: This study examines medical students' attitudes towards peer accountability. METHODS: A nationally representative sample of 564 third year medical students was surveyed. Students reported their agreement or disagreement with two statements: "I feel professionally obligated to report peers whose personal behaviors compromise their professional responsibilities" and "I feel professionally obligated to report peers who I believe are seriously unfit to practice medicine." RESULTS: The majority of students (81.6 %) either agreed strongly or agreed somewhat that they feel obligated to report peers whose personal behaviors compromise their professional responsibilities. The majority (84.1 %) also agreed that they feel professionally obligated to report peers who they believe are seriously unfit to practice medicine. CONCLUSION: In contrast with previous studies, this national study found that a significant majority of students reported that they feel obligated to report unfit peers.

Whistle-blowing and workplace culture in older peoples' care: qualitative insights from the healthcare and social care workforce.

Inquiries in the UK into mistreatment of older people by healthcare employees over the last 30 years have focused on introducing or supporting employee whistle-blowing. Although whistle-blowers have made an important contribution to patient safety it remains a controversial activity. The fate of whistle-blowers is bleak, often resulting in personal and professional sacrifices. Here we draw on the views of healthcare and social care employees working with older people to explore perceptions of whistle-blowing as well as alternative strategies that may be used to raise concerns about the mistreatment of patients by co-workers. Whistle-blowing was perceived as a negative term. Managers said they promoted open cultures underpinned by regular team meetings and an open-door ethos. Others described workplace norms that were somewhat at odds with these open culture ideals. Whistle-blowing was considered risky, and this led to staff creating informal channels through which to raise concerns. Those who witnessed wrongdoing were aware that support was available from external agencies but preferred local solutions and drew upon personal ethics rather than regulatory edicts to shape their responses. We argue that the importance of workplace relationships and informal channels for raising concerns should be better understood to help prevent the mistreatment of vulnerable groups.

Career opportunity of whistle-blower in the workplace: the role of privacy legislation and supervisor support.

Purpose: This study aims to explain the interaction of perceived privacy legislation on the relationship between affective commitment and whistle-blowing. Additionally, it seeks to determine the consequences of whistle-blowing on employee careers moderated by perceived supervisor support in government organizations. Design/methodology/approach: A Moderated Regression Analysis was used to analyze survey data from 411 local government employees in West Java, Indonesia. Findings: The result found a positive relationship between affective commitment and whistle-blowing. Perceived privacy legislation also had a significant moderating effect on the correlation between the two variables. Furthermore, whistle-blowing found a positive relationship with career opportunities, moderated by perceived supervisor support. Originality/value: The finding may contribute to the extension of scientific literature by making privacy legislation a moderator with the potential to increase employee affective commitment to whistle-blowing behavior. It determines the relationship between whistle-blowing on employee careers opportunity moderated by perceived supervisor support. In contrast, previous studies only focused on factors influencing whistle-blowing behavior.

Understanding the social impacts of enforcement activities on illegal wildlife trade in China.

Illegal wildlife trade enforcement is a cornerstone conservation strategy worldwide, yet we have a limited understanding on its social impacts. Using Chinese online wildlife seizure news (2003-2018), we evaluated the interactions among enforcement operations, news frequency, and social engagement (i.e., whistle-blowing) frequency. Our results showed that intensive enforcement operations, which commenced after 2012, have social impacts by increasing the frequency of all seizure news significantly by 28% [95% Confidence Interval (CI): 5%, 51%] and those via whistle-blowing by 24% [95% CI: 2%, 45%], when compared to counterfactual models where possible confounding factors were accounted for. Furthermore, we revealed the potential interaction between enforcement seizure news with and without social engagement, and the consequential social feedback process. Of the species identified from 'whistle-blowing' news, up to 28% are considered as high conservation priorities. Overall, we expanded our understanding of the enforcement impacts to social dimensions, which could contribute to improving the cost-effectiveness of such conservation efforts.

Good friend or good student? An interview study of perceived conflicts between personal and academic integrity among students in three European countries.

Students are often reluctant to report the academic dishonesty of their peers. Loyalty to friends and classmates has previously been identified as an important reason for this. This paper explores loyalty conflicts among students from upper secondary school, through bachelor's, to Ph.D. level. Drawing on semi-structured qualitative interviews (N = 72) conducted in Denmark, Ireland and Hungary, we show that loyalty considerations among students can be complex and draw on a range of norms including responsibility. The study demonstrates how students are often willing to assume substantial personal responsibility for dealing with the academic dishonesty of a peer, often preferring this to reporting. However, when deciding on the right course of action, they also perceive tensions between the norms of the good researcher and student and their own norms of being a good friend and person. The loyalty considerations and tension were identified in all three countries and across the educational levels, which suggests that this is a cross-cultural challenge. We argue that institutions should formally decide whether they want students to take some degree of responsibility themselves for addressing less serious cases of academic dishonesty and communicate their decision to their students.

Humiliating Whistle-Blowers: Li Wenliang, the Response to Covid-19, and the Call for a Decent Society.

The ethical experience and lessons of China's and the world's response to COVID-19 will be debated for many years to come. But one feature of the Chinese authoritarian response that should not be overlooked is its practice of silencing and humiliating the whistle-blowers who told the truth about the epidemic. In this article, we document the humiliation of Dr Li Wenliang (1986-2020), the most prominent whistle-blower in the Chinese COVID-19 epidemic. Engaging with the thought of Israeli philosopher Avishai Margalit, who argues that humiliation constitutes an injury to a person's self-respect, we discuss his contention that a decent society is one that abolishes conditions which constitute a justification for its dependents to consider themselves humiliated. We explore the ways that institutions humiliate whistle-blowers in Western countries as well as in China.

'Blowing the whistle': the ethical, professional and legal implications of raising concerns and self-regulation within dentistry.

'Whistle-blowers' are a necessary part of any system; dentistry is no different. The role of whistle-blowers in dentistry has been enshrined in Australian law since 2010. Raising concerns has become a legal duty as well as an ethical and professional obligation. It is important that these different aspects of raising concerns are explored as each adds another layer of consideration to the issue. The health professional's duty to whistle-blow could be viewed as problematic; the observance of this duty is associated with being 'trapped between a rock and a hard place' where any decision to engage or not may have negative consequences. For the obligation of raising concerns to gain acceptability within the dental profession, the concept requires reframing as being necessary for the profession's continued success. The stigma of mandatory reporting needs to be removed to allow this essential process to occur. This article will discuss the ethical, professional and legal imperatives for the dental profession to engage with whistle-blowing and the likely challenges that are likely to be met in doing so.

A Narrative on The Witch-Hunt Narrative: The Moral Dimensions.

Ross Cheit's The Witch-Hunt Narrative raises a number of complex moral issues. Cheit's principal purpose is to challenge the belief that our society has overreacted to claims about the sexual abuse of children. Both directly and indirectly, Cheit's in-depth analysis broaches moral concerns pertaining to the integrity of child abuse allegations, investigations, civil litigation, and criminal prosecution, with an emphasis on the mixed motives of the parties involved in key cases. This article provides an overview of ethical questions pertaining to gathering information from very vulnerable individuals, informed consent, institutional review, protection of research participants, the use of deception and coercion, confidentiality and privacy, reporting research results, and conflicts of interest. In addition, the author discusses the phenomenon of whistle-blowing as it pertains to professionals' ethical judgments about disclosure of wrongdoing and misconduct. The author outlines key ethics-related concepts, applies relevant moral theory, and explores the implications of the moral issues raised by The Witch-Hunt Narrative for child sexual abuse victims, perpetrators, child welfare and law enforcement professionals, scholars and researchers, and the public at large.

Nursing and midwifery students' encounters with poor clinical practice: A systematic review.

The aim of this paper was to systematically review evidence about nursing and midwifery students' encounters with poor clinical care. We undertook a systematic review of English language empirical research using multiple databases from inception to April 2016. Hand searching was also undertaken. Included papers contained accounts of empirical research which reported on students' encounters with poor care. These were quality-assessed, information was extracted into tables, and study results were synthesized using thematic analysis. N = 14 papers met inclusion criteria; study quality was moderate to good. Study synthesis revealed four themes: i) encounters with poor practice: students encounter poor practice that is likely to be worthy of professional sanction; ii) while intention to report is high in hypothetical scenarios, this appears not always to translate to actual practice; iii) a range of influencing factors impact the likelihood of reporting; iv) the consequences of encountering and subsequently reporting poor practice appeared to have a lasting effect on students. Research is required to determine the frequency and nature of students' encounters with poor care, when and where they encounter it, how to increase the likelihood that they will report it, and how they can be supported in doing so.

"Supporting nursing, midwifery and allied health professional students to raise concerns with the quality of care: A review of the research literature".

BACKGROUND: This article reports aspects of a systematic literature review commissioned by the UK Council of Deans of Health. The review collated and analysed UK and international literature on pre-registration healthcare students raising concerns with poor quality care. The research found in that review is summarised here. OBJECTIVE: To review research on healthcare students raising concerns with regard to the quality of practice published from 2009 to the present. DATA SOURCES: In addition to grey literature and Google Scholar a search was completed of the CINAHL, Medline, ERIC, BEI, ASSIA, PsychInfo, British Nursing Index, Education Research Complete databases. REVIEW METHOD: Sandelowski and Barroso's (2007) method of metasynthesis was used to screen and analyse the research literature. The review covered students from nursing, midwifery, health visiting, paramedic science, operating department practice, physiotherapy, chiropody, podiatry, speech and language therapy, orthoptist, occupational therapy, orthotist, prosthetist, radiography, dietitian, and music and art therapy. RESULTS: Twenty three research studies were analysed. Most of the research relates to nursing students with physiotherapy being the next most studied group. Students often express a desire to report concerns, but factors such as the potential negative impact on assessment of their practice hinders reporting. There was a lack of evidence on how, when and to whom students should report. The most commonly used research approach found utilised vignettes asking students to anticipate how they would report. CONCLUSIONS: Raising a concern with the quality of practice carries an emotional burden for the student as it may lead to sanctions from staff. Further research is required into the experiences of students to further understand the mechanisms that would enhance reporting and support them in the reporting process.

The place and role of (moral) anger in organizational behavior studies.

The aim of this article is to conceptually delineate moral anger from other related constructs. Drawing upon social functional accounts of anger, we contend that distilling the finer nuances of morally motivated anger and its expression can increase the precision with which we examine prosocial forms of anger (e.g., redressing injustice), in general, and moral anger, in particular. Without this differentiation, we assert that (i) moral anger remains theoretically elusive, (ii) that this thwarts our ability to methodologically capture the unique variance moral anger can explain in important work outcomes, and that (iii) this can promote ill-informed organizational policies and practice. We offer a four-factor definition of moral anger and demonstrate the utility of this characterization as a distinct construct with application for workplace phenomena such as, but not limited to, whistle-blowing. Next, we outline a future research agenda, including how to operationalize the construct and address issues of construct, discriminant, and convergent validity. Finally, we argue for greater appreciation of anger's prosocial functions and concomitant understanding that many anger displays can be justified and lack harmful intent. If allowed and addressed with interest and concern, these emotional displays can lead to improved organizational practice.

What About Leadership?: Comment on "Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations".

In their valuable discussion of whistleblowing in healthcare organisations, Mannion and Davies highlight the importance of organisational culture in influencing whether people raise concerns, and whether these concerns are listened to and acted upon. The role of leadership in shaping organisational culture is well-established and in this commentary, we will examine the influence of leaders in creating cultures of silence or cultures of voice.