| 1. |
- Abelsson, Anna, 1971-, et al.
(författare)
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What is dignity in prehospital emergency care?
- 2017
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 24:3, s. 268-278
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation.OBJECTIVE: To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care.RESEARCH DESIGN: The study had a qualitative approach.METHOD: Data were collected by Flanagan's critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis.ETHICAL CONSIDERATIONS: The study followed the ethical principles in accordance with the Declaration of Helsinki.FINDINGS: The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient's world and make professional decisions. The ambulance nurse respects the patient's will and protects the patient's body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient.DISCUSSION: It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human.CONCLUSION: Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students' ethical obligation results in the courage to see when a patient's dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.
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| 2. |
- Andersson Marchesoni, Maria, et al.
(författare)
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Technologies in older people's care : Values related to a caring rationality
- 2017
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 24:2, s. 125-137
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDThe tension between care-based and technology-based rationalities motivates studies concerning how technology can be used in the care sector to support the relational foundation of care.OBJECTIVESThis study interprets values related to care and technologies connected to the practice of good care.RESEARCH DESIGNThis research study was part of a development project aimed at developing innovative work practices through information and communication technology. Participants and research context: All staff (n = 18) working at two wards in a care facility for older people were asked to participate in interviews, and 12 accepted. We analysed the data using latent content analysis in combination with normative analysis. Ethical considerations: The caregivers were informed that participation was voluntary and that they could drop out at any time without providing any explanation.FINDINGSFour values were identified: 'presence', 'appreciation', 'competence' and 'trust'. Caregivers wanted to focus on care receivers as unique persons, a view that they thought was compromised by time-consuming and beeping electronic devices. Appraising from next-of-kin and been seen as someone who can contribute together with knowledge to handle different situations were other desires. The caregivers also desired positive feedback from next-of-kin, as they wanted to be seen as professionals who have the knowledge and skills to handle difficult situations. In addition, the caregivers wanted their employer to trust them, and they wanted to work in a calm environment.DISCUSSIONCaregivers' desire for disturbance-free interactions, being valued for their skills and working in a trustful working environment were interpreted as their base for providing good care. The caregivers' arguments are based on caring rationality, and sometimes they felt the technological rationality interfered with their main mission, providing quality care.CONCLUSIONIntroducing new technology in caring should support the caring relationship. Although society's overall technology-based approach may have gained popularity as a problem solver, technology-based rationality may compromise a care-based rationality. A shift in attitudes towards care as a concept on all societal levels is needed.
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| 3. |
- Bartholdson, C, et al.
(författare)
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Clarifying perspectives: Ethics case reflection sessions in childhood cancer care
- 2016
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Ingår i: Nursing ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 23:4, s. 421-431
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Tidskriftsartikel (refereegranskat)abstract
- Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child’s growing autonomy are known ethical concerns that involve the whole professional team around the child’s care. Objectives: The purpose of this study was to explore healthcare professionals’ experiences of participating in ethics case reflection sessions in childhood cancer care. Research design: Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology. Participants and research context: Healthcare professionals working at a publicly funded children’s hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on. Ethical considerations: The children’s and their parents’ integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board. Findings: Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants’ articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions. Discussion: The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care. Conclusion: Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child. A consolidated care approach would be valuable for both the child and the healthcare professionals because of the common care goals.
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| 4. |
- Bartholdson, C, et al.
(författare)
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Healthcare professionals' perceptions of the ethical climate in paediatric cancer care
- 2016
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Ingår i: Nursing ethics. - : SAGE Publications. - 1477-0989 .- 0969-7330. ; 23:8, s. 877-888
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Tidskriftsartikel (refereegranskat)abstract
- How well ethical concerns are handled in healthcare is influenced by the ethical climate of the workplace, which in this study is described as workplace factors that contribute to healthcare professionals’ ability to identify and deal with ethical issues in order to provide the patient with ethically good care. Objectives: The overall aim of the study was to describe perceptions of the paediatric hospital ethical climate among healthcare professionals who treat/care for children with cancer. Research design: Data were collected using the Hospital Ethical Climate Survey developed by Olsson as a separate section in a questionnaire. Descriptive statistics were used to analyse perceptions of the ethical climate. Participants and research context: Physicians, nurses and nurse-aides (n = 89) from three paediatric units participated in this study: haematology/oncology, chronic diseases and neurology. Ethical considerations: The study was approved by the regional ethical review board. Findings: Different perceptions of the ethical climate were rated as positive or negative/neutral. Nurses’ ratings were less positive than physicians on all items. One-third of the participants perceived that they were able to practice ethically good care as they believed it should be practised. Discussion: Differences in professional roles, involving more or less power and influence, might explain why physicians and nurses rated items differently. A positive perception of the possibility to practice ethically good care seems to be related to inter-professional trust and listening to guardians/parents. A negative/neutral perception of the possibility to practice ethically good care appears to be influenced by experiences of ethical conflicts as well as a lack of ethical support, for example, time for reflection and discussion. Conclusion: The two-thirds of participants who had a negative/neutral perception of the possibility to practice ethically good care are at risk of developing moral stress. Clinical ethics support needs to be implemented in care where important values are at stake.
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| 5. |
- Blomberg, Ann-Catrin, et al.
(författare)
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Student nurses' experiences of preserved dignity in perioperative practice : Part 1
- 2015
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 22:6, s. 676-687
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:In recent years, operating theatre nurse students' education focussed on ethical value issues and how the patient's dignity is respected in the perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient's care during surgery.OBJECTIVE:The objective of this study was to present what operating theatre nurse students experienced and interpreted as preserved dignity in perioperative practice.RESEARCH DESIGN:The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan's critical incident technique.PARTICIPANTS AND RESEARCH CONTEXT:Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation.ETHICAL CONSIDERATIONS:The study was conducted accordance with the Declaration of Helsinki and approved by a local University Ethics Research Committee. FINDINGS:The findings revealed that students experienced that operating theatre nurses perserved patient's dignity in perioperative practice by being present for each other and making themselves known to the patient. Operating theatre nurses caring for the patient by being compassionate and preserved the patient privacy. The new understanding that emerged was that the operating theatre nurse students understood that the operating theatre nurse wanted to care for the patient like a human being. DISCUSSION:In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act. CONCLUSION:Preserved dignity is an ethical and caring act. Ethical questions and how to preserve dignity in perioperative practice should be discussed more both in educations of healthcare professionals and in clinical practice.
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| 6. |
- Blomberg, Karin, 1970-, et al.
(författare)
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Clinical group supervision for integrating ethical reasoning : Views from students and supervisors
- 2016
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Ingår i: Nursing Ethics. - London, United Kingdom : Sage Publications. - 0969-7330 .- 1477-0989. ; 23:7, s. 761-769
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clinical group supervision has existed for over 20 years in nursing. However, there is a lack of studies about the role of supervision in nursing students' education and especially the focus on ethical reasoning.Aim: The aim of this study was to explore and describe nursing students' ethical reasoning and their supervisors' experiences related to participation in clinical group supervision.Research design: The study is a qualitative interview study with interpretative description as an analysis approach.Participants and research context: A total of 17 interviews were conducted with nursing students (n = 12) who had participated in clinical group supervision in their first year of nursing education, and with their supervisors (n = 5).Ethical conciderations: The study was based on the ethical principles outlined in the Declaration of Helsinki, and permission was obtained from the Regional Ethical Review Board in Sweden.Findings: The analysis revealed that both the form and content of clinical group supervision stimulated reflection and discussion of handling of situations with ethical aspects. Unethical situations were identified, and the process uncovered underlying caring actions.Disscusion and conclusion: Clinical group supervision is a model that can be used in nursing education to train ethical reflection and to develop an ethical competence among nursing students. Outcomes from the model could also improve nursing education itself, as well as healthcare organizations, in terms of reducing moral blindness and unethical nursing practice.
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| 7. |
- Bremer, Anders, 1957-, et al.
(författare)
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Ethical values in emergency medical services : A pilot study
- 2015
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 22:8, s. 928-942
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ambulance professionals often address conflicts between ethical values. As individuals’values represent basic convictions of what is right or good and motivate behaviour, research is neededto understand their value profiles.Objectives: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure thepresence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles inSpain and Sweden.Methods: The instrument was translated and culturally adapted. A content validity index was calculated.Pilot tests were carried out with 46 participants.Ethical considerations: This study conforms to the ethical principles for research involving humansubjects and adheres to national laws and regulations concerning informed consent and confidentiality.Findings: Spanish professionals favoured justice and Swedish professionals’ rights in their ambulanceorganizations. Both countries favoured utilitarianism least. Gender differences across countries showedthat males favoured rights. Spanish female professionals favoured justice most strongly of all.Discussion: Swedes favour rights while Spaniards favour justice. Both contexts scored low onutilitarianism focusing on total population effect, preferring the opposite, individualized approach of therights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardizeambulance professionals’ moral right to make individual assessments based on the needs of the patientat hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justiceand rights perspectives portrayed in the survey mainly concern relationship to the organization and peerswithin the organization, this relationship might at worst be given priority over the equal treatment andmoral rights of the patient.Conclusion: A balanced view on ethical perspectives is needed to make professionals observant and readyto act optimally – especially if these perspectives are used in patient care. Research is needed to clarify howjustice and rights are prioritized by ambulance services and whether or not these organization-related valuesare also implemented in patient care.
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| 8. |
- Brüggemann, Jelmer
(författare)
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Exploring patient strategies in response to untoward healthcare encounters
- 2017
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 24:2, s. 190-197
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increasing attention to patients’ rights and their ability to choose their healthcare provider have changed the way patients can respond to untoward, disempowering and abusive healthcare encounters. These responses are often seen as crucial for quality improvement, yet they are little explored and conceptualized.Objective: To explore patients’ potential responses to untoward healthcare encounters and looking at their possible consequences for care quality improvement as well as for the individual patient.Research design: The article is structured looking at two primary strategies: patient exit (leaving a healthcare provider) and patient voice (expressing grievances), derived from Hirschman (1970). These strategies were explored by the use of theoretical and empirical literature and applied to an individual patient case. The case functions as a pedagogical tool to illustrate and problematize what exit and voice strategies can mean for a single patient.Ethical considerations: The patient case is my version of a generalized scenario that is described elsewhere. It does not represent an individual patient’s story, but aims to be realistic and recognizable.Findings and conclusion: Based on the existing literature, it is hypothesized that, in their current form, exit and voice strategies have a limited effect on care quality and can come at a price for patients. However, both strategies may be of value to patients and providers. Therefore, the healthcare system could empower patients to engage in action and could further develop ways for providers to effectively use patients’ responses to improve practice and find ways to prevent patients from untoward experiences in healthcare.
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| 9. |
- Fahlquist, Jessica Nihlén
(författare)
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Experience of non-breastfeeding mothers : Norms and ethically responsible risk communication
- 2016
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 23:2, s. 231-241
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Breastfeeding is currently strongly recommended by midwives and paediatricians, and the recommendations are based on documents provided by the World Health Organization and public health authorities worldwide.RESEARCH QUESTION: The underlying question is, how are non-breastfeeding mothers affected emotionally when informed that breastfeeding is the safest and healthiest option?RESEARCH DESIGN: The method used is an anonymous web-based qualitative survey exploring the narratives of non-breastfeeding mothers, published on Thesistools.com. The aim is to achieve qualitative knowledge about the emotions of non-breastfeeding mothers.PARTICIPANTS AND RESEARCH CONTEXT: Participants were based in Sweden, the United Kingdom and the Netherlands and were selected through a purposeful sample.ETHICAL CONSIDERATIONS: The online survey anonymizes responses automatically, and all respondents had to tick a box agreeing to be quoted anonymously in scientific articles. The study conforms to research ethics guidelines.FINDINGS: Respondents describe how they were affected, and the following themes emerged in studying their descriptions: depression, anxiety and pain, feeling failed as a mother and woman, loss of freedom/feeling trapped, relief and guilt.DISCUSSION: The themes are discussed against the background of the ethics of care and a theory of ethically responsible risk communication.CONCLUSION: Three conclusions are made. First, the message should become more empathetic. Second, information should be given in an attentive dialogue. Third, information providers should evaluate effects in a more inclusive way.
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| 10. |
- Fischer Grönlund, Catarina, et al.
(författare)
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Ethically difficult situations in hemodialysis care : nurses' narratives
- 2015
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 22:6, s. 711-722
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose.RESEARCH QUESTION: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses' experiences of being in ethically difficult situations that give rise to a troubled conscience.RESEARCH DESIGN: This study has a phenomenological hermeneutic approach.PARTICIPANTS: Narrative interviews were carried out with 10 registered nurses working in dialysis care.ETHICAL CONSIDERATIONS: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University.RESULTS: One theme, 'Calling for a deliberative dialogue', and six sub-themes emerged: 'Dealing with patients' ambiguity', 'Responding to patients' reluctance', 'Acting against patients' will', 'Acting against one's moral convictions', 'Lacking involvement with patients and relatives' and 'Being trapped in feelings of guilt'.DISCUSSION: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience.CONCLUSION: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.
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