Nursing Ethics

The effectiveness of ethics education continues to be disputed. No studies exist on how nursing students perceive the effectiveness of nursing ethics education in Flanders, Belgium.

To develop a valid and reliable instrument, named the ‘Students’ Perceived Effectiveness of Ethics Education Scale’ (SPEEES), to measure students’ perceptions of the effectiveness of ethics education, and to conduct a pilot study in Flemish nursing students to investigate the perceived efficacy of nursing ethics education in Flanders.

Content validity, comprehensibility and usability of the SPEEES were assessed. Reliability was assessed by means of a quantitative descriptive non-experimental pilot study.

86 third-year baccalaureate nursing students of two purposefully selected university colleges answered the SPEEES.

Formal approval was given by the ethics committee. Informed consent was obtained and anonymity was ensured for both colleges and their participating students.

The scale content validity index/Ave scores for the subscales were 1.00, 1.00 and 0.86. The comprehensibility and user-friendliness were favourable. Cronbach’s alpha was 0.94 for general effectiveness, 0.89 for teaching methods and 0.85 for ethical content. Students perceived ‘case study’, ‘lecture’ and ‘instructional dialogue’ to be effective teaching methods and ‘general ethical concepts’ to contain effective content. ‘Reflecting critically on their own values’ was mentioned as the only ethical competence that, was promoted by the ethics courses. The study revealed rather large differences between both schools in students’ perceptions of the contribution of ethics education to other ethical competences.

The study revealed that according to the students, ethics courses failed to meet some basic objectives of ethics education. Although the SPEEES proved to be a valid and reliable measure, the pilot study suggests that there is still space for improvement and a need for larger scale research. Additional insights will enable educators to improve current nursing ethics education.

Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy.

To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy.

Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people with intellectual disabilities.

Ethnographic field study.

The boards representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee.

Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.”

Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach.

Hospices are based on a holistic approach which places the physical, psychological, social and spiritual welfare of their patients at the forefront of their work. Furthermore, they draw up their own mission statements which they are at pains to follow and seek to conduct their work in accordance with codes of ethics and standards of care.

Our study researched what form the processes and degrees of latitude in decision-making take in practice when questions of an ethical and ethically relevant nature arise. We used a qualitative approach. Data collection and evaluation was based on the methods of grounded theory.

The study was reported to the relevant Ethics Commission who had raised no objections following the submission of the study protocol. The study at the hospices was approved by the directors of the hospices and the nursing teams. The rights of the participants were protected by obtaining informed consent.

Medication in the prefinal phase and questions affecting the provision of solids and liquids in the end-of-life phase have an ethical dimension. In the context of these two fields, decisions are taken collectively. A nurse’s individual (and ethically relevant) leeway in decision-making processes is restricted to the nurse’s own style of administering care. The nurse’s decision-making often depends to a far greater degree on her ability to adapt her concept of ideal care to fit the practical realities of her work than to any conceptual framework.

An adaptive process is necessary for the nurse because she is required to incorporate the four pillars of hospice care – namely, physical, psychological, social and spiritual care – into the practice of her daily work.

Ethically relevant decisions are often characterised by nurses adjusting their aspiration levels to the practical conditions with which they are confronted.

According to Norwegian law, nurses are obligated to provide an acceptable level of health assistance to patients and their family members and to allow patients and their family members to participate in the planning of patient care and treatment.

The aim of this study is to compare the perceptions of older patients undergoing haemodialysis treatment and of their next of kin and of nurses regarding patient participation in the context of haemodialysis treatment.

The study adopts an approach that is both comparative and explorative in nature by examining the narratives of patients, nurses and next of kin and by performing critical discourse analysis as outlined by Fairclough.

Permission to carry out the research was granted by the Regional Committee for Medical and Health Research Ethics of Mid-Norway and by the participating hospitals. Informed consent and confidentiality were ensured.

Two discourses were found: (a) the discourse of paternalism with the discursive practices of achieving physiological balance in patients, trusting the healthcare team and being excluded or included in the difficult end-of-life decision-making process, and (b) the discourse of patient participation, with the themes of maintaining patients’ quality of life and trusting patients.

The participation of older patients and their next of kin was not as well integrated as social practice in dialysis units. The dominant discourse seemed to have an ideology and social practice of paternalism. However, there existed hegemonic struggles for an ideology of patient participation that involved (a) achieving physiological balance in patients versus maintaining patients’ quality of life, (b) trusting the healthcare team versus trusting the patient, and (c) being excluded versus included in the difficult end-of-life decision-making process.

The development of society and science, especially medical science, gives rise to new moral and ethical challenges in healthcare.

In order to respond to the contemporary challenges that require autonomous decision-making in different work contexts, a pedagogical experiment was conducted to identify the readiness and responsiveness of current organisation of nursing higher education in Slovenia. It compared the successfulness of active learning methods online (experimental group) and in the traditional classroom (control group) and their impact on the ethical competences of nursing students. The hypothesis set in the experiment, hypothesis 1 (the experimental group will be successful and will have good achievements in comprehension and application of ethical principles) was confirmed based on pre-tests and post-tests. The hypothesis tested by the questionnaire, hypothesis 2 (according to the students, the active learning methods online in the experimental group have a positive impact on the development of ethical competences) was confirmed.

The pedagogical experiment was supported by a multiple-case study that enabled the in-depth analysis of the students’ attitudes towards the active learning methods in both settings.

The study included Slovenian first-year nursing students (N = 211) of all the enrolled students (N = 225) at the University of Ljubljana and University of Primorska in the academic year 2010/2011.

Before the study ethical permission was obtained from the managements of both participating faculties. The students were given all the necessary information of the experiment before the tutorials.

No significant difference was found between the two learning settings and both had a positive impact upon learning. The results of the content analysis show that the students’ active engagement with the active learning methods in the group enables the development of ethical competences and the related communicative competences, interpersonal skills, collaboration and critical thinking.

Active learning methods in the settings compared, online and the traditional classroom, enabled the development of a higher level of knowledge defined by the ability of critical thinking and reflective response, the core of ethical competences. Students develop ethical competence through active engagement in a group work, role play and discussion, and there is no difference between online or traditional learning settings.

In the healthcare, it is crucial for providers to be capable of making autonomous decisions and managing various communication situations and contexts in which the moral attitudes and ethical sensibility are essential.

Essential for the help relation, empathy is the ability to understand, share, and perceive the subjective experience of other human beings.

The objective in this non-experimental, exploratory, and descriptive research was to verify, observe, and document empathy in nursing professionals.

Non-experimental, exploratory, and descriptive research. Participants and research context: the study was conducted at two large hospitals, one public and the other private, across all shifts. The sample included 159 individuals. A questionnaire was used to identify sociodemographic characteristics and the empathy inventory was applied.

This study received approval from the Research Ethics Committee at the University of São Paulo at Ribeirão Preto College of Nursing, opinion 1348/2011, and authorization from the health institutions involved.

The association tests demonstrated that professionals working in the night shift and in a work scale rotation scheme, older professionals, and professionals with longer professional experience are less empathetic. On the other hand, professionals working in the day shift and in a single shift are more empathetic. Other influential factors are the time on the job, education, and work shift.

There is a lack of empathy studies in professional practice contexts, in human resource development programs, and throughout the professional education process.

This study explores experiences of patients suffering from Korsakoff’s syndrome. It contributes to improved reflection on the value of patient knowledge.

An ethics of care perspective states the importance of moving to patients in their vulnerable state of being, and to figure out patients’ individual needs necessary to provide good care. The information given by patients suffering from Korsakoff’s syndrome might be mistaken, invented and even not true. The value of these patients’ experiences and knowledge had not been researched to date.

Data from six in-depth interviews were analysed concurrently through the constant comparative method.

The principles of voluntariness, confidentiality and anonymity were respected during the research process.

Four important themes within patients’ knowledge emerged: health condition, involuntary admission into the nursing home, the daily routine and interpretation of the caring abilities of healthcare professionals. The findings show that our respondents were able to provide a window into their inner perspective.

This study deepens our understanding of the value of patient knowledge in situations where patients see the world in a different manner as do healthcare professionals. The conversations revealed personal subjective knowledge which our respondents create and live by. Healthcare professionals are encouraged to discover and affirm the understandings of these patients, and not be prepossessed due to the diagnosis or general nursing home rules. Understanding patients’ unique knowledge through appreciation of the complexity and richness of different views on the situation can assist to give a more humane response to individual needs and pain. Health staff in healthcare institutions are encouraged to evaluate the – unintended – effect of rigidly applied nursing home rules, and the government is challenged to rethink its policy about care, and provide more resources permitting relational care that nurtures the dignity of patients suffering from Korsakoff’s syndrome.