This study explored tacit knowledge based on an expert nurse's practice who cares for stroke patients by using the hermeneutic phenomenological approach. The participant (‘Ms. A’) was a nursing researcher and college faculty member involved in the education of advanced practice nurses; her specialty was stroke rehabilitation nursing. She was asked to describe the meaning and value she gained from her memorable nursing experiences. Four interviews—approximately 1 h each—were conducted, and the associated data were (...) interpreted together with the participant based on the method of interpretive circulation. Notably, the analysis was ended when a fusion of horizons was recognized. The participant recalled her nursing experiences based on six model cases. During the analysis, the following five elements were extracted: [belief in the ability of vulnerable people to survive]; [being together]; [respect for human dignity]; [preparedness to respond to and bear suffering together]; and [theoretical knowledge base approaches true understanding of patient experience]. Further, the nursing model—the Roy Adaptation Model—utilized by Ms. A in the process of recognizing humans as whole beings was deeply interpreted and implemented as a guideline for her implicit advanced practice. Moreover, her deep understanding and utilization of theoretical knowledge base also built the foundation for her implicit advanced practice. In conclusion, Ms. A's tacit knowledge and the elements support the process of tacit knowledge acquisition. Her narratives, hermeneutic attitude as an interpreter, and learning attitude throughout interaction with others will strongly help her knowledge development. We intend to continue the study with multiple participants and explore the structure of tacit knowledge possessed by advanced practitioners. Future endeavours will include the development of a tacit knowledge learning strategy. (shrink)

Background: Through education, individuals acquire knowledge, skill and attitudes that facilitate professional socialization; it involves intellectual, emotional and psychomotor skill development. Teachers are role models for behaviour modification and value development. Objective: To examine students’ perceptions of faculty members’ ethical and unethical attitudes during interactions in undergraduate nursing. Research design: This descriptive study consisted of two phases. In Phase I, we developed an instrument, which was administered to nursing students to assess validity and reliability. Exploratory factor analysis (...) yielded 32 items. Cronbach’s α was 0.83, and test–retest reliability was good. In Phase II, a 32-item version of the instrument was administered to nursing students from another university. Participants and research context: Participants included 219 nursing students from one university in Phase I and 196 from another university in Phase II. The study was conducted at the universities attended by the participants. Ethical considerations: Ethical approval was granted by the institutions involved, and all participants provided informed consent. Findings: In Phase I, the instrument demonstrated good psychometric properties for measuring nursing students’ perceptions of faculty members’ ethical and unethical behaviours. In Phase II, students considered certain professional and personal qualities, including respecting confidentiality and students’ private lives and assuming an impartial stance during interactions in the classroom, examinations, or clinical practice, ethical. They considered using obscene examples or unprofessional speech during teaching, selling textbooks in class, using university facilities for personal interests, engaging in romantic relationships with students, and humiliating students in front of patients or staff in clinical settings unethical. Conclusion: Results of this study suggest that nurse educators should be aware of their critical role in the teaching–learning process, and they must scrutinize their attitudes towards students from an ethical point of view. (shrink)

The purpose of this research was to describe attitudes of nursing students (and paramedic officers) towards marginalized clients. Convenience quota sampling in a major health faculty was employed. Students participated on a voluntary basis. A 58-item Likert scale, developed by the authors, assessed the student nurses’ attitudes. In general, attitudes towards homeless clients were neutral; detailed analyses, however, revealed that student nurses would decline to care for homeless clients in various situations. Personal experience with homeless patients and positive (...) attitudes of nurses significantly contributed to increased quality of care and equality of treatment for homeless clients. Certain student nurse behaviors warrant immediate attention to prevent marginalized patients from being exposed to unfair, inaccessible and biased nursing care. Based on our results, we recommend that further research attention be paid to the role of ethics education and faculty behaviors, as faculty members serve as role models for professionalization. (shrink)

Background Ethics communication has been described as a pedagogical form, promoting development of ethical competence among nursing students. The ‘one to five method’ was developed by this research group as a tool for facilitating ethical communication in groups among healthcare professionals but has not yet been evaluated. Aim To explore post-graduate nursing students’ experiences of practicing ethical communication in groups Research design The study design is qualitative. Participants and research context The study comprised 12 nursing students on (...) a post-graduate course for Registered Nurses focusing on palliative care. After education the students engaged as participants and facilitators in ethics communication in groups, with support from the ‘one to five method’. Data were derived from the students written reflections and subjected to thematic analysis. Ethical considerations The study was performed in accordance with the ethical standards in the 2013 Helsinki Declaration and approved by the Ethics Committee of the Medical Faculty at Umeå University Results An overall theme was identified, ‘being supported to achieve a democratic dialogue concerning ethical problems’ and five themes, related to each step of the ‘one to five method’. The themes concerned: putting the experience of an ethical dilemma into words; being confirmed by shared emotions; defining the value conflict using ethical principles; expressing virtues of empathy and raised awareness; jointly finding various action approaches. Discussion Regular ethics communication in groups encourages nursing students to actively seek understanding and clarification of ethically difficult situations. Conclusions The results indicate that ethics communication in groups could be a way of developing virtues during education. Interventions using the ‘one to five method’ need to be further studied among student groups from other healthcare contexts. (shrink)

Social justice is put forth as a core professional nursing value, although conceptualizations within foundational documents and among nurse educators remain inconsistent and contradictory. The purpose of this study was to explore how faculty teach social justice in theory courses in Baccalaureate programs. This qualitative study utilized constructivist grounded theory methods to examine processes informing participants' teaching. Participants utilize four overarching approaches: fostering engaging classroom climates, utilizing various naming strategies, framing diversity and culture as social justice, and role (...) modeling a critical stance. They deploy specific strategies, varying largely by race, educational background, and nursing specialty. A background in social sciences supports pedagogy that interrogates health inequities rather than merely raising awareness about disparities. Findings also reveal that faculty of color navigate institutional structures predicated upon colorblind racism and problematic views of culture, which many white faculty teaching non‐Community Health Nursing courses described doing. To enact social justice and be answerable to our communities, concerted anti‐oppression efforts are needed across education, research, practice, and policy. This includes sustained commitment to address colonialism and whiteness in every institution that defines, promotes, and claims to advance nursing so that we can fulfill our responsibility to address unjust systems and structures to serve our communities. (shrink)

Effective socialization of nurses has led to positive outcomes for both hospitals and nurses, including higher retention and greater job satisfaction. The importance of faculty, preceptors, and patients in the socialization of nursing students has been documented extensively in the literature. The research presented in this article examines data from qualitative, longitudinal interview transcripts of 15 students as they progressed through a 2‐year nursing program to determine how these three types of influence socialize nursing students, and (...) at which points in their education. Using multiple perspective qualitative longitudinal interviews, I interviewed participants every semester of nursing school about their experiences. From the data, these three parties have an impact at different points in their socialization, starting with faculty who socialize students to nursing school by helping them think like nurses. Next, preceptors can be barriers or facilitators of learning by demonstrating how to act like nurses and providing insight about how and why nurses may act the way that they do. Finally, patients help students put everything together by applying classroom lessons to clinical settings. The research concludes with implications for research, practice, and policy. (shrink)

In nursing, expectations of honesty and integrity are clearly stipulated throughout professional standards and codes of conduct, thus the concept of academic integrity has even more impetus in preparing students for graduate practice. However, a disparity between policy and practice misses the opportunity to instil the principles of academic integrity, and at its core honesty, a pivotal trait in the nursing profession. This study draws upon the experience of the nursing faculty to explore how (...) academic integrity policy of deterrence operate in nursing education.While participants deplored cheating behaviours, they expressed frustration in having to ‘police’ large numbers of students who had little awareness of the academic standards to meet policy requirements. In addition, they were cynical because of a perceived lack of severity in sanctions for students who repeatedly breached integrity. Participants expressed a moral obligation as educators to meet student learning needs and preferred to engage with students in a more meaningful way to uphold academic integrity. The ambivalence to detect and report breaches in integrity undermines the effectiveness of policy. Therefore, faculty must recognise the importance of their role in detecting and escalating cases of dishonesty and execute deterrence in a more consistent way. To do this, greater support at an institutional level, such as smaller class sizes, inclusion in decision making around sanctions and recognition of additional workload, will enable faculty to uphold policy. Although policing was not their preferred approach, the role of faculty in detecting and reporting cases of misconduct is crucial to increase the certainty of students getting caught, which is essential if policy is to be effective in deterring dishonest behaviour. (shrink)

The aim of this study is to examine the current profile of bioethics education in the nursing curriculum as perceived by nursing students and faculty in Korea. A convenience sampling method was used for recruiting 1223 undergraduate nursing students and 140 nursing faculty in Korea. Experience of Bioethics Education, Quality of Bioethics Education, and Demand for Bioethics Education Scales were developed. The Experience of Bioethics Education Scale showed that the nursing curriculum in Korea (...) does not provide adequate bioethics education. The Quality of Bioethics Education Scale revealed that the topics of human nature and human rights were relatively well taught compared to other topics. The Demand for Bioethics Education Scale determined that the majority of the participants believed that bioethics education should be a major requirement in the nursing curriculum. The findings of this study suggest that bioethics should be systemically incorporated into nursing courses, clinical practice during the program, and during continuing education. (shrink)

Background Ethics positions, consisting of the two fundamental dimensions of idealism and relativism, influence individuals’ decision-making significantly. Particularly in an applied field such as nursing, the ethics positions of nurses can play a significant role in clinical decisions. Therefore, it is important to know the factors affecting the ethics positions of nurses in clinical decision-making. Aim The aim of the study is to examine the factors affecting the ethics positions of nursing students in clinical decision-making. Research design This (...) is a two-phase sequential explanatory mixed methods study designed in accordance with the COREQ criteria. A participant Information Form and the Ethics Position Questionnaire were used to collect quantitative data. Qualitative data were obtained through focus group interviews. Ethical considerations This study was conducted after receiving written permission from X University Ethics Board. Additionally, permission was obtained from the participating nursing faculty. Participants Among the fourth-year nursing students, 180 students participated in the quantitative phase and 30 students in the qualitative phase of the study. Results The quantitative data analysis showed that the idealism sub-dimension mean scores of the participants were higher than the relativism sub-dimension mean scores. The analysis of the qualitative data resulted in four main themes that influence participants’ ethics positions in clinical decision-making: (1) attitudes of role models in clinical practice (staff nurses/mentors/lecturers), (2) resources related to clinical practice (labs, hospitals/classrooms), (3) health system (hospital policies/school policies), and (4) personal differences (act with emotion/act with logic). Conclusion The results showed that the health system, role models in the clinic, personal differences, and skill-related resources affect the ethics positions of nursing students in clinical decision-making. In this regard, awareness can be raised by providing training to nursing students by academic instructors on ethics positions and the factors that are determined to affect ethics positions in clinical decision-making. (shrink)

The aim of this study is to examine the current profile of bioethics education in the nursing curriculum as perceived by nursing students and faculty in Korea. A convenience sampling method was used for recruiting 1223 undergraduate nursing students and 140 nursing faculty in Korea. Experience of Bioethics Education, Quality of Bioethics Education, and Demand for Bioethics Education Scales were developed. The Experience of Bioethics Education Scale showed that the nursing curriculum in Korea (...) does not provide adequate bioethics education. The Quality of Bioethics Education Scale revealed that the topics of human nature and human rights were relatively well taught compared to other topics. The Demand for Bioethics Education Scale determined that the majority of the participants believed that bioethics education should be a major requirement in the nursing curriculum. The findings of this study suggest that bioethics should be systemically incorporated into nursing courses, clinical practice during the program, and during continuing education. (shrink)

There is no co-ordinated focus on liabilities arising from nurses’ medical interventions in terms of occupational, administrative, civil legal and criminal activities. However, the Turkish Criminal Code, the Turkish Medical Ethics Code of Practice, and guidelines for patients’ rights offer some framework for the relevant ethical principles and responsibilities of nurses. The aim of this study was to investigate the evaluation of nursing students’ training in their legal liabilities. The sample consisted of 309 students who were taking a (...) course entitled ‘Nurses’ legal liabilities under Turkish criminal and civil law arising from medical interventions’. Data were obtained by means of self-administered questionnaires and McNemar’s test was used to evaluate the answers. In conclusion, after their training, a great majority of the students demonstrated an improvement in terms of their percentage of correct answers relating to malpractice. This does not, however, mean that they will not face malpractice charges after graduating, but their increased awareness of the issue may encourage them to make more effort to reduce the risk of mistakes. It is recommended that nursing faculty carry out studies into medical malpractice, that they focus more on this subject in nursing education, and that all nursing schools review their curricula from the point of view of malpractice. (shrink)

The term “Socratic method” is so pervasive in education across the disciplines that it has largely lost its meaning, and it has lost its roots in its originator—the historical Socrates. In this article we draw from the original source, Plato's ancient dialogues, to understand the theory and principles behind the questioning used in Socratic method. A deep understanding of Socratic method is particularly timely now as nursing leaders call for increased use of theory‐based debriefing across the nursing curriculum. (...) Socratic questioning is ideally suited as a method for debriefing in nursing classrooms because of its ability to enhance critical thinking and self‐reflection of the learner and because of its basis in care for the learner through a learner‐centred design. We present an analysis of the Socratic method in Plato's works and provide an overview of the key Socratic principles and techniques. We illustrate these principles and techniques with examples of how Socratic teaching can be applied in the nursing classroom, and we address the challenges and rewards for nursing faculty implementing Socratic method. Learning about Socratic method directly from Plato's dialogues can provide a richer and more robust understanding of this key pedagogical technique and help nurse educators practice more intentional and informed Socratic questioning and debriefing. (shrink)

Providing ethically competent care requires nurses to reflect not only on nursing ethics, but also on their own ethical traditions. New challenges for nurse educators over the last decade have been the increasing globalization of the nursing workforce and the internationalization of nursing education. In New Zealand, there has been a large increase in numbers of Chinese students, both international and immigrant, already acculturated with ethical and cultural values derived from Chinese Confucian moral traditions. Recently, several incidents (...) involving Chinese nursing students in morally conflicting situations have led to one nursing faculty reflecting upon how moral philosophy is taught to non-European students and the support given to Chinese students in integrating the taught curriculum into real-life clinical practice settings. This article uses a case study involving a Chinese student to reflect on the challenges for both faculty members and students when encountering situations that present ethical dilemmas. (shrink)

Canadian Schools of Nursing rest upon white, colonial legacies that have shaped and defined what is valued as nursing knowledge and pedagogy. The diversity that exists in clinical nursing and is emerging within the graduate student population is not currently reflected within nursing faculty and academic leadership. Black, Indigenous, and People of Color (BIPOC) nurse leaders, historically and presently, are repeatedly left unacknowledged as knowers and keepers of nursing knowledge. This lack of diversity persists (...) across nursing knowledge generation, research, and healthcare practices that ultimately aim to serve the increasingly diverse Canadian population. This narrative inquiry study examined the experiences of eight BIPOC graduate nursing students as they navigated white academic nursing spaces. The findings are presented to reflect their experiences of entrenched in whiteness, erasure of identity, and navigating belonging. These study findings highlight the importance of surfacing academic nursing history shaped by colonialism and racism, the need to diversify nursing faculty and the graduate nursing student population, and implementing nursing curricular and syllabi audits to ensure that they reflect the multitude of ways of knowing to expand dominant Eurocentric and Western knowledge in nursing education. (shrink)

Background: Social inequities in health systems are threats to global health. Considering the important role of nurses in establishing social justice, identification of factors affecting nurses’ participation in this area can contribute to the development of social justice. Objective: This study aimed to identify factors affecting nurses’ participation in establishing social justice in the health system. Research design and methods: The study was conducted using conventional qualitative content analysis approach. Purposive sampling was used to select 14 participants in 2019. The (...) data were collected through semi-structured interviews and analyzed concurrently with data gathering. Participants and research context: In total, six faculty members, five nursing managers, and three clinical nurses from three different universities were interviewed. Ethical considerations: The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran. Findings: Four main themes were found, including inadequate professional authority, insufficient attention to social justice in the area of education, clinical concerns as barriers to professional presence in society, and reflection of personality traits in the profession. These are the main factors affecting nurses’ participation in establishing social justice in the health system. Discussion: Authorities need to take effective steps to establish social justice through reforming the health system’s policy-making and power-acquisition domains, promoting nurses’ involvement in social factors in health issues, and adding professional values as a part of nursing curriculum. The clinical practice environment can also be helpful through providing quality, safe, and cost-effective services. In addition, fair and efficient recruitment process for new nurses can contribute to the establishment of social justice in the health system. Conclusion: Macro-level managerial factors such as policy, education, and clinical environment, along with personal factors, play a significant role in the participation of nursing profession in establishing social justice. (shrink)

Background:Nurses and nursing students increasingly confront ethical problems in clinical practice. Moral sensitivity, moral reasoning, and ethical decision-making are therefore important skills throughout the nursing profession. Innovative teaching methods as part of the ethics training of nursing students help them acquire these fundamental skills.Aim:This study investigated the effects and potential benefits of using standardized patients in ethics education on nursing baccalaureate students’ moral sensitivity, moral reasoning, and ethical decision-making by comparing this method with in-class case (...) analyses.Research design:This is a quasi-experimental study.Participants and research context:The sample comprised 89 students in Hacettepe University’s Faculty of Nursing. Following lectures describing the theoretical components of ethics, students were randomly assigned to two working groups, one using standardized patients and the other using in-class case analyses. Data were collected using the Moral Sensitivity Questionnaire, Rest’s Defining Issues Test, and the Nursing Dilemma Test. All data were analysed using IBM SPSS Statistics Version 23.Ethical considerations:Ethical approval and official permission were obtained. All participating students completed informed consent forms.Findings:According to the results, the moral sensitivity of students in the standardized patient group significantly improved over time compared to those in the case analysis group, while the mean scores of students in both groups for moral reasoning and ethical decision-making were not statistically significant.Conclusion:Based on our results, we recommend the use of both standardized patients and case analysis as appropriate teaching methods in ethics education. (shrink)

Background: Students’ gaining and adopting basic professional values, improving their emotional intelligence skills during the process of nursing education plays a significant role on meeting the needs of healthy/patient individual and his or her family, and individualized care practices. Objectives: This (descriptive, correlational) research was carried out to evaluate the nursing values, emotional intelligence levels, and individualized care perceptions of senior nursing students and to determine the relationship between them. Research question: (1) What is the status of (...) students to adopt nursing values? (2) What is the level of students’ emotional intelligence? (3) What is the students’ individualized care perception? (4) Is there a relationship between students’ nursing values, levels of emotional intelligence, and individualized perceptions of care? Participants and research context: The research was carried out with 218 senior nursing students at the Faculty of Nursing, affiliated to a state university in Istanbul, who agreed to participate in the study, completing basic nursing education in May 2017. Ethical considerations: Ethical approval for this study was obtained from the Ethics Committee of Clinical Investigations of the Istanbul University Dentistry Faculty. Written permission was also obtained from the institution that research would be conducted. Before the data were collected, verbal permission was obtained by the investigator. Findings: It was observed that nursing values perceptions of students, emotional intelligence levels and individualized care perceptions were at a good level and there was a supportive relationship between them in the positive direction. It was determined that emotional intelligence skills of students, adoption of nursing values and individualized care perceptions increased in parallel with each other. Conclusion: In nursing education, nursing values peculiar to affective field, caring behaviors, and emotional intelligence skills that are guiding to maintain and direct these behaviors should be gained to students by supporting with correct learning methods and role models. (shrink)

Background: Moral philosophical positions and professional values have been shown to influence nurses’ practice behaviours. Understanding nursing students’ professional values and ethical ideologies, therefore, is important as they may help inform evidence-informed curriculum decisions and education strategies to develop students’ professional reflective competencies. However, there is a dearth in current empirical data on Canadian nursing students’ perceptions of professional values and ethical positions. Objectives: This study’s purpose was to examine undergraduate nursing student’s perceptions of professional values (...) and ethical ideology and explore relationships in data and selected participant demographic variables. Research design, participants and context: A descriptive cross-sectional research design was conducted with a convenience sample of undergraduate nursing students recruited from a university in Canada. An online encrypted survey consisting of two validated instruments was administered to participants who met study eligibility criteria. Descriptive and inferential statistics were employed to analyse the data and classify nursing students’ ethical ideologies into four categories based on mean scores for idealism and relativism. Ethical considerations: This study received ethical approval from the institutional Behavioural Research Ethics Board and was executed in-line with ethical principles for research involving humans. Findings: Nursing students scored high on professional values and ethical idealism and differed significantly on a measure of ethical relativism in terms of age and year of study. Professional values were significantly associated with ethical idealism. Based on mean scores for idealism and relativism, most nursing students in the study were classified as situationists. Discussion and conclusion: Findings suggest that faculty pay attention to influences of moral philosophical positions in facilitating nursing students’ professional values development. Implications for future research and curriculum are highlighted to strengthen nursing students’ professional values. (shrink)

Background: Nurses engaging in research are held to research ethics standards. Research aim: Examine experiences, behaviors, and perceptions of nurses in Israel regarding research ethics and explore possible related factors. Research design: An original investigator-designed self-administered questionnaire measured five variables: (a) ethics in research, (b) encountered research misconduct during the course of one’s studies, (c) the inclination to fabricate data, (d) the inclination to select or omit data, and (e) knowledge of research misconduct in the workplace. Additionally, demographic data were (...) collected. Participants and research context: The questionnaire was completed by 151 Israeli registered nurses. 10.2% hold a PhD, 34 % hold an MA, 42.2% hold a BA, and 13.6% with no academic degree. Ethical considerations: The study was approved by the University’s ethics committee; anonymity and consent of the respondents were respected. Findings: Registered nurses’ level of studies achieved was significantly associated with a lower inclination to fabricate data, with one exception—PhD nurses were more inclined to fabricate data than nurses with a Master’s degree. A trend was found in which a higher level of studies is associated with higher knowledge of research misconduct in the workplace. Discussion: Results indicate that nurses’ perceptions of research ethics change throughout their academic studies, indicating a positive influence of level of studies, research experience, and work experience on ethics perceptions. Nevertheless, PhD nurses showed a greater inclination to actually select, omit, or even fabricate data than MA nurses. This may be related to pressure to publish. Conclusion: PhD nursing programs should include ethics training. Academic faculty members should serve as role models regarding research integrity. Research ethics deserves further emphasis on all levels of nurse education in Israel, as well as in the nurses’ code of ethics and related documents. This may positively impact ethical research practices. (shrink)

Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed (...) to graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of decision-making that confront them in daily practice.” Six major themes corresponding to questions posed to the participants included the ability to advocate for good patient care; to support and empower colleagues, patients, and families; they experienced personal and professional transformation; they valued the multimodal nature of the program; and were using their new knowledge and skills in practice. However, they also recognized that their development as moral agents was an ongoing process. Discussion: Findings support that enhancing nurse confidence in their moral agency with a multimodal educational approach that includes mentored practice in ethical decision-making, enhancing communication skills and role-play can mitigate moral distress. A majority found the program personally and professionally transformative. However, they recognized that ongoing ethics discussion involvement and supportive environments would be important in their continued development of ethical agency. Conclusion: Multimodal ethics education programs have potential to be transformative and enhance nurse confidence in their ethical decision-making. (shrink)

Background: In order to fully understand nurses’ ethical decision-making in cases of physical restraint in acute older people care, contextual influences on the process of decision-making should be clarified. Research questions: What is the influence of context on nurses’ decision-making process in cases of physical restraint, and what is the impact of context on the prioritizing of ethical values when making a decision on physical restraint? Research design: A qualitative descriptive study inspired by the Grounded Theory approach was carried out. (...) Participants and research context: In total, 21 in-depth interviews were carried out with nurses working on acute geriatric wards in Flanders, Belgium. Ethical considerations: The research protocol was approved by the Ethics Committee of the Faculty of Medicine, Leuven. Findings: Relationships with nursing colleagues and the patient’s family form an inter-personal network. Nurses also point to the importance of the procedural–legal context as expressed in an institutional ethics policy and procedures, or through legal requirements concerning physical restraint. Furthermore, the architectural structure of a ward, the availability of materials and alternatives for restraint use can be decisive in nurses’ decision-making. All interviewed nurses highlighted the unquestionable role of the practical context of care. Context can have a guiding, supportive, or decisive role in decision-making concerning the application of physical restraint. Discussion: The discussion focuses on the role of the inter-personal network of nurses on the process of decision-making. Conclusion: An institutional ethics policy and a value-supportive care environment can support nurses in their challenge to take ethically sound decisions. (shrink)

Nursing education, as with professionalization projects, is fraught with epistemicide, false separations, and a focus on expertise over relations and accountability. This is a critical reflection of the first 5 years of a four‐semester prelicensure Community Engagement course series. As the course lead, I have consistently initiated adjustments, based on experiences teaching multiple sections and synthesizing comments and feedback from students and faculty, with an eye toward longstanding and pressing concerns in the world around us. Two broad epistemic (...) arrangements emerge from this critical excavation: (1) naturalized hierarchy, false separations, and appraisals of relevance and (2) relationality and reflection as unsettling. There is a need for sustained collective examination and shift in how the nursing education and healthcare industries curate the meanings and practice of “community,” “health,” and “nursing,” peering out from the regulatory oversight of neoliberal forces. How might we situate student progression, program implementation, institutional contracts, and curricular standards within the contexts of nursing programs' responsibilities to local communities in light of unfolding events locally and globally and their historical antecedents? How are we all, as faculty, disrupting siloes, false separations, and the contradictions of professionalism and the biomedical model to intentionally advance health equity? May we continue to illuminate the presence of community as being everywhere, not merely in juxtaposition to acute care. May we unsettle the prevailing theorization and practices of community throughout nursing education and commit to imagining and practicing relational praxis. (shrink)

Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric‐driven competency‐based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context, including its hidden curriculums, impacted student writing activities. We viewed this qualitative data through the lens of activity theory. Students spoke about navigating a rigid writing context. This resulted in a hyper‐focus on “figuring (...) out” the teacher with minimal focus on the act of writing. Students used a form of behavioral “code‐switching” to maximize their grade while considering how their “valuing” of the assignment fit within their writing motives. Hidden curriculum messages taught students that academic success was assured whether their writing mirrored instructor preferences. Instructional practices of rigidity reinforced unequal social conditions for some minority students. Faculty can counteract the impact of the hidden curriculum through encouragement of choice and independent thinking about writing activities. Acknowledging power relationships and their influence on how students navigate writing assignments and nursing discourse may relieve pressures on students who fear penalties for countering norms and result in a more flexible learning environment. (shrink)

The purpose of this study was to clarify the minimum necessary educational content in the area of nursing ethics in a basic nursing education program, and the level of students’ mastery of this content, based on a Delphi study in both educational and clinical settings. A Delphi study was conducted in three rounds with faculty members who teach nursing ethics at all 158 four-year nursing universities in Japan as targeted panelists. In this study the opinions (...) on nursing ethics of nursing instructors responsible for hospital education at all 82 special functioning hospitals were reflected in the panelists’ opinions. Consensus was obtained on 41 items from a total of 63 items in 4 proposed frameworks. There were 20 items related to the Concept of nursing ethics, 7 items related to Ethical codes, 13 items related to Ethical issues and methods to resolve them, and 1 item related to Efforts and issues in practical and educational settings. Consensus as to desired level of mastery was reached on a total of 40 items. This agreed-upon level involved understanding of the concept for 22 items, the ability to explain the concept for 16 items, and the ability to act based on the concept for 2 items. (shrink)

This paper defines and analyzes the processes of “othering” as they manifest in the practice and praxis of nursing education. Othering is bound up in the establishment and reinforcement of norms, and shores up power inequities that negatively impact faculty, students, and patients. While previous analyses have addressed othering in nursing more broadly, this paper adds a consideration of the multiple processes of othering that operate within the context of nursing education spaces. Cases from recent (...) nursing education literature are interpreted through the frameworks of exclusionary, inclusionary, and structural othering, and provide specific illustrations of the concepts described. The paper concludes by arguing for an application of norm‐critical pedagogical practice to counteract, disrupt and dismantle othering processes within nursing education. (shrink)

This research investigated how dramatization simulation affected nursing students' ethical attitudes. Most nurses and nursing students encounter ethical issues in their healthcare practices. Students who receive an education in ethics are better equipped to solve ethical problems, develop ethical sensitivity, and adopt an ethical attitude. Dramatization simulation, which has recently been applied in nursing education, is said to be an effective teaching method. A mixed-method approach was employed in the research. The sample consisted of 60 students enrolled (...) in the final year of the Nursing Department of the Faculty of Health Sciences at a State university. Students were randomly assigned to experimental and control groups. In the experimental group, the dramatization simulation method was used to evaluate the effectiveness of the training method. The data were collected using the Descriptive Characteristics Form, Ethical Principles Attitude Scale, and Semi-Structured Focus Group Interview Form. SPSS 22 software was used to analyze the quantitative data, and Colaizzi's phenomenological analysis and MAXQDA 2020 software were used to analyze the qualitative data. The post-test total score of the group ethical attitude scale for the students in the experimental group showed a statistically significant improvement (_p_. (shrink)

The quality of phenomenological research in nursing has been a subject of long‐standing debate and critique, but conversation took a particularly contentious turn following publication of John Paley's 2017 Phenomenology as Qualitative Research (Routledge), which elicited strong reactions. Faculty in nursing doctoral programs now face a challenge: in light of current controversies, what can we teach that is appropriately labeled phenomenological, and is there a way to present philosophical concepts that might equip students to avoid the most (...) egregious mistakes of the past? In this article, I suggest that ordinary clinical nursing practice is an inherently phenomenological enterprise, and creative bedside insights belong at the center of our teaching, as they embody an everyday phenomenology which exemplifies core elements of the phenomenological method. Instead of following ever‐more‐precisely elaborated instructional manuals, I propose, our students should begin their studies of phenomenology by returning attention to the way creative insight emerges during routine care. Bedside insights have been rendered invisible by our discipline's valuing of technical proceduralism over artistry in research and by the turn to evidence‐based practice in clinical work, but they are a valuable pathway to learning and should be part of our response to the current crisis. (shrink)

Background: Written reflections on practice are frequently requirements of nursing curricula. They are widely accepted as necessary for improving critical thinking and problem-solving skills. Faculty, are expected to review reflections and provide feedback that helps professional development and facilitates good practice. It is less clear what the actions of nurse educators should be when ethical infractions are revealed in the narratives. Objectives: We had two aims: 1) To combine insights from a literature review of empirical and (...) theoretical research related to responding to ethical issues revealed in student reflections with our experiences reviewing the reflections of undergraduate nursing and midwifery students, and 2) to construct and analyze a hybrid case from these insights in order to develop guidelines for nurse educators. Research Design: A literature review was conducted using CINAHL, MEDLINE, PsycINFO, SocINDEX and ERIC databases and pertinent key words. A hybrid case was constructed of commonly encountered ethical issues using insights from the literature review and the authors’ experiences. The case was analyzed by combining Beauchamp and Childress’ principlist approach with Campbell and McCarthy’s ethical decision-making tool (Table 1). Participants and Research Context: No human participants Findings: A gap in the literature exists related to addressing ethical issues revealed in student practice reflections. However, a combination of insights from the literature and the authors’ experiences facilitated the development of a hybrid case. Subsequent case analysis facilitated the development of a series of guidelines that can be utilized to address a range of issues commonly emerging in the reflections of nursing students during practice experiences. Discussion: A number of recommendations and guidelines are provided to enable the safeguarding of students and staff and support them in practicing ethically. Conclusion: Structured ethical analysis of a constructed hybrid reflection of commonly revealed ethical issues was useful in developing guidelines for educators. (shrink)

Drawing on a comprehensive, pan-national analysis of the corporatization of Canadian universities, as well as the notions of ‘parrhesiastic’ mentorship and practice, the authors examine the effects of the corporatized university, its implications for graduate nursing education and nursing's relative silence on the subject. With the preponderance of business interests, the increasing dependence of universities on industry funding, cults of efficiency, research intensivity, and the pursuit of profit so prevalent in today's corporatized university, we argue that philosophical (...) presuppositions so crucial to critical teaching, research, and reflection on nursing as a discipline are troublingly losing ground. We lament the erosion and fragmentation of philosophy, politics, and ethics as foundations for graduate education, which are increasingly perceived as less valuable, problematic, and in some cases, even burdensome. The effect of corporatization is the suppression of the critical engagement required of faculty in the everyday workings of institutions. We argue that, when the ideals of intellectual freedom, academic responsibility, duty, and obligation, as supported by philosophical thought, are smothered by the normalizing power of corporatized research agendas, philosophical approaches to inquiry and knowledge development become marginalized as scholars find themselves floundering in the face of a seeming ‘philosophy lost’. (shrink)

Background: Attention to patients’ spirituality, as a moral obligation of care, is now widely accepted in nursing practice. However, until recently, many nursing programs have paid little attention to spirituality. Objective: The objective of this study was to identify the impact of two different curricula, used to teach undergraduate nursing students, on increasing nursing student awareness of spirituality in the care of patients. Research design: A quasi-experimental post-intervention two-group design was conducted in 2009–2010 and 2010–2011 (...) academic years. Participants and research context: The study included a total of 130 volunteer senior-year students. The students were assigned as “the intervention group/integrated system” that were informed about spirituality or as “the control group/traditional system” that received no information on spirituality. Data were collected via a personal information form and the Spirituality and Spiritual Care Rating Scale was used to assess responses. The study was conducted at the Department of Nursing of the Faculty of Health Sciences, Cumhuriyet University, in Central Anatolia/Turkey. Ethical considerations: Permission to conduct the study at the nursing school was obtained from the schools’ management teams. The rights of the participants were protected in this study by obtaining informed consent. Findings: The results revealed that the intervention group had a higher mean score on the Spirituality and Spiritual Care Rating Scale than did the control group. The students in the intervention group defined the terms of spirituality and spiritual care more accurately than did the control group students. Discussion: Nurses are professionally and ethically responsible for providing spiritual care. Nurses’ competence in meeting the spiritual needs of their patients should be improved by undergraduate education on spiritual care. Nursing scholars reported a significant difference in the knowledge and attitudes toward spirituality of nursing students as a result of the integration of spirituality into the undergraduate nursing curriculum. Conclusion: Spirituality should be more widely included in nursing education. (shrink)

Background The ethical climate is an essential component of organizational climate or culture. The ethical climate is necessary for clinical practice in operating rooms. Objective This study aimed to compare the ethical climate from the perspective of operating room nursing students and operating room staff of hospitals affiliated with Mashhad University of Medical Sciences, Iran. Method This analytical study was performed on 95 operating room nursing students and 169 operating room staff of hospitals in Mashhad, Iran. The (...) students were selected through the census method and the staff were selected by using stratified random sampling. The data were collected via Olson’s Hospital Ethical Climate Survey and analyzed by using BMI SPSS version 21. Results The total mean scores of the ethical climate were 3.44 ± 0.45 and 3.32 ± 0.48 from students and staff’s perspectives, and the independent t-test showed no significant difference between them ( p 0.05). Furthermore, the results of the study indicated a significant difference in communication with physicians’ score between operating room staff (2.82 ± 0.49) and students’ views (3.25 ± 0.6) ( p < 0.05). Conclusion Although it is difficult to create a right ethical climate in operating rooms, but hospital managers should implement practical programs to improve the ethical climate of operating rooms and inter-professional teamwork. Besides, deans of faculties can provide ethical-based education for students, who can effectively create an ethical climate. (shrink)

Pedagogy, power and practice ethics: clinical teaching in psychiatric/mental health settings Often, baccalaureate nursing students initially approach a psychiatric mental health practicum with uncertainty, and even fear. They may feel unprepared for the myriad complex practice situations encountered. In addition, memories of personal painful life events may be vicariously evoked through learning about and listening to the experiences of those diagnosed with mental disorders. When faced with such challenging situations, nursing students often seek counsel from the (...) clinical and/or classroom faculty. Pedagogic boundaries may begin to blur in the face of student distress. For the nurse educator, several questions arise: Should a nurse educator provide counseling to students? How does one best negotiate the boundaries between ‘counselor’, and ‘caring educator’? What are the limits of a caring and professional pedagogic relation? What different knowledges provide guidance and to what differential consequences for ethical pedagogic relationships? This paper offers a comparative analysis of three philosophical stances to examine differences in key assumptions, pedagogic positioning, relationships of power/knowledge, and consequences for professional ethical pedagogic practices. While definitive answers are difficult, the authors pose several questions for consideration in discerning how best to proceed and under what particular conditions. (shrink)

The population of most non-dominant ethnic groups in the USA is growing dramatically. Faculty members are challenged to develop curricula that adequately prepare our future nurses. An increased focus on clinical ethics has resulted from the use of sophisticated technology, changes in health care financing, an increasing elderly population and the shift of care from inpatient to outpatient settings. Nurses frequently face situations demanding resolution of ethical dilemmas involving cultural differences. Nursing curricula must include content on both ethics (...) and cultural sensitivity. Active student participation is an important element providing a foundation for ethical practice. A proposed educational format was introduced with graduating baccalaureate students. In a pilot study, curricular content on cultural sensitivity and ethical practice was taught in separate modules. Students were then asked to identify and problem solve an ethical dilemma involving patients and professional caregivers from vastly different cultures. Course faculty members provided discussion questions to guide the students' thinking. (shrink)

Background: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students’ perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. Research design: An Italian national cross-sectional study design was performed in 2015–2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (...) (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 – ‘never’ to 3 – ‘very much’). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Findings: Overall, 4707 (49%) perceived to have discussed ethical issues ‘much’ or ‘very much’; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, ‘enough’ or ‘never’ ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues. Conclusion: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice. (shrink)

Student evaluations of teaching are ubiquitous in higher education; however, most prior research has focused on the numeric ratings, with little systematic attention given to the qualitative comments. In this study, written comments were collected as part of the regular evaluation of a community health nursing course over four semesters. Taken as a whole, student comments were strikingly consistent and mostly negative. Students emphasized the authority of the textbook and framed the course as preparation for the National Council Licensure (...) Examination (NCLEX). Instructor efforts to focus on critical analysis of social issues were met with confusion, suspicion, and resistance. Student comments were further analyzed in relation to 3 levels of discourse: the student/teacher level, the nursing‐education level, and the social–historical level. For each level, the comments reveal problems, but not the ones suggested by a conventional reading of student evaluations. If students and teachers have conflicting expectations about goals and methods for learning, formal student evaluations may be less useful as a measure of teaching effectiveness. This study also raises troubling concerns about current practices in nursing pedagogy, particularly the emphasis on standardized testing and highly structured didactics, and the overlap between student evaluation systems and the technologies of neoliberalism. (shrink)

Introduction: Healthcare practitioners have a legal, ethical and professional obligation to obtain patient consent for all healthcare treatments. There is increasing evidence which suggests dissonance and variation in practice in assessment of decision-making capacity and consent processes. Aims: This study explores healthcare practitioners’ knowledge and practices of assessing decision-making capacity and obtaining patient consent to treatment in the acute generalist setting. Methods: An exploratory descriptive cross-sectional survey design, using an online questionnaire, method was employed with all professional groups invited (...) via email to participate. Data were collected over 3 months from July to September 2015. Survey content and format was reviewed by the liaison psychiatry team and subsequently contained five sections (demographics, general knowledge and practice, delirium context, legal aspects and education/training). Descriptive, univariate and bivariate analysis of quantitative data and qualitative content analysis of qualitative data were undertaken. Ethical considerations: The study was approved by the institutional Human Research and Ethics Committee and informed consent was taken to be provided by participants upon completion and submission of the de-identified survey. Results: In total, 86 participants engaged the survey with n = 24, exiting at the first consent question. Almost two-thirds of respondents indicated that all treatments required patient consent. Knowledge of consent and decision-making capacity as legal constructs was deficient. Decision-making capacity was primarily assessed using professional judgement and perceived predominantly as the responsibility of medical and psychology staff. A range of patient psychological and behavioural symptoms were identified as indicators requiring assessment of decision-making capacity. Despite this, many patients with delirium have their decision-making capacity assessed and documented only sometimes. Uncertain knowledge and inconsistent application of legislative frameworks are evident. Many participants were unsure of the legal mechanisms for obtaining substitute consent in patients with impaired decision-making capacity and refusing treatment. Conclusion: The legal context of decision-making capacity and consent to treatment appears complex for healthcare practitioners. Professional, ethical and legal standards of care in this context can benefit from structured education programmes and supportive governance processes. An understanding of why ‘duty of care’ is being used as a framework within the context of impaired decision-making capacity is warranted, alongside a review of the context of Duty of Care within health policy, guidance and faculty teaching. (shrink)

This book provides a current review of Medical Research Ethics on a global basis. The book contains chapters that are historically and philosophically reflective and aimed to promote a discussion about controversial and foundational aspects in the field. An elaborate group of chapters concentrates on key areas of medical research where there are core ethical issues that arise both in theory and practice: genetics, neuroscience, surgery, palliative care, diagnostics, risk and prediction, security, pandemic threats, finances, technology, and public policy.This (...) book is suitable for use from the most basic introductory courses to the highest levels of expertise in multidisciplinary contexts. The insights and research by this group of top scholars in the field of bioethics is an indispensable read for medical students in bioethics seminars and courses as well as for philosophy of bioethics classes in departments of philosophy, nursing faculties, law schools where bioethics is linked to medical law, experts in comparative law and public health, international human rights, and is equally useful for policy planning in pharmaceutical companies. (shrink)

Background: The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. Objectives: This study explored nurses’ care practices at the end (...) of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. Findings: A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Discussion: Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Conclusion: Despite the avoidance of death talk and nurses’ lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values. (shrink)

The practice of research is full of ethical challenges, many of which might be addressed through the teaching of responsible conduct of research . Although such training is increasingly required, there is no clear consensus about either the goals or content of an RCR curriculum. The present study was designed to assess community standards in three domains of research practice: authorship, collaboration, and data management. A survey, developed through advice from content matter experts, focus groups, and interviews, was (...) distributed in November 2010 to U.S. faculty from 50 graduate programs for each of four different disciplines: microbiology, neuroscience, nursing, and psychology. The survey addressed practices and perceived standards, as well as perceptions about teaching and learning. Over 1,300 responses yielded statistically significant differences in responses to nearly all questions. However the magnitude of these differences was typically small, leaving little reason to argue for community consensus on standards. For nearly all questions asked, the clear finding was that there was nothing approaching consensus. These results may be useful not so much to teach what the standards are, but to increase student awareness of the diversity of those standards in reported practice. (shrink)

Despite repeated calls for equity, diversity, and inclusion in nursing education and the significance of disability for the vocation of nursing, the voices and experiences of nursing faculty with disabilities are largely absent from our literature. In this paper, we present a critical grounded theory of the experiences of disabled nursing faculty in academe to begin to amend this gap. Using critical disability studies as a sensitizing framework and building on prior work on racism (...) and other systems of oppression in nursing, we theorize that nursing academe is a normalized space produced by White, able‐mindbodied, and cis‐heteropatriarchal discourses that regulate the boundaries of inclusion via exclusionary social norms. Further, we describe the operations of normalcy in nursing academe, discuss implications for education and health care, and consider avenues for change. (shrink)

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing (...) care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science. (shrink)

In this paper, we examine the practicalities of nurse managers’ work. We expose how managers’ commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We (...) learned how nurse managers’ responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers’ responsibilities are shaped to conform to institutional purposes. (shrink)

Background Social justice is recognized by reputable international organizations as a professional nursing value. However, there are serious doubts as to whether it is embodied in Catalan nursing education. Objectives To explore what nursing students take away from two teaching activities led by expert patients (one presentation and three expert patient illness narratives) on the topics of social justice, patient rights, and person-centered care. Research design Qualitative study using a content analysis approach. The research plan included (1) (...) think-pair-share activities (additional faculty-assisted presentation and three faculty-assisted, semi-structured scripted narratives); (2) paired reflections; (3) focus groups; and (4) content analysis of paired reflections and focus groups. Participants and research context Fourth-year nursing degree students at the Autonomous University of Barcelona (UAB), Spain. Convenience sampling was used. Ethical considerations The UAB Research Ethics Committee did not deem it necessary to apply any specific measures. We fully explained to patients that they could decide what medical information they would share with the students that was relevant to their learning, and we provided students with guidelines about patient confidentiality, dignity, and respect. Findings/results The students engaged in reflection about their education (recognizing that it had been centered on the professional and not the patient) and their relationship with the patient, in which they reproduced low-involvement patient care by modeling behaviors of their nurse educator. Moreover, they valued a person-centered care model with an emphasis on the emotional part but left out decision-making as an individual right of people. Conclusions The think-pair-share activities were useful to spark self-reflection among students, who identified aspects to change in their own practice, and reflected about their own education process, both of which promote change. (shrink)

PERRON A and HOLMES D. Nursing Inquiry 2011; 18: 191–204Constructing mentally ill inmates: nurses’ discursive practices in correctionsThe concepts of discourse, subjectivity and power allow for innovative explorations in nursing research. Discourse take many different forms and may be maintained, transmitted, even imposed, in various ways. Nursing practice makes possible many discursive spaces where discourses intersect. Using a Foucauldian perspective, were explored the ways in which forensic psychiatric nurses construct the subjectivity of mentally ill inmates. Progress (...) notes and individual interviews constitute discursive spaces within which nurses construct patients’ subjectivities. Progress notes provide a written (and permanent) form of discourse, while interviews set the space for a more fluid and contextual form of discourse. We identified five types of subjectivities – the (in)visible patient, the patient as risk, the deviant patient, the disturbed patient and the disciplined patient. These subjectivities were rooted in various types of discourses circulating in the selected setting. Despite the multiple discursive dimensions of forensic psychiatric nursing, progress notes remain the main formal source of information regarding nursing care even though it is not representative of the care provided nor is it representative of nurses’ complex discursive practices in corrections. (shrink)

Background: Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. Aim: To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. Research design and context: A case study was conducted (...) in a professional development course (‘learning circle’) for home care nurses, including participant observations and focus groups. The theoretical notion of ‘relational agency’ and the moral concept of ‘practices of responsibility’ were used to conduct a narrative analysis on the nurses’ stories about autonomy. Participants: Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Findings: Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients’ strengths and collaboration with patients and informal caregivers. Discussion: On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. Conclusion: The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together. (shrink)

Ethnic minority patients have been discussed and problematised in Western health literature. Drawing on an interpretation of central parts of the French philosopher Michel Foucault's authorship, we analysed a broad selection of materials to identify mechanisms through which the truth about ethnic minority patients is constructed. We identified a single, yet consistent discursive strategy that we termed ‘figure of inconvenience’ in which ethnic minority patients were classified and assigned a specific subjection illustrating them as ‘inconvenient’ to the nurse's practice. (...) Concurrently, their relatives were afforded the position of substitutes. The discourse exemplifies how the behaviour or appearances of ethnic minority patients cannot be reconciled with the traits of ethnic Danish patients. Finally, we discussed implications that such a strategy may have for the provision of healthcare services for ethnic minority patients in Denmark. (shrink)