Increasing attention is being paid to spirituality in nursing practice. Much of the literature on spiritual care uses the nursing process to describe this aspect of care. However, the use of the nursing process in the area of spirituality may be problematic, depending upon the understandings of the nature and intent of this process. Is it primarily a descriptive process meant to make visible the nursing actions to provide spiritual support, or is (...) it a prescriptive process meant to guide nursing actions for intervening in the spirituality of patients? A prescriptive nursing process approach implies influencing, and in some cases reframing, the spirituality of patients and thereby extends beyond general notions of spiritual support. In this paper we discuss four problematic assumptions that form the basis for a prescriptive approach to spiritual care. We conclude that this approach extends the nursing role beyond appropriate professional boundaries, making it ethically problematic. (shrink)

Derek Nurse looks at variations in the form and function of tense and aspect in Bantu, a branch of Niger-Congo, the world's largest language phylum. Bantu languages are spoken in central, eastern, and southern sub-Saharan Africa south of a line between Nigeria and Somalia. By current estimates there are between 250 and 600 of them, as yet neither adequately classified nor fully described. Professor Nurse's account is based on data from more than 200 Bantu languages and varieties, a representative sample (...) of which is freely available on the publisher's website. He devotes substantial chapters to the analysis and comparison of the different tense and aspect systems found in Bantu. He also examines the verbal categories with which they interact, including negation and focus. Synchronic and diachronic perspectives are interwoven throughout the book. Following a brief history of Bantu over the last five thousand years, the final two chapters look systematically at the history of tense and aspect in Bantu. The first deals with the reconstruction of the earlier forms from which contemporary structures, morphemes, and categories are derived, and the second with the processes of change, including grammaticalization, by means of which older analytical structures and independent lexical items moved as they became incorporated as grammatical inflections and categories. (shrink)

Background: Nurses’ voices remain unheard in most debates about euthanasia, although their crucial role in the euthanasia process is widely acknowledged. Moreover, in Canadian euthanasia law, nurses have a more active role, which further highlights the need for knowledge about nurses’ attitudes towards their role in the euthanasia process. Research questions: What are Finnish nurses’ attitudes towards their potential role in the euthanasia process? Which characteristics are associated with those attitudes? Research design: Cross-sectional web-based survey. Participants and (...) research context: 1003 nurses, recruited via social media and the members’ bulletin of the Finnish Nurses Association. Ethical considerations: Ethical approval was obtained from the Committee on Research Ethics of the university to which the first author was affiliated. Findings: The great majority (85.2%) of nurses felt that their perspective should be considered in decision-making related to euthanasia. Furthermore, most of the participants (74.7%) reported willingness to participate in the euthanasia process if it were legal, and 88.6% agreed that a nurse should be present when euthanasia is performed if the patient wishes so. Furthermore, over half agreed that some of the preparatory tasks were part of their job description. However, a minority (32.9%) agreed with a possible obligation to participate based on their profession. Nurses’ age, religiosity and educational level influenced their attitudes in the current results. Discussion: Despite the strong agreement on decision-making concerning euthanasia and participation in the euthanasia process, obligation to participate based on the profession was rejected by most participants. Nurses regarded themselves as consultants in the decision-making process, which may indicate their unwillingness to share the responsibility for the decision itself. Conclusion: Specific safety mechanisms should be considered to protect nurses who refuse to be involved in the euthanasia process due to harm that involuntary participation might cause. (shrink)

Ethical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables ‘frequency’ and ‘degree of conflict’. In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable ‘exposure to conflict’, as well as considering six ‘types of ethical conflict’. An instrument (...) was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV). (shrink)

Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians’ and nurses’ perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis (...) was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient’s decision-making process, The challenge awaiting the family members’ processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient’s possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context. (shrink)

In this article,we address how the professionalization process is reflected in the way Danish nursing textbooks present ‘nursing’ to new members of the profession during the 20th century. The discussion is based on a discourse analysis of seven Danish textbooks on basic nursing published between 1904 and 1996. The analysis was inspired by the work of Michel Foucault, in particular the concepts of rupture and rules of formation. First, we explain how the dominating role of the (...) human body in nursing textbooks disappears in the mid‐20th century. This transformation can of course be attributed to changes in tasks and responsibilities for nurses or to the implementation of increasing amounts of knowledge and theories from other disciplines than medicine into the nurses’ knowledge base. However, inspired by Foucault, we consider these historical changes to be the conditions of possibilities and not causes. The second part of the analysis shows that along with ‘the disappearance of the body’, a second discursive change appears: the role of doctors and medicine changes fundamentally from about mid‐20th century. Finally, we argue that this discursive reorganization enabling new patterns of thought to emerge was driven by a professional interest in describing nursing as an independent profession. (shrink)

Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this ‘understanding’ in clinical education is and how it is promoted in clinical nursing education (...) becomes important to clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third‐year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding‐based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding‐based, interpretative education in nursing. (shrink)

Background: Informed consent is fundamental to the autonomous decision-making of patients, yet much is still unknown about the process in the clinical setting. In an evolving healthcare landscape, nurses must be prepared to address patient understanding and participate in the informed consent process to better fulfill their well-established role as patient advocates. Research objective: This study examines hospital-based nurses’ experiences and understandings of the informed consent process. Research design: This qualitative descriptive study utilized a semi-structured interview approach (...) identifying thematic concerns, experiences, and knowledge of informed consent across a selected population of clinically practicing nurses. Participants and research context: In all, 20 baccalaureate prepared registered nurses practicing in various clinical settings (i.e. critical care, oncology, medical/surgical) at a large northeastern academic medical center in the United States completed semi-structured interviews and a demographic survey. The mean age of participants was 36.6 years old, with a mean of 12.2 years of clinical experience. Ethical considerations: Participation in this study involved minimal risk and no invasive measures. This study received Institutional Review Board approval from the University of Pennsylvania. All participants voluntarily consented. Findings: The majority of participants (N = 19) believe patient safety is directly linked to patient comprehension of the informed consent process. However, when asked if nurses have a defined role in the informed consent process, nearly half did not agree (N = 9). Through this qualitative approach, three major nursing roles emerged: the nurse as a communicator, the nurse as an advocate, and the clerical role of the nurse. Discussion and conclusion: This investigation contributes to the foundation of ethical research that will better prepare nurses for patient engagement, advance current understanding of informed consent, and allow for future development of solutions. Nurses are at the forefront of patient–provider interactions and they are often presented opportunities to learn about and engage in the informed consent process. (shrink)

In this article, I try to document the lived experiences of nurses who were sent to Wuhan to work in the COVID‐19 wards and consider the impact of such experiences on their psychological well‐being. I show the contextual factors in Wuhan, the inherent nature of nursing during the pandemic and the transition from the immediate reactions of nurses to long‐term impacts on their personalities, formed through the whole process of abjection. Therefore, I argue that we need to consider (...) how nursing experiences, before, during and after their professional work in the wards, would instigate abjection within nurses. The abjection of nurses does not start only from the ward, nor does it not end in the ward. Rather, the abjection of nurses, as a reaction to lived experiences, is nuanced and the study of it can reveal rich details of nurses' life both inside and outside of the ward. (shrink)

The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published (...) between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and PubMed. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an individual deficit. A focus on the individual as a source of trouble can serve as a distraction from more complex systematic problems. (shrink)

Background: Nursing students on clinical placements as part of their professional training are routinely faced with situations involving ethical conflicts. The initial act of perceiving a situation as causing an ethical dilemma is the result of both the students’ personal values, drawn from their culture and families, and of the professional knowledge and values that they have acquired through training and experience. Objectives: Nursing students’ experiences on clinical placements in primary care settings were investigated in order to identify (...) situations that they perceived as involving ethical conflict and describe the elements they took into consideration during their decision-making processes in these situations. Methods: The research design was qualitative descriptive case study. Around 50 students from three different intakes to a nursing degree answered a questionnaire and discussed it in focus groups. Ethical considerations: The study was designed in accordance with the principles guiding research with human beings and was approved by the Human Research Ethics Committee. Results: Synthesised into two principal axes: (a) ethical conflicts in primary care, linked with the domains of working processes, professional nursing ethics and human and social rights and (b) students’ decision-making processes – realisation, reflection and intervention. Conclusion: The student nurses saw themselves both as actors and spectators in situations involving ethical problems and demanding moral deliberation, demonstrating the ability to base their arguments soundly. They tended to emphasise the possibilities offered by dialogue and that different ethical values must be respected to find fair solutions to ethical problems. (shrink)

In this article, we report findings from a qualitative study that explored how the relatives of intensive care unit patients experienced the nurses’ role and relationship with them in the end-of-life decision-making processes. In all, 27 relatives of 21 deceased patients were interviewed about their experiences in this challenging ethical issue. The findings reveal that despite bedside experiences of care, compassion and comfort, the nurses were perceived as vague and evasive in their communication, and the relatives missed a long-term perspective (...) in the dialogue. Few experienced that nurses participated in meetings with doctors and relatives. The ethical consequences imply increased loneliness and uncertainty, and the experience that the relatives themselves have the responsibility of obtaining information and understanding their role in the decision-making process. The relatives therefore felt that the nurses could have been more involved in the process. (shrink)

This article deals with making decisions about starting terminal care. The results are part of a larger survey on nurses’ conceptions of terminal care in community health centres in Finland. The importance, frequency and timing of decision making as well as communication and the number of investigations and procedures carried out are examined. The relationship between decision making and the size of a health centre’s catchment population is also discussed. The results make it possible to compare the current situation in (...) Finland with the national law on patients’ rights. The sample consisted of 328 nurses who worked on the wards of 32 community health centres. The data were collected by means of a structured questionnaire and processed with the Statistical Package for Social Sciences software. The nurses agreed that explicit decision making and documentation about starting terminal care were necessary, but it was highlighted that the practice had many shortcomings. Decisions were often made too late and the patients were not always aware of their situation; family members and the nursing staff were mostly better informed. It was noted that many investigations and other procedures were carried out on terminally ill patients, often at the request of family members. Decision making was found to have some relationship to the size of a health centre’s catchment area. (shrink)

Although there is a growing acknowledgement of the potential of a more nuanced healthcare paradigm and practice, the discourses of health promotion—and with that nursing and other healthcare professionals’ practice—still tend to focus on the medical diagnosis, disease and the rationale of biomedicine. There is a need for shifting to a human practice that draws on a broader perspective related to illness. This requires a transformation of practices which can be constructed within a narrative understanding. A narrative approach appreciates (...) the importance of emotion and intersubjective relation in the telling and listening that occur in the clinical encounter. The essence of nursing lies in the creative imagination, the sensitive spirit and the intelligent understanding of the individuals’ possibilities of becoming empowered in his or her own life. This entails that the focus of the use of patients’ narratives is, ultimately, not the story itself, but the nurses’ and other healthcare professionals’ ability to support the patients in finding useful meaning in their stories. Herein, it is of particular importance to let the patients narrate about what is sparkling moments or events in the lived life. Stories with such focus can open up for patients’ hopes and dreams, which gives inspiration for finding meaningful ways to cope in life empowering personal recovery. It is, therefore, crucial to transform clinical settings into places that acknowledge the need for imagination and creativity, aiming at creating the opportunity for sensibility and vision essential to encouraging a narrative approach and thereby the ability to reflect upon and promote a healing process. (shrink)

Collaboration for nursing is a core competence and therefore educational interventions are essentials for collaborative skills. To identify such interventions, we carried out a study to understand nursing students' collaborative process. A narrative inquiry method was used to explore the collaborative process of first‐year undergraduate nursing students. The analysis was conducted on field notes from 70 h of observation of 87 nursing students' collaboration during skills lab activities. It also included transcriptions of four focus (...) group discussions with 11 students. The results are presented as a sequential process of (1) navigating in unfamiliar territory, (2) navigating together to cope, and (3) navigating together towards independency and the future nursing profession. We identified a transition from teacher‐led assistance and guidance to student interdependency and reciprocal learning, ending with student‐led assistance supporting independency. In line with Vygotsky's theory of zone of proximal development, different scaffolding interventions are needed depending on where the students are in the collaborative process. (shrink)

The final chapter of the book 'redraws the map', to create a new picture of nursing science based on the following principles: Problems of practice should guide ...

Background The learning process about dignity and how undergraduate nursing students experience and use this ethical knowledge is an under-represented field in nursing research. To overcome the lack of conceptual clarity, it is important to understand what processes and dimensions students develop to support this learning outcome. Objective This study aimed to explain the process of learning about dignity by undergraduate nursing students. Research design and methods A qualitative study was conducted using the grounded theory (...) method. Participants and research context Data was collected through free reports and in-depth semi-structured interviews with 20 participants. A focus group was held for the selective coding. Sampling began purposefully and evolved into theoretical. Reflective and theoretical memos were generated from the data collection and constant comparison. Data analysis was performed using qualitative data analysis software using Corbin and Strauss’ method. Ethical considerations The research was approved by a specialized research ethics committee from a Health School. Findings The process of learning about dignity by undergraduate nursing students revealed ‘recognition of dignity’ as the core category, supported by five main categories: ‘proto-conscience of dignity’, ‘pathway to nursing’, ‘consciousness of dignity’, ‘ways of learning’, and ‘becoming capable’. These categories illustrate the processes and dimensions involved in nursing students’ concept translation of dignity learning, allowing a theory to emerge. Conclusions The ‘Recognition of Dignity’ theory aims to contribute to developing educational, training, and supervision processes for nursing programs. It seeks to enhance the ethical and moral development of undergraduate nursing students by helping them understand the concept of dignity and its fundamental importance in nursing. (shrink)

Mainstream nursing history often positions itself in opposition to philosophy and many nursing historians are reticent of theorizing. In the quest to illuminate the lives of nurses and women current historical approaches are driven by reformist aspirations but are based on the conception that nursing or caring is basically good and the timelessness of universal values. This has the effect of essentialising political categories of identity such as class, race and gender. This kind of history is about (...) affirmation rather than friction and about the conservation of memory and musealization. In contrast, we will focus on how we imagine nursing history could be used as a philosophical, critical perspective to challenge the ongoing transformations of our societies. Existing reality must be confronted with strangeness and the historically different can assume the function of this counterpart, meaning present and past must continuously be set in relation to each other. Thus, critical history is always the history of the present but not merely the pre‐history of the present – critique must rather present different realities and different certainties. In this paper, we use this approach to discuss the implementation of the nursing process (NP) in Germany. The nursing process appears to be a technology that helped to set up an infrastructure ‐ or assemblage ‐ to transform nursing interventions into a commodity exchangable between consumers and nurses in a free market. In our theoretical perspective, we argue that NP was a step in the realization of the German ordoliberal program, a specific variety of neoliberalism. In order to implement market‐orientation in the healthcare system it was necessary to transform hospitals into calculable spaces and to make all performances in the hospital calculable. This radically transformed not just the systems, but the ways in which nurses and patients conveived of themselves. (shrink)

In a recent, currently unpublished, research project that sought to examine the meaning and enactment of ethical nursing practice across a variety of clinical settings, the significance of moral identity was highlighted. This article describes the findings and illuminates how the moral identities of the nurse participants arose and evolved as they navigated their way through the contextual and systemic forces that shaped the moral situations of their practice. The study revealed the socially-mediated process of identity development and (...) the narrative, dialogical, relational and contextual nature of nurses’ moral identities. (shrink)

Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (...) (#191046). Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed. (shrink)

This paper examines nurses’ international migration within the broader context of female migration, particularly against more studied groups of women who have migrated for employment in care‐giving roles. We analyze the similarities and differences between skilled professional female migrants (nurses) and domestic workers (nannies and in‐home caretakers) and how societal expectations, meanings, and values of care and ‘women's work’, together with myriad social, cultural, economic and political processes, construct the female migrant care‐giver experience. We argue that, as the recruitment of (...) foreign workers gains visibility, strategies are introduced to better prepare female migrant care‐givers for the marketplace. Language, specifically command of English and accent modification, is highlighted as one means to assimilate migrant care‐givers to host communities. (shrink)

Background In the dynamic landscape of healthcare, nurses play a crucial role as ethical stewards, responsible for whistleblowing, nurse advocacy, and patient safety. Their duties involve ensuring patient well-being through ethical practices and advocacy initiatives. Aim This study investigates the ethical responsibilities of nurses regarding whistleblowing and advocacy in reporting concerns about patient safety. Research Design A cross-sectional study utilized cluster and simple random sampling to gather a representative sample of actively practicing registered nurses. Data collection involved a demographic form, (...) Nurse Whistleblowing Intentions Scale, Nursing Advocacy Scale, and Clinical Decision-Making Scale. Participants and Research Context The study utilizing a robust sample size determination formula for reliable findings included 96 diverse nurses, predominantly females. Engaged actively in direct patient care across various outpatients clinics. The recruitment process specifically sought individuals with expertise in safety protocols and reporting, contributing to a nuanced understanding of the study’s focus. Ethical Considerations Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. A thorough ethical review was conducted to guarantee participant protection and adherence to ethical principles. Results Surveyed nurses demonstrated positive whistleblowing (Overall Mean Score: 3.58), high advocacy (Overall Mean Score: 12.2), and nuanced ethical decision-making for patient safety (Overall Mean Score: 15.78). Demographic factors, such as nationality and ethical training, significantly impacted whistleblowing intentions, while age, gender, and ethical training correlated with nursing advocacy behavior. Associations with experience and qualification emerged in ethical decision-making. Conclusion The gained insights foster targeted interventions, improving ethical practices, advocacy, and informed decision-making in nursing. This study explores the intricate link between demographics and ethical considerations among surveyed nurses, acting as a catalyst for ongoing initiatives to strengthen the ethical foundation in healthcare sector. (shrink)

In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses’ decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a (...) nuanced and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses’ reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009–April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses’ decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly. (shrink)

Shared governance in hospitals promotes the inclusion of nurses' expertise, knowledge and skills in organisational processes, and nurses increasingly fulfil positions in organisational hierarchies. However, incorporating nursing expertise in strategic governance structures might be complicated, as these structures are primarily linked to managerial and biomedical expertise. Drawing on a Foucauldian perspective on knowledge and power, intertwined and embedded in everyday (inter)actions, we study how newly appointed directors of nursing challenge these dominant ‘modes of knowing’. By focusing on a (...) (Dutch) healthcare organisation, a large academic medical centre, we gained insight into how the history of director of nursing roles relates to how nursing expertise is valued. We gathered qualitative data (from multiple sources) to get close to the daily practices of these directors. In this way, we were able to highlight three tactics that enable directors to relate to new ‘knowledge‐power knots’: (1) positioning, by creating more unity; (2) profiling, by showing significance and (3) powering, by being alert and intervening. With these tactics, the directors of nursing try to embed themselves and their expertise in hospital governance. This study contributes to an everyday understanding of power and the tactics that directors of nursing employ as an ongoing practice. This provides practical starting points for embedding nursing in governance and decision‐making. (shrink)

While for decades nursing has advocated for theory‐informed practice, more recent attention has tended to focus on mid‐range theory rather than the earlier focus on developing grand theory to encompass all of nursing practice. However, there has been continued interest in the holistic nursing community on grand theory and, in particular, on Integral Theory. Although Integral Theory's four‐quadrant (AQAL) perspective is familiar in nursing, little is known about how it is being used by nurses in direct (...) practice. The purpose of this interpretive descriptive study was to provide a practice‐based perspective on Ken Wilber's Integral Theory in professional nursing practice. The following research question was investigated: How does Integral Theory assist nurses in describing and understanding their professional work? Nurses participating in this study used Integral Theory as a map or heuristic that gave structure to an inquiry process in professional nursing practice and in nursing education in a manner that was holonic, multiperspectival, and self‐reflective. Challenges constraining nurses’ use of Integral Theory included its intricacy, as well as contextual factors in practice environments. Implications for nursing practice and education for the use of Integral Theory's meta‐framework are described. (shrink)

The integration of technology in care is core business in nursing and this role requires that we must understand and use technology informed by evidence that goes much deeper and broader than actions and behaviours. We need to delve more deeply into its complexity because there is nothing minor or insignificant about technology as a major influence in healthcare outcomes and experiences. Evidence is needed that addresses technology and nursing from perspectives that examine the effects of technology, especially (...) related to increasing demands for efficiency, the relationship of technology to nursing and caring, and a range of philosophical questions associated with empowering people in their healthcare choices. Specifically, there is a need to confront in practice the ways technique influences care. Technique is the creation of a kind of thinking that is necessary for contemporary healthcare technology to develop and be applied in an efficient and rational manner. Technique is not an entity or specific thing, but rather a way of thinking that seeks to shape and organize nursing activity, and manage efficiently individual difference(s) in care. It emphasizes predetermined causal relationships, conformity, and sameness of product, process, and thought. In response is needed a radical vision of nursing that attempts in a real sense to ensure we meet the needs of individuals and their community. Activism and advocacy are needed, and a willingness to create a certain detachment from the imperatives that technique demands. It is argued that our responsibility as nurses is to respond in practice to the errors, advantages, difficulties, and temptations of technology for the benefit of those who most need our assistance and care. (shrink)

Background: Nurses need moral courage to ensure ethically good care. Moral courage is an individual characteristic and therefore it is relevant to examine its association with nurses’ socio-demographic factors. Objective: To describe nurses’ self-assessed level of moral courage and its association with their socio-demographic factors. Research design: Quantitative descriptive cross-sectional study. The data were collected with Nurses’ Moral Courage Scale and analyzed statistically. Participants and research context: A total of 482 registered nurses from a major university hospital in Southern Finland (...) completed the Finnish language version of Nurses’ Moral Courage Scale in autumn 2017. Ethical considerations: Ethical approval was obtained from the university ethics committee and permission for the data collection from the participating hospital. Ethical principles and scientific guidelines were followed throughout the research process. Findings: Nurses’ self-assessed level of moral courage was rather high. On Visual Analogy Scale (0–10), the mean value was 8.20 and the mean score of the four dimensional, 21-item Nurses’ Moral Courage Scale was 4.09 on a 5-point Likert-type scale. Respondents’ gender, present work role, ethical knowledge base, additional ethics education, self-study as a means to acquire ethical knowledge, and frequency of work situations needing moral courage were statistically significantly associated with nurses’ moral courage. Discussion: Strongest association was found between nurses’ higher moral courage level and formal and informal ethics education. Honesty and patient’s humane and dignified encounter received the highest scores indicating respondents’ internalization of the core values of nursing. Conclusion: Although nurses were fairly morally courageous, moral courage should be a part of nurses’ basic and continuing education thus covering its theoretical and practical learning. Since moral courage is a virtue that can be taught, learnt, and practiced, education is a relevant way to maintain and further strengthen nurses’ moral courage. (shrink)

Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances (...) surrounding end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)

Background The practice of health advocacy in nursing has been defined as a process aimed at promoting the independence and autonomy of users of health services, in addition to providing information on healthcare decision-making and offering support for decisions taken. Ethical considerations Ethics approval was not required to conduct this review. Aim This integrative review aims to synthesize evidence in the literature on health advocacy in professional nursing practice. Methods An integrative review methodology guided by Whittemore and (...) Knalf was used. Studies were identified by conducting searches on PubMed, Scopus, Web of Science, CINAHL, and LILACS databases. Of 2179 records, 34 studies matched the inclusion criteria. Results The main aspects involved in the practice of health advocacy by professional nurses are related to the ethical principles of the nursing profession, such as protecting patients seeking autonomy and care. Furthermore, the practice of health advocacy by nurses requires an empathetic attitude, responsibility, and assertive communication. Conclusion The diverse possibilities for the practice of advocacy synthesized in this study allow nurses to approach and become familiarized with the topic, being able to acquire and complement knowledge that will reflect on their professional practice in different work environments such as the educational field, in hospital practice, or basic health care. (shrink)

Indigenous nurse scholars across nations colonised by Europeans articulate the need for accomplices (as opposed to mere performative allies) to work alongside them and support their ongoing struggle for health equity and respect and to prioritise and promote culturally safe healthcare. Although cultural safety is now being mandated in nursing codes of practice as a strategy to address racism in healthcare, it is important that white nurse educators have a comprehensive understanding about cultural safety and the pedagogical skills needed (...) to teach it to undergraduate nurses. We open this article with stories of our journeys as two white nurses in becoming accomplices and working alongside Indigenous Peoples, as patients and colleagues. Our lived experience of the inertia of healthcare and education organisations to address systemic and institutional resistance to the practice of cultural safety underpins the intention of this article. We understand that delivering this challenging and complex topic effectively and respectfully is best achieved when Indigenous and white educators work together at the cultural interface. Doing so requires commitment from white nurses and power holders within universities and healthcare institutions. A decolonising approach to nurse education at individual and institutional levels is fundamental to support and grow the work that needs to be done to reduce health inequity and increase cultural safety. White nurse accomplices can play an important role in teaching future nurses the importance of critical reflection and aiming to reduce power imbalances and racism within healthcare environments. Reducing power imbalances in healthcare environments and decolonising nursing practice is the strength of a cultural safety framework. (shrink)

Background Nursing students spend approximately half of their time in clinical practice. It is important that clinical supervisors understand nursing students’ path of learning and can support their growth and development during the different and multifaceted learning situations offered in the clinical-practice period. Objective Based on nursing students’ perspective and rooted in the didactics of caring science, to examine how a learning and constructive caring relationship between nursing students and supervisors in clinical practice can be formed. (...) Design Qualitative and quantitative concurrent triangulation design of mixed methods. Methods Focus group interviews with Finnish nursing students (n = 21) in the qualitative part of the study. In the quantitative part, a closed questionnaire with closed answers was analysed using descriptive statistics. The analysis process was conducted using inductive content analysis. Ethical considerations Ethical issues were considered throughout the research process according to ethical principles and scientific guidelines. Informed consent was obtained from the informants, confidentiality regarding the data material was guaranteed and quotations were anonymized. Results A caring relationship between nursing students and supervisors is based on mutual respect, the ethos of responsibility, motivation, willingness and professionalism. Dignity and a caring ethical approach, where nursing students feel they belong, are recognized, seen and heard enables learning and professional development. It is also significant that the supervisor’s actions and reflections are ethically defensible, equal and protect nursing students from suffering and various power relationships in clinical practice. Conclusion A good cooperative relationship and shared responsibility between the nurse education institution, which offers theory and prepares nursing students for the encounter with clinical practice and the healthcare organizations is crucial for enabling a caring relationship in clinical supervision. (shrink)

As pressure to publish increases in the academic nursing world, journal submission numbers and rejection rates are soaring. The review process is crucial to journals in publishing high quality, cutting‐edge knowledge development, and to authors in preparing their papers to a high quality to enable the nursing world to benefit from developments in knowledge that affect nursing practice and patient outcomes and the development of the discipline. This paper does not intend to contribute to the debate (...) regarding the ethics of reviewing, but rather seeks to explore notions of how the quality of the reviewing process can be enhanced to benefit authors, the reviewers, and the state of nursing knowledge. Furthermore, a call is made to editors to devise strategies for aiding reviewers to attain higher validity and reliability within the reviewing process by establishing clear standards and expectations and to ensure published work is judged against industry norms for quality. (shrink)

Background Belonging to the clinical environment and the professional values of the performers play a role in forming a professional identity. Therefore, it is necessary to understand the degree of connection among these concepts. Aim This study aimed to examine the mediating effects of professional values on the relationship between nurses’ clinical environment belongingness and professional identity. Design In the present study, a descriptive cross-sectional multicenter design was used. Participants and research context A convenient sample of 635 nurses recruited from (...) three hospitals in Fars Province, Southern Iran, from September 2023 to January 2024. Nurses Professional Values Scale–Revised, Clinical Environment Belongingness Scale, and Professional Identity Scale were used to collect the data. The mediation model was analyzed using SPSS v27 and the Process Macro 4.0. Ethical considerations The protocol of this study was approved by the Research Ethics Committee of Fasa University of Medical Sciences, and informed consent was obtained from all nurses. The study conforms to the principles outlined in the Declaration of Helsinki. Results Based on the results of regression analysis, clinical environment belongingness had a positive and significant impact on professional identity (β = 0.366, p < 0.001) and professional value (β = 0.676, p < 0.001). Professional value significantly predicted professional identity (β = 0.170, p < 0.001). The indirect effect of clinical environment belongingness on professional identity via professional values was statistically significant (β = 0.115, SE = 0.024, 95% CI = [0.068, 0.162]), and this effect was directly (β = 0.336, SE = 0.034, 95% CI = [0.297, 0.434]) significant. Conclusions The new theoretical framework for nurses developed in this study can contribute to professional development. It is further recommended that the promotion of professional value and clinical environment belongingness may be effective in enhancing the professional identity of the nursing staff, as indicated by the results. (shrink)

The aims of this study were to present themes in nursing motifs as depicted in tattoos and to describe how it reflects upon nursing in popular culture as well as within professional nursing culture. An archival and cross‐sectional observational study was conducted online to search for images of nursing tattoos that were freely available, by utilizing the netnographic methodology. The 400 images were analyzed in a process that consisted of four analytical steps focusing on metaphors (...) and meanings in the tattoos. The findings present four themes: angels of mercy and domination; hegemonic nursing technology; embodying the corps; and nurses within the belly of the monster. The tattoos serve as a mirror of popular culture and the professional culture of nurses and nursing practice within the context of body art. Body art policy statements have been included in nursing personnel dress code policies. Usually these policies prohibit tattoos that are sexist, symbolize sex or could contribute and reproduce racial oppression. The results show that the tattoos can be interpreted according to several layers of meanings in relation to such policies. We therefore stress that this is an area highly relevant for further analyses in nursing research. (shrink)

A personal and professional issue that confronts all nurses is that of attempting to understand the experiences of our patients or clients. The position taken here is that understanding another person as a human being is much more than being able to explain their experience according to a particular model of ill‐health. Rather, it is an issue of human dignity and respectfulness. Gadamerian hermeneutics has been used in nursing research to articulate the process of understanding and to develop (...) interpretations of particular experiences. Gadamer's exposition of understanding shows that we need to be aware that our understanding of other people is developed through a fusion of our own history, language and culture with that of the other person. This occurs through a hermeneutic question–answer dialogue in which we put our ideas at risk of being modified or rejected in the process. Understanding then, is a perceptual and conceptual process in which we fully participate. In this way, the experience of understanding those we nurse increases our understanding of ourselves as well as enhancing our ability to further understand others. (shrink)

BackgroundAlthough nurses are crucial to ensure patients’ peaceful death in hospitals, many nurses experience various ethical conflicts during end-of-life care. Therefore, research on nurses’ entire ethical decision-making process is required to improve nurses’ ethical decision-making in end-of-life care. This study aimed to identify Korean nurses’ ethical decision-making process based on their moral sensitivity to end-of-life patients.MethodsIn total, 171 nurses caring for terminal patients responded to the survey questionnaire. To measure the participants’ moral sensitivity and ethical decision-making process, (...) we used the Korean version of the Moral Sensitivity Questionnaire and Nurses’ Ethical Decision-Making around End of Life Care Scale. Finally, multiple linear regression analysis was used to investigate the effect of moral sensitivity on nurses’ ethical decision-making.ResultsThe mean of moral sensitivity was 4.8 ± 0.5 (out of 7), and that of ethical decision-making was 4.6 ± 0.5 (out of 6). Among the sub-dimensions of ethical decision-making, the highest score was in perceived professional accountability (5.2 ± 0.5), and the lowest in moral reasoning and moral agency (3.9 ± 0.6); the score of moral practice was 4.4 ± 0.7. In the multiple linear regression model, moral sensitivity (β = 0.852, p <.001), clinical department (β = − 7.018, p =.035), ethics education (β = 20.450, p <.001), job satisfaction (β = 5.273, p <.001), and ethical conflict (β = − 2.260, p = 0.031) were influential ethical decision-making factors.ConclusionsThis study revealed a gap between nurses’ thoughts and practices through the ethical decision-making process. They failed to lead their thought to moral practice. It also implies that moral sensitivity could positively affect nurses’ ethical decision-making. To make nurses morally sensitive, exposing them to various clinical cases would be helpful. Additionally, ethics education and clinical ethics supporting services are valuable for improving nurses’ ethical decision-making. If nurses improved their ethical decision-making regarding end-of-life care, their patients could experience a better quality of death. (shrink)

Background: Nursing students experience ethical conflicts and challenges during their clinical education. These may lead to moral distress and disturb the learning process. Objectives: This study aimed to explore and to evaluate the nursing students’ ethical challenges in the clinical settings in Iran. Research design: This was a mixed-methods study with an exploratory sequential design. Participants and research context: A total of 37 and 120 Iranian nursing students participated in the qualitative and quantitative phases, respectively. Ethical (...) considerations: The ethical committee of Kerman University of Medical Sciences, Iran, approved the protocol of the study. Findings: Three main categories were extracted from qualitative data including Low attention of nurses to the patients’ preferences; Lack of authority; and Inadequate support. A total of 97% of the students had more than one ethical challenge in clinical settings and 48% of them stated that their challenges did not resolve. The total score of perceived ethical challenges was 62.03 ± 9.17, which was moderate. The highest mean score related to the “Low attention of nurses to the patients’ preferences” subscale. Discussion: The finding confirmed most of the existing results of other international researches about the frequency and kinds of baccalaureate nursing students’ ethical challenges. Conclusion: Identifying student ethical challenges helps teachers to manage their clinical learning process better. This study may provide a view for the nurses, clinical educators, and managers toward nursing students’ ethical challenges and their impact on nursing students’ clinical experiences. (shrink)

The work of nursing involves both treatment orientated action and care orientated action, but there exists a ‘treatment–care’ dichotomy that is structured by social factors and views of knowledge that privilege scientific, instrumental rationality. It is a claim of this paper that there is a need to establish connections between ‘treatment’ and ‘care’. The study of work processes in the healthcare field make it possible for nursing to recognize the technical and social separation of work, the separation between (...) manual and intellectual work, the dominance of medicine among healthcare professionals, and other relations of power within institutions. The authors believe that Habermas' theory of communicative action offers an alternative view, one suitable for transforming healthcare practices and helping nurses build new responses to healthcare needs. (shrink)

Nursing professionalization is both ongoing and global, being significant not only for the nursing workforce but also for patients and healthcare systems. For this reason, it is important to have an in‐depth understanding of this process and the factors that could affect it. This literature review utilizes a welfare state approach to examine macrolevel structural determinants of nursing professionalization, addressing a previously identified gap in this literature, and synthesizes research on the relevance of studying nursing (...) professionalization. The use of a welfare state framework facilitates the understanding that the wider social, economic, and political system exercises significant power over the distribution of resources in a society, providing a glimpse into the complex politics of health and health care. The findings shed light on structural factors outside of nursing, such as country‐level education, health, labor market, and gender policies that could impact the process of professionalization and thus could be utilized to strengthen nursing through facilitating increased professionalization levels. Addressing gender inequalities and other structural determinants of nursing professionalization could contribute to achieving health equity and could benefit health systems through enhanced availability, skill‐level, and sustainability of nursing human resources, improved and efficient access to care, improved patient outcomes, and cost savings. (shrink)

Historically nurses have lacked significant input in end-of-life decision-making, despite being an integral part of care. Nurses experience negative feelings and moral conflict when forced to aggressively deliver care to patients at the EOL. As a result, nurses participate in slow codes, described as a limited resuscitation effort with no intended benefit of patient survival. The purpose of this study was to explore and understand the process nurses followed when making decisions about participation in limited resuscitation. Five core categories (...) emerged that describe this theory: (1) recognition of patient and family values at the EOL; (2) stretching time and reluctance in decision-making; (3) harm and suffering caused by the physical components of CPR; (4) nurse’s emotional and moral response to delivering aggressive care, and; (5) choosing limited resuscitation with or without a physician order. Several factors in end-of-life disputes contribute to negative feelings and moral distress driving some nurses to perform slow codes in order to preserve their own moral conflict, while other nurses refrain unless specifically ordered by physicians to provide limited care through tailored orders. (shrink)

Background: Informal coercion, that is, situations where caregivers use subtle coercive measures to impose their will on patients, is common in adult psychiatric inpatient care. It has been described as ‘a necessary evil’, confronting nurses with an ethical dilemma where they need to balance between a wish to do good, and the risk of violating patients’ dignity and autonomy. Aim: To describe nurses’ experiences of being involved in informal coercion in adult psychiatric inpatient care. Research design: The study has a (...) qualitative, inductive design. Participants and research context: Semi-structured interviews with 10 Swedish psychiatric nurses were analysed with qualitative content analysis. Ethical considerations: The study was performed in accordance with the Declaration of Helsinki. In line with the Swedish Ethical Review Act, it was also subject to ethical procedures at the university. Findings: Four domains comprise informal coercion as a process over time. These domains contain 11 categories focusing on different experiences involved in the process: Striving to connect, involving others, adjusting to the caring culture, dealing with laws, justifying coercion, waiting for the patient, persuading the patient, negotiating with the patient, using professional power, scrutinizing one’s actions and learning together. Discussion: Informal coercion is associated with moral stress as nurses might find themselves torn between a wish to do good for the patient, general practices and ‘house rules’ in the caring culture. In addition, nurses need to be aware of the asymmetry of the caring relationship, in order to avoid compliance becoming a consequence of patients subordinating to nurse power, rather than a result of mutual understanding. Reflections are thus necessary through the process to promote mutual learning and to avoid violations of patients’ dignity and autonomy. Conclusion: If there is a need for coercion, that is, if the coercion is found to be an ‘unpleasant good’, rather than ‘necessary evil’ considering the consequences for the patient, it should be subject to reflecting and learning together with the patient. (shrink)

Background Despite its negative impact on patients and nurses, the use of restraint in somatic health care continues in many settings. Understanding the reasons and justifications for the use of restraint among nurses is crucial in order to manage this challenge. Aim To understand nurses’ justifications for restraint use in neurosurgical care. Research design A qualitative, descriptive design was used. Data were analysed with inductive qualitative content analysis. Participants and research context Semi-structured interviews with 15 nurses working in three neurosurgical (...) departments in Sweden. Ethical considerations Approved by The Regional Ethics Committee, Stockholm, Sweden. Findings The analysis resulted in three categories. The category Patient factors influencing restraint use describes patient factors that trigger restraint, such as a diminished decision-making competence, restlessness, and need for invasive devices. The category Specific reasons for justifying restraint describes reasons for restraining patients, such as restraint being used for the sake of the patient or for the sake of others. The category General reasoning in justifying restraint describes how nurses reason when using restraint, and the decision to use restraint was often based on a consequentialist approach where the nurses’ weighed the pros and cons of different alternatives. Discussion Nurses with experience of restraint use were engaged in a constant process of justifying and balancing different options and actions. Restraint was considered legitimate if the benefit exceeded the suffering, but decisions on which restraint measures to use and when to use them depended on the values of the individual nurse. Conclusion How nurses reason when justifying restraint, why they use restraint, and who they use restraint on must be considered when creating programs and guidelines to reduce the use of restraint and to ensure that when it is used it is used carefully, appropriately, and with respect. (shrink)

알프레드 노쓰 화이트헤드(Alfred North Whitehead, 1861-1947)는 과정철학이라는 독특한 철학을 발전시킨 20세기의 위대한 철학자이다. 그가 주창한 과정철학은 흔히 유기체 철학(philosophy of organism)이라고 불리운다. 화이트헤드는 유기체적인 관점을 통해 철학의 근본 문제를 새롭게 설명하면서, 과학과 철학의 결합을 통해 매우 풍요로운 결실을 맺은 철학자로 평가받고 있다. 화이트헤드 본인도 밝혔듯이, 과정철학의 유기체적이며 관계적인 우주론은 서구 철학과 사상보다도 아시아의 사상과 많은 유사점을 지니고 있다는 점에서 한국의 현실에서 보다 제대로 이해될 수 있으며, 다양한 학문 영역과의 대화를 통해 새롭게 발전할 수 있을 것이다. 특히 화이트헤드 과정철학을 통해 얻게 (...) 되는 철학적 통찰은 우리나라의 교육 현실에 매우 적절하며 의미 있는 시사점을 제시할 수 있다. 오늘날 우리 사회가 처한 교육의 문제는 새로운 대안이나 개혁이 잘 못되었다기보다는 우리의 교육이 근거하고 있는 철학의 부재로 인해 발생했다고 볼 수 있기 때문이다. 현재 우리나라는 다문화 사회로 변해가고 있다. 그동안 단일민족이라는 신화를 중심으로 지탱해왔던 단일민족 국가라는 환상은 깨지고 있다. 1980년대부터 유입되기 시작한 외국인 노동자, 인종간의 결혼, 북한 이탈 주민 등으로 인해 우리 사회는 이제 다문화의 문제를 더 이상 외면할 수 없게 되었다. 이런 현실에서 다문화교육은 시대적으로 필수불가결한 교육의 내용이 되었다. 특히 다문화 이주민들의 건강문제를 담당하는 간호사들이 이들에게 보다 효과적이고 적절한 의료서비스를 제공하기 위해서는 다문화간호교육이 필수적이다. 본 논문에서는 화이트헤드의 과정철학이 시대적으로 요청되는 다문화간호교육에 철학적으로 어떤 의미를 줄 수 있는지 살펴보고자 한다. 이를 위해, 본 논문에서는 철학과 간호학의 융복합적인 관점에서 논의를 전개하고자 한다. 먼저, 화이트헤드 과정 철학의 개요에 대해 주요 범주들을 중심으로 살펴보고자 한다. 다음으로, 다문화간호교육의 개념을 살펴본 후, 화이트헤드의 과정철학이 다문화간호교육에게 주는 의미에 대해 논하고자 한다. 결론적으로 서로 상이한 성격을 지닌 철학과 간호학의 융복합적 연구가 지니는 의미와 한계 및 과제를 제시하고자 한다. (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)

Scholars of color have been instrumental in advancing nursing knowledge development but find limited spaces where one can authentically share their philosophical perspective. Although there is a call for antiracism in nursing and making way for more diverse and inclusive theories and philosophies, our voices remain at the margins of nursing theory and philosophy. In nursing philosophy, there continues to be a lack of racial diversity in those who are given the platform to share their scholarship. (...) Five nurse scholars of color attended the International Nursing Philosophy Conference in August 2022. We established a collective system of support by sharing our experiences as researchers, scholars, and educators with each other. The theory of emancipatory nursing praxis informed this process. In this dialogue, we reflected on what it is like to present at and attend predominantly white nursing conferences. We shared our experiences of how we exist as nurse scholars, our philosophical views, and our thoughts on how we create spaces where scholars of color can feel welcomed and acknowledged for their contributions to advancing nursing knowledge. (shrink)

The aim of this study was to deepen nurses’ understanding of the importance of carefully managing the first nurse-patient encounter in a psychiatric setting according to each patient’s suffering and future hopes. The study was carried out using an action research approach. The action planned was the implementation of a conceptual model reflecting Eriksson’s caring theory. Data were collected by interviews with nurses and observational notes kept in a research diary. The data analysis followed the procedure of qualitative content analysis. (...) A generalization of the entire learning process shows the first nurse-patient encounter to be a moral commitment in nursing. A theoretical framework of nursing assessment conveying knowledge about the patient as unique and being a whole person can support the nurse in encouraging the patient to enter into a relationship. This insight stimulated the nurses in this study to reflect on the moral responsibility of continuing the relationship and initiating an ongoing nursing process. Awareness of this responsibility made them reflect more on the possibility of nurses taking autonomous actions in order not to abandon the patient and to avoid feeling guilty. (shrink)