Background: Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety. Objectives: The purpose of this review was to describe how dilemmas and environmental, relational, and (...) organizational factors contribute to moral distress in undergraduate student nurses during their clinical experience and professional education. Research design: The research design was a systematic literature review. Method: The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check. Ethical consideration: Since this was a systematic review, no ethical approval was required. Findings: From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses. Conclusion: Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students. (shrink)

Background: Prisons are contexts where nurses are required to have specific skills to ensure that, in a setting designed for the expiation of crime, prisoners receive the same type of care as anyone else. But this is not always the case, giving rise to ethical issues. Research questions: ‘How do correctional nurses describe their working experience in prisons? What issues emerged?’ Methodology: This is a qualitative descriptive study. Following purposive sampling, we conducted five focus groups. Thematic analysis was used to (...) analyse the data. Participants and research context: Our sample included 31 correctional nurses in seven prisons in Northern Italy. Ethical considerations: The scientific merit of this study was recognized by the Academic Board of the University of Genoa. Approval to conduct the study was obtained from the Liguria Regional Government that funded this study and from the Local Health Authority that was the prison nurses’ employer. Formal consent was obtained from all the nurses who volunteered to participate in this study. Findings: Five themes emerged from the focus groups: (1) prisoners’ healthcare needs, (2) negotiation between custody and care, (3) satisfaction of working in prisons, (4) obstacles to quality care and (5) safety. ‘Manipulation’ was a transversal theme that emerged from all the focus groups. Discussion: The problems generated by the clash between prison security and nursing care priorities did not enable nurses to practice autonomously and provide the best possible to care prisoners, giving rise to ethical issues and moral distress. This in turn causes high nursing turnover rates that negatively impact continuum of care. Conclusion: In Italy, correctional nurses urgently require specific education interventions with the participation of all those who work in prisons. Interventions based on the post-modern concept of restorative nursing could offer prison nurses the opportunity to both resolve ethical issues and reduce moral distress. (shrink)

Background: Paediatric nurses often face complex situations requiring decisions that sometimes clash with their own values and beliefs, or with the needs of the children they care for and their families. Paediatric nurses often use new technology that changes the way they provide care, but also reduces their direct interaction with the child. This may generate ethical issues, which nurses should be able to address in the full respect of the child. Research question and objectives: The purpose of this review (...) is to describe the main ethical dimensions of paediatric nursing. Our research question was, ‘What are the most common ethical dimensions and competences related to paediatric nursing?’ Research design: A rapid evidence assessment. Method: According to the principles of the rapid evidence assessment, we searched the PubMed, SCOPUS and CINAHL databases for papers published between January 2001 and March 2015. These papers were then independently read by two researchers and analysed according to the inclusion criteria. Ethical considerations: Since this was a rapid evidence assessment, no approval from the ethics committee was required. Findings: Ten papers met our inclusion criteria. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process. Conclusion: Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses’ perceptions and experiences. Paediatric nurses require specific educational interventions to help them resolve ethical issues, contribute to the decision-making process and fulfil their role as advocates of a vulnerable population (i.e. sick children and their families). Further research is needed to investigate how paediatric nurses can improve the involvement of children and their families in decision-making processes related to their care plan. (shrink)

En este artículo se revisa la noción jurídica y moral de dignidad personal, más allá de los enfoques realistas y constructivistas tout court, para llegar a colocar de relieve modos de sufrimiento y experiencias del daño. Las herramientas con las que cuentan habitualmente las perspectivas jurídicas y morales al momento de identificar y juzgar cursos de acción no parecen ser suficientes si fijamos la atención en la fragilidad y la precariedad ontológica que caracteriza a la subjetividad. Indicar la naturaleza relacional (...) de la dignidad, y solventar la perjudicial adherencia entre lo jurídico y lo moral como consecuencia de su empleo, serán objetivos perseguidos en el artículo, al desembarazarse de enfoques realistas o naturalistas y rechazar cualquier atisbo romanticista que no considere las disonancias requeridas para la dignidad o exponga a los menos aventajados ante situaciones injustificadas de poder y dominación. (shrink)

El artículo aborda la función material que ocupa en nuestro tiempo la universidad, y dentro de ella las humanidades, en relación con la generación, apropiación y fiscalización del saber. Para ello se abordan sus contemporáneas formas de corporativización, precarización laboral, mercantilización y burocratización, y se elabora un marco teórico materialista que permite analizarlas en relación con las estructuras vigentes de producción capitalista. El marco teórico es estructurado con base en los conceptos de general intellect (Karl Marx), cuerpo y técnica (Paolo (...) Virno), y experiencia (Walter Benjamin), y sirve a los autores para ofrecer un análisis acerca de la impotencia que exhiben las humanidades a la hora de actualizar algún componente de la promesa material que algunos teóricos identifican en aquel saber público denominado general intellect. El artículo sugiere que dicha impotencia radica en la promoción de una experiencia laboral universitaria signada por la ambigüedad de la técnica (que oscila entre su ausencia y falsa presencia), la aislación individual, la precariedad material y temporal, y la generación endémica de síntomas tanto físicos como anímicos en sus trabajadores (docentes e investigadores). Como saldo, se recomienda orientar el análisis de estos problemas hacia la dificultosa relación que la universidad traba con el general intellect. (shrink)