ABSTRACT
The aims of this study were to identify (1) the ethics and human rights issues experienced by nurses in leadership roles (NLs); (2) how frequently these issue occurred in the NLs'practices; and (3) how disturbed the NLs were by the issues. Dillman's Total Design Method (1978) for mailed surveys guided the study design. Data analysis was performed on 470 questionnaires from New England RNs in nursing leadership roles. The most frequently experienced ethics and human rights issues during the previous 12 months were (1) protecting patient right and human dignity; (2) respecting or not respecting informed consent to treatment; (3) use or nonuse of physical or chemical restraints; (4) providing care with possible risks to the RN's health; (5) following or not following advance directives; and (6) staffing patterns that limit patient access to nursing care. The most disturbing ethics and human rights issues experienced by the NLs were staffing patterns that limited patient access to nursing care, prolonging the dying process with inappropriate measures, working with unethical, incompetent, or impaired colleagues, implementing managed care policies that threaten quality of care, not considering quality of the patient's life, and caring for patients and families who are uninformed or misinformed about treatment, prognosis, or medical alternatives. Nearly 39% of the NLs reported experiencing ethics and human rights issues one to four times a week or more, and more than 90% handled their most recent ethics issue by discussing it with nursing peers. Study findings have implications for ethics education and resource support for nurses in leadership roles, and for further research on how NLs handle ethics and human rights issues in the workplace.
Subject(s)
Ethics, Nursing , Human Rights , Leadership , Nurse Administrators/ethics , Nurse's Role/psychology , Adaptation, Psychological/ethics , Adult , Advance Directives/ethics , Aged , Attitude of Health Personnel , Factor Analysis, Statistical , Female , Humans , Male , Middle Aged , New England , Nurse Administrators/organization & administration , Nurse Administrators/psychology , Nursing Administration Research , Nursing Methodology Research , Nursing Staff/supply & distribution , Patient Rights/ethics , Personnel Staffing and Scheduling/ethics , Restraint, Physical/ethics , Surveys and QuestionnairesABSTRACT
The purpose of this article is to describe the development of a model of moral distress in military nursing. The model evolved through an analysis of the moral distress and military nursing literature, and the analysis of interview data obtained from US Army Nurse Corps officers (n = 13). Stories of moral distress (n = 10) given by the interview participants identified the process of the moral distress experience among military nurses and the dimensions of the military nursing moral distress phenomenon. Models of both the process of military nursing moral distress and the phenomenon itself are proposed. Recommendations are made for the use of the military nursing moral distress models in future research studies and in interventions to ameliorate the experience of moral distress in crisis military deployments.
Subject(s)
Attitude of Health Personnel , Burnout, Professional/psychology , Ethics, Nursing , Military Nursing/organization & administration , Models, Nursing , Models, Psychological , Nursing Staff/psychology , Adaptation, Psychological , Adult , Burnout, Professional/diagnosis , Burnout, Professional/etiology , Burnout, Professional/prevention & control , Conflict, Psychological , Female , Humans , Male , Middle Aged , Nursing Methodology Research , Risk Factors , Surveys and Questionnaires , United StatesABSTRACT
... The essays in this issue of the Journal highlight the types of insights that nursing ethics brings to health care ethics, in general, and attempt to address questions about the adequacy of the conceptual and theoretical foundations of bioethics for a practice discipline like nursing. The essays are written by nurses and non-nurses and bring a surprising balance to the discussion of important issues in nursing ethics from several perspectives. The essays do not represent the full scope of philosophical thought and normative judgements in nursing ethics at the present time, but they do provide a view of nursing ethics through the lens of nursing ethics research, past and present. [Introductions follow to essays by Joy H. Penticuff, Joan Liaschenko and Anne J. Davis, Nancy S. Jecker and Donnie J. Self, Betty J. Winslow and Gerald R. Winslow, Robert J. Connelly, Patricia A. Roth and Janet K. Harrison, and Kevin Wildes].
Subject(s)
Ethics, Nursing , Aged , Bioethics , Chronic Disease , Decision Making , Empathy , Ethical Theory , Ethics , Humans , Medicine , Nurse-Patient Relations , Nurses , Nutritional Support , Patient Care , Placebos , Social Values , VirtuesABSTRACT
...teaching institutions should establish policies for all aspects of care provided by residents-in-training (not just for the acquisition of informed consent to treatment) and establish mechanisms to monitor how these policies are implemented and their effect on the quality of patient care and patient satisfaction with care. Clear policy on which treatments are provided by junior residents and which treatments and aspects of care are provided by senior residents is necessary for patients and their families to have control over what happens to them in the health-care institution.... Teaching institutions should regularly assess whether residents are being asked to take on more responsibilities in patient care than they are prepared to do. The reasons to do this are not solely related to protecting the patient from harm. Protecting the residents-in-training from overwhelming guilt, fear, and providing them with a more humane approach to medical education should be a minimal expectation for the training of those who will be expected to provide humane care to others....
