[Pain and suffering. Ethics aspects]. / Dolor y sufrimiento. Aspectos eticos.

The understanding of pain and suffering have evolved throughout the different stages of history. In modern times, pain, thanks to scientific and technological advances has been dealt with more efficiently although there is still a long way to go towards the relief of suffering due to its complexity. Good nursing care requires nurses to have good training as well as having the ability to relate to patients. They also need professional maturity in order to deal with emotional problems arising from pain and suffering. New nursing theories place responsibility with the nurse when treating the challenges brought about by pain and suffering.

Dolor y sufrimiento. Aspectos éticos / Pain and suffering. Ethics aspects

El significado de los conceptos de dolor y sufrimiento ha evolucionado a lo largo de las diferentes etapas de la historia. En la época moderna el dolor, gracias a los avances científicos y tecnológicos, ha podido ser combatido con más eficacia, quedando aún mucho camino por recorrer en el alivio del sufrimiento, por su complejidad. Unos buenos cuidados enfermeros requieren de las enfermeras, además de una gran formación, poseer gran habilidad para relacionarse con los pacientes y madurez profesional para hacer frente a los problemas emocionales que éstos comportan. Nuevas teorías defienden la responsabilidad de la enfermera frente a los retos que plantean el dolor y sufrimiento(AU)

The understanding of pain and suffering have evolved throughout the different stages of history. In modern times, pain, thanks to scientific and technological advances has been dealt with more efficiently, although there is still a long way to go towards the relief of suffering due to its complexity. Good nursing care requires nurses to have good training as well as having the ability to relate to patients. They also need professional maturity in order to deal with emotional problems arising from pain and suffering. New nursing theories place responsibility with the nurse when treating the challenges brought about by pain and suffering(AU)

[Autonomy and informed consent in surgical care-patients' and staff perceptions]. / Autonomie und informierte Zustimmung in der Pflege chirurgischer Patienten aus Sicht von Patienten und Pflegenden.

The aim of this study was to describe autonomy and informed consent in surgical care. The study is a part of the international BIOMED 2 project "Patients' Autonomy and Privacy in Nursing Interventions" (BIOMED2, BMH4-CT98-3555; 1998-2001) supported by the European Commission. For this study, data of patients (n = 254) and nurses (n = 205) in eleven Berlin hospitals and three hospitals outside Berlin were collected by means of a structured questionnaire. The findings of the study indicate, that information-giving was more positive than decision-making. Patients perceived they were more frequently informed about their surgery than about their care. According to the perceptions of nurses the case was reversed. The perceptions of both groups differed, since from the point of view of nurses, patients' autonomy was more frequently heeded and their consent was sought more often than from the point of view of the patients. Patients admitted as emergencies and in multi-bed rooms perceived their autonomy more negatively than those with a planned surgery or in single rooms. Elderly nurses were more frequently than younger nurses of the opinion to grant patients autonomy. Nurses with a longer working experience in nursing care perceived that patients were more frequently asked their consent. Further, nurses with a higher educational qualification and with a higher occupational status perceived decision-making more negatively. The findings of the present study give implications for clinical practice, nursing education, and for further research.

Self-determination in surgical patients in five European countries.

OBJECTIVE: To analyze the effects of informational support, desire for behavioral involvement in health decision-making (behavioral involvement), opportunities to make decisions, and independence on subjective health status in surgical patients. A theoretical model of self-determination was applied and tested. METHODS: The data were collected by structured questionnaires with a sample of 1,454 surgical patients in five European countries. LISREL analyses were used to test the theoretical causal model of self-determination. RESULTS: Patients' perceptions of informational support received from nursing professionals and their desired involvement in health decision-making affected patients' opportunities to make decisions and further their independence level, which in turn affected patients' subjective health status. CONCLUSIONS: Understanding of factors that increase self-determination in patients can help health care professionals to promote patients' well-being.

Perceptions of autonomy, privacy and informed consent in the care of elderly people in five European countries: general overview.

Ethical issues in the care of elderly people have been identified in many countries. We report the findings of a comparative research project funded by the European Commission, which took place between 1998 and 2001. The project explored the issues of autonomy (part I), privacy (part II) and informed consent (part III) in nursing practice. Data were collected from elderly residents/patients (n = 573) and nursing staff (n = 887) in five European countries: Finland, Spain, Greece, Germany and the UK (Scotland). Questionnaires were used as the data collection tool (self-completion questionnaires for staff, structured interviews for the elderly participants). Four basic nursing interventions in the care of elderly people were targeted: hygiene, fluid intake and nutrition, medication, and elimination. The data were analysed statistically. The results indicated differences within all five countries between staff and patient perceptions of autonomy, privacy and informed consent. There were also similar differences between individual countries. Conclusions were reached concerning practice, education and research. This is the first of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

Perceptions of autonomy in the care of elderly people in five European countries.

The focus of this article is perceptions of elderly patients and nurses regarding patients' autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which patients received information from nursing staff or were offered opportunities to make decisions. This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

Perceptions of privacy in the care of elderly people in five European countries.

The focus of this article is on elderly patients' and nursing staff perceptions of privacy in the care of elderly patients/residents in five European countries. Privacy includes physical, social and informational elements. The results show that perceptions of privacy were strongest in the UK (Scotland) and weakest in Greece. Country comparisons revealed statistically significant differences between the perceptions of elderly patients and also between those of nurses working in the same ward or long-term care facility. Perceptions of privacy by patients and their nursing staff were quite similar in Finland, Germany and the UK. In contrast, in Greece and Spain these perceptions were different: nurses believed that they took account of their patients' privacy needs more often than the patients themselves felt this was the case. Among Spanish and UK patients, an association was found between lower levels of independence and comparatively less positive perceptions of privacy. No associations were established between nurses' perceptions and their demographic factors. This is the third of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

Perceptions of informed consent in the care of elderly people in five European countries.

The focus of this article is on elderly patients' and nursing staff perceptions of informed consent in the care of elderly patients/residents in five European countries. The results suggest that patients and nurses differ in their views on how informed consent is implemented. Among elderly patients the highest frequency for securing informed consent was reported in Finland; the lowest was in Germany. In contrast, among nurses, the highest frequency was reported in the UK (Scotland) and the lowest in Finland. In a comparison of patients' and nurses' perceptions, nurses had more positive views than patients in all countries except Finland. Patients with less need for nursing interventions in Greece and Spain gave their consent less often. The German and Greek patients were older, and the results also point to an association between this and their lower frequency of giving consent. In Spain, patients who were married or who had a family member or friend to look after their personal affairs were more likely to be included in the group whose consent was sought less often. This is the fourth of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

Perceptions of autonomy, privacy and informed consent in the care of elderly people in five European countries: comparison and implications for the future.

This article discusses nurses' and elderly patients' perceptions of the realization of autonomy, privacy and informed consent in five European countries. Comparisons between the concepts and the countries indicated that both nurses and patients gave the highest ratings to privacy and the lowest to informed consent. There were differences between countries. According to the patient data, autonomy is best realized in Spain, privacy in the UK (Scotland), and informed consent in Finland. For the staff data, the best results tended to concentrate in the UK. The conceptual and methodological limitations of the study are identified and discussed. Implications of the results are divided into three areas: nursing practice, education and research. In practice, the analysis of patients' values and the ethical sensitivity of nurses are important as part of ethically good care. In nurse education, students should learn to recognize ethical problems, generally and particularly, among vulnerable groups of patients. Multicultural international research is needed in this area. This is the last of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

Maintaining privacy on post-natal wards: a study in five European countries.

AIM: Maintaining privacy on post-natal wards: a study in five European countries Aim. To describe how mothers' privacy is maintained on post-natal wards in five European countries: Finland, Spain, Greece, Germany and Scotland [United Kingdom (UK)] BACKGROUND: Privacy is an important concept in nursing and nursing ethics. Empirical studies in this field, however, are few. In this study, privacy is defined as comprising both physical and social-informational dimensions and both the perceptions of mothers and professional were investigated. METHODS: The data were collected by a questionnaire from mothers (n=1192) and midwife/nursing staff (n=952). RESULTS: The results revealed differences both between the different countries and between patients' and professionals' views. Mothers in Finland, Germany and Scotland felt their privacy was maintained better than mothers in Greece and Spain. The differences in staff perceptions are less clear-cut. Different background factors emerge as statistically significant in different countries. CONCLUSION: Empirical studies in privacy are important and give ideas about the problems in nursing practice. Future analyses should look also at other areas of nursing.

Autonomía y consentimiento informado en centros sociosanitarios en cataluña. percepciones de ancianos y enfermeras en España (iii) / Autonomy and Informed Consent in Health Care Centers in Catalonia (Spain). Perception of Elderly Patients and Nursing Staff (III)

En este tercer artículo se exponen los resultados parciales de la muestra correspondiente al grupo de ancianos del estudio multicéntrico financiado por la Comisión Europea: Autonomía, Privacidad y Consentimiento Informado e Intervenciones de Enfermería. Dicho estudio ha contado con la participación de Finlandia, Alemania, Grecia, Reino Unido y España. Su objetivo es describir y analizar desde la dimensión jurídica y ética el principio de autonomía y el consentimiento informado en centros sociosanitarios de Cataluña. Los datos han sido recogidos en cuatro centros, mediante entrevistas y basándose en unos cuestionarios estructurados (ancianos y enfermeras), diseñados especialmente para este estudio. La muestra corresponde a 100 ancianos y 132 enfermeras. Los resultados han sido tratados estadísticamente y muestran que existen diferencias entre las percepciones de los ancianos y las enfermeras respecto a las intervenciones de enfermería, concernientes a la autonomía y el consentimiento informado.Asimismo, se hallaron diferencias en función de los antecedentes. El primer y el segundo artículos del estudio acerca de los cuidados maternales y cuidados quirúrgicos fueron publicados en el volumen 11, números 5 y 6 de ENFERMERÍA CLÍNICA. (AU)

Autonomía y consentimiento informado en unidades quirúrgicas. percepciones de pacientes y enfermeras en españa / Autonomy and informed consent in surgical units. Patient and nursing staff perception in Spain

En este segundo artículo se presentan los resultados del estudio sobre los pacientes y enfermeras de servicios de cirugía de España. Dicho estudio es la segunda parte de un proyecto financiado por la Comisión Europea y en el que han participado, además de España, los siguientes países: Finlandia, Alemania, Gran Bretaña (Escocia) y Grecia. El objetivo de este estudio, comparativo, multicultural y multicéntrico, es describir y analizar las percepciones de los pacientes y enfermeras acerca de cómo éstas respetan los derechos de autonomía y consentimiento informado de los pacientes ingresados en las unidades de hospitalización quirúrgicas. La muestra corresponde a 173 pacientes y 233 enfermeras. Los datos han sido recogidos en 6 hospitales universitarios y/o generales de España, mediante unos cuestionarios estructurados y especialmente diseñados para este estudio y, a su vez, han sido analizados tanto desde la perspectiva jurídica como ética. Los resultados han sido tratados estadísticamente, y demuestran que existen diferencias significativas tanto en los antecedentes como en las percepciones, entre los pacientes y las enfermeras respecto a las intervenciones de enfermería concernientes a la autonomía y al consentimiento informado. El primer artículo del estudio acerca de los cuidados maternales fue publicado en el volumen 11, número 5 de ENFERMERÍA CLÍNICA (AU)