Improving patient care through the use of research.

Developing research-based clinical practice is a challenging goal. Practice based on rigorously acquired knowledge is preferred to tradition, trial and error, or simply the advice of a colleague. The use of a systematic approach for this process will facilitate the clinician's ability to reach such a goal. An eight-step method is described as a basic guide to complete the process--from problem identification to dissemination of the results of the experience. Other important steps include summarizing the related research, development of an innovation, analysis of the setting, planning and implementing the change process, and evaluation of the outcomes. Rewards for engaging in this activity as well as limitations are addressed.

Using web-based discussion as a teaching strategy: bioethics as an exemplar.

Using web-based discussion as a teaching strategy: bioethics as an exemplar Nurses are required to be competent in the area of bioethics based on several accreditation standards. Bioethics courses are one strategy to develop such a competency. Bioethics education itself has various goals including the need to engage in discussion and the ability to debate diverse issues. Providing an educational experience that meets both disciplinary and topic needs can be challenging. On-line conferencing through WebBoard 3.0, a web-based discussion software program, within a graduate level bioethics course successfully contributed to meeting these needs. A technical description of the WebBoard is provided in the following discussion along with a description of the integration of this device into a bioethics course. The WebBoard conferencing allowed all students to enter the class discussion and especially facilitated discussion for reticent speakers and distance learners. Evaluations of the bioethics course from both the faculty and students' perspectives were generally positive. Most students found the technique easy to use and liked the asynchronous format that allowed them to read and contribute at any hour of the day or night. Despite the labour intensive nature of this experience, the strategy ensured participation by every student, a major goal of the project. Developing an interdisciplinary situation would increase the value of such an experience.

Confidentiality: concept analysis and clinical application.

The author examines confidentiality both from a theoretical perspective using concept analysis and through a clinically based, empirical investigation. A review of the literature determines defining attributes, antecedents, consequences, and empirical referents. The themes from definitions of confidentiality provided by participants in a research project on confidentiality issues in the context of HIV/AIDS also are described. The author compares the results from the two approaches and discusses implications for clinical practice, including but not limited to people with HIV/AIDS.

Confidentiality through a feminist lens. Reaction piece.

An ethical foundation for confidentiality is found in the AAOHN Code, grounded in a respect for autonomy. Confidentiality is a phenomenon involving a trust relationship between at least two people. An undesirable outcome could result if the confidential information or observation is revealed. Although confidentiality has an impact regardless of the individual's gender, women can be at higher risk for compromises to confidentiality. The implications for women include but are not limited to the inherent inequality in client/professional relationships, paternalistic practices in health care delivery, and the importance of autonomy as an ethical principle. The nurse's sensitivity to the possible vulnerability of women, the recognition of the importance of trust and communication in professional relationships, and an effort to ask the gender question contribute to an ethical practice in occupational health care related to the issue of confidentiality.

Moral orientation of elderly persons: considering ethical dilemmas in health care.

Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons (n = 20) in order to explore and describe their moral orientation based on the paradigms of justice (Kohlberg) and care (Gilligan). The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men's moral reasoning was dominated by caring, but justice dominated the reasoning of four women. The implications for ethical decision-making and future research are discussed.

Ethics in the neonatal intensive care unit: parental perceptions at four years postdischarge.

Ethical issues for the parents of neonates in neonatal intensive care units (NICUs) have not been widely researched. A multistage, qualitative project explored 23 families' perceptions of moral conflict and ethical decision making related to the NICU experience. Through in-depth interviews and the use of content analysis at 4 years postdischarge, life goes on (the major theme) and three conceptual categories were identified as characterizations of this phase. This phase, combined with two earlier phases (predischarge and 6 months postdischarge), represents a clinical manifestation of Reich's Theory of Suffering and provides a framework for understanding the parents' ethical perspective. Strategies for nurses that will facilitate parental participation in ethical decision making are presented.

Ethics in nursing practice: confidentiality for women and their children with HIV/AIDS.

HIV-positive women and their children experience substantial problems brought about by the illness itself and service-delivery issues. Significant ethical concerns are raised when providing care to this patient population, and the ramifications of compromises in patient confidentiality are extremely serious. All practicing nurses should be familiar with the issues and potential solutions.

Implementation of the Patient Self-Determination Act: a survey of Nebraska hospitals.

The purpose of this survey of Nebraska hospitals (N = 79) was to describe the planning, implementation, and evaluation of the Patient Self-Determination Act (PSDA) and to explore the role of the nurse in these processes. Results indicate nurses were very involved in the planning phase but rarely in the implementing phase. Few evaluation strategies were utilized and only some respondents identified problematic issues related to the implementation of the PSDA. Clinical implications for issues related to the PSDA are discussed and framed within the American Nurses' Association Position Statement on the PSDA (1991). Future studies are suggested, especially related to evaluation of PSDA implementation.

Ethical perceptions of parents and nurses in NICU: the case of baby Michael.

A case was used to examine ethical challenges in the neonatal intensive care unit from the perspective of parents and nurses. Discussion focuses on issues of treatment versus nontreatment, informed consent, and decision making. An integration of crisis intervention techniques and caring processes is presented for nurses to assist parents through the neonatal intensive care unit experience.

Synthesis: implementing a complex process.

Synthesis is a complex task required in many scholarly activities, such as literature reviews for various projects or concept analyses. A process for synthesizing materials is described, beginning with the preliminary task of constructing a summary of the selected references. Synthesis is posited as a task that can benefit from an approach similar to content analysis used in qualitative research methods. A detailed description of the process is provided using a literature review as an example. Strategies for writing the synthesis product conclude the discussion.

Vertical transmission in HIV infection/AIDS: a feminist perspective.

HIV infection and AIDS create a unique dilemma for women in their potential for vertical transmission of these conditions. Selected feminist perspectives in ontology, epistemology, and axiology are reviewed to illuminate possible social, cultural, and political circumstances of these women. Drawing both on these perspectives and various sources of data about women with HIV/AIDS, some implications for nursing complete this discussion.