ABSTRACT
This article contains Letters from the Readears.
Subject(s)
Leadership , Nursing/trends , Editorial Policies , HumansABSTRACT
There has been limited attention to ethical leadership for formal nurse leaders around the world. Assuming that codes of ethics provide meaningful standards of what is expected of health professionals, what specific guidance for ethical leadership is available to formal nurse leaders in national nursing codes of ethics? We conducted an integrative review of national nursing codes of ethics for 131 member countries of the International Council of Nurses (ICN). In the ICN Code, nurse managers/leaders are highlighted for their role in ethical practice. With the exception of the US, no other country code focuses as much attention on formal nurse leaders. While all country codes (except the United States) implicitly group nurses, practitioners and managers together, most codes do not provide meaningful guidance for formal nurse leaders. The level of ethical guidance provided to formal nurse leaders in national nursing codes of ethics is lacking. However, creating a separate code of ethics for formal nurse leaders is not the answer. Rather, including specific guidance in nursing codes of ethics not only informs nurses about what they can expect of nurse leaders but also allows formal nurse leaders to use the code with their own senior leaders, conveying what their professional body expects of them.
Subject(s)
Ethics, Nursing , Leadership , Codes of Ethics/trends , Guidelines as Topic , Humans , InternationalityABSTRACT
Nurses are frequently portrayed in the literature as being silent about ethical concerns that arise in their practice. This silence is often represented as a lack of voice. However, in our study, we found that nurses who responded to questions about moral distress were not so much silent as silenced. These nurses were enacting their moral agency by engaging in diverse, multiple and time-consuming actions in response to situations identified as morally distressing with families, colleagues, physicians, educators or managers. In many situations, they took action by contacting other healthcare team members, making referrals and coordinating care with other departments such as home care and hospice, as well as initiating contact with groups such as professional regulatory bodies or unions. Examining the relationship between ethical climate, moral distress and voice offers insights into both the meaning and impact of being silenced in the workplace.
Subject(s)
Communication , Conflict, Psychological , Interprofessional Relations/ethics , Nursing Care/ethics , Patient Advocacy/ethics , Adult , British Columbia , Female , Health Care Surveys , Humans , Male , Organizational Culture , Physician-Nurse Relations , Power, PsychologicalABSTRACT
This paper reports the results of a qualitative study of nurses' ethical decision-making. Focus groups of nurses in diverse practice contexts were used as a means to explore the meaning of ethics and the enactment of ethical practice. The findings centre on the metaphor ofa moral horizon--the horizon representing "the good" towards which the nurses were navigating.The findings suggest that currents within the moral climate of nurses' work significantly influence nurses' progress towards their moral horizon. All too often the nurses found themselves navigating against a current characterized by the privileging of biomedicine and a corporate ethos. Conversely, a current of supportive colleagues as well as professional guidelines and standards and ethics education helped them to move towards their horizon.The implications for nursing practice and for our understanding of ethical decision-making are discussed.
Subject(s)
Codes of Ethics , Ethics, Nursing , Societies, Nursing , Canada , Humans , Social ResponsibilityABSTRACT
Physicians and nurses need to sustain their unique strengths and work in true collaboration, recognizing their interdependence and the complementarity of their knowledge, skills and perspectives, as well as their common moral commitments. In this article, challenges often faced by both nurses and physicians in working collaboratively are explored with a focus on the ways in which each profession's preparation for practice has differed over time, including shifts in knowledge development and codes of ethics guiding their practice. A call for envisioning their practice as shared moral work as well as practical strategies to begin that work are offered as a basis for reflection towards enhanced nurse-physician relationships.
Subject(s)
Cooperative Behavior , Morals , Nurse's Role/psychology , Physician's Role/psychology , Physician-Nurse Relations , Attitude of Health Personnel , Codes of Ethics , Communication , Ethics, Medical , Ethics, Nursing , Health Knowledge, Attitudes, Practice , Humans , Knowledge , Patient Care Team/ethics , Patient Care Team/organization & administration , Philosophy, Medical , Philosophy, NursingSubject(s)
Baths/psychology , Community Health Nursing/organization & administration , Environmental Illness/prevention & control , Nursing Staff/psychology , Attitude of Health Personnel , Baths/ethics , Baths/legislation & jurisprudence , Codes of Ethics , Community Health Nursing/ethics , House Calls , Humans , Nursing Staff/ethics , Nursing Staff/legislation & jurisprudenceABSTRACT
In this paper, the author questions the focus of the patient safety movement, speculating that it might be just another "bandwagon" that health executives and some health professionals are eager to join. The history of this current emphasis on patient safety is briefly sketched, including current activities in Canada, and questions are raised about whether the movement aids or avoids pressing healthcare issues, many of which are supported by good evidence. These include the relationship between nursing staffing and patient outcomes, the way in which a "cult of efficiency" has operated to make errors more likely and how the silencing of nurses and other staff leads to error. Whether or not one considers the current focus on patient safety a bandwagon, it is important to reflect critically upon the activities undertaken to address the issue and to determine whether one should jump on this bandwagon.
Subject(s)
Medical Errors/prevention & control , Philosophy, Nursing , Quality Assurance, Health Care/organization & administration , Safety Management/organization & administration , Social Support , Attitude of Health Personnel , Attitude to Health , Canada , Efficiency, Organizational , Evidence-Based Medicine , Health Services Needs and Demand , Humans , Nursing Staff/organization & administration , Nursing Staff/psychology , Organizational Culture , Outcome Assessment, Health Care/organization & administration , Social Values , Systems AnalysisSubject(s)
National Health Programs/organization & administration , Single-Payer System/organization & administration , Canada , Cost Control , Ethics, Nursing , Forecasting , Health Care Reform/organization & administration , Health Services Accessibility/organization & administration , Humans , National Health Programs/economics , Nursing/organization & administration , Quality of Health CareSubject(s)
Ethics, Nursing , Global Health , Minority Groups , Nurse-Patient Relations/ethics , Vulnerable Populations , Aged , Confidentiality , Female , Humans , Male , PrejudiceABSTRACT
BACKGROUND: While contemporary ethical theory is of tremendous value to nursing, the extent to which such theory has been informed by the concerns and practices of nurses has been limited. PURPOSE: With a view to complementing extant ethical theory, a study was undertaken to explore, from the perspective of nurses, the meaning of ethics and the enactment of ethical practice in nursing. DESIGN AND METHODS: Located in the interpretive/constructivist paradigm, using an emergent design, this inquiry employed focus groups to collect the data. Eighty-seven nurses from a wide range of practice settings were interviewed in 19 focus groups of three to nine nurses each. FINDINGS: The nurses described ethics in their practice as both a way of being and a process of enactment. They described drawing on a wide range of sources of moral knowledge in a dynamic process of developing awareness of themselves as moral agents. Enacting moral agency involved working in a shifting moral context, and working in-between their own values and those of the organizations in which they worked, in-between their own values and those of others, and in-between competing values and interests. CONCLUSIONS: Analysis of the experiences and concerns of the nurses offered new understanding of ethics in nursing and direction for the development of ethical theory pertinent to nursing practice.
Subject(s)
Delivery of Health Care/ethics , Ethics, Nursing , Professional Practice/ethics , Adult , Attitude of Health Personnel , Canada , Decision Making , Ethical Theory , Female , Focus Groups/methods , Humans , Male , Moral Development , Professional Practice/standardsABSTRACT
In this article, we focus our attention on the Canadian Nurses Association's Code of Ethics (Code) for Registered Nurses (1997) and the background against which it was developed. In doing so, we highlight the participation of nurses in its development and the strategies designed to keep the Code "alive," useful, and current.
Subject(s)
Codes of Ethics/trends , Ethics, Nursing , Societies, Nursing/ethics , Canada , HumansABSTRACT
This paper reports the results of a qualitative study of nurses' ethical decision-making. Focus groups of nurses in diverse practice contexts were used as a means to explore the meaning of ethics and the enactment of ethical practice. The findings centre on the metaphor of a moral horizon--the horizon representing "the good" towards which the nurses were navigating. The findings suggest that currents within the moral climate of nurses' work significantly influence nurses' progress towards their moral horizon. All too often, the nurses found themselves navigating against a current characterized by the privileging of biomedicine and a corporate ethos. Conversely, a current of supportive colleagues as well as professional guidelines and standards and ethics education helped them to move towards their horizon. The implications for nursing practice and for our understanding of ethical decision-making are discussed.
