Compromissos diante da violência doméstica: olhar de universitários como cidadãos e futuros profissionais / Responsibilities in the face of intimate partner violence: the perspectives of college students as citizens and future professionals

Objetivo: analisar o conhecimento de universitários sobre os compromissos, profissionais e cidadãos, diante da violência doméstica contra a mulher. Métodos: pesquisa qualitativa realizada nas casas do estudante da Universidade Federal do Rio Grande, em Rio Grande/RS, no ano de 2019. Foram convidados, aleatoriamente, dois homens e duas mulheres de cada casa, totalizando 28 participantes. Todos responderam a entrevistas semiestruturadas e o corpus foi analisado segundo a Análise de Conteúdo. Resultados: enquanto alguns universitários não aproximavam a temática com seus cursos de graduação, outros a reconheciam como importante tema de debate e compromisso com a formação profissional. Como cidadãos, mencionaram o dever de debater o assunto entre amigos, denunciar casos de violência, oferecer apoio à mulher; embora apresentassem dúvidas sobre essa conduta. Conclusão: o reconhecimento dos compromissos frente à violência doméstica contra a mulher é uma das estratégias de enfrentamento.

Objective: to analyze the knowledge of college students regarding their responsibility, as future professionals and citizens, in the face of intimate partner violence. Methods: a qualitative study was conducted in the undergraduate residence halls at the Federal University of Rio Grande, Rio Grande, RS, Brazil, in 2019. Two men and two women from each residence hall were randomly invited, totaling 28 students. All the participants answered semi-structured interviews, and Content Analysis was used to interpret the corpus. Results: some students did not relate the topic to their undergraduate programs, but others recognized it was related to their professional field and as an important subject to be debated. As citizens, they considered being responsible for discussing it with their friends, reporting violence cases, and providing support to victims, though they had doubts about it. Conclusion: recognizing one's responsibilities in the face of intimate partner violence is one strategy to combat it.

Staying alert to ethical challenges.

Please replace the abstract with: Nurse practitioners (NPs) are faced with many ethical challenges. It requires moral courage to stand up for ones' beliefs and resolve ethical issues. Ethical challenges of NPs are discussed including some specific disciplinary situations involving a state board of nursing. Solutions that may help NPs stay alert to ethical challenges include ethics courses and lifelong mentoring. In this "Year of the Nurse and Midwife," NPs and other nurses should ensure that we maintain the designation of most trusted profession.

Medical Assistance in Dying: A Review of Canadian Regulatory Documents.

After years of heated debate about the issue, medical assistance in dying (MAiD) was legalized in Canada in 2016. Canada became the first jurisdiction where MAiD may be delivered by nurse practitioners as well as physicians. Experience has revealed significant public demand for the service, and Canadians expect nurses to advocate for safe, high-quality, ethical practice in this new area of care. Pesut et al. offer a superb analysis of the related Canadian nursing regulatory documents and the challenges in creating a harmonized approach that arise in a federation where the Criminal Code is a federal entity and the regulation of health care providers and delivery of care fall under provincial and territorial legislation. Organizations like the Canadian Nurses Association contribute to the development of good legislation by working with partners to present evidence to help legislators consider impacts on public health, health care, and providers. Nursing regulators across Canada responded quickly to the unfolding policy landscape as the federal legislation evolved and will face that task again: In February 2020, the federal government tabled legislation to relax conditions related to MAiD requests that will force regulators and professional associations back to public advocacy and legislative tables. The success of the cautious approach exercised by nursing bodies throughout this journey should continue to reassure Canadians that their high trust in the profession is well placed.

Nursing and euthanasia: A narrative review of the nursing ethics literature.

BACKGROUND: Medical Assistance in Dying, also known as euthanasia or assisted suicide, is expanding internationally. Canada is the first country to permit Nurse Practitioners to provide euthanasia. These developments highlight the need for nurses to reflect upon the moral and ethical issues that euthanasia presents for nursing practice. PURPOSE: The purpose of this article is to provide a narrative review of the ethical arguments surrounding euthanasia in relationship to nursing practice. METHODS: Systematic search and narrative review. Nine electronic databases were searched using vocabulary developed from a stage 1 search of Medline and CINAHL. Articles that analysed a focused ethical question related to euthanasia in the context of nursing practice were included. Articles were synthesized to provide an overview of the literature of nursing ethics and euthanasia. ETHICAL CONSIDERATIONS: This review was conducted as per established scientific guidelines. We have tried to be fair and respectful to the authors discussed. FINDINGS: Forty-three articles were identified and arranged inductively into four themes: arguments from the nature of nursing; arguments from ethical principles, concepts and theories; arguments for moral consistency; and arguments from the nature of the social good. Key considerations included nursing's moral ontology, the nurse-patient relationship, potential impact on the profession, ethical principles and theories, moral culpability for acts versus omissions, the role of intention and the nature of the society in which euthanasia would be enacted. In many cases, the same assumptions, values, principles and theories were used to argue both for and against euthanasia. DISCUSSION: The review identified a relative paucity of literature in light of the expansion of euthanasia internationally. However, the literature provided a fulsome range of positions for nurses to consider as they reflect on their own participation in euthanasia. Many of the arguments reviewed were not nursing-specific, but rather are relevant across healthcare disciplines. Arguments explicitly grounded within the nature of nursing and nurse-patient relationships warrant further exploration.

Percepção dos profissionais de enfermagem quanto ao trabalho em equipe / La percepción de los profesionales de la enfermería sobre el trabajo en equipo / Perception of nursing professionals regarding teamwork

Objetivo conhecer a percepção dos profissionais de enfermagem quanto ao trabalho em equipe. Método estudo transversal, exploratório, realizado em um hospital geral de grande porte, privado, na cidade de São Paulo. Resultados amostra composta por 63% de técnicos de enfermagem e 37% de enfermeiros. Quanto ao trabalho em equipe, 95% concordaram ter bom relacionamento entre pares, receberem ajuda quando atarefados e retribuí-la; 94,6% atendiam a campainha, mesmo não sendo sua. Quanto aos benefícios do trabalho em equipe, 99,1% concordaram que a colaboração entre colegas de trabalho facilitava a assistência; 94,6%, que diminuía o tempo de resposta às chamadas; 96,4%, que o resultado do trabalho em equipe era mérito coletivo. Conclusão os profissionais de enfermagem reconheceram fatores favorecedores do trabalho em equipe, como bom relacionamento interpessoal e clareza nos objetivos da instituição, além dos benefícios propiciados, como o papel do enfermeiro no desenvolvimento e como facilitador dessa dinâmica de trabalho.

Objetivo conocer la percepción de los profesionales de la enfermería sobre el trabajo en equipo. Método estudio transversal y exploratorio, realizado en un gran hospital general privado de la ciudad de São Paulo. Resultados muestra compuesta por el 63% de técnicos de enfermería y el 37% de enfermeras. En cuanto al trabajo en equipo, el 95% aceptó tener buenas relaciones entre pares, recibir ayuda cuando estaba ocupado y devolverla; el 94,6% respondió al timbre, aunque no era suyo. En cuanto a los beneficios del trabajo en equipo, el 99,1% estuvo de acuerdo en que la colaboración entre los compañeros de trabajo facilitaba la asistencia; el 94,6% redujo el tiempo de respuesta a las llamadas; el 96,4% consideró que el resultado del trabajo en equipo era un mérito colectivo. Conclusión los profesionales de la enfermería reconocieron factores que favorecen el trabajo en equipo, como la buena relación interpersonal y la claridad en los objetivos de la institución, además de los beneficios proporcionados, como el papel de la enfermera en el desarrollo y como facilitadora de esta dinámica de trabajo.

Objective to know the perception of nursing professionals regarding teamwork. Method transversal, exploratory study, carried out in a large, private, general hospital in the city of São Paulo. Results sample composed by 63% of nursing technicians and 37% of nurses. As for teamwork, 95% agreed to have good relationships among peers, receive help when busy and give it back; 94.6% answered the bell, even though it was not theirs. As for the benefits of teamwork, 99.1% agreed that collaboration among co-workers facilitated assistance; 94.6% reduced response time to calls; 96.4% that the result of teamwork was collective merit. Conclusion the nursing professionals recognized factors favoring teamwork, such as good interpersonal relationship and clarity in the objectives of the institution, in addition to the benefits provided, such as the role of the nurse in the development and as a facilitator of this work dynamic.

But it's legal, isn't it? Law and ethics in nursing practice related to medical assistance in dying.

In June 2015, the Supreme Court of Canada struck down the Criminal Code's prohibition on assisted death. Just over a year later, the federal government crafted legislation to entrench medical assistance in dying (MAiD), the term used in Canada in place of physician-assisted death. Notably, Canada became the first country to allow nurse practitioners to act as assessors and providers, a result of a strong lobby by the Canadian Nurses Association. However, a legislated approach to assisted death has proven challenging in a number of areas. Although it facilitates a degree of accountability, precision and accessibility, it has also resulted in particular challenges negotiating the diverse perspectives of such a morally contentious act. One of these challenges is the tendency to conflate what is legal and what is moral in a modern liberal constitutionalism that places supreme value on autonomy and choice. Such a conflation tends to render invisible the legal and moral/ethical considerations necessary for nurses and nurse practitioners to remain ethical actors. In this paper, we introduce this conflation and then discuss the process of lawmaking in Canada, including the legalization of MAiD and the contributions of nursing to that legalization. We then engage in a hypothetical dialogue about the legal and moral/ethical implications of MAiD for nursing in Canada. We conclude with an appeal for morally sustainable workspaces that, when implementing MAiD, appropriately balance patient choices and nurses' moral well-being.

A Comparison of Physicians' and Nurse Practitioners' Use of Race in Clinical Decision-Making.

Objective: The debate over use of race as a proxy for genetic risk of disease continues, but little is known about how primary care providers (nurse practitioners and general internal medicine physicians) currently use race in their clinical practice. Our study investigates primary care providers' use of race in clinical practice. Methods: Survey data from three cross-sectional parent studies were used. A total of 178 nurse practitioners (NPs) and 759 general internal medicine physicians were included. The outcome of interest was the Racial Attributes in Clinical Evaluation (RACE) scale, which measures explicit use of race in clinical decision-making. Predictor variables included the Genetic Variation Knowledge Assessment Index (GKAI), which measures the providers' knowledge of human genetic variation. Results: In the final multivariable model, NPs had an average RACE score that was 1.60 points higher than the physicians' score (P=.03). The GKAI score was not significantly associated with the RACE outcome in the final model (P=.67). Conclusions: Physicians had more knowledge of genetic variation and used patients' race less in the clinical decision-making process than NPs. We speculate that these differences may be related to differences in discipline-specific clinical training and approaches to clinical care. Further exploration of these differences is needed, including examination of physicians' and NPs' beliefs about race, how they use race in disease screening and treatment, and if the use of race is contributing to health care disparities.

A clinical nursing rotation transforms medical students' interprofessional attitudes.

This study explores the extent to which a one-week nursing rotation for medical students changed the interprofessional attitudes of the participating nurses and students. Third-year medical students worked with nurses before starting clinical rotations. Pre- and post-experience surveys assessing perceptions of mutual respect, nurse-doctor roles, and interprofessional communication and teamwork were given to 55 nurses and 57 students. The surveys consisted of qualitative questions and a Likert scale questionnaire that was analyzed using qualitative and quantitative content analyses. The response rate was 51/57 (89%) students and 44/55 (80%) nurse preceptors. Nurses reported that students met nurses' expectations by displaying responsibility, respect, effective communication, and an understanding of nursing roles. Medical students' narratives demonstrated two significant changes. First, their views of nurses changed from that of physician helpers to that of collaborative patient-centred professionals. Second, they began defining nursing not by its tasks, but as a caring- and communication-centred profession. Responses to Likert-scaled questions showed significant differences corresponding to changes described in the narrative. A one-week immersive clinical nursing rotation for medical students was a transformative way of learning interprofessional competencies. Learning in an authentic workplace during a clinical rotation engendered mutual respect between nurses and future doctors. Students' view of the role of nurses changed from nurses working for doctors with patients, to working with doctors for patients.

Professional organization membership: Advancing the nurse practitioner role.

With a paucity of literature on professional organization membership by nurse practitioners (NPs), the authors base the discussion of the personal benefits associated with membership on literature focusing on clinicians other than NPs and their personal experiences as members of multiple organizations. Membership is described as related to NP socialization, engagement, networking, mentorship, advocacy, policy, leadership development, research dissemination, professional development, and volunteerism. In addition to encouraging active participation in one or more professional organizations, the need for research into factors influencing the degree to which NPs participate in organizations and the associated benefits is identified.

Relationships among moral distress, level of practice independence, and intent to leave of nurse practitioners in emergency departments: results from a national survey.

The aims of this research study were to investigate moral distress among emergency department (ED) nurse practitioners (NPs) and examine relationships between moral distress and level of practice independence as well as intent to leave a position. Moral distress has been studied regarding registered nurses and physicians (MDs) but less so in NPs. It is important to explore moral distress in NPs because they tread a unique path between nursing and physician roles. Moral distress may play a significant role in staff nurses' intention to leave practice, and level of practice independence is found to have a relationship with NPs' intention to leave. A convenience sample of ED NPs was obtained from a mailing list of a national nursing specialty organization, the Emergency Nurses Association. Using a correlational design, survey methods assessed moral distress with the Moral Distress Scale-Revised (MDS-R), level of practice independence with the Dempster Practice Behavior Scale, and intent to leave with self-report. Correlational and regression analyses of data were conducted to characterize moral distress among ED NPs and associations between moral distress, level of practice independence, and intent to leave. Results found ED NPs do experience moral distress with poor patient care results from inadequate staff communication and working with incompetent coworkers in their practice. The MDS-R was a significant predictor of intention to leave among respondents. This study is the first of its kind to explore moral distress in ED NPs. Results suggest moral distress influences ED NPs' intent to leave their position. Further studies are needed to explore the findings from this research and to formulate interventions to alleviate moral distress in ED NPs and improve retention in the clinical setting.

Ethics of utilizing nurse practitioners and physician's assistants in the dermatology setting.

Our current supply of dermatologists in training is insufficient to meet the growing demand for dermatology services. In an era of declining reimbursements and the ever increasing clamor for increased access to care, many practices are turning to nurse practitioners and physician assistants as a cost effective means of fulfilling patient demand. Despite the recommendations of the American Academy of Dermatology, there is no explicit consensus among dermatologists on the educational requirements or appropriate utilization of NPs and PAs in dermatology settings. Colleges of nursing and physician assistant programs recognize the provider demand in dermatology and have begun to implement training programs to address the need for specialty training. Academic settings offer a unique opportunity for NPs and PAs to receive a medically oriented grounding in basic science, dermatopathology, and research.

Adolescent girls: a vulnerable population.

Issues key to adolescent girls are discussed. The importance and relevance of the adolescent girl as a vulnerable population are explicated. Potential interventions and how they impact global health are explained. Nursing theory and model use are examined. Pyschosocial developmental theory is applied. Strategies to improve outcomes are explored.

The surgical care practitioner: a critical analysis.

The role of the surgical care practitioner has been in existence for many years in some form or another with a variety of job titles and a wide range of duties. With the adoption of the European Working Time Directive and the need for skilled assistance, not only at the operating table but also pre and post surgery, the role is becoming formalised with voluntary codes of conduct, performance, ethics, standards and scope of practice.