Journal articles on the topic 'Cancer Research Moral and ethical aspects'
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Bartholdson, Cecilia, Margareta af Sandeberg, Kim Lützén, Klas Blomgren, and Pernilla Pergert. "Healthcare professionals’ perceptions of the ethical climate in paediatric cancer care." Nursing Ethics 23, no. 8 (August 3, 2016): 877–88. http://dx.doi.org/10.1177/0969733015587778.
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Background: How well ethical concerns are handled in healthcare is influenced by the ethical climate of the workplace, which in this study is described as workplace factors that contribute to healthcare professionals’ ability to identify and deal with ethical issues in order to provide the patient with ethically good care. Objectives: The overall aim of the study was to describe perceptions of the paediatric hospital ethical climate among healthcare professionals who treat/care for children with cancer. Research design: Data were collected using the Hospital Ethical Climate Survey developed by Olsson as a separate section in a questionnaire. Descriptive statistics were used to analyse perceptions of the ethical climate. Participants and research context: Physicians, nurses and nurse-aides (n = 89) from three paediatric units participated in this study: haematology/oncology, chronic diseases and neurology. Ethical considerations: The study was approved by the regional ethical review board. Findings: Different perceptions of the ethical climate were rated as positive or negative/neutral. Nurses’ ratings were less positive than physicians on all items. One-third of the participants perceived that they were able to practice ethically good care as they believed it should be practised. Discussion: Differences in professional roles, involving more or less power and influence, might explain why physicians and nurses rated items differently. A positive perception of the possibility to practice ethically good care seems to be related to inter-professional trust and listening to guardians/parents. A negative/neutral perception of the possibility to practice ethically good care appears to be influenced by experiences of ethical conflicts as well as a lack of ethical support, for example, time for reflection and discussion. Conclusion: The two-thirds of participants who had a negative/neutral perception of the possibility to practice ethically good care are at risk of developing moral stress. Clinical ethics support needs to be implemented in care where important values are at stake.
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Bagherian, Samaneh, Farkhondeh Sharif, Ladan Zarshenas, Camellia Torabizadeh, Abbas Abbaszadeh, and Payam Izadpanahi. "Cancer patients’ perspectives on dignity in care." Nursing Ethics 27, no. 1 (May 16, 2019): 127–40. http://dx.doi.org/10.1177/0969733019845126.
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Background: Since “dignity” is one of the fundamental rights of every patient, consideration for patients’ dignity is essential. Unfortunately, in many cases, especially in cancer patients, dignity is not fully respected. Dignity is an abstract concept, and there are only a few comprehensive studies on the dignity of cancer patients in Iran. Research objective: This study aimed to evaluate the perception of Iranian cancer patients on human dignity. Research design: A qualitative research approach was used as the study design. The data were collected through individual semi-structured interviews and analyzed using the qualitative content analysis method. Participants and research context: This study was conducted on cancer patients in internal medicine wards in Iran. The data were gathered through semi-structured interviews from May 2017 to February 2018. Ethical considerations: The study protocol was approved by the Research Ethics Committee of medical universities located in Southwest of Iran. The ethical principles were carefully followed throughout the study. Findings: Based on the results of the interviews, 3 main themes and 11 categories were determined. The main themes were identified as the “personal space and privacy,” “respect for human values,” and “moral support.” Discussion: The results of the present study showed the necessity of care for cancer patients in a respectful manner. The key elements in such care were the preservation of their personal space and privacy, respect for their values, and the provision of adequate moral support. These measures will have a positive effect on the perception of such patients on human dignity. Conclusion: Considering the special care required by cancer patients, the Iranian healthcare and hygiene managers should design and implement a care plan that includes the ethical principles related to human dignity.
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Melis, Paola, Maura Galletta, Cesar Ivan Aviles Gonzalez, Paolo Contu, and Maria Francisca Jimenez Herrera. "Ethical perspectives in communication in cancer care: An interpretative phenomenological study." Nursing Ethics 27, no. 6 (May 14, 2020): 1418–35. http://dx.doi.org/10.1177/0969733020916771.
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Background: In cancer care, many clinical contexts still lack a good-quality patient–health professional communication about diagnosis and prognosis. Information transmission enables patients to make informed choices about their own healthcare. Nevertheless, disclosure is still an ethically challenging clinical problem in cancer care. High-quality care can be achieved by understanding the perspectives of others. The perspective of patients, their caregivers, physicians and nurses have seldom been simultaneously studied. Objective: To investigate the phenomenon of diagnosis and prognosis-related communication as experienced by patients, their caregivers, and both their attending nurses and physicians, to enlighten meanings attached to communication by the four parties. Methods: A qualitative study using interpretative phenomenological analysis was performed. Participants and research context: Purposive sampling of six patients, six caregivers, seven nurses and five physicians was performed in two oncological hospitals in Italy. Ethical considerations: Local Ethics Committee approved the study. It was guided by the ethical principles of voluntary enrolment, anonymity, privacy and confidentiality. Results: Three main themes were identified: (a) the infinite range of possibilities in knowing and willing to know, (b) communication with the patient as a conflicting situation and (c) the bind of implicit and explicit meaning of communication. Conclusion: The interplay of meanings attached by patients, their caregivers, and their attending oncologist and nurse to communication about diagnosis and prognosis revealed complexities and ambiguities not yet settled. Physicians still need to solve the ethical tensions in their caring relationship with patients to really allow them ‘to choose with dignity and being aware of it’. Nurses need to develop awareness about their role in diagnosis and prognosis-related communication. This cognizance is essential not just to assure consistency of communication within the multi-disciplinary team but mostly because it allows and enables the moral agent to take its own responsibilities and be accountable for them.
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van Meeteren, Antoinette Schouten, Simone Lenting, Mirjam Sulkers, and Marianne van de Wetering. "OTHR-21. Ethical reflections via the dilemma method in a pediatric neuro-oncology department." Neuro-Oncology 24, Supplement_1 (June 1, 2022): i151. http://dx.doi.org/10.1093/neuonc/noac079.560.
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Abstract BACKGROUND: Professional care for children with a brain tumor can bring considerable ethical questions in clinical practice. These questions can be burdensome and cause distress among professionals, parents and patients. Awareness and skills to bring these aspects into a respectful discussion among colleagues can be meaningful and alleviate the distress. Our objective is to give overview of the ethical case deliberations which took place during a monthly multidisciplinary meeting on the pediatric neuro-oncology department. METHOD: To describe the type of ethical case deliberations as spontaneously proposed and selected by the team members for discussion. To identify main values in the care process for professionals via the dilemma method in monthly meetings led by a trained facilitator. RESULTS: The monthly meetings were visited regularly by 9-14 diverse professionals (median 10) of the team: nurses, oncologists, social worker, psychologist, educational specialist. The selected moral questions concerned children with a brain tumor between 4-13 year old (median 9) with following ten subjects: 3 not sharing the infaust prognosis with a child, 2 avoiding medical care in follow up /treatment, 2 cultural different approach for food and drink intake, 2 crossing professional boundaries and 1 time worries about emotional safety of a child. The main values that were recognized to play crucial role in the care process were honesty, respect, autonomy, quality of life, health, tolerance, courage and safety. The participants felt supported in their professional skills by sharing reflections on personal moral considerations and by openly discussing different views and experiences of other participants. CONCLUSION: The monthly ethical case discussions disclose high lights in the burden of professional care in pediatric neuro-oncology. These meetings about moral questions are supportive in the competence of the professionals to recognize and communicate about these important dilemmas.
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Ko, Hsun-Kuei, Chi-Chun Chin, Min-Tao Hsu, and Shu-Li Lee. "Phenomenon of moral distress through the aspect of interpretive interactionism." Nursing Ethics 26, no. 5 (April 15, 2018): 1484–93. http://dx.doi.org/10.1177/0969733018766579.
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Background: Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses’ values, the physician–nurse power hierarchy, and the influence of the culture. Research objective: To analyze the main causes for moral distress with interpretive interactionism. Research design: A qualitative study was adopted. Participants: Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Ethical considerations: Approval from the Institutional Review Board of the Kaohsiung Medical University Hospital. Findings: Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician–nurse power hierarchy, and the Oriental culture affect nurses’ goodness-based intention for patients, which deteriorates moral distress. Discussion: The main cause for moral distress is the moral goodness of nurses. If nurses’ goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients’ right to know about their diseases, the choice of treatment, and patients’ autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. Conclusion: The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses’ confidence and cultural sensitivity, so as to reduce the moral distress of nurses.
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Popova, N. V., and E. V. Popova. "VOLUNTEERING AS A FACTOR IN THE FORMATION OF MORAL STANDARDS AMONG YOUNG PEOPLE." Education and science journal 20, no. 10 (December 31, 2018): 139–55. http://dx.doi.org/10.17853/1994-5639-2018-10-139-155.
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Introduction.Volunteering is a socially significant activity, which contributes to solving separate acute social issues and showing the best qualities of an individual – compassion, ability to sympathise and readiness to provide assistance to people in need. Through volunteering, a person achieves self-esteem and a feeling of his or her relevance and usefulness. Under the present circumstances, aspects of the study of volunteering and youth attitudes to this concept are especially relevant. Over the last decades, social transformations have occurred, leading to a reassessment of the value system, and, consequently, society has lost its moral compass. Participation in volunteering can become one of the effective factors in the formation of ethical standards and humanistic value orientations among young people.Theaimof the research was to investigate the educational potential of volunteering through studying the attitudes of young people.Methodology and research methods.The research was based on axiological and sociological approaches. In the course of the research, the following methods were used: review and synthesis of historical-philosophical and sociological literature, sociological group face-to-face surveys, and comparative analysis of statistical data. Results and scientific novelty.The authors justified the necessity for moral education of working youth through the involvement of young people in realizing charitable projects and organising philanthropic events. The authors highlighted the aspects of conducting charitable activities in one of the socially-oriented enterprises of the Urals – Sinarsky Pipe Plant. A questionnaire based survey conducted among young workers of that metal manufacturer revealed the fact of mass participation in various charitable activities (out of the sample seize of 180 young workers, 89% of respondents admitted their involvement in philanthropic activities). The respondents expressed interest in charitable projects and readiness to spend own time, energy and money for rendering disinterested targeted assistance to children with special needs and children with disabilities (56.3%), to elderly people living in difficult life situations (52.5%), to stray animals (50.0%), to children suffering from cancer (49.3%). It was concluded that charity work forms ethical standards at young people, and develops altruistic qualities such as disinterestedness and responsiveness, as well as civil consciousness.Practical significance.The research outcomes can be used when preparing, organising and holding charitable work with the aim of bringing up morally and ethically educated young workers, as well as students of educational institutions of different levels.
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Behan, Justine M., Ramandeep Singh Arora, Franco A. Carnevale, Sameer Bakhshi, Bani Bhattacharjee, and Argerie Tsimicalis. "An Ethnographic Study of the Moral Experiences of Children with Cancer in New Delhi, India." Global Qualitative Nursing Research 8 (January 2021): 233339362199581. http://dx.doi.org/10.1177/2333393621995814.
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There is a paucity of research examining children’s experiences with cancer in India. Childhood ethics is an emerging field, focusing on the moral dimension of children’s experiences, to promote children’s participation in their health care. A focused ethnography, using a moral experience framework, was conducted to better understand children’s participation in decisions, discussions, and actions in three oncology settings in New Delhi, India. We interviewed key informants, retrieved key documents, and conducted semi-structured interviews and participant observations with children. All 22 children demonstrated interest in varying aspects of their cancer care. Certain factors facilitated or impeded their participation. Some children became distressed when they lacked information about their treatment or were not given opportunities to enhance their understanding. The results advance our understanding of the moral experiences of children with cancer in India for healthcare professionals, policy makers, families, and interested others.
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Richardson, Daniel R., Gary Winzelberg, Donald Lee Rosenstein, and Frances A. Collichio. "Development of an “Art of Oncology” curriculum to mitigate burnout and foster solidarity among hematology/oncology fellows." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 10507. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.10507.
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10507 Background: Oncologists and fellows in Hematology/Oncology (HO) training programs report high levels of burnout. The ACGME requires accredited programs to have a mechanism to foster “well-being” and “ethical behavior” among fellows. A loss of solidarity among oncology professionals may contribute to known causes of burnout, such as heavy workload and severity of patient illness, that may in turn negatively impact patient outcomes. Methods: Through a multidisciplinary process involving fellows and faculty from psychiatry, palliative care, and hematology/oncology, a 3-year longitudinal “Art of Oncology” (AOO) curriculum was created for HO fellows at our institution to foster solidarity and mitigate burnout. The curriculum principally involved monthly hour-long sessions intended to promote reflection on oncologists’ shared experiences and the humanistic aspects of caring for patients with cancer. Facilitated by topic experts utilizing personal and published narratives, sessions foster group discussion. Fellows are also invited to write a personal narrative reflecting on their role as an oncologist. Topics include death and dying, caring for patients after treatment failure, cultivating resilience, religion/spirituality, the moral responsibility of oncologists, and oncology as a calling. Cancer patients and spouses were invited to facilitate a session to emphasize the patient experience. Burnout and preparedness for covered topic areas were measured prior to curriculum initiation and will be re-assessed annually. Results: The curriculum began in 2018. Of current fellows, 94.7% (18/19) completed the initial survey. A greater proportion of HO fellows participated in the AOO sessions than non-AOO didactic lectures (mean attendance, 59.2% v. 42.7%, p = 0.037). At curriculum initiation, most fellows reported burnout a few times or more a month (all fellows = 75%, 1st year = 85.7%, 2nd year = 80%, and higher = 62.5%). Conclusions: The implementation of a dedicated curriculum to foster solidarity among HO fellows through narrative medicine and group discussion of the humanistic aspects of oncology is feasible. A substantial degree of burnout exists among HO fellows, even incoming fellows. Further research to assess whether this curriculum mitigates burnout is needed. Because burnout is already a problem for incoming fellows, further work should investigate interventions aimed at ameliorating burnout among both residents and fellows.
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Valeyeva, Elvira T., Venera T. Akhmetshina, Elmira R. Shaikhlislamova, Rosa M. Bakieva, and Albina A. Distanova. "Аnalysis of selected indices of disability of adult population and health care workers of the Republic of Bashkortostan." HEALTH CARE OF THE RUSSIAN FEDERATION 65, no. 3 (July 12, 2021): 191–97. http://dx.doi.org/10.47470/0044-197x-2021-65-3-191-197.
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Introduction. The problem of disability of the population includes medical and social, economic, moral, and ethical aspects, since it affects a considerable number of people, mainly of working age. This also applies to health care workers, whose role in solving the tasks of state policy to preserve and prolong the active life of a person is invaluable. Purpose. Analysis of the levels, trend, and structure of primary disability among the Republic of Bashkortostan’s adult population and health care workers. Material and methods. Primary disability was studied according to the annual reports and 936 certificates of examination for disability in the Bureau of medical and Social expertise of the Republic of Bashkortostan for 2015-2017. Results. During the analyzed period, there is practically no tendency to decrease disability indices among the population of the Republic of Bashkortostan; among health care workers, in 2017 this value decreased by 1.1 times compared to 2015, amounting to 49.5 per 10 thousand population. In the structure of primary disability, the most numerous both among the population and among medical workers were persons with group III disability. Among the causes of disability of the adult population of the Republic of Bashkortostan, diseases of malignant aetiology (37.4%) and diseases of the circulatory system (25.9%) hold the top place. The direct access to disability, the cause of neoplasms of malignant aetiology, in medical workers for all the years of observation exceeded the national indices by 1.1-1.4 times. Breast, ovarian, and cervical cancer prevailed in the structure of oncological diseases among doctors. Disability among medical workers due to conditions of the circulatory system is established for every third doctor (32.9%). Conclusion. The basis for early diagnosis of diseases and prevention of disability of health care workers should be high-quality periodic medical examinations with mandatory implementation of the full scope of laboratory and functional research methods.
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Magnusson, K. "Ethical aspects of cancer prevention." European Journal of Cancer 37 (April 2001): S401. http://dx.doi.org/10.1016/s0959-8049(01)81932-8.
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Miller, Franklin G. "Research Ethics and Misguided Moral Intuition." Journal of Law, Medicine & Ethics 32, no. 1 (2004): 111–16. http://dx.doi.org/10.1111/j.1748-720x.2004.tb00455.x.
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The term therapeutic misconception was coined by Paul Appelbaum and his colleagues to describe the tendency of patients enrolled in clinical trials to confuse research participation with the personal clinical attention characteristic of medical care. It has not been recognized that an analogous therapeutic misconception pervades ethical thinking about clinical research with patient-subjects. Investigators and bioethicists often judge the ethics of clinical research based on ethical standards appropriate to the physician-patient relationship in therapeutic medicine. This ethical approach to clinical research constitutes a misconception because it fails to appreciate the ethically significant differences between clinical research and clinical care.In this article I argue that the assumption that the ethical principles governing the practice of therapeutic medicine should also apply to clinical research with patient- subjects produces incoherence in research ethics and erroneous guidance concerning certain controversial research designs.
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Fida, Roberta, Carlo Tramontano, Marinella Paciello, Mari Kangasniemi, Alessandro Sili, Andrea Bobbio, and Claudio Barbaranelli. "Nurse moral disengagement." Nursing Ethics 23, no. 5 (August 2016): 547–64. http://dx.doi.org/10.1177/0969733015574924.
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Background: Ethics is a founding component of the nursing profession; however, nurses sometimes find it difficult to constantly adhere to the required ethical standards. There is limited knowledge about the factors that cause a committed nurse to violate standards; moral disengagement, originally developed by Bandura, is an essential variable to consider. Research objectives: This study aimed at developing and validating a nursing moral disengagement scale and investigated how moral disengagement is associated with counterproductive and citizenship behaviour at work. Research design: The research comprised a qualitative study and a quantitative study, combining a cross-validation approach and a structural equation model. Participants and research context: A total of 60 Italian nurses (63% female) involved in clinical work and enrolled as students in a postgraduate master’s programme took part in the qualitative study. In 2012, the researchers recruited 434 nurses (76% female) from different Italian hospitals using a convenience sampling method to take part in the quantitative study. Ethical considerations: All the organisations involved and the university gave ethical approval; all respondents participated on a voluntary basis and did not receive any form of compensation. Findings: The nursing moral disengagement scale comprised a total of 22 items. Results attested the mono-dimensionality of the scale and its good psychometric properties. In addition, results highlighted a significant association between moral disengagement and both counterproductive and citizenship behaviours. Discussion: Results showed that nurses sometimes resort to moral disengagement in their daily practice, bypassing moral and ethical codes that would normally prevent them from enacting behaviours that violate their norms and protocols. Conclusion: The nursing moral disengagement scale can complement personnel monitoring and assessment procedures already in place and provide additional information to nursing management for designing interventions aimed at increasing compliance with ethical codes by improving the quality of the nurses’ work environment.
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Atabay, Gülem, Burcu Güneri Çangarli, and Şebnem Penbek. "Impact of ethical climate on moral distress revisited." Nursing Ethics 22, no. 1 (August 7, 2014): 103–16. http://dx.doi.org/10.1177/0969733014542674.
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Background: Moral distress is a major problem in nursing profession. Researchers identified that the stronger the ethical basis of the organization, the less moral distress is reported. However, different ethical climates may have different impacts on moral distress. Moreover, conceptualization of moral distress and ethical climate as well as their relationship may change according to the cultural context. Objectives: The main aim of the study is to investigate the relationship between different types of ethical climate as described in Victor and Cullen’s framework, and moral distress intensity among nurses in Turkish healthcare settings. Research design: An online survey was administrated to collect data. Questionnaires included moral distress and ethical climate scales in addition to demographic questions. Participants and research context: Data were collected from registered nurses in Turkey. In all, 201 of 279 nurses completed questionnaires, resulting in a response rate of 72%. Ethical considerations: Ethical approval was obtained from the university to which the authors were affiliated, after a detailed investigation of the content and data collection method. Findings: Factor analyses showed that moral distress had three dimensions, namely, organizational constraints, misinformed and over-treated patients, and lack of time and resources, while ethical climate had four types, namely, rules, well-being of stakeholders, individualism, and organizational interests. Positive correlations were identified between certain types of ethical climate (rules, individualism, or organizational interests) and moral distress intensity. Discussion: Factor distribution of the scales shows some commonalities with the findings of previous research. However, context-specific dimensions and types were also detected. No particular ethical climate type was found to have a negative correlation with moral distress. Conclusion: Recommendations were made for reducing the negative impact of ethical climate on moral distress. These include solving the nursing-shortage problem, increasing autonomy, and improving physical conditions.
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Koplin, Julian J., and Julian Savulescu. "Moral Limits of Brain Organoid Research." Journal of Law, Medicine & Ethics 47, no. 4 (2019): 760–67. http://dx.doi.org/10.1177/1073110519897789.
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Brain organoid research raises ethical challenges not seen in other forms of stem cell research. Given that brain organoids partially recapitulate the development of the human brain, it is plausible that brain organoids could one day attain consciousness and perhaps even higher cognitive abilities. Brain organoid research therefore raises difficult questions about these organoids' moral status – questions that currently fall outside the scope of existing regulations and guidelines. This paper shows how these gaps can be addressed. We outline a moral framework for brain organoid research that can address the relevant ethical concerns without unduly impeding this important area of research.
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Pauly, Bernadette, Colleen Varcoe, Janet Storch, and Lorelei Newton. "Registered Nurses’ Perceptions of Moral Distress and Ethical Climate." Nursing Ethics 16, no. 5 (August 11, 2009): 561–73. http://dx.doi.org/10.1177/0969733009106649.
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Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients.
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Oelhafen, Stephan, Settimio Monteverde, and Eva Cignacco. "Exploring moral problems and moral competences in midwifery: A qualitative study." Nursing Ethics 26, no. 5 (March 27, 2018): 1373–86. http://dx.doi.org/10.1177/0969733018761174.
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Background: Most undergraduate midwifery curricula comprise ethics courses to strengthen the moral competences of future midwives. By contrast, surprisingly little is known about the specific moral competences considered to be relevant for midwifery practice. Describing these competences not only depends on generic assumptions about the moral nature of midwifery practice but also reflects which issues practitioners themselves classify as moral. Objective: The goal of this study was to gain insight into the ethical issues midwives encounter in their daily work, the key competences and resources they consider indispensable to understand and deal with them, and to assess phenomena linked to moral distress. Methods: We conducted individual semi-structured interviews with eight midwives and two other health professionals, varying in terms of years of experience and work setting. Interview transcripts were analyzed in an interdisciplinary research group, following thematic analysis. Ethical considerations: This study was not subject to approval according to the Swiss Law on Research with Humans. Participants were informed about the study goals and gave written informed consent prior to participation. Results: External constraints limiting the midwife’s and the patient’s autonomy and resulting interpersonal conflicts were found to be the most relevant ethical issues encountered in clinical practice and were most often associated with moral distress. These conflicts often arise in the context of medical interventions midwives consider as not appropriate and situations in which less experienced midwives in particular observe a lack of both interprofessional communication and trust in their professional competence. Ethical issues related to late abortions or prenatal diagnostics and selective abortions were also frequently addressed, but many midwives involved had learned to cope with them. Discussion: In the light of the ethical issues and factors contributing to phenomena of moral distress, an empirically grounded profile of moral competences is drafted. Curricular implications in the light of possible adaptations within undergraduate midwifery education are critically discussed.
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Ventovaara, Päivi, Margareta af Sandeberg, Janne Räsänen, and Pernilla Pergert. "Ethical climate and moral distress in paediatric oncology nursing." Nursing Ethics 28, no. 6 (March 11, 2021): 1061–72. http://dx.doi.org/10.1177/0969733021994169.
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Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.
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Amantova-Salmane, Liene. "ETHICAL ASPECTS OF REGIONAL ECONOMY." Latgale National Economy Research 1, no. 3 (June 23, 2011): 18. http://dx.doi.org/10.17770/lner2011vol1.3.1803.
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In the beginning of economic history, economics as a social science was closely related to ethics and had a moral dimension. The works of Aristotle and Adam Smith show that the science of economics has evolved taking into consideration the ethical stand. However, during the twentieth century, ethics was not considered in the economic analysis, but this situation transformed and ethics became a part of economics. Removing ethics from economics also removes social responsibility and critical awareness. This research analyzes the ethical aspects of regional economy. Regional economy has an ethical dimension because its main goal is to reduce the disparities between regions. There is carried out a brief reference to the relationship between ethics and economy. In the following article there are analysed ethical aspects of regional policy.
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Abou Hashish, Ebtsam Aly, and Nadia Hassan Ali Awad. "Relationship between ethical ideology and moral judgment: Academic nurse educators’ perception." Nursing Ethics 26, no. 3 (September 11, 2017): 845–58. http://dx.doi.org/10.1177/0969733017722825.
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Background: Ascertaining the relationship between ethical ideology, moral judgment, and ethical decision among academic nurse educators at work appears to be a challenge particularly in situations when they are faced with a need to solve an ethical problem and make a moral decision. Purpose: This study aims to investigate the relationship between ethical ideology, moral judgment, and ethical decision as perceived by academic nurse educators. Methods: A descriptive correlational research design was conducted at Faculty of Nursing, Alexandria University. All academic nurse educators were included in the study (N = 220). Ethical Position Questionnaire and Questionnaire of Moral Judgment and Ethical Decisions were proved reliable to measure study variables. Ethical considerations: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University. Privacy and confidentiality of data were maintained and assured by obtaining subjects’ informed consent. Findings: This study reveals a significant positive moderate correlation between idealism construct of ethical ideology and moral judgment in terms of recognition of the behavior as an ethical issue and the magnitude of emotional consequences of the ethical situation (p < 0.001; p = 0.031) respectively. Also, there is a positive significant moderate correlation between relativism construct of ethical ideology and overall moral judgment (p = 0.010). Approximately 3.5% of the explained variance of overall moral judgment is predicted by idealism together with relativism. Discussion: The findings suggest that variations in ethical position and ideology are associated with moral judgment and ethical decision. Conclusion: Organizations of academic nursing education should provide a supportive work environment to help their academic staff to develop their self-awareness and knowledge of their ethical position and promoting their ethical ideologies and, in turn, enhance their moral judgment as well as develop ethical reasoning and decision-making capability of nursing students. More emphasis in nursing curricula is needed on ethical concepts for developing nursing competencies.
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ASLAMOVA, M. "ACCIOLOGICAL ASPECTS OF IMPROVING MORAL-ETHICAL QUALITIES OF THE FUTURE DOCTOR." ТHE SOURCES OF PEDAGOGICAL SKILLS, no. 20 (November 22, 2017): 11–15. http://dx.doi.org/10.33989/2075-146x.2017.20.209479.
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The author analyzes the problem of upbringing the moral and ethical qualities of the future doctor through the prism of the value perception of professional requirements, reveals the tasks of educational influence on the student in the educational process, ensures the formation of a humanistic, professionally verified system of values as a basis for perfect moral choice in professional activity. With the purpose of research, the criteria (motivational-value, cognitive, procedural-analytical) and levels (elementary, low, medium, high) education of the moral and ethical qualities of the future doctor, which can be achieved in the educational process of medical education, are described and described. requirements for professional activities in the field of medicine. The means of the confirmatory experiment noted how stable the pattern of positive dynamics of education of moral and ethical qualities of future physicians from the first to the graduation course, which was achieved by the traditional means of organizing the educational process in higher education, which allows us to conclude that the orientation of professional training for the education of each student as highly moral, conscious regarding his professional duty of the individual. As a direction of further research, a hypothesis was formulated in relation to the growth of the established dynamics, provided that the future system of exercises that include the axiological aspect of the education of moral and ethical qualities is included in the humanitarian training of future physicians.
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Heggestad, Anne Kari T., Per Nortvedt, and Åshild Slettebø. "The importance of moral sensitivity when including persons with dementia in qualitative research." Nursing Ethics 20, no. 1 (November 19, 2012): 30–40. http://dx.doi.org/10.1177/0969733012455564.
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The aim of this article is to show the importance of moral sensitivity when including persons with dementia in research. The article presents and discusses ethical challenges encountered when a total of 15 persons with dementia from two nursing homes and seven proxies were included in a qualitative study. The examples show that the ethical challenges may be unpredictable. As researchers, you participate with the informants in their daily life and in the interviews, and it is not possible to plan all that may happen during the research. A procedural proposal to an ethical committee at the beginning of a research project based on traditional research ethical principles may serve as a guideline, but it cannot solve all the ethical problems one faces during the research process. Our main argument in this article is, therefore, that moral sensitivity is required in addition to the traditional research ethical principles throughout the whole process of observing and interviewing the respondents.
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Ko, Hsun-Kuei, Hui-Chen Tseng, Chi-Chun Chin, and Min-Tao Hsu. "Phronesis of nurses: A response to moral distress." Nursing Ethics 27, no. 1 (April 11, 2019): 67–76. http://dx.doi.org/10.1177/0969733019833126.
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Background: As moral action could help nurses reduce moral distress, it is necessary to carry out qualitative research to present the experiences in which nurses apply moral action. Aim: To describe and analyze the phronesis applied by nurses in the face of moral distress. Research design: The research participants were invited to participate in in-depth interviews. The research materials were based on the stories described by the research participants and recorded by means of first-person narrative. Narrative analysis was applied to interpret the nurses’ phronesis. Participants: Twenty-seven nurses from Taiwan. Ethical considerations: The Institutional Review Board of the Kaohsiung Medical University Hospital in Taiwan confirmed that this study passed the research ethical review. Findings: According to the narrative analysis results, the phenomenon of moral distress contains difficulty, action, and idea transformation. The difficulty is the source of moral distress, action is the practice of moral courage, and idea transformation is the nurse’s emotional movement. Action and idea transformation are collectively called phronesis in this study. Discussion: Moral distress refers to a state of suffering caused by situations in which nurses cannot carry out their ethical intentions. Phronesis is the process through which nurses take actions and relocate the subjects and is an ethical way to find relief from moral distress. Starting with empathy and respectful attitudes arising from self-reflection, nurses may be helped to get relief from the suffering of moral distress. Conclusion: Phronesis can help nurses positively face the emotional strain of moral distress. This article puts forward a narrative method to complete the four steps of phronesis: write about the care experience, identify the difficulties in the stories, seek the possibility of action, and form a new care attitude, which could help nurses learn to reduce their moral distress.
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Leino-Kilpi, H. "Ethical aspects of emotional labour." European Journal of Cancer 37 (April 2001): S389. http://dx.doi.org/10.1016/s0959-8049(01)81889-x.
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Norvoll, Reidun, and Reidar Pedersen. "Patients’ moral views on coercion in mental healthcare." Nursing Ethics 25, no. 6 (October 27, 2016): 796–807. http://dx.doi.org/10.1177/0969733016674768.
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Background: Coercion in mental healthcare has led to ethical debate on its nature and use. However, few studies have explicitly explored patients’ moral evaluations of coercion. Aim: The purpose of this study is to increase understanding of patients’ moral views and considerations regarding coercion. Research design: Semi-structured focus-group and individual interviews were conducted and data were analysed through a thematic content analysis. Participants and research context: A total of 24 adult participants with various mental health problems and experiences with coercion were interviewed in 2012–2013 in three regions of Norway. Ethical considerations: Ethical approval and permissions were obtained according to required procedures. Informed consent and confidentiality were also secured. Findings: Ethical considerations regarding coercion included seven main themes: the need for alternative perspectives and solutions, the existence of a danger or harm to oneself or others, the problem of paternalism, the problem of discrimination and stigma, the need for proportionality, the importance of the content and consequences of coercion and concerns about way that coercion is carried out in practice. Discussion: The participants’ views and considerations are in line with previous research and reflect the range of normative arguments commonly encountered in ethical and legal debates. The study accentuates the significance of institutional factors and alternative voluntary treatment opportunities, as well as the legal and ethical principles of proportionality and purposefulness, in moral evaluations of coercion. Conclusion: Broader perspectives on coercion are required to comprehend its ethical challenges and derive possible solutions to these from a patient perspective.
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Lützén, Kim, Tammy Blom, Béatrice Ewalds-Kvist, and Sarah Winch. "Moral stress, moral climate and moral sensitivity among psychiatric professionals." Nursing Ethics 17, no. 2 (February 25, 2010): 213–24. http://dx.doi.org/10.1177/0969733009351951.
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The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s moral sensitivity. The nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency.
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Kucukkelepce, Gulhan Erkus, Leyla Dinc, and Melih Elcin. "Effects of using standardized patients on nursing students’ moral skills." Nursing Ethics 27, no. 7 (July 30, 2020): 1587–602. http://dx.doi.org/10.1177/0969733020935954.
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Background: Nurses and nursing students increasingly confront ethical problems in clinical practice. Moral sensitivity, moral reasoning, and ethical decision-making are therefore important skills throughout the nursing profession. Innovative teaching methods as part of the ethics training of nursing students help them acquire these fundamental skills. Aim: This study investigated the effects and potential benefits of using standardized patients in ethics education on nursing baccalaureate students’ moral sensitivity, moral reasoning, and ethical decision-making by comparing this method with in-class case analyses. Research design: This is a quasi-experimental study. Participants and research context: The sample comprised 89 students in Hacettepe University’s Faculty of Nursing. Following lectures describing the theoretical components of ethics, students were randomly assigned to two working groups, one using standardized patients and the other using in-class case analyses. Data were collected using the Moral Sensitivity Questionnaire, Rest’s Defining Issues Test, and the Nursing Dilemma Test. All data were analysed using IBM SPSS Statistics Version 23. Ethical considerations: Ethical approval and official permission were obtained. All participating students completed informed consent forms. Findings: According to the results, the moral sensitivity of students in the standardized patient group significantly improved over time compared to those in the case analysis group, while the mean scores of students in both groups for moral reasoning and ethical decision-making were not statistically significant. Conclusion: Based on our results, we recommend the use of both standardized patients and case analysis as appropriate teaching methods in ethics education.
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Huang, Fei Fei, Qing Yang, Jie Zhang, Qing Hua Zhang, Kaveh Khoshnood, and Jing Ping Zhang. "Cross-cultural validation of the moral sensitivity questionnaire-revised Chinese version." Nursing Ethics 23, no. 7 (August 3, 2016): 784–93. http://dx.doi.org/10.1177/0969733015583183.
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Background: Ethical issues pose challenges for nurses who are increasingly caring for patients in complicated situations. Ethical sensitivity is a prerequisite for nurses to make decisions in the best interest of their patients in daily practice. Currently, there is no tool for assessing ethical sensitivity in Chinese language, and no empirical studies of ethical sensitivity among Chinese nurses. Research objectives: The study was conducted to translate the Moral Sensitivity Questionnaire–Revised Version (MSQ-R) into Chinese and establish the psychometric properties of the Moral Sensitivity Questionnaire–Revised Version into Chinese (MSQ-R-CV). Research design: This research was a methodological and descriptive study. Participants and research context: MSQ-R was translated into Chinese using Brislin’s model, and the Translation Validity Index was evaluated. MSQ-R-CV was then distributed along with a demographic questionnaire to 360 nurses working at tertiary and municipal hospitals in Changsha, China. Ethical considerations: This study was approved by the Institutional Review Boards of Yale University and Central South University. Findings: MSQ-R-CV achieved Cronbach’s alpha 0.82, Spearman-Brown coefficient 0.75, significant item discrimination (p < 0.001), and item-total correlation values ranging from 0.524 to 0.717. A two-factor structure was illustrated by exploratory factor analysis, and further confirmed by confirmatory factor analysis. Chinese nurses had a mean total score of 40.22 ± 7.08 on the MSQ-R-CV, and sub-scores of 23.85 ± 4.4 for moral responsibility and strength and 16.37 ± 3.75 for sense of moral burden. Discussion: The findings of this study were compared with studies from other countries to examine the structure and meaningful implications of ethical sensitivity in Chinese nurses. Conclusion: The two-factor MSQ-R-CV (moral responsibility and strength, and sense of moral burden) is a linguistically and culturally appropriate instrument for assessing ethical sensitivity among Chinese nurses.
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Kendrick, Kevin, and Bev Cubbin. "Ethics in the Intensive Care Unit: a Need for Research." Nursing Ethics 3, no. 2 (June 1996): 157–64. http://dx.doi.org/10.1177/096973309600300208.
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Intensive care units are challenging and technologically advanced environments. Dealing with situations that have an ethical dimension is an intrinsic part of working in such a milieu. When a moral dilemma emerges, it can cause anxiety and unease for all staff involved with it. Theoretical and abstract papers reveal that having to confront situations of ethical difficulty is a contributory factor to levels of poor morale and burnout among critical care staff. Despite this, there is a surprising dearth of published nursing research in the UK that investigates how staff deal with ethical issues in intensive care units. The purpose of this paper is to explore and discuss the development of a research framework designed to explore how staff deal with moral dilemmas in a British inten sive care unit.
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Schluter, Jessica, Sarah Winch, Kerri Holzhauser, and Amanda Henderson. "Nurses' Moral Sensitivity and Hospital Ethical Climate: a Literature Review." Nursing Ethics 15, no. 3 (May 2008): 304–21. http://dx.doi.org/10.1177/0969733007088357.
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Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in acute care settings. Health care research has shown that facilities that are able to attract and retain nursing staff in a competitive environment and provide high quality care have the capacity for nurses to process and resolve moral and ethical dilemmas. This article reports on the findings of a systematic review of the empirical literature (1980 — February 2007) on the effects of unresolved moral distress and poor ethical climate on nurse turnover. Articles were sought to answer the review question: Does unresolved moral distress and a poor organizational ethical climate increase nurse turnover? Nine articles met the criteria of the review process. Although the prevailing sentiment was that poor ethical climate and moral distress caused staff turnover, definitive answers to the review question remain elusive because there are limited data that confidently support this statement.
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Vahakangas, K. "Ethical aspects of molecular epidemiology of cancer." Carcinogenesis 25, no. 4 (October 24, 2003): 465–71. http://dx.doi.org/10.1093/carcin/bgh043.
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Holloway, Immy, and Stephanie Wheeler. "Ethical Issues in Qualitative Nursing Research." Nursing Ethics 2, no. 3 (September 1995): 223–32. http://dx.doi.org/10.1177/096973309500200305.
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This article is concerned with ethical issues that have to be considered when under taking qualitative research. Some of the issues - such as informed consent, the dignity and privacy of the research subjects, voluntary participation and protection from harm - are the same as in other types of research and have their basis in moral and ethical principles. Qualitative research, however, generates specific ethical problems because of the close relationship that researchers form with participants. Qualitative research with patients is especially difficult because of their vulnerability and lack of power in the clinical situation. Therefore the potential conflict between the dual role of the nurse - the professional and the research roles - has to be solved. Researchers also learn how to cope with the tension of subjective and objective elements of the research. Nurses who attempt qualitative research have to consider a variety of complex ethical issues, which are addressed in this paper.
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Asgari, Sharareh, Vida Shafipour, Zohreh Taraghi, and Jamshid Yazdani-Charati. "Relationship between moral distress and ethical climate with job satisfaction in nurses." Nursing Ethics 26, no. 2 (July 18, 2017): 346–56. http://dx.doi.org/10.1177/0969733017712083.
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Background: Moral distress and ethical climate are important issues in the workplace that appear to affect people’s quality of work life. Objectives: This study was conducted to determine the relationship of moral distress and ethical climate to job satisfaction in critical care nurses. Materials and methods: This descriptive-correlation study was conducted on 142 critical care nurses, selected from five social security hospitals in north Iran through census sampling. Data were collected using a demographic questionnaire, the Moral Distress Scale–Revised, the Olson’s Hospital Ethical Climate Survey, and the Brayfield and Rothe Job Satisfaction index. Ethical considerations: The research project was approved by the Ethics Committee of Mazandaran University of Medical Sciences and the Medical Deputy of the Social Security Organization. Findings: The mean scores obtained by the critical care nurses for moral distress, ethical climate, and job satisfaction were 87.02 ± 44.56, 3.51 ± 0.53, and 62.64 ± 9.39, respectively. Although no significant relationships were observed between moral distress and job satisfaction, the relationship between ethical climate and job satisfaction was statistically significant (p < 0.05). Conclusion: Identifying ethical stressors in the workplace and giving proper feedback to the authorities to eliminate these factors and improve the ethical climate in these workplaces can help enhance job satisfaction in nurses and lead to higher quality care.
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Ohnishi, Kayoko, Kazuyo Kitaoka, Jun Nakahara, Maritta Välimäki, Raija Kontio, and Minna Anttila. "Impact of moral sensitivity on moral distress among psychiatric nurses." Nursing Ethics 26, no. 5 (March 1, 2018): 1473–83. http://dx.doi.org/10.1177/0969733017751264.
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Background: Moral distress occurs when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Moral distress was found to cause negative feelings, burnout, and/or resignation. Not only external factors such as lack of staff but also internal ones affect moral distress. Moral sensitivity, which is thought of as an advantage of nurses, could effect moral distress, as nurses being unaware of existing ethical problems must feel little distress. Objectives: To examine the impact of moral sensitivity on moral distress among psychiatric nurses, and affirm the hypothesis that nurses with higher moral sensitivity will suffer moral distress more than nurses with less moral sensitivity in two different samples. Ethical consideration: The study obtained ethical approval from the Research Ethics Committee of the Faculty of Medicine at Mie University (# 1111, 20.4.2010), and by the Turku University Ethics Board (29.5.2012). Permissions to undertake the study was obtained from the in two hospital districts and in one city (§ 48/4.10.2012, § 63/4.9.2012, 51/2012 27.8.2012). Informed consent was not formally obtained, because the questionnaire was anonymously reported by the participants who volunteered to answer. The participants responded voluntarily and anonymously. Methods: An anonymous questionnaire containing the Revised Moral Sensitivity Questionnaire and the Moral Distress Scale for Psychiatric nurses was conducted to 997 nurses in 12 hospitals in Japan, and 974 nurses in 10 hospitals in Finland after obtaining of approval by research ethics committees. Data were analyzed using a multi-group structural equation model analysis. Findings: A set of analyses imply that the association of moral sensitivity with moral distress is significant and similar between Japan and Finland, whereas the factor structures of moral sensitivity and moral distress may be partially different. Discussion: The result of this study may indicate that nurses with high moral sensitivity can sense and identify moral problems, but not resolve them. Therefore, supporting nurses to solve ethical problems, not benumbing them, can be important for better nursing care and prevention of nurses’ resignation. Conclusion: Moral sensitivity and moral distress were positively correlated among psychiatric nurses in both Japan and Finland, although the participating nurses from the two countries were different in qualification, age, and cultural background. Nurses with high moral sensitivity suffer from moral distress.
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Deschenes, Sadie, and Diane Kunyk. "Situating moral distress within relational ethics." Nursing Ethics 27, no. 3 (December 5, 2019): 767–77. http://dx.doi.org/10.1177/0969733019884621.
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Nurses may, and often do, experience moral distress in their careers. This is related to the complicated work environment and the complex nature of ethical situations in everyday nursing practice. The outcomes of moral distress may include psychological and physical symptoms, reduced job satisfaction and even inadequate or inappropriate nursing care. Moral distress can also impact retention of nurses. Although research has grown considerably over the past few decades, there is still a great deal about this topic that we do not know including how to deal well with moral distress. A critical key step is to develop a deeper understanding of relational practice as it pertains to moral distress. In this article, exploration of the experience of moral distress among nurses is guided by the key elements of relational ethics. This ethical approach was chosen because it recognizes that ethical practice is situated in relationships and it acknowledges the importance of the broader environment on influencing ethical action. The findings from this theoretical exploration will provide a theoretical foundation upon which to advance our knowledge about moral distress.
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Dahlöf, Carl. "Ethical considerations in biomedical research: A personal view." Cephalalgia 33, no. 8 (May 13, 2013): 507–11. http://dx.doi.org/10.1177/0333102412468674.
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Premise Ethical considerations are made when an experiment is planned and take a regulatory system of moral principles into account. Discussion Ethical considerations should first and foremost be made in order to protect the individual subject/animal from being exposed to any unethical and perhaps even illegal intervention and to ensure that the experimental conditions used are appropriate. Summary The main role of research ethics committees is to assess the scientific and ethical aspects of submitted protocols and follow up the trial until its closure.
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Dalla Nora, Carlise R., Elma LCP Zoboli, and Margarida M. Vieira. "Validation of a Brazilian version of the moral sensitivity questionnaire." Nursing Ethics 26, no. 3 (August 17, 2017): 823–32. http://dx.doi.org/10.1177/0969733017720849.
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Background: Moral sensitivity has been identified as a foundational component of ethical action. Diminished or absent moral sensitivity can result in deficient care. In this context, assessing moral sensitivity is imperative for designing interventions to facilitate ethical practice and ensure that nurses make appropriate decisions. Objective: The main purpose of this study was to validate a scale for examining the moral sensitivity of Brazilian nurses. Research design: A pre-existing scale, the Moral Sensitivity Questionnaire, which was developed by Lützén, was used after the deletion of three items. The reliability and validity of the scale were examined using Cronbach’s alpha and factor analysis, respectively. Participants and research context: Overall, 316 nurses from Rio Grande do Sul, Brazil, participated in the study. Ethical considerations: This study was approved by the Ethics Committee of Research of the Nursing School of the University of São Paulo. Findings: The Moral Sensitivity Questionnaire contained 27 items that were distributed across four dimensions: interpersonal orientation, professional knowledge, moral conflict and moral meaning. The questionnaire accounted for 55.8% of the total variance, with Cronbach’s alpha of 0.82. The mean score for moral sensitivity was 4.45 (out of 7). Discussion and conclusion: The results of this study were compared with studies from other countries to examine the structure and implications of the moral sensitivity of nurses in Brazil. The Moral Sensitivity Questionnaire is an appropriate tool for examining the moral sensitivity of Brazilian nurses.
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Borhani, Fariba, Abbas Abbaszadeh, Elham Mohamadi, Erfan Ghasemi, and Mohammad Javad Hoseinabad-Farahani. "Moral sensitivity and moral distress in Iranian critical care nurses." Nursing Ethics 24, no. 4 (September 28, 2015): 474–82. http://dx.doi.org/10.1177/0969733015604700.
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Background: Moral sensitivity is the foremost prerequisite to ethical performance; a review of literature shows that nurses are sometimes not sensitive enough for a variety of reasons. Moral distress is a frequent phenomenon in nursing, which may result in paradoxes in care, dealing with patients and rendering high-quality care. This may, in turn, hinder the meeting of care objectives, thus affecting social healthcare standards. Research objective: The present research was conducted to determine the relationship between moral sensitivity and moral distress of nurses in intensive care units. Research design: This study is a descriptive-correlation research. Lutzen’s moral sensitivity questionnaire and Corley Moral Distress Questionnaire were used to gather data. Participants and research context: A total of 153 qualified nurses working in the hospitals affiliated to Shahid Beheshti University of Medical Sciences were selected for this study. Subjects were selected by census method. Ethical considerations: After explaining the objectives of the study, all the participants completed and signed the written consent form. To conduct the study, permission was obtained from the selected hospitals. Findings: Nurses’ average moral sensitivity grade was 68.6 ± 7.8, which shows a moderate level of moral sensitivity. On the other hand, nurses also experienced a moderate level of moral distress (44.8 ± 16.6). Moreover, there was no meaningful statistical relationship between moral sensitivity and moral distress (p = 0.26). Discussion: Although the nurses’ moral sensitivity and moral distress were expected to be high in the intensive care units, it was moderate. This finding is consistent with the results of some studies and contradicts with others. Conclusion: As moral sensitivity is a crucial factor in care, it is suggested that necessary training be provided to develop moral sensitivity in nurses in education and practical environments. Furthermore, removing factors that contribute to moral distress may help decrease it in nurses.
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Rodger, Daniel, Bruce Blackshaw, and Amanda Young. "Moral distress in healthcare assistants: A discussion with recommendations." Nursing Ethics 26, no. 7-8 (August 22, 2018): 2306–13. http://dx.doi.org/10.1177/0969733018791339.
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Background: Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants. Objective: This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures. Research Design: This is a survey of the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts. Participants and Research Context: No research participants were part of this analysis. Ethical Considerations: This article offers a conceptual analysis and recommendations only. Findings: The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress. Discussion: Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants. Conclusion: This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations.
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Sancho García, Sonsoles. "Research in oncology: legal and ethical aspects." Clinical and Translational Oncology 10, no. 7 (July 2008): 383–84. http://dx.doi.org/10.1007/s12094-008-0218-5.
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Kolodko, G. "Ethical Aspects of Business, Economy and Politics." Voprosy Ekonomiki, no. 11 (November 20, 2007): 44–54. http://dx.doi.org/10.32609/0042-8736-2007-11-44-54.
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Despite the main attention being given within the economic activity to the issues of efficiency and competitiveness, one shouldn’t oversee the ethical aspects of business and economic policy. Quite important are also the matters of truth and false in economic research. Several phenomena and processes - subsidies, dumping, weapons trading, fiscal system and policy - do have also their moral dimension, not just the economic one. Hence, the issues of ethics should be considered and discussed in a wider context. From this perspective there is still a lot to be done, especially in the countries with weak market institutions and relatively lower quality of market culture, including post-socialist countries in transition to market system.
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Zhang, Na, Mingfang Li, Zhenxing Gong, and Dingxin Xu. "Effects of ethical leadership on nurses’ service behaviors." Nursing Ethics 26, no. 6 (August 5, 2018): 1861–72. http://dx.doi.org/10.1177/0969733018787220.
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Background: Nurses’ service behaviors have critical implications for hospitals. However, few studies had adequate ethical considerations of service behaviors and accounted for how organizational or individual antecedents can induce nurses to engage in service behaviors. In addition, they mainly focused on the one side of role-prescribed or extra-role service behavior. Objective: This study aims to explore the chained mediation effect of ethical climate and moral sensitivity on the relationship between organizational ethical leadership and nurses’ service behaviors and to examine the relationship, from a comparative view, of the role-prescribed service behavior and extra-role service behavior. Methods: In all, 476 nurses from three tertiary hospitals were investigated with the Ethical Leadership Scale, Ethical Climate Scale, Moral Sensitivity Questionnaire and Service Behavior Questionnaire. Structural equation modeling was adopted to analyze the data. SPSS and Mplus statistical software was used in the data analysis. Ethical considerations: Approval was obtained from the Ethics Committee at School of Nursing, Hebei Medical University. Data privacy and confidentiality were maintained and assured by obtaining subjects’ informed consent to participate in the research before data collection. Results: The effects of ethical leadership on nurses’ service behaviors are mediated by two variables in turn: ethical climate and nurses’ moral sensitivity. Ethical climate and moral sensitivity partially mediated the relationship between ethical leadership and nurses’ role-prescribed service behavior and fully mediated the relationship between ethical leadership and nurses’ extra-role service behavior. Conclusion: Organizational ethical leadership positively affected ethical climate, which positively affected nurses’ moral sensitivity and affected both their role-prescribed service behavior and extra-role service behavior.
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Elmore, James, David Kenneth Wright, and Maude Paradis. "Nurses’ moral experiences of assisted death: A meta-synthesis of qualitative research." Nursing Ethics 25, no. 8 (December 28, 2016): 955–72. http://dx.doi.org/10.1177/0969733016679468.
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Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is (1) defined by a profound sense of responsibility, (2) shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and (3) sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded.
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Passos dos Santos, Raissa, Eliane Tatsch Neves, and Franco Carnevale. "The moral experiences of pediatric nurses in Brazil: Engagement and relationships." Nursing Ethics 26, no. 5 (March 1, 2018): 1566–78. http://dx.doi.org/10.1177/0969733017753744.
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Background: Pediatric nursing care involves many significant ethical challenges. Although nurses are broadly recognized as professionals with relevant knowledge about children and families, little is known about how nurses experience ethical concerns in their everyday practice. Objective: The objective of this study was to better understand the moral experiences and related moral distress experiences of nurses working in pediatric settings in Brazil. Design: Interpretative phenomenological study conducted through narrative interviews. Participants and research context: Nine nurses working in three pediatric settings of a teaching hospital in a city of Southern Brazil. Ethical considerations: The study was approved by the Research Ethics Committee of the research site, and research ethics principles were respected throughout the study. Findings: This investigation illuminated a broader dimension of nurses’ moral distress, which was recognized as moral experience. In advancing our understanding of nurses’ moral experiences, engagement was identified as a central phenomenon that is present in the understandings and actions of nurses within their relationships in their daily practice and lived experiences. Three themes were described with regard to nurses’ relationships and their moral experiences: (a) relationship with the healthcare team; (b) relationship with the family; and (c) relationship with the child. Discussion: The findings of this study are congruent with emerging health literature that demonstrated the focus on moral distress as limiting for bioethical inquiry. Moreover, it is important to better understand and recognize nurses’ relational environment and engagements to advance understandings of the ethical dimensions of pediatric nursing practice. Conclusion: This study provides a better understanding on how engagement affects moral experiences, demonstrating how nurses can experience distress but also satisfaction, gratification, rewarding feelings, and a sense of responsibility for the care they provide.
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Pinch, W. J. Ellenchild, and Mary E. Parsons. "Moral Orientation of Elderly Persons: considering ethical dilemmas in health care." Nursing Ethics 4, no. 5 (September 1997): 380–93. http://dx.doi.org/10.1177/096973309700400504.
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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.
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de Casterlé, Bernadette Dierckx, Mieke Grypdonck, Magda Vuylsteke-Wauters, and Piet J. Janssen. "Nursing Students’ Responses to Ethical Dilemmas in Nursing Practice." Nursing Ethics 4, no. 1 (January 1997): 12–28. http://dx.doi.org/10.1177/096973309700400103.
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In literature as well as in nursing practice a growing concern about nurses’ ethical competence can be observed. Based on the cognitive theory of moral development by Kohlberg, this research examined nursing students’ ethical behaviour in five nursing dilemmas. Ethical behaviour refers not only to the ethical reasoning of nursing students but also to the relationship between reasoning and behaviour. Kohlberg’s definition of morality was refined by adding a care perspective. The results show that the majority of students can be located in the fourth moral stage according to Kohlberg’s theory, that is, the conventional level of moral development. This finding implies that students are still guided by professional rules, norms and duties, and have not (yet) succeeded in making personal ethical decisions on the basis of their own principles and acting according to such decisions.
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Falcó-Pegueroles, Anna, Teresa Lluch-Canut, Juan Roldan-Merino, Josefina Goberna-Tricas, and Joan Guàrdia-Olmos. "Ethical conflict in critical care nursing." Nursing Ethics 22, no. 5 (October 20, 2014): 594–607. http://dx.doi.org/10.1177/0969733014549883.
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Background: Ethical conflicts in nursing have generally been studied in terms of temporal frequency and the degree of conflict. This study presents a new perspective for examining ethical conflict in terms of the degree of exposure to conflict and its typology. Objectives: The aim was to examine the level of exposure to ethical conflict for professional nurses in critical care units and to analyze the relation between this level and the types of ethical conflict and moral states. Research design: This was a descriptive correlational study. Central and dispersion, normality tests, and analysis of variance were carried out. Participants and research context: A total of 203 nurses were from two third-level teaching hospitals in Spain. Both centers are part of the University of Barcelona Health Network. Participants filled out the Ethical Conflict in Nursing Questionnaire–Critical Care Version. Ethical considerations: This investigation received the approval of the ethical committees for clinical investigation of the two participating hospitals. Participants were informed of the authorship and aims of the study. Findings: The index of exposure to ethical conflict was [Formula: see text]. The situations involving analgesic treatment and end-of-life care were shown to be frequent sources of conflict. The types of ethical conflict and moral states generally arranged themselves from lesser to greater levels of index of exposure to ethical conflict. Discussion: The moderate level of exposure to ethical conflict was consistent with other international studies. However, the situations related with family are infrequent, and this presents differences with previous research. The results suggest that there is a logical relationship between types of conflict and levels of exposure to ethical conflict. Conclusion: The types of ethical conflict and moral states were related with the levels of exposure to ethical conflict. The new perspective was shown to be useful for analyzing the phenomenon of ethical conflict in the nurse.
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Monteverde, Settimio. "Undergraduate healthcare ethics education, moral resilience, and the role of ethical theories." Nursing Ethics 21, no. 4 (December 5, 2013): 385–401. http://dx.doi.org/10.1177/0969733013505308.
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Background: This article combines foundational and empirical aspects of healthcare education and develops a framework for teaching ethical theories inspired by pragmatist learning theory and recent work on the concept of moral resilience. It describes an exemplary implementation and presents data from student evaluation. Objectives: After a pilot implementation in a regular ethics module, the feasibility and acceptance of the novel framework by students were evaluated. Research design: In addition to the regular online module evaluation, specific questions referring to the teaching of ethical theories were added using simple (yes/no) and Likert rating answer formats. Participants and research context: At the Bern University of Applied Sciences, a total of 93 students from 2 parallel sub-cohorts of the bachelor’s program in nursing science were sent the online survey link after having been exposed to the same modular contents. A total of 62% of all students participated in the survey. Ethical considerations: The survey was voluntary and anonymous. Students were free to write their name and additional comments. Findings: Students consider ethical theories—as taught within the proposed framework—as practically applicable, useful, and transferable into practice. Discussion: Teaching ethical theories within the proposed framework overcomes the shortcomings described by current research. Students do not consider the mutually exclusive character of ethical theories as an insurmountable problem. Conclusion: The proposed framework is likely to promote the effectiveness of healthcare ethics education. Inspired by pragmatist learning theory, it enables students to consider ethical theories as educative playgrounds that help them to “frame” and “name” the ethical issues they encounter in daily practice, which is seen as an expression of moral resilience. Since it does not advocate a single ethical theory, but is open to the diversity of traditions that shape ethical thinking, it promotes a culturally sensitive, ethically reflected healthcare practice.
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Hyder, Adnan A., Abbas Rattani, and Bridget Pratt. "Research Capacity Strengthening in Low- and Middle-Income Countries: Ethical Explorations." Journal of Law, Medicine & Ethics 45, no. 1 (2017): 129–37. http://dx.doi.org/10.1177/1073110517703106.
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With developed country governments and high resource institutions engaging in research in low- and middle-income countries (LMIC), we argue that these entities have a moral obligation to help build and strengthen research infrastructure and capacity so local scientists and institutions can adequately conduct studies to understand and resolve the health burdens in low and middle income countries. We explore the moral justifications and motivations behind engaging in research capacity strengthening in the health sector in LMIC at multiple levels. In highlighting these issues, this paper aims to initiate a global discourse around why capacity development in LMIC has a moral basis at the individual, institutional and system levels.
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Rennó, Heloiza Maria Siqueira, Flávia Regina Souza Ramos, and Maria José Menezes Brito. "Moral distress of nursing undergraduates: Myth or reality?" Nursing Ethics 25, no. 3 (May 18, 2016): 304–12. http://dx.doi.org/10.1177/0969733016643862.
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Introduction: During their education process, nursing undergraduates experience ethical conflicts and dilemmas that can lead to moral distress. Moral distress can deprive the undergraduates of their working potential and may cause physical and mental health problems. Objective: We investigated the experiences of the undergraduates in order to identify the existence of moral distress caused by ethical conflict and dilemmas experienced during their nursing education. Ethical considerations: This study was designed according to the principles of research with human beings and was approved by the Human Research Ethics Committee. Method: A qualitative multiple-case study. Two federal higher education institutions were surveyed, from which 58 undergraduates in nursing participated in the study. The undergraduates were undergoing their professional training. The data were collected through focus groups and were submitted to thematic content analysis, with the resources of the ATLAS TI 7.0 software. Results: Moral distress in undergraduates is a reality and was identified in three axes of analysis: (1) moral distress is experienced by undergraduates in the reality of healthcare services, (2) the teacher as a source of moral distress, and (3) moral distress as a positive experience. Conclusion: The undergraduates in nursing manifest moral distress in different stages of their education, particularly during their professional training. The academic community should reflect and seek solutions for the reality of moral distress in undergraduates.
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Kleemola, Emmi, Helena Leino-Kilpi, and Olivia Numminen. "Care situations demanding moral courage: Content analysis of nurses’ experiences." Nursing Ethics 27, no. 3 (January 26, 2020): 714–25. http://dx.doi.org/10.1177/0969733019897780.
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Background: Nurses encounter complex ethical dilemmas in everyday nursing care. It is important for nurses to have moral courage to act in these situations which threaten patients’ safety or their good care. However, there is lack of research of moral courage. Purpose: This study describes nurses’ experiences of care situations demanding moral courage and their actions in these situations. Method: A qualitative descriptive research design was applied. The data were collected with an open-ended question in the questionnaire used in validation of the Nurses’ Moral Courage Scale. The sample consisted of 286 nurses from four different clinical fields in a major university hospital in Finland, providing a total of 611 answers. Data were analyzed using inductive content analysis. Ethical considerations: The study followed the commonly recognized principles of good scientific practice. The use of data was authorized by the developer of the instrument, the data collector, and the participating hospital. Ethical approval was obtained from the university ethics committee. Findings: Nurses acted morally courageously in most situations but sometimes they failed to do so. Although situations demanding moral courage varied, they could be categorized into seven main domains relating to colleagues, physicians, patients, relatives, nurses themselves, managers, and organizations. Nurses acted in the situations in different ways. The main acts in solving the situations were verbal communication or immediate action, such as interrupting of action. Conclusion: Care situations demanding moral courage focus on good and safe patient care and the patient’s good is at the center of attention. The situations are mostly related to the activities of other healthcare professionals. Findings may be applied in developing ethical nursing care through basic and continuing nursing education. Research is needed on the moral courage of physicians and managers, as well as on patients’ and their relatives’ experiences of care situations demanding moral courage.