Journal articles on the topic 'Fashion design – Moral and ethical aspects'
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Peter, Elizabeth, Anne Simmonds, and Joan Liaschenko. "Nurses’ narratives of moral identity: Making a difference and reciprocal holding." Nursing Ethics 25, no. 3 (May 24, 2016): 324–34. http://dx.doi.org/10.1177/0969733016648206.
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Background: Explicating nurses’ moral identities is important given the powerful influence moral identity has on the capacity to exercise moral agency. Research objectives: The purpose of this study was to explore how nurses narrate their moral identity through their understanding of their work. An additional purpose was to understand how these moral identities are held in the social space that nurses occupy. Research design: The Registered Nurse Journal, a bimonthly publication of the Registered Nurses’ Association of Ontario, Canada, features a regular column entitled, ‘In the End … What Nursing Means to Me …’ These short narratives generally include a story of an important moment in the careers of the authors that defined their identities as nurses. All 29 narratives published before June 2015 were analysed using a critical narrative approach, informed by the work of Margaret Urban Walker and Hilde Lindemann, to identify a typology of moral identity. Ethical considerations: Ethics approval was not required because the narratives are publicly available. Findings: Two narrative types were identified that represent the moral identities of nurses as expressed through their work: (1) making a difference in the lives of individuals and communities and (2) holding the identities of vulnerable individuals. Discussion: Nurses’ moral identities became evident when they could see improvement in the health of patients or communities or when they could maintain the identity of their patients despite the disruptive forces of illness and hospitalization. In reciprocal fashion, the responses of their patients, including expressions of gratitude, served to hold the moral identities of these nurses. Conclusion: Ultimately, the sustainability of nurses’ moral identities may be dependent on the recognition of their own needs for professional satisfaction and care in ways that go beyond the kind of acknowledgement that patients can offer.
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Gyde, Ciara, and Lisa S. McNeill. "Fashion Rental: Smart Business or Ethical Folly?" Sustainability 13, no. 16 (August 9, 2021): 8888. http://dx.doi.org/10.3390/su13168888.
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The research presented here illustrates the spectrum of fashion rental PSS firms and business strategies within the New Zealand fashion rental market. The evidence collected suggests that there is a market for fashion rental; however, this market is underdeveloped in regard to its potential as a benefit exchange medium that encourages alternative consumption practice. This study finds that there is, indeed, enormous potential in PSSs as a means to divert fashion-conscious consumers away from ownership behaviours; however, the current systems fall short of this goal. This study offers a taxonomy to create and develop fashion rental PSSs that achieve central aims of circular economy fashion systems, enhancing the collective, social aspects of access, value-sharing and continuing development of mutual gain within the system. It is anticipated that this taxonomy could be further refined and extended through research in other countries, including those with more established, larger fashion rental organisations. Further, there is potential for action research approaches to the design and analysis of alternative fashion rental PSSs.
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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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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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Manchiraju, Srikant, and Amrut Sadachar. "Personal values and ethical fashion consumption." Journal of Fashion Marketing and Management 18, no. 3 (July 8, 2014): 357–74. http://dx.doi.org/10.1108/jfmm-02-2013-0013.
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Purpose – The role of personal values in consumer behavior is well documented; however, in the context of fashion consumption, the role of personal values’ influence on consumers’ ethical behavior has not been studied. Consequently, the purpose of this paper is to seek to explore whether consumers’ personal values predict consumers’ behavioral intentions to engage in ethical fashion consumption. Design/methodology/approach – The present study employed the Fritzsche model, which states that an individual's personal values are related to his/her intentions to engage in ethical behavior. The present study examined the causal relationship between the personal values and behavioral intentions to engage in ethical fashion consumption. Data collected from the US national sample were subjected to structural equation modeling. Findings – The proposed model explained 42 percent of variance in consumer's behavioral intentions toward ethical fashion consumption. Furthermore, a significant negative relationship between self-enhancement personal values and behavioral intention toward ethical fashion consumption was found. Several theoretical and practical implications related to the present study were discussed. Originality/value – To the authors’ knowledge, the study is first of its kind in several aspects: first, ethical fashion consumption has been conceptualized in the broadest definition possible, as oppose to focussing on a particular facet of fashion consumption (e.g. organic products or counterfeit fashion); second, linking consumer personal values as a predictor of his/her ethical fashion consumption behavioral intentions; and third, employing the Fritzsche model in fashion behavior context.
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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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Kälvemark Sporrong, Sofia, Bengt Arnetz, Mats G. Hansson, Peter Westerholm, and Anna T. Höglund. "Developing Ethical Competence in Health Care Organizations." Nursing Ethics 14, no. 6 (November 2007): 825–37. http://dx.doi.org/10.1177/0969733007082142.
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Increased work complexity and financial strain in the health care sector have led to higher demands on staff to handle ethical issues. These demands can elicit stress reactions, that is, moral distress. One way to support professionals in handling ethical dilemmas is education and training in ethics. This article reports on a controlled prospective study evaluating a structured education and training program in ethics concerning its effects on moral distress. The results show that the participants were positive about the training program. Moral distress did not change significantly. This could be interpreted as competence development, with no effects on moral distress. Alternatively, the result could be attributed to shortcomings of the training program, or that it was too short, or it could be due to the evaluation instrument used. Organizational factors such as management involvement are also crucial. There is a need to design and evaluate ethics competence programs concerning their efficacy.
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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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Krawczyk, Rosemary M. "Teaching Ethics: Effect on Moral Development." Nursing Ethics 4, no. 1 (January 1997): 57–65. http://dx.doi.org/10.1177/096973309700400107.
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The purpose of this study was to determine the development of moral judgement in first-year and senior baccalaureate nursing students. These students were enrolled in three separate nursing programmes, each of which differed significantly in ethical content. The sample totalled 180 students enrolled in three New England programmes. Programme A included an ethics course taught by a professor of ethics. Programme B integrated ethical issues into all nursing theory courses. Programme C did not include ethical content in theory courses. The design was of a developmental cross-sectional study. The dependent variable was the development of moral judgement, as measured by Rest’s Defining Issues Test. The independent variable was the amount of ethics taught in the nursing programmes and the level of academic education. The senior nursing students from programme A scored significantly higher than the other senior groups on the Defining Issues Test. The conclusion is that an ethics course with group participation and a decision-making element significantly facilitated nursing students’ development of moral judgement.
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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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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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Numminen, Olivia, Hanna Repo, and Helena Leino-Kilpi. "Moral courage in nursing: A concept analysis." Nursing Ethics 24, no. 8 (March 22, 2016): 878–91. http://dx.doi.org/10.1177/0969733016634155.
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Background: Nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one’s moral values. Nurses need moral courage in all areas and at all levels of nursing. Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Nevertheless, what the concept of moral courage means in nursing contexts remains ambiguous. Objective: This article is an analysis of the concept of moral courage in nursing. Design: Rodgers’ evolutionary method of concept analysis provided the framework to conduct the analysis. Data sources: The literature search was carried out in September 2015 in six databases: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and The Philosopher’s Index. The following key words were used: “moral” OR “ethical” AND “courage” OR “strength” AND “nurs*” with no time limit. After applying inclusion and exclusion criteria, 31 studies were included in the final analysis. Ethical considerations: This study was conducted according to good scientific guidelines. Results: Seven core attributes of moral courage were identified: true presence, moral integrity, responsibility, honesty, advocacy, commitment and perseverance, and personal risk. Antecedents were ethical sensitivity, conscience, and experience. Consequences included personal and professional development and empowerment. Discussion and conclusion: This preliminary clarification warrants further exploring through theoretical and philosophical literature, expert opinions, and empirical research to gain validity and reliability for its application in nursing practice.
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Jansen, Trine-Lise, Marit Helene Hem, Lars Johan Dambolt, and Ingrid Hanssen. "Moral distress in acute psychiatric nursing: Multifaceted dilemmas and demands." Nursing Ethics 27, no. 5 (October 20, 2019): 1315–26. http://dx.doi.org/10.1177/0969733019877526.
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Background In this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored. Research design A qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used. Ethical considerations Approval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary. Findings Based on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness. Conclusion Moral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves.
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Lee, Hsiao Lu, Shu-He Huang, and Chiu-Mieh Huang. "Evaluating the effect of three teaching strategies on student nurses’ moral sensitivity." Nursing Ethics 24, no. 6 (January 27, 2016): 732–43. http://dx.doi.org/10.1177/0969733015623095.
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Background: The Taiwan Nursing Accreditation Council has proposed eight core professional nursing qualities including ethical literacy. Consequently, nursing ethics education is a required course for student nurses. These courses are intended to improve the ethical literacy. Moral sensitivity is the cornerstone of ethical literacy, and learning moral sensitivity is the initial step towards developing ethical literacy. Objectives: To explore the effect of nursing ethics educational interventions based on multiple teaching strategies on student nurses moral sensitivity. Based on the visual, auditory and kinaesthetic model, three strategies were developed for determining the programme components and corresponding learning styles. Research design: This was a quasi-experimental study. Participants: A total of 234 junior-college student nurses participated in this study. All participants were aged 18–19 years. Ethical considerations: The study protocol was approved by the institutional review boards of Kaohsiung Veterans General Hospital. Only the participants who signed an informed consent form took part in the study. The participants were permitted to withdraw from the study at any point if they wished to do so without affecting their academic score. Results: The scores of Modified Moral Sensitivity Questionnaire for Student Nurses were significantly improved after the intervention of integrating multiple teaching strategies ( p = .042). Significant relationships were observed between the satisfaction scores of two teaching strategies and moral sensitivity. The results indicated that using multiple teaching strategies is effective for promoting nursing ethics learning. Conclusion: This strategy was consistent with the student nurses’ preferred learning style and was used to correct their erroneous ethical conceptions, assisting in developing their ethical knowledge.
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Tuvesson, Hanna, and Kim Lützén. "Demographic factors associated with moral sensitivity among nursing students." Nursing Ethics 24, no. 7 (January 28, 2016): 847–55. http://dx.doi.org/10.1177/0969733015626602.
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Background: Today’s healthcare environment is often characterized by an ethically demanding work situation, and nursing students need to prepare to meet ethical challenges in their future role. Moral sensitivity is an important aspect of the ethical decision-making process, but little is known regarding nursing students’ moral sensitivity and its possible development during nursing education. Objectives: The aims of this study were to investigate moral sensitivity among nursing students, differences in moral sensitivity according to sample sub-group, and the relation between demographic characteristics of nursing students and moral sensitivity. Research design: A convenience sample of 299 nursing students from one university completed a questionnaire comprising questions about demographic information and the revised Moral Sensitivity Questionnaire. With the use of SPSS, non-parametric statistics, including logistic regression models, were used to investigate the relationship between demographic characteristics and moral sensitivity. Ethical considerations: The study followed the regulations according to the Swedish Ethical Review Act and was reviewed by the Ethics Committee of South-East Sweden. Findings: The findings showed that mean scores of nursing students’ moral sensitivity were found in the middle to upper segment of the rating scale. Multivariate analysis showed that gender (odds ratio = 3.32), age (odds ratio = 2.09; 1.73), and parental status (odds ratio = 0.31) were of relevance to nursing students’ moral sensitivity. Academic year was found to be unrelated to moral sensitivity. Discussion and conclusion: These demographic aspects should be considered when designing ethics education for nursing students. Future studies should continue to investigate moral sensitivity in nursing students, such as if and how various pedagogical strategies in ethics may contribute to moral sensitivity in nursing students.
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Sasso, Loredana, Annamaria Bagnasco, Monica Bianchi, Valentina Bressan, and Franco Carnevale. "Moral distress in undergraduate nursing students." Nursing Ethics 23, no. 5 (August 2016): 523–34. http://dx.doi.org/10.1177/0969733015574926.
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Background: Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety. Objectives: The purpose of this review was to describe how dilemmas and environmental, relational, and organizational factors contribute to moral distress in undergraduate student nurses during their clinical experience and professional education. Research design: The research design was a systematic literature review. Method: The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check. Ethical consideration: Since this was a systematic review, no ethical approval was required. Findings: From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses. Conclusion: Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students.
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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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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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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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McLeod-Sordjan, Renee. "Evaluating moral reasoning in nursing education." Nursing Ethics 21, no. 4 (November 13, 2013): 473–83. http://dx.doi.org/10.1177/0969733013505309.
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Evidence-based practice suggests the best approach to improving professionalism in practice is ethics curricula. However, recent research has demonstrated that millennium graduates do not advocate for patients or assert themselves during moral conflicts. The aim of this article is the exploration of evaluation techniques to evaluate one measurable outcome of ethics curricula: moral reasoning. A review of literature, published between 1995 and 2013, demonstrated that the moral orientations of care and justice as conceptualized by Gilligan and Kohlberg are utilized by nursing students to solve ethical dilemmas. Data obtained by means of reflective journaling, Ethics of Care Interview (ECI) and Defining Issues Test (DIT), would objectively measure the interrelated pathways of care-based and justice-based moral reasoning. In conclusion, educators have an ethical responsibility to foster students' ability to exercise sound clinical judgment, and support their professional development. It is recommended that educators design authentic assessments to demonstrate student's improvement of moral reasoning.
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Macpherson, Ignacio, María Victoria Roqué, and Ignacio Segarra. "Moral dilemmas involving anthropological and ethical dimensions in healthcare curriculum." Nursing Ethics 27, no. 5 (April 29, 2020): 1238–49. http://dx.doi.org/10.1177/0969733020914382.
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Background Currently a variety of novel scenarios have appeared within nursing practice such as confidentiality of a patient victim of abuse, justice in insolvent patients, poorly informed consent delivery, non-satisfactory medicine outputs, or the possibility to reject a recommended treatment. These scenarios presuppose skills that are not usually acquired during the degree. Thus, the implementation of teaching approaches that promote the acquisition of these skills in the nursing curriculum is increasingly relevant. Objective The article analyzes an academic model which integrates in the curriculum a series of specific theoretical concepts together with practical skills to acquire the basic ethic assessment competency. Research design The project includes designing two subjects, General Anthropology and Ethics-Bioethics, with an applied approach in the nursing curriculum. The sequential structure of the curriculum in both subjects is constituted by three learning domains (theoretical, practical, and communicative) with different educational strategies. Ethical considerations No significant ethical considerations as this is a discussion paper. Findings The model was structured from the anthropology’s concepts and decision-making process, applied to real situations. The structure of the three domains theoretical–practical–communicative is present in each session. Discussion It is observed that theoretical domain fosters the capacity for critical analysis and subsequent ability to judge diverse situations. The practical domain reflected two significant difficulties: students’ resistance to internalizing moral problems and the tendency to superficial criticism. The communicative domain has frequently shown that the conflicting points are in the principles to be applied. Conclusion We conclude that this design achieves its objectives and may provide future nursing professionals with ethical competences especially useful in healthcare practice. The three domains of the presented scheme are associated with the same process used in decision making at individual levels, where the exercise of clinical prudence acquires particular relevance.
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Kumar Padhi, Prafulla. "Valuation and Inception of Ethical Fashion Smart Wearable Born-Global Speculative Start-up (BGSS)." International Journal of Community Development and Management Studies 1 (2017): 117–48. http://dx.doi.org/10.31355/17.
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NOTE: THIS ARTICLE WAS PUBLISHED WITH THE INFORMING SCIENCE INSTITUTE. Aim/Purpose.............................................................................................................................................................................................. Since the valuation of a born-global speculative start-up (BGSS) has been a guessing game and there is no framework in the literature from ethical fashion smart wearable (EFSW) venture valuation perspective, this research explores to create a holistic model using multi-stage valuation method to valuate BGSS at its inception and investigates how ethical is ethical fashion? Background................................................................................................................................................................................................ The concept of ‘Born-Global’ firm was introduced into business theory during 1988. Nowadays, ventures start with a global vision from their inception to introduce products and services in overseas markets. Speculative investment has been a common practice to start-up expedition. Investors gamble on speculative start-ups. The inception phase of any start-up is the embryonic phase and is, therefore, more speculative than successive phases for additional investments. BGSS at its inception possess no operating history. Today fashion industry is one of the largest industries globally, growing leaps and bounds with valuation at 3 trillion U.S. dollars. The emerging smart fashion wearable market projected to cross US$ 30 billion during 2017. Fashion exists not only in garments but also other wearable such as the bracelet, watches, jewelry, and other accessories. Ethical fashion is all about betterment for the people and community at large. This paper identifies the relevant actors and their impact on the ethical aspects and status of the fashion industry. Methodology............................................................................................................................................................................................... The methodology used in this research both qualitative and quantitative approach. Since ethical fashion is a social phenomenon, the qualitative approach is appropriate to deal with various perspective analysis of ethical fashion using case study on four ethical fashion smart wearable ventures. The quantitative method calibrates the valuation of a BGSS at the inception stage using a noble pragmatic multi-stage valuation method because it provides the incentive to focus on achieving the best risk/cost ratio. Contribution.............................................................................................................................................................................................. This research bestows valuable insight using a noble multi-stage valuation method that has been proven successful based on author´s extensive practice to value BGSS at its inception contributing new knowledge to the literature. The application of informing system to frame the discussion on the inter-disciplinary domain of ethical fashion smart wearable creates awareness for fashion industry stakeholders and academic researchers. Findings.................................................................................................................................................................................................... The analysis shows that BGSS is a contemporary phenomenon since so many smart fashions wearable companies have gone through thought provoking and compelling stories to became successful in a highly competitive smart fashion wearable industry. BGSS concept is a brand-new perspective in the EFSW academic research. The findings of this research provide information to various stakeholders of the fashion industry and benefit to a global community at large with a more nuanced understanding of the changes and challenges of the emerging EFSW industry and the way to measure the valuation of a venture at its inception. Recommendations for Practitioners......................................................................................................................................................... This paper reveals nuance understanding for the practitioners in the BGSS valuation at its inception. Since all the traditional valuation methods have their drawbacks when applied to the inception stage of BGSS, this study recommends using multi-stage valuation method because it provides incentive for the best risk/cost ratio. Fashion brands (designers and other stakeholders) should abide by the ethical criteria to make a difference in the global community at large by reducing degradation of the environmental conditions. For the future of ethical fashion, ethical choices must be an available alternative to customers. Fashion companies need to embark upon design to not only be ethical but also stylish, therefore need to create trust by adopting transparency and integrity throughout the value chain. Fashion brand should take advantage of ethical fashion criteria to provide assurance to consumers with socio-cultural aspects in mind, to promote their fashion collections effectively. Recommendation for Researchers............................................................................................................................................................... More research work needs to be accomplished to have a clear analysis of the ethical fashion perspective to cover environmental, socio-cultural, fair trade, human rights, animal rights and other aspects. It is important to study the various stages of BGSS valuation from growth stage to initial public offering stage and beyond to bridge the gap between academic research and practitioners using the multi-stage valuation method. Impact on Society.......................................................................................................................................................................................... Since ethical fashion is of great significance for the contemporary society, raising awareness among various cultural communities globally to promote avantgarde ways regarding ethical fashion criteria, specifically to curb the degradation of the environment, stopping the cruelty on animals and protecting the human rights among consumers is paramount. Future Research............................................................................................................................................................................................ This study will bridge the gap between practice and academic research, scholars should embark upon creating a total addressable market (TAM) theory and empirical analysis studies because the total addressable market is the key and practical determinant of BGSS success. Ethical fashion academic research should be pursued beyond sustainability on smart wearable.
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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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Andersson, Petra Lilja, Åsa Petersén, Caroline Graff, and Anna-Karin Edberg. "Ethical aspects of a predictive test for Huntington’s Disease." Nursing Ethics 23, no. 5 (August 2016): 565–75. http://dx.doi.org/10.1177/0969733015576356.
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Background: A predictive genetic test for Huntington’s disease can be used before any symptoms are apparent, but there is only sparse knowledge about the long-term consequences of a positive test result. Such knowledge is important in order to gain a deeper understanding of families’ experiences. Objectives: The aim of the study was to describe a young couple’s long-term experiences and the consequences of a predictive test for Huntington’s disease. Research design: A descriptive case study design was used with a longitudinal narrative life history approach. Participants and research context: The study was based on 18 interviews with a young couple, covering a period of 2.5 years; starting 6 months after the disclosure of the test results showing the woman to be a carrier of the gene causing Huntington’s disease. Ethical considerations: Even though the study was extremely sensitive, where potential harm constantly had to be balanced against the benefits, the couple had a strong wish to contribute to increased knowledge about people in their situation. The study was approved by the ethics committee. Findings: The results show that the long-term consequences were devastating for the family. This 3-year period was characterized by anxiety, repeated suicide attempts, financial difficulties and eventually divorce. Discussion: By offering a predictive test, the healthcare system has an ethical and moral responsibility. Once the test result is disclosed, the individual and the family cannot live without the knowledge it brings. Support is needed in a long-term perspective and should involve counselling concerning the families’ everyday life involving important decision-making, reorientation towards a new outlook of the future and the meaning of life. Conclusion: As health professionals, our ethical and moral responsibility thus embraces not only the phase in direct connection to the actual genetic test but also a commitment to provide support to help the family deal with the long-term consequences of the test.
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Escolar-Chua, Rowena L. "Moral sensitivity, moral distress, and moral courage among baccalaureate Filipino nursing students." Nursing Ethics 25, no. 4 (June 29, 2016): 458–69. http://dx.doi.org/10.1177/0969733016654317.
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Background: Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students. Aim/objective: The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students. Research design: The research employed a descriptive-correlational design to explore the relationships between and among moral distress, moral sensitivity, and moral courage of undergraduate nursing students. Participants and research context: A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study. Ethical considerations: Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants. Findings: Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency ( r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity ( r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity. Conclusion: Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators.
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Mazzotta, Rocco, Maddalena De Maria, Davide Bove, Sondra Badolamenti, Simonì Saraiva Bordignon, Luana Claudia Jacoby Silveira, Ercole Vellone, Rosaria Alvaro, and Giampiera Bulfone. "Moral distress in nursing students: Cultural adaptation and validation study." Nursing Ethics 29, no. 2 (November 22, 2021): 384–401. http://dx.doi.org/10.1177/09697330211030671.
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Background: Moral distress, defined as moral suffering or a psychological imbalance, can affect nursing students. However, many new instruments or adaptations of other scales that are typically used to measure moral distress have not been used for nursing students. Aim: This study aimed to translate, culturally adapt and evaluate the psychometric properties of an Italian version of the Moral Distress Scale for Nursing Students (It-ESMEE) for use with delayed nursing students (students who could not graduate on time or failed the exams necessary to progress to the next level). Research design: The study used a cross-sectional research design. Participants and research context: Incidental sampling resulted in a sample of 282 delayed nursing students (mean age = 26.73 ± 4.43 years, 73% female) enrolled between May and August 2020 in a University of central Italy. Ethical considerations: The research protocol was approved by the internal review board of the university, and all participants provided their written informed consent. Results: The study confirmed a multidimensional second-order factorial structure for the It-ESMEE with five dimensions: improper institutional conditions to teach user care, authoritarian teaching practices, disrespect for the ethical dimension of vocational training, lack of competence of the teacher and commitment of ethical dimension of user care. The internal consistency was high (0.753–0.990 across the factors), and the standard error of measurement and smallest detectable change were adequate. Discussion: The It-ESMEE is able to assess moral distress in delayed nursing students with good validity and reliability. It can be used in research and to determine moral distress levels, helping teachers to monitor the condition in nursing students. Conclusion: This instrument can help in comprehending moral distress, enabling students to develop coping and intervention strategies to maintain their well-being, and to ensure the quality of nurse education.
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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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Čartolovni, Anto, Minna Stolt, P. Anne Scott, and Riitta Suhonen. "Moral injury in healthcare professionals: A scoping review and discussion." Nursing Ethics 28, no. 5 (January 11, 2021): 590–602. http://dx.doi.org/10.1177/0969733020966776.
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Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration.
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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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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.
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Schipper, Karen, Elleke Landeweer, and Tineke A. Abma. "Living with end-stage renal disease: Moral responsibilities of patients." Nursing Ethics 25, no. 8 (January 18, 2017): 1017–29. http://dx.doi.org/10.1177/0969733016687154.
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Background: Living with a renal disease often reduces quality of life because of the stress it entails. No attention has been paid to the moral challenges of living with renal disease. Objectives: To explore the moral challenges of living with a renal disease. Research design: A case study based on qualitative research. We used Walker’s ethical framework combined with narrative ethics to analyse how negotiating care responsibilities lead to a new perspective on moral issues. Participants and research context: One case was chosen from 20 qualitative interviews with renal patients in the Netherlands. Ethical considerations: Several actions have been taken to ensure the informed consent, privacy, anonymity and confidentiality of the patient in this article. More details are offered in this article. The study has been conducted in line with the recommendations of the Medical Ethical Committee of the VU Medical Center. Findings: A renal disease can force people to change their identity, relationships, values and responsibilities. The case study illustrates the moral challenges confronting renal patients. Discussion and conclusion:: Moral issues can be raised by the changes to identities, relationships, values and responsibilities caused by renal disease. Support services for renal patients and their relatives should pay more attention to these issues in order to promote self-management.
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Huang, Fei Fei, Qing Yang, Jie Zhang, Kaveh Khoshnood, and Jing Ping Zhang. "Chinese nurses’ perceived barriers and facilitators of ethical sensitivity." Nursing Ethics 23, no. 5 (August 2016): 507–22. http://dx.doi.org/10.1177/0969733015574925.
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Background: An overview of ethical sensitivity among Chinese registered nurses is needed to develop and optimize the education programs and interventions to cultivate and improve ethical sensitivity. Aim: The study was conducted to explore the barriers to and facilitators of ethical sensitivity among Chinese registered nurses working in hospital settings. Research design: A convergent parallel mixed-methods research design was adopted. Participants and research context: In the cross-sectional quantitative study, the Chinese Moral Sensitivity Questionnaire–revised version was used to assess the levels of ethical sensitivity among registered nurses, and the scores were correlated with key demographics, training experiences in ethics, and workplace cultural environments ( n = 306). In the qualitative study, semi-structured interviews were used to elicit the nurses’ perceptions of the barriers and facilitators in nurturing ethical sensitivity ( n = 15). The data were collected from February to June 2014. Ethical considerations: This study was approved by the Institutional Review Boards of Yale University and Central South University. Results: Despite moderately high overall Chinese Moral Sensitivity Questionnaire–revised version scores, the ethical sensitivity among Chinese nurses lags in practice. Barriers to ethical sensitivity include the lack of knowledge related to ethics, lack of working experience as a nurse, the hierarchical organizational climate, and the conformist working attitude. The positive workplace cultural environments and application of ethical knowledge in practice were considered potential facilitators of ethical sensitivity. Discussion: The findings of this study were compared with studies from other countries to examine the barriers and facilitators of ethical sensitivity in Chinese nurses. Conclusion: This mixed-methods study showed that even though the Chinese nurses have moderately high sensitivity to the ethical issues encountered in hospitals, there is still room for improvement. The barriers to and facilitators of ethical sensitivity identified here offer new and important strategies to support and enhance the nurses’ sensitivity to ethical issues.
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Saeedi, Smat, Leila Jouybari, Akram Sanagoo, and Mohammad Ali Vakili. "The effectiveness of narrative writing on the moral distress of intensive care nurses." Nursing Ethics 26, no. 7-8 (November 3, 2018): 2195–203. http://dx.doi.org/10.1177/0969733018806342.
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Background: Nursing is a profession that has always been accompanied with common ethical concerns. There are some evidences which indicate that narrative writing on traumatic experiences may improve an individual’s emotional health. Objective: This study aimed to determine the effectiveness of narrative writing on moral distress of nurses working in intensive care unit. Research design: This study was a clinical trial with pre- and post-test design. The frequency and intensity of moral distress was measured by a valid and reliable questionnaire (Corely) at baseline and after 8 weeks. The intervention group was asked to write about their deepest emotions and stressful experiences in the intensive care unit for 8 weeks. Participants and research context: Using consensus sampling, 120 nurses of intensive care unit and neonatal intensive care unit of the teaching hospitals (in Iran) were invited to and were randomly allocated into the intervention and control groups. Ethical considerations: Participation was voluntary, data were anonymized, and the confidentiality of the participating nurses and their institutions maintained. The ethical approval was obtained from an IRB or research ethics committee. Findings: In total, 106 nurses completed the trial consisting of 87.75% females. The mean work experience of nurses in the intervention and control groups was 7.21 ± 4.96 and 8.28 ± 5.45 years, respectively. Independent t-test showed no statistical difference neither in the intensity of moral distress ( P = 0.8), nor in its frequency ( P = 0.5) between the two groups. Discussion: As nurses constantly face ethical tensions, moral distress is a phenomenon that results from the different situations of critical care units. Their concern about receiving negative feedback from the managerial level may have influenced the outcome of the intervention. Conclusion: Narratives writing by the nurses showed no effect on reducing the intensity and frequency of moral distress. It seems that due to the intensity of moral distress in clinical settings, we need to test variety solutions to reduce the problem.
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Arries, Ebin J. "Professional values and ethical ideology: Perceptions of nursing students." Nursing Ethics 27, no. 3 (December 12, 2019): 726–40. http://dx.doi.org/10.1177/0969733019889396.
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Background: Moral philosophical positions and professional values have been shown to influence nurses’ practice behaviours. Understanding nursing students’ professional values and ethical ideologies, therefore, is important as they may help inform evidence-informed curriculum decisions and education strategies to develop students’ professional reflective competencies. However, there is a dearth in current empirical data on Canadian nursing students’ perceptions of professional values and ethical positions. Objectives: This study’s purpose was to examine undergraduate nursing student’s perceptions of professional values and ethical ideology and explore relationships in data and selected participant demographic variables. Research design, participants and context: A descriptive cross-sectional research design was conducted with a convenience sample of undergraduate nursing students recruited from a university in Canada. An online encrypted survey consisting of two validated instruments was administered to participants who met study eligibility criteria. Descriptive and inferential statistics were employed to analyse the data and classify nursing students’ ethical ideologies into four categories based on mean scores for idealism and relativism. Ethical considerations: This study received ethical approval from the institutional Behavioural Research Ethics Board and was executed in-line with ethical principles for research involving humans. Findings: Nursing students scored high on professional values and ethical idealism and differed significantly on a measure of ethical relativism in terms of age and year of study. Professional values were significantly associated with ethical idealism. Based on mean scores for idealism and relativism, most nursing students in the study were classified as situationists. Discussion and conclusion: Findings suggest that faculty pay attention to influences of moral philosophical positions in facilitating nursing students’ professional values development. Implications for future research and curriculum are highlighted to strengthen nursing students’ professional values.
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Chen, Pei-Pei, Hsiao-Lu Lee, Shu-He Huang, Ching-Ling Wang, and Chiu-Mieh Huang. "Nurses’ perspectives on moral distress: A Q methodology approach." Nursing Ethics 25, no. 6 (September 28, 2016): 734–45. http://dx.doi.org/10.1177/0969733016664976.
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Background: Moral distress occurs when nurses experience ethical dilemmas. Issues related to these dilemmas are addressed in some nursing education courses. Nurses’ reaction to dilemma such as moral distress is relatively less noticed. Objective: This study aimed to identify and describe the various types of perceptions of moral distress exhibited by nurses. Research design: This study applied Q methodology to explore the perspectives of nurses regarding moral distress. Data were collected in two stages. First, in-depth interviews were conducted to collect nurses’ opinions. Sentences that best fit the concepts of moral distress were extracted for the construction of Q statements. Second, nurses subjectively ranked these Q statements so that the relevant severity of moral distress could be determined using Q sorts. The study participants were nurses at a regional teaching hospital in northeast Taiwan. A total of 60 participants were invited to rank 40 moral distress Q statements. Ethical considerations: The study protocol was approved by the institutional review board of National Yang-Ming University Hospital. Only the participants who signed an informed consent form participated in the study. The respondents’ right to withdraw from the study was respected. Findings: Five types of responses were identified regarding the nurses’ perspectives. These types were “conflict with personal values,” “excessive of workload,” “curbing of autonomy,” “constraint engendered by organizational norms,” and “self-expectation frustration.” Conclusion: The findings regarding nurses’ experiences of moral distress can be used to construct multifaceted policies and solutions and to incorporate ethical education in training programs.
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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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Soleimani, Mohammad Ali, Saeed Pahlevan Sharif, Ameneh Yaghoobzadeh, Mohammad Reza Sheikhi, Bianca Panarello, and Ma Thin Mar Win. "Spiritual well-being and moral distress among Iranian nurses." Nursing Ethics 26, no. 4 (June 16, 2016): 1101–13. http://dx.doi.org/10.1177/0969733016650993.
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Background: Moral distress is increasingly recognized as a problem affecting healthcare professionals, especially nurses. If not addressed, it may create job dissatisfaction, withdrawal from the moral dimensions of patient care, or even encourage one to leave the profession. Spiritual well-being is a concept which is considered when dealing with problems and stress relating to a variety of issues. Objective: This research aimed to examine the relationship between spiritual well-being and moral distress among a sample of Iranian nurses and also to study the determinant factors of moral distress and spiritual well-being in nurses. Research design: A cross-sectional, correlational design was employed to collect data from 193 nurses using the Spiritual Well-Being Scale and the Moral Distress Scale-Revised. Ethical considerations: This study was approved by the Regional Committee of Medical Research Ethics. The ethical principles of voluntary participation, anonymity, and confidentiality were considered. Findings: Mean scores of spiritual well-being and moral distress were 94.73 ± 15.89 and 109.56 ± 58.70, respectively. There was no significant correlation between spiritual well-being and moral distress ( r = −.053, p = .462). Marital status and job satisfaction were found to be independent predictors of spiritual well-being. However, gender and educational levels were found to be independent predictors for moral distress. Age, working in rotation shifts, and a tendency to leave the current job also became significant after adjusting other factors for moral distress. Discussion and conclusion: This study could not support the relationship between spiritual well-being and moral distress. However, the results showed that moral distress is related to many elements including individual ideals and differences as well as organizational factors. Informing nurses about moral distress and its consequences, establishing periodic consultations, and making some organizational arrangement may play an important role in the identification and management of moral distress and spiritual well-being.
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Brewer, Katherine C. "Institutional betrayal in nursing: A concept analysis." Nursing Ethics 28, no. 6 (March 15, 2021): 1081–89. http://dx.doi.org/10.1177/0969733021992448.
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Background: Ethical relationships are important among many participants in healthcare, including the ethical relationship between nurse and employer. One aspect of organizational behavior that can impact ethical culture and moral well-being is institutional betrayal. Research aim: The purpose of this concept analysis is to develop a conceptual understanding of institutional betrayal in nursing by defining the concept and differentiating it from other forms of betrayal. Design: This analysis uses the method developed by Walker and Avant. Research context: Studies were reviewed using health literature databases with no date restrictions. Ethical considerations: Analysis was conducted using established guidelines for ethical research. Findings: Although institutional betrayal is a concept applied in the literature, there was a paucity of studies exploring the concept within nursing. Examples of the concept in the literature include violation of trust between organization (i.e. employer) and nurse, such as provision of inadequate workplace protections, ineffective or hostile management, and gaslighting of those who experience negative events. Examples of institutional betrayal have become more visible during the COVID-19 pandemic. Discussion: A conceptual definition of institutional betrayal is a deep violation of trust or confidence or violation of moral standards committed by an institution toward a nurse. This definition incorporates experiences and issues suggested by the literature. Outcomes are likely negative, including impacts on nurse psychological and workplace well-being. This concept likely fits within a framework of ethical workplaces and has conceptual relationships with moral distress and moral resilience. Further studies can help qualitatively explore and empirically measure this concept. Conclusion: In the pursuit of improving the ethical culture of healthcare workplaces, this concept can provide meaningful insight into organizational behavior and its consequences. Naming and describing the concept can promote conceptual clarity and equip researchers, nurses, and leaders to identify and mitigate the issue.
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Humphries, Anne, and Martin Woods. "A study of nurses’ ethical climate perceptions." Nursing Ethics 23, no. 3 (January 6, 2015): 265–76. http://dx.doi.org/10.1177/0969733014564101.
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Background: Acting ethically, in accordance with professional and personal moral values, lies at the heart of nursing practice. However, contextual factors, or obstacles within the work environment, can constrain nurses in their ethical practice – hence the importance of the workplace ethical climate. Interest in nurse workplace ethical climates has snowballed in recent years because the ethical climate has emerged as a key variable in the experience of nurse moral distress. Significantly, this study appears to be the first of its kind carried out in New Zealand. Aim/objective: The purpose of this study was to explore and describe how registered nurses working on a medical ward in a New Zealand hospital perceive their workplace ethical climate. Research design/participants/context: This was a small, qualitative descriptive study. Seven registered nurses were interviewed in two focus group meetings. An inductive method of thematic data analysis was used for this research. Ethical considerations: Ethics approval for this study was granted by the New Zealand Ministry of Health’s Central Regional Health and Disability Ethics Committee on 14 June 2012. Findings: The themes identified in the data centred on three dominant elements that – together – shaped the prevailing ethical climate: staffing levels, patient throughput and the attitude of some managers towards nursing staff. Discussion: While findings from this study regarding staffing levels and the power dynamics between nurses and managers support those from other ethical climate studies, of note is the impact of patient throughput on local nurses’ ethical practice. This issue has not been singled out as having a detrimental influence on ethical climates elsewhere. Conclusion: Moral distress is inevitable in an ethical climate where the organisation’s main priorities are perceived by nursing staff to be budget and patient throughput, rather than patient safety and care.
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Pergert, Pernilla, Cecilia Bartholdson, Klas Blomgren, and Margareta af Sandeberg. "Moral distress in paediatric oncology: Contributing factors and group differences." Nursing Ethics 26, no. 7-8 (November 9, 2018): 2351–63. http://dx.doi.org/10.1177/0969733018809806.
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Background: Providing oncological care to children is demanding and ethical issues concerning what is best for the child can contribute to moral distress. Objectives: To explore healthcare professionals’ experiences of situations that generate moral distress in Swedish paediatric oncology. Research design: In this national study, data collection was conducted using the Swedish Moral Distress Scale-Revised. The data analysis included descriptive statistics and non-parametric analysis of differences between groups. Participants and research context: Healthcare professionals at all paediatric oncology centres in Sweden were invited to participate. A total of 278 healthcare professionals participated. The response rate was 89%. Ethical considerations: In its advisory statement, the Regional Ethical Review Board decided that the study was of such a nature that the legislation concerning ethical reviews was not applicable. All participants received written information about the aim of the study and confidentiality. Participants demonstrated their consent by returning the survey. Findings: The two situations with the highest moral distress scores concerned lack of competence and continuity of personnel. All professional groups reported high levels of disturbance. Nurses rated significantly higher frequencies and higher total Moral Distress Scale scores compared to medical doctors and nursing assistants. Discussion: Lack of competence and continuity, as the two most morally distressing situations, confirms the findings of studies from other countries, where inadequate staffing was reported as being among the top five morally distressing situations. The levels of total Moral Distress Scale scores were more similar to those reported in intensive care units than in other paediatric care settings. Conclusion: The two most morally distressing situations, lack of competence and continuity, are both organisational in nature. Thus, clinical ethics support services need to be combined with organisational improvements in order to reduce moral distress, thereby maintaining job satisfaction, preventing a high turnover of staff and ensuring the quality of care.
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Vryonides, Stavros, Evridiki Papastavrou, Andreas Charalambous, Panayiota Andreou, and Anastasios Merkouris. "The ethical dimension of nursing care rationing." Nursing Ethics 22, no. 8 (November 3, 2014): 881–900. http://dx.doi.org/10.1177/0969733014551377.
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Background: In the face of scarcity, nurses may inevitably delay or omit some nursing interventions and give priority to others. This increases the risk of adverse patient outcomes and threatens safety, quality, and dignity in care. However, it is not clear if there is an ethical element in nursing care rationing and how nurses experience the phenomenon in its ethical perspective. Objectives: The purpose was to synthesize studies that relate care rationing with the ethical perspectives of nursing, and find the deeper, moral meaning of this phenomenon. Research design: A systematic review and thematic synthesis of qualitative studies was used. Searching was based on guidelines suggested by Joana Brigs Institute, while the synthesis has drawn from the methodology described. Primary studies were sought from nine electronic databases and manual searches. The explicitness of reporting was assed using consolidated criteria for reporting qualitative research. Nine studies involving 167 nurse participants were included. Synthesis resulted in 35 preliminary themes, 14 descriptive themes, and four analytical themes (professional challenges and moral dilemmas, dominating considerations, perception of a moral role, and experiences of the ethical effects of rationing). Discussion of relationships between themes revealed a new thematic framework. Ethical consideration: Every effort has been taken, for the thoroughness in searching and retrieving the primary studies of this synthesis, and in order for them to be treated accurately, fairly and honestly and without intentional misinterpretations of their findings. Discussion: Within limitations of scarcity, nurses face moral challenges and their decisions may jeopardize professional values, leading to role conflict, feelings of guilt, distress and difficulty in fulfilling a morally acceptable role. However, more research is needed to support certain relationships. Conclusions: Related literature is limited. The few studies found highlighted the essence of justice, equality in care and in values when prioritizing care—with little support to the ethical effects of rationing on nurses. Further research on ethical dimension of care rationing may illuminate other important aspects of this phenomenon.
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Fredwall, Terje Emil, and Inger Beate Larsen. "Textbook descriptions of people with psychosis – some ethical aspects." Nursing Ethics 26, no. 5 (April 29, 2018): 1554–65. http://dx.doi.org/10.1177/0969733017753742.
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Background: Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field. Objectives: This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis. Research design: We used qualitative content analysis. Ethical considerations: The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required. Findings: The analysis shows that all 12 textbooks describe and present people who are considered as psychotic from a ‘perspective from above’. In this perspective, the readers are learning about psychosis in the professional’s language and from the author’s viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a ‘perspective from within’. Here, the readers are learning about psychosis from the patients’ own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person. Discussion and conclusion: Drawing partly on Rita Charon’s writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients’ own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness.
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Lee, Susan, Ellen M. Robinson, Pamela J. Grace, Angelika Zollfrank, and Martha Jurchak. "Developing a moral compass: Themes from the Clinical Ethics Residency for Nurses’ final essays." Nursing Ethics 27, no. 1 (April 28, 2019): 28–39. http://dx.doi.org/10.1177/0969733019833125.
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Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed to graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of decision-making that confront them in daily practice.” Six major themes corresponding to questions posed to the participants included the ability to advocate for good patient care; to support and empower colleagues, patients, and families; they experienced personal and professional transformation; they valued the multimodal nature of the program; and were using their new knowledge and skills in practice. However, they also recognized that their development as moral agents was an ongoing process. Discussion: Findings support that enhancing nurse confidence in their moral agency with a multimodal educational approach that includes mentored practice in ethical decision-making, enhancing communication skills and role-play can mitigate moral distress. A majority found the program personally and professionally transformative. However, they recognized that ongoing ethics discussion involvement and supportive environments would be important in their continued development of ethical agency. Conclusion: Multimodal ethics education programs have potential to be transformative and enhance nurse confidence in their ethical decision-making.
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Rasoal, Dara, Annica Kihlgren, Inger James, and Mia Svantesson. "What healthcare teams find ethically difficult." Nursing Ethics 23, no. 8 (August 3, 2016): 825–37. http://dx.doi.org/10.1177/0969733015583928.
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Background: Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss. Aim: To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation. Research design: A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis. Ethical considerations: An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation. Findings: Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient’s/next-of-kin’s emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient’s autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have. Discussion: The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders. Conclusion: MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.
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Numminen, Olivia, Kasper Konings, Roelant Claerhout, Chris Gastmans, Jouko Katajisto, Helena Leino-Kilpi, and Bernadette Dierckx de Casterlé. "Validation of the Dutch-language version of Nurses’ Moral Courage Scale." Nursing Ethics 28, no. 5 (January 11, 2021): 809–22. http://dx.doi.org/10.1177/0969733020981754.
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Background: Moral courage as a part of nurses’ moral competence has gained increasing interest as a means to strengthen nurses acting on their moral decisions and offering alleviation to their moral distress. To measure and assess nurses’ moral courage, the development of culturally and internationally validated instruments is needed. Objective: The objective of this study was to validate the Dutch-language version of the four-component Nurses’ Moral Courage Scale originally developed and validated in Finnish data. Research design: This methodological study used non-experimental, cross-sectional exploratory design. Participants and research context: A total of 559 nurses from two hospitals in Flanders, Belgium, completed the Dutch-language version of the Nurses’ Moral Courage Scale. Ethical considerations: Good scientific inquiry guidelines were followed throughout the study. Permission to translate the Nurses’ Moral Courage Scale was obtained from the copyright holder, and the ethical approval and permissions to conduct the study were obtained from the participating university and hospitals, respectively. Findings: The four-component 21-item, Dutch-language version of the Nurses’ Moral Courage Scale proved to be valid and reliable as the original Finnish Nurses’ Moral Courage Scale. The scale’s internal consistency reliability was high (0.91) corresponding with the original Nurses’ Moral Courage Scale validation study (0.93). The principal component analysis confirmed the four-component structure of the original Nurses’ Moral Courage Scale to be valid also in the Belgian data explaining 58.1% of the variance. Confirmatory factor analysis based on goodness-of-fit indices provided evidence of the scale’s construct validity. The use of a comparable sample of Belgian nurses working in speciality care settings as in the Finnish study supported the stability of the structure. Discussion and conclusion: The Dutch-language version of the Nurses’ Moral Courage Scale is a reliable and valid instrument to measure nurses’ self-assessed moral courage in speciality care nursing environments. Further validation studies in other countries, languages and nurse samples representing different healthcare environments would provide additional evidence of the scale’s validity and initiatives for its further development.
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Vincent, Heather, Deborah J. Jones, and Joan Engebretson. "Moral distress perspectives among interprofessional intensive care unit team members." Nursing Ethics 27, no. 6 (May 14, 2020): 1450–60. http://dx.doi.org/10.1177/0969733020916747.
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Aim: To examine interprofessional healthcare professionals’ perceptions of triggers and root causes of moral distress. Design: Qualitative description of open-text comments written on the Moral Distress Scale–Revised survey. Methods: A subset of interprofessional providers from a parent study provided open-text comments that originated from four areas of the Moral Distress Scale–Revised, including the margins of the 21-item questionnaire, the designated open-text section, shared perceptions of team communication and dynamics affecting moral distress, and the section addressing an intent to leave a clinical position because of moral distress. Open-text comments were captured, coded, and divided into meaning units and themes using systematic text condensation. Participants: Twenty-eight of the 223 parent study participants completing the Moral Distress Scale–Revised shared comments on situations contributing to moral distress. Results: All 28 participants working in the four medical center intensive care units reported feelings of moral distress. Feelings of moral distress were associated with professional anguish over patient care decisions, team, and system-level factors. Professional-level contributors reflected clinician concerns of continuing life support measures perceived not in the patient’s best interest. Team and unit-level factors were related to poor communication, bullying, and a lack of collegial collaboration. System-level factors included clinicians feeling unsupported by senior administration and institutional culpability as a result of healthcare processes and system constraints impeding reliable patient care delivery. Ethical considerations: Approval was obtained from the Institutional Review Board (IRB) of the University of Texas Health IRB and the organization in which the study was conducted. Conclusion: Moral distress was associated with feelings of anguish, professional intimidation, and organizational factors that impacted the delivery of ethically based patient care. Participants expressed a sense of awareness that they may experience ethical dilemmas as a consequence of the changing reality of providing healthcare within complex healthcare systems. Strategies to combat moral distress should target team and system interventions designed to improve interprofessional collaboration and support professional ethical values and moral commitments of all healthcare providers.
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Kolosnichenko, Olena, Tetyana Krotova, and Kalina Pashkevych. "Sustainable Fashion as a Modern Trend." Art Research of Ukraine, no. 21 (November 29, 2021): 35–42. http://dx.doi.org/10.31500/2309-8155.21.2021.254670.
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The essence and ideology of sustainable fashion are analyzed and the basic principles of conscious fashion are determined: the use of ecological materials and fabrics obtained from recycled waste; saving all the resources needed for clothing production; as well as changing society's attitude towards clothing. It is noted that among the means of influence available to the designer is consumer behavior, which is a key success factor for great "environmental benefits" - the consumer becomes interested in aspects of origin of materials and manufacture, country of origin, recyclability or recycling. Peculiarities of consumption of fashionable goods by young people of generations Y and Z, which is aimed at environmental friendliness, encouragement and creation of more ethical design, are considered. Research has shown that conscious fashion is a choice, information, cultural diversity and identity.
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Solum, Eva Merethe, Veronica Mary Maluwa, Bodil Tveit, and Elisabeth Severinsson. "Enhancing students’ moral competence in practice." Nursing Ethics 23, no. 6 (August 3, 2016): 685–97. http://dx.doi.org/10.1177/0969733015580811.
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Background: Nurses and student nurses in Malawi often encounter challenges in taking a moral course of action. Several studies have demonstrated a need for increased awareness of ethical issues in the nursing education. Objective: To explore the challenges experienced by nurse teachers in Malawi in their efforts to enhance students’ moral competence in clinical practice. Research design: A qualitative hermeneutic approach was employed to interpret the teachers’ experiences. Participants and research context: Individual interviews (N = 8) and a focus group interview with teachers (N = 9) from different nursing colleges were conducted. Ethical considerations: Ethical approval was granted and all participants signed their informed consent. Findings: Two overall themes emerged: (1) authoritarian learning climate, with three subthemes: (a) fear of making critical comments about clinical practice, (b) fear of disclosing mistakes and lack of knowledge and (c) lack of a culture of critical discussion and reflection that promotes moral competence; and (2) discrepancy between expectations on learning outcome from nursing college and the learning opportunities in practice comprising three subthemes: (a) gap between the theory taught in class and learning opportunities in clinical practice, (b) lack of good role models and (c) lack of resources. Discussion: Our findings indicated that showing respect was a central objective when the students were assessed in practice. A number of previous studies have enlightened the need for critical reflection in nursing education. Few studies have linked this to challenges experienced by teachers for development of moral competence in practice. This is one of the first such studies done in an African setting. Conclusion: There is a clear relationship between the two themes. A less authoritarian learning climate may enhance critical reflection and discussion between students, teachers and nurses. This can narrow the gap between the theory taught in college and what is demonstrated in clinical practice. Moral competence must be enhanced in order to ensure patients’ rights and safety.
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Fischer Grönlund, Catarina EC, Anna IS Söderberg, Karin M. Zingmark, S. Mikael Sandlund, and Vera Dahlqvist. "Ethically difficult situations in hemodialysis care – Nurses' narratives." Nursing Ethics 22, no. 6 (August 7, 2014): 711–22. http://dx.doi.org/10.1177/0969733014542677.
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Background: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose. Research question: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses’ experiences of being in ethically difficult situations that give rise to a troubled conscience. Research design: This study has a phenomenological hermeneutic approach. Participants: Narrative interviews were carried out with 10 registered nurses working in dialysis care. Ethical considerations: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University. Results: One theme, ‘Calling for a deliberative dialogue’, and six sub-themes emerged: ‘Dealing with patients’ ambiguity’, ‘Responding to patients’ reluctance’, ‘Acting against patients’ will’, ‘Acting against one’s moral convictions’, ‘Lacking involvement with patients and relatives’ and ‘Being trapped in feelings of guilt’. Discussion: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience. Conclusion: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.