Дисертації з теми "Nursing ethic"

Thesis (Ed.D.) -- Teachers College, Columbia University, 1991.
Typescript; issued also on microfilm. Sponsor: Thomas A. Leemon. Dissertation Committee: Mary Mowrey-Raddock. Includes bibliographical references: (leaves 119-141).

The primary purpose of this study was to test the theory of experiential learning by measuring to what extent work experience predicts the work ethic characteristics of students in baccalaureate nursing programs at three regional universities in Texas, including Midwestern State University in Wichita Falls, Tarleton State University in Stephenville, and West Texas A&M University in Canyon. Work experience is the amount full-time or part-time on-the-job experience. Work ethic attributes are referred to as considerate, ambitious, dependable, and cooperative. Results generated in this study failed to reject the null hypotheses, which means that work experience, does not provide evidence of the ability to predict the development of work ethic characteristics in baccalaureate nursing students who participated in this research study. Knowledge generated in this study provided alternative directions for future research with respect to the relationship between work experiences and work ethic characteristics in nursing students. Such research may be useful to nursing educators and trainers in the design and delivery phases of the educational process for nurses.

Drygt 50 miljoner personer världen över lider idag av demenssjukdom. En siffra som förväntas tredubblats vid år 2050. Demenssjukdomar beskrivs som kroniska och degenerativa och har påverkan på personens minne, beteende samt förmågan att utföra dagliga sysslor. Personer med demenssjukdom är i behov av kompetent omvårdnad baserad på respekt för personens autonomi, integritet och värdighet. I takt med ökningen krävs mer kunskap kring omvårdnad vid demenssjukdom, för att personer med diagnosen skall erhålla rätt och passande vård. Syftet med studien var att belysa etiska utmaningar i omvårdnaden av personer med demenssjukdom. För att besvara syftet genomfördes en litteraturstudie med artikelsökningar i tre olika databaser. Det resulterade i fem kategorier; Bevara personens värdighet, Bristande kompetens, Bristande stöd, Bristande tid och resurser samt Bristande kommunikativ förmåga – den outtalade utmaningen. Det är av vikt att besitta kunskap kring de etiska utmaningar som uppstår i omvårdnaden av personer med demenssjukdom, då det kan öka förutsättningarna för en personcentrerad vård och därmed bevara personens autonomi, integritet och värdighet.
Approxmently 50 million people worldwide suffer from dementia today. A number that is expected to triple by year 2050. Dementia is described as chronic and degenerative and has an impact on the person's memory, behavior and ability to perform daily chores. People with dementia are in need of competent nursing based on respect for the person's autonomy, integrity and dignity. In line with the increase more knowledge about dementiacare is needed in order for people with the diagnosis to receive the right and appropriate care. The aim of this study was to highlight ethical challenges in the care of people with dementia. To answer the purpose, a literature study was conducted with article searches in three different databases. It resulted in five categories; Preserve the person's dignity, Lack of competense, Lack of support, Lack of time and resources and Lack of communicative – the unspoken challenge. It is important to have knowledge about the ethical challenges that arise in the care of people with dementia, as it can increase the conditions for a person-centered care and thus preserve the person's autonomy, integrity and dignity.

A escassa bibliografia acerca deste tema motivou-nos a desenvolver este estudo.Os objetivos foram: verificar o entendimento dos enfermeiros membros da Comissão de Ética de Enfermagem (CEE) acerca do conceito de ética; investigar quais foram as dificuldades encontradas na implantação da Comissão de Ética de Enfermagem; levantar como tem sido a atuação da Comissão de Ética de Enfermagem, visando o cumprimento do seu papel e conhecer as estratégias utilizadas para o desenvolvimento do trabalho da Comissão de Ética de Enfermagem. Tratou-se de uma abordagem qualitativa, exploratória, descritiva, realizada em quatro hospitais de um município do interior paulista. Os sujeitos da pesquisa foram 18 (dezoito) enfermeiras, membros da Comissão de Ética de Enfermagem nos respectivos hospitais. Os dados foram coletados por meio de entrevista utilizando um roteiro norteador contendo questões abertas. A técnica utilizada para inferência sobre os resultados foi baseada na análise de conteúdo de Bardin (1977). Pudemos apreender que o perfil das entrevistadas não foi fator determinante para sua participação ou não, na fase de implantação da CEE. O conceito de ética foi manifestado sob vários aspectos, desde a forma em que se refere apenas ao ponto de vista da moral até uma somatória de valores individuais e sociais, imprescindíveis para o relacionamento interpessoal. As dificuldades apontadas para a implantação foram principalmente a falta de entendimento do regimento proposto pelo COREN-SP, mais especificamente do papel que a CEE teria que desempenhar, falta de tempo para participar das reuniões e o receio de alguns profissionais em participar da CEE, especialmente pela sua conotação punitiva. As estratégias utilizadas para a atuação acompanharam, de certa forma, o estágio de desenvolvimento em que cada Comissão se encontrava. Algumas se mostraram ainda incipientes, cumprindo o mínimo indispensável para justificar sua existência, outras investindo em parcerias intersetoriais a fim de mostrar sua importância.
The scarse bibliography about this theme motivated us to develop this study. The goals were: To check out the nurses members of Nursing Ethics Committee understanding about the concept of ethics, to investigate the likely difficulties found in the implantation of Nursing Ethics Committee, evaluate the acting of this Committee, aiming the meeting of its role and to know some strategies used to develop the Nursing Ethics Committee work. It is about a qualitative, exploratory, descriptive approach made in four hospitals in one county of São Paulo State. The Subjects of the research were 18 (eighteen) women nurses members of the Nursing Ethics Committee in these hospitals. The data were obtained through interviews using norms to be followed with open questions. The technique used to infer about the results was based in the Bardin Contents analysis (1977). We could learn that the interviewed ones´ profile was not a determining factor to their participation or not in the CEE implatation phase. The Ethics Concept was shown up under several aspects since the way in which, just the moral point of view was referred, until to the set of social and individual values fundamental to the interpersonal relationship. The difficulties pointed to the implantation were mainly the lack of understanding of the regiment proposed by COREN -SP , specifically the role that CEE would be supposed to play, lack of time to take part in the meetings, and some professionals´ fear of taking part of CEE specially by its punitive connotation. The strategies of action used follow in some way, the level of developing in which each committee was. Some appeared to be at the very beginning doing the minimal required to justify their existence, others investing in intersectorials partnerships to show their importance.

Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of schoolchildren’s health and to analyse factors influencing the recording of school-children’s health in the School Health Record (SHR). An additional aim is to evaluate fam-ily nursing interventions as a tool for the school nurses in the School Health Service (SHS). Methods: The thesis comprises four papers. A combination of qualitative and quantita-tive methods was used through individual interviews with a strategic sample of school nurses (n=12) (PI), a national survey to a representative sample of school nurses (n=129) (PII, III) and the implementation of family nursing models developed in Canada with girls in their early ad-olescence with recurrent health complaints and their families (n=4) in co-operation with their school nurses (n=2) (PIV). The Strengths and Difficulties Questionnaire (SDQ) was used as pre and post test. Evaluation interviews were conducted with the families and the nurses separate-ly. Qualitative content analyses were used to analyze the interview text with the school nurs-es and the families. Manifest content analysis was used to analyze the free text answers of the survey and the evaluation interview with the school nurses. Descriptive statistical analyses were used to describe demographic data in all four papers. The SDQ was hand-scored statistically. Findings: The findings showed that nurses judged the schoolchildren’s mental health as dete-riorated, especially in socially disadvantaged areas and more generally among girls expressed as psychosomatic symptoms. Individual factors related to lifestyle affected the schoolchildren’s physical health, and the mental health was, to a large extent, affected by the school environ-ment and family relations. The latter seemed to be the most important factor affecting school-children’s mental health. The basis for the school nurses judgement of the physical health was health check-ups and the health dialogues. Spontaneous visits were more commonly used to judge the mental health. Recording schoolchildren’s mental health was a challenge for school nurses. Difficulties were related to ethical considerations, tradition, lack of time and the im-proper structure of the SHR. Fears of marking the schoolchild for life related to the schoolchild itself, the parents or to other authorities/successive caregivers were brought up as hinders for recording mental and social health. Family sessions may be useful within the profession when handling recurrent health complaints among adolescence girls. The girls and their families ex-perienced relief, they felt confirmed and that their feelings and reactions were normal in that situation. The families became aware of their own strengths and possibilities and this was sup-ported by the SDQ which showed an increased well-being. The school nurses valued this way of working and meant that the sessions seemed to start a changing process within the families. Conclusions: The results indicate that school nurses have a deep knowledge about schoolchil-dren’s health which is not used to its full potential in a public health perspective. However, the experienced difficulties recording schoolchildren’s mental health seem obvious, which would de-mand developing the SHR for the needs of today. Family sessions in SHS with the school nurse as a collaborator with the family seemed useful and may be transferable to other health problems expressed by the schoolchildren. Bronfenbrenner’s ecological systems theory and other models for health determinants are used to illustrate the school nurse as a mediator working on the bridge over different health streams with schoolchildren’s health on an individual and a population level.

The number of people with another culture is

increasing in Sweden. This change in society brings

consequences in health care that has not any methods

to manage. The Muslim woman’s meeting with the

health care is one of those areas. The aim with this

study was to describe the nurses meeting with female

Muslim patient. The study carried out as a literature

study and the results which based on 9 articles

showed the lack of knowledge about culture and

religion among health care staff. The authors further

believed that to achieve an adequate result with

meeting between staff and patient requires

knowledge about different culture and religion. The

study shows furthermore a necessity for nurses

training individually to create instinct in how their

own cultural opinion affects the nurse in her/his

profession. The patients felt like nurses had a

stereotype to doing their job and got very difficult to

satisfy patients with the needs. In view of the

circumstances it notifies proposals to improvement in

the existing health care through curses and seminars

about culture and religion but even concrete

information about Islam and Muslim female patient’s

needed in an institutional care. Madeleine

Leininger’s theory of culture care was used as the

conceptual framework and support for the study.

Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of school children’s health and to analyse factors influencing the recording of schoolchildren’s health in the School Health Record (SHR). An additional aim is to evaluate family nursing interventions as a tool for the school nurses in the School Health Service (SHS).Methods: The thesis comprises four papers. A combination of qualitative and quantitative methods was used through individual interviews with a strategic sample of school nurses (n=12) (PI), a national survey to a representative sample of school nurses (n=129) (PII, III) and the implementation of family nursing models developed in Canada with girls in their early adolescence with recurrent health complaints and their families (n=4) in co-operation with their school nurses (n=2) (PIV). The Strengths and Difficulties Questionnaire (SDQ) was used as pre and post test. Evaluation interviews were conducted with the families and the nurses separately. Qualitative content analyses were used to analyze the interview text with the school nurses and the families. Manifest content analysis was used to analyze the free text answers of the survey and the evaluation interview with the school nurses. Descriptive statistical analyses were used to describe demographic data in all four papers. The SDQ was hand-scored statistically.Findings: The findings showed that nurses judged the schoolchildren’s mental health as deteriorated, especially in socially disadvantaged areas and more generally among girls expressed as psychosomatic symptoms. Individual factors related to lifestyle affected the schoolchildren’s physical health, and the mental health was, to a large extent, affected by the school environment and family relations. The latter seemed to be the most important factor affecting schoolchildren’s mental health. The basis for the school nurses judgement of the physical health was health check-ups and the health dialogues. Spontaneous visits were more commonly used to judge the mental health. Recording schoolchildren’s mental health was a challenge for school nurses. Difficulties were related to ethical considerations, tradition, lack of time and the improper structure of the SHR. Fears of marking the schoolchild for life related to the schoolchild itself, the parents or to other authorities/successive caregivers were brought up as hinders for recording mental and social health. Family sessions may be useful within the profession when handling recurrent health complaints among adolescence girls. The girls and their families experienced relief, they felt confirmed and that their feelings and reactions were normal in that situation. The families became aware of their own strengths and possibilities and this was supported by the SDQ which showed an increased well-being. The school nurses valued this way of working and meant that the sessions seemed to start a changing process within the families.Conclusions: The results indicate that school nurses have a deep knowledge about schoolchildren’s health which is not used to its full potential in a public health perspective. However, the experienced difficulties recording schoolchildren’s mental health seem obvious, which would demand developing the SHR for the needs of today. Family sessions in SHS with the school nurse as a collaborator with the family seemed useful and may be transferable to other health problems expressed by the schoolchildren. Bronfenbrenner’s ecological systems theory and other models for health determinants are used to illustrate the school nurse as a mediator working on the bridge over different health streams with schoolchildren’s health on an individual and a population level.
Syfte: Avhandlingens övergripande syfte är att undersöka skolsköterskors uppfattning om skolbarns hälsa och att analysera faktorer som påverkar dokumentation av skolbarns hälsa i skolhälsovårdsjournalen. Ett ytterligare syfte är att utvärdera modeller för familjeinterventioner som redskap för skolsköterskor i skolhälsovård.Metoder: Avhandlingen består av fyra delarbeten. En kombination av kvalitativa och kvantitativa metoder användes. I delarbete I genomfördes intervjuer med ett strategiskt urval av skolsköterskor (n=12). Intervjuerna analyserades med kvalitativ innehållsanalys. I delarbeten II och III distribuerades en nationell enkät till ett representativt urval av Sveriges skolsköterskor (n=129). Manifest innehållsanalys användes vid analys av de öppna frågorna. I delarbete IV genomfördes en interventionsstudie med familjesamtal, inspirerad av modeller för familjefokuserad omvårdnad utvecklade i Kanada. Skolflickor i tidig adolescens med återkommande subjektiva hälsoproblem (n=4) och deras föräldrar i samarbete med deras verksamma skolsköterskor (n=2) ingick i studien. Separata utvärderingsintervjuer genomfördes med familjer och skolsköterskor. Intervjuerna analyserades med kvalitativ och manifest innehållsanalys respektive. The Strengths and Difficulties Questionnaire (SDQ) användes som före/efter test vid interventionen och resultatet bearbetades statistiskt manuellt. Deskriptiv statistik användes för analys av demografisk data i samtliga delarbeten.Resultat: Resultatet visade att skolsköterskorna bedömde skolbarnens mentala hälsa som försämrad särskilt bland flickor och i socioekonomiskt utsatta områden. Individuella livsstilsfaktorer påverkade skolbarnens fysiska hälsa och den mentala hälsan var i stor utsträckning påverkad av skolmiljö och familjerelationer. Det sistnämnda verkade vara den mest betydelsefulla påverkansfaktorn för skolbarnens mentala hälsa. Bedömningen av den fysiska hälsan baserades på hälsokontroller och hälsosamtal medan spontana besök var vanligare för bedömning av den mentala hälsan. Dokumentation av mentala hälsa var en utmaning för skolsköterskorna. Svårigheterna kunde relateras till etiska överväganden, tradition och tidsbrist samt till skolhälsovårdsjournalens struktur som inte ansågs uppfylla dagens krav. Skolsköterskorna uttryckte en rädsla för att journalanteckningarna skulle märka skolbarnet för livet. Framtida tolkningar relaterade till skolbarnet själv, föräldrar eller andra/påföljande vårdgivare uttrycktes som hinder för att dokumentera mental och social hälsa. Familjesamtal visade sig vara användbara i skolhälsovården. De medverkande flickorna och deras familjer kände sig bekräftade i att deras känslor och reaktioner var normala. De sade sig bli medvetna om egna styrkor och möjligheter vilket styrktes av SDQ som visade ett ökat välbefinnande efter sammankomsterna, både hos skolbarnen och hos föräldrarna. Skolsköterskorna var positiva till att arbeta med familjesamtal och upplevde sig mer som samverkanspartner än som expert. Samtalen ledde till att en förändringsprocess startade i familjerna enligt skolsköterskorna.Slutsatser: Resultatet indikerar att skolsköterskor har en djup kunskap om skolbarns hälsa som sannolikt kunde tas tillvara på ett bättre sätt ur ett folkhälsoperspektiv på såväl nationell som lokal nivå. Behovet av att utveckla skolhälsovårdsjournalen efter dagens behov och fördjupad kunskap om de upplevda svårigheterna att dokumentera skolbarns mentala hälsa är uppenbar. Familjesamtal, där skolsköterskan intar en roll som samverkanspartner, visade sig användbara och kan sannolikt överföras till andra hälsoproblem bland skolbarn. Bronfenbrenners utvecklingsekologiska systemteori och andra modeller för hälsodeterminanter används för att illustrera skolsköterskans arbete med skolbarns hälsa på såväl en individuell nivå som folkhälsonivå.

Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2009.
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O cotidiano da enfermagem, freqüentemente, é permeado por situações conflituosas, as quais se constituem em fonte de dilemas morais e sofrimento moral para as enfermeiras. Dessa forma, apresentou-se como objetivo geral conhecer a produção científica acerca do sofrimento moral na enfermagem, na literatura científica nacional e internacional publicada nos últimos 10 anos; e como objetivos específicos: conhecer as implicações do sofrimento moral para a vida das enfermeiras; identificar aproximações entre as manifestações de sofrimento moral e burnout; e, conhecer as possíveis estratégias de enfrentamento do sofrimento moral. A metodologia utilizada foi a revisão integrativa, realizada em cinco fases: formulação e identificação do problema; coleta de dados; avaliação dos dados; análise e interpretação dos dados coletados; e, apresentação dos dados. Para a coleta de dados, utilizou-se as palavras-chave: sofrimento moral, burnout e enfermagem, nas bases de dados da CINAHL, MEDLINE e SAGE, tendo sido selecionados um total de vinte e um artigos, submetidos à análise, realizada em quatro etapas: redução dos dados com sua organização em subgrupos; visualização dos dados, em que os dados foram agrupados em quadros de exibição, explicitando os mais relevantes de acordo com o problema de pesquisa; comparação dos dados, quando foram analisados os quadros de visualização dos dados, identificando temas e relações; e, verificação e esboço da conclusão, em que foram elaboradas graduais generalizações para cada subgrupo analisado, ou os dados foram categorizados e resumidos de maneira integrada. Dessa forma, após a análise de dados, foram construídas duas categorias: 1) O Sofrimento Moral na Enfermagem, com sua associação, principalmente, à prestação de cuidados fúteis, a questões organizacionais e, aos diferentes ambientes de atuação das enfermeiras e aos tipos de pacientes cuidados; e, 2) Implicações do Sofrimento Moral para a vida das enfermeiras e aproximações com o burnout, na qual foram identificadas manifestações emocionais, como frustração, impotência, culpa, raiva, ressentimentos, humilhações, vergonha, tristeza, angústia, ansiedade, medo, insegurança e depressão; e manifestações físicas, como dores de cabeça, perda do sono, pesadelos, crises de choro, taquicardia, dores musculares, suores, tremores, distúrbios gastrointestinais e estresse, numa aproximação com o burnout. As estratégias de prevenção e enfrentamento do sofrimento moral focaram-se nas dimensões educativa, comunicativa e organizacional. Parece evidente a necessidade de desenvolvimento de alternativas e estratégias que possibilitem modificações nos ambientes de atuação das enfermeiras, tanto nas questões éticas e organizacionais, como na educação em enfermagem e na implementação de novas pesquisas sobre a temática, para que estas profissionais possam atuar de um modo mais autônomo, expressando seus valores e saberes, em defesa dos valores profissionais e dos direitos dos pacientes.
The daily routine of nursing is frequently permeated by conflicting situations, which are constituted of sources of moral dilemmas and moral distress for nurses. This way, the general objective was to analyse the scientific production of the national and international scientific literature published in the last 10 years that concerns moral distress in nursing work; and the specific objectives were: to get familiar with the implications of the moral distress for the nurses' life; to identify similarities between the manifestations of moral distress and burn-out; and, to determine the possible strategies to face moral distress. The research method was the integrative review, which has been accomplished in five phases: formulation and identification of the problem; data collection; data evaluation; analysis and interpretation of the collected data; and, presentation of the data. For the data collection, it has been used the following keywords in CINAHL, MEDLINE and SAGE databases: moral suffering, burn-out, and nursing. A total of twenty-one articles has been selected, and submitted to the analysis, which has been carried out in four stages: reduction of the data with its organization in subgroups; visualization of the data, in which the data were set in exhibition pictures, pointing out the most relevant ones according to the research problem; comparison of the data, when the data visualization pictures were analysed, identifying themes and relations; and, verification and conclusion sketch, in which gradual generalizations have been elaborated for each analyzed subgroup, or the data have been classified and summarized in an integrated way. This way, two categories were built after the data analysis: 1) Moral Distress in Nursing, with its association, mainly, to the rendering of futile cares, to organizational issues and, to the nurses' various performance atmospheres, and the types of patients being looked after; and, 2) Implications of Moral Distress for nurses' life and similarities with burn-out, in the which it has been identified emotional manifestations such as frustration, impotence, guilt, rage, resentments, humiliations, shame, sadness, anguish, anxiety, fear, insecurity, and depression; and physical manifestations such as headaches, loss of the sleep, nightmares, crying fits, palpitation, muscular pains, perspirations, tremors, gastrointestinal disturbances, and stress, in a close relation to burn-out. The strategies for preventing and facing the moral distress focused in the educational, communicative and organizational dimensions. It seems to be evident the need of development of alternatives and strategies that enable modifications in the environment of the nurses' performance, not only in the ethical and organizational issues, but also in the nursing education and in the implementation of new researches on the theme, so that these professionals can work in a more autonomous way, expressing their values and knowledge, in defence of the professional values and of the patients' rights.
La práctica de la enfermería frecuentemente, está atravesada por situaciones de conflicto, que constituyen una fuente de dilemas morales y sufrimiento moral para las enfermeras. Así, presentó como objetivo general el conocimiento científico sobre el sufrimiento moral en la enfermería, en la literatura científica nacional e internacionalmente publicada en los últimos 10 años; y como objetivos específicos: conocer las implicaciones de sufrimiento moral para la vida de las enfermeras; identificar similitudes entre las manifestaciones del sufrimiento moral y burnout y, conocer las posibles estrategias de enfrentamiento del sufrimiento moral. La metodología utilizada fue la revisión integradora, realizada en cinco etapas: formulación e identificación del problemas; colecta de datos; evaluación de datos; análisis e interpretación de los datos colectados; y presentación de datos. Para colecta de los datos, fueron utilizadas las palabras clave: sufrimiento moral, burnout e enfermería, en las bases de datos CINAHL, MEDLINE y SAGE, se seleccionó un total de veintiún artículos, sometidos a análisis en cuatro etapas: reducción de datos con su organización en subgrupos; visualización de los datos, en que los datos fueron agrupados en cuadros de exhibición, destacando los más relevantes de acuerdo con el problema de la investigación; visualización de los datos, donde los datos fueron agrupados en cuadros de exhibición, identificando los más relevantes temas relacionados a la investigación; comparación de los datos, cuando fueron analizados los cuadros de verificación de los datos, identificando temas y relaciones; y, verificación e esbozo de la conclusión, los cuales fueron desarrollados graduales generalizaciones para cada subgrupo analizado, o los datos fueron clasificados y resumidos de manera integrada. Así, después de análisis, se construyeron dos categorías: 1) Sufrimiento Moral en Enfermería, con su composición, principalmente para proporcionar cuidados en vano, las cuestiones de organización y los diferentes ambientes de actuación de las enfermeras y los tipos de pacientes cuidados; y, 2) Implicaciones del Sufrimiento Moral para la vida de las enfermeras y las proximidades con el burnout, que fueron identificadas las manifestaciones emocionales, como la frustración, desesperanza, culpa, ira, resentimiento, humillación, vergüenza, tristeza, ansiedad, miedo, inseguridad y la depresión; y las manifestaciones físicas, como dolores de cabeza, pérdida del sueño, pesadillas, ataques de lloro, taquicardia, dolores musculares, sudoración, temblores, trastornos gastrointestinales y estrés, en una aproximación con el burnout. Las estrategias para la prevención y enfrentamiento del sufrimiento moral centrado en las dimensiones educativas, comunicativa y organizacional. Esto pone de relieve la necesidad de desarrollar alternativas y estrategias para facilitar los cambios en el ambiente de actuación de las enfermeras, tanto en los temas éticos y organizacionales, como en la educación de enfermería y la implementación de nuevas investigaciones sobre el tema, para que estos profesionales pueden actuar en un de una manera más autónoma, expresando sus valores y conocimientos, en defensa de los valores profesionales y los derechos de los pacientes.

Introdução: A crescente prevalência das condições crônicas de saúde traz a demanda por Cuidados Paliativos (CP) para a agenda da Atenção Primária á Saúde (APS), gerando questionamentos acerca do impacto da incorporação dos CP sobre os problemas éticos da APS. A bioética não é só reativa, mas precisa reconhecer prospectivamente desafios éticos. Objetivos: Discutir desafios éticos (DE) para incorporação dos CP na APS, considerando o desempenho dos atributos deste âmbito do sistema de saúde na Região de Parelheiros, São Paulo; Cotejar os: problemas éticos dos cuidados paliativos na APS com o Instrumento PCATool-Brasil; problemas éticos dos CP na APS com a avaliação que os profissionais fazem do desempenho dos atributos deste nível do sistema de saúde na Região de Parelheiros, SP; o discurso dos gestores da saúde sobre a atenção às condições crônicas com os problemas éticos dos CP na APS. Método: Estudo de Caso, com múltiplas fontes de dados: entrevistas com profissionais da ESF para aplicação do PCATool-Brasil Versão Profissionais; discursos dos gestores locais sobre a rede de atenção às condições crônicas; resultados de uma scoping review sobre problemas éticos dos CP na APS. As perguntas e os resultados do PCATool foram correlacionadas com os desafios éticos sintetizados a partir dos problemas éticos da scoping review. O cenário de estudo fica na Região Sul da cidade de São Paulo, área com cobertura de ESF em quase 100%, com carência de serviços especializados e alta vulnerabilidade em saúde. Resultados: Os DE foram: o despreparo dos profissionais frente aos CP; a comunicação falha entre os profissionais na rede de atenção à saúde; infraestrutura inadequada para assegurar a continuidade da assistência paliativa por 24 horas; desgaste dos profissionais da APS devido á sobrecarga do trabalho; desconforto para falar sobre CP com o paciente; apoio familiar inapropriado; desconhecimento das Diretivas Antecipadas de Vontade. Considerando o desempenho dos atributos da APS como avaliado pelos profissionais da ESF na Região de Parelheiros, os três primeiros desafios éticos são as áreas de maior tensão ética para a incorporação dos CP na APS. Os discursos dos gestores reconhecem a demanda por CP existente no território, porém, mencionam que as demandas relativas às condições de violência e vulnerabilidades da Região acabam sendo prioritárias pelas urgências que representam. Todos os atributos do PCATool foram relacionados com os desafios éticos indicando que a avaliação do desempenho dos atributos permite reconhecer áreas de tensão ética na releitura feita do Instrumento. Conclusão: Identificando proativamente os DE dessa incorporação, com base na experiência de equipes que já ofertam este serviço e contextualizando-a à realidade local por meio do desempenho dos atributos da APS, torna-se possível confrontá-los com questões éticas correntes na APS, apontando caminhos para os profissionais e gestores com educação continuada, deixando-os mais preparados para o reconhecimento e manejo dos CP, com vistas a fomentar os valores necessários para o novo cenário dos serviços com a incorporação dessa atenção na APS.
Introduction: The increasing prevalence of chronic health conditions brings demand for Palliative Care (PC) to the agenda of Primary Health Care (PHC), raising questions about the impact of the merger of PC on the ethical problems of APS. The bioethics is not only reactive, but must prospectively recognize ethical challenges. Objectives: To discuss ethical challenges (EC) for incorporation of PC in the PHC, considering the performance of the attributes of this part of the health system in Parelheiros Region, São Paulo; Collating: ethical problems of palliative care in PHC with PCATool-Brazil Instrument; ethical problems of PC in the PHC with the assessment that the professionals do the performance attributes of this level of the health system in Parelheiros Region, SP; the discourse of health managers of care for chronic conditions with the ethical problems of PC in the PHC. Method: Case Study with multiple data sources: interviews with Family health strategy (FHS) professionals for the application of PCATool-Brazil Version professionals; speeches by local managers on the network of care for chronic conditions; results of a scopingreview on ethical problems of PC in the PHC. The questions and results of PCATool were correlated with the ethical challenges synthesized from the ethical problems of scopingreview. The study scenario is in the southern region of São Paulo, FHS coverage area with almost 100%, with lack of specialized services and high vulnerability to health. Results: the EC were: the unpreparedness of the professionals in the PC; communication failure among professionals in the health care network; inadequate infrastructure to ensure the continuity of palliative care for 24 hours; wear PHC practitioners due to work overload; discomfort to talk about PC with the patient, familiar support inappropriate; ignorance of the Advance Directives Will. Considering the performance of PHC attributes as evaluated by FHS professionals in Parelheiros Region, the first three ethical challenges are the areas of highest ethical tension to the incorporation of PC in the PHC. The speeches of the managers recognize the demand for PC existing on the territory, however, mention that the demands on the conditions of violence and Region vulnerabilities end up being priority by the urgencies they represent. All PCATool attributes were related to the ethical challenges indicating that the attributes of performance assessment allows us to recognize areas of ethical tension in rereading made the instrument. Conclusion: Identifying proactively the EC this merger, based on the experience of teams that have proffer this service and contextualizing it to local conditions through the performance attributes of the PHC, it is possible to compare them with current ethical issues in PHC, pointing paths for professionals and managers with continuing education, making them more prepared for the recognition and management of PC, designed to promote the values needed for the new scenario for services with the incorporation of this attention in the PHC.

Book Summary: Financial Management for Nurse Managers: Merging the Heart with the Dollar, Third Edition is an essential text for nursing students and professionals because it addresses the financial management issues faced by nurse managers. Chief nursing officers and those in nurse administrator roles will also find this text valuable because of the acute focus on the financial impact of administrative and management decisions across hospitals and healthcare organizations.The Third Edition covers a broad range of topics, and demonstrates the interconnectivity between finance and other aspects of health care through evidence in healthcare finance, economics and cost accounting, budgeting, staffing effectiveness, and legal and ethical issues. The text is expertly organized and includes real-world examples to lend context to the reader.Coverage of the value-based reimbursement system is an integral component of the Third Edition. The authors emphasize the concept of giving the patient what is valued and recommend listening to patient needs, collaboration in healthcare decision-making, and shifting the role of the administrator to support care leaders. Additionally, the text has been updated to reflect the impact of the Affordable Care Act.

Book Summary: Completely revised and updated, the Second Edition addresses a myriad of financial concepts ranging from staffing and budgeting to measuring productivity and forecasting costs. Examples and explanations of terminology will help nurse managers successfully correspond with the financial department to implement change without negatively affecting patient care and outcomes.

This thesis is concerned with the role of partiality and impartiality in nursing ethics. Nurses are often faced with the following challenge: should I provide care for the patient who is my patient or should I give preference to someone else in greater need of nursing care? This challenge can be characterised as a conflict between impartial and partialist moral demands on the nurse. The thesis analyses the concepts of impartiality and partiality as found in moral philosophy and then applies these concepts and their implications to the nurse-patient relationship. Some issues of particular interest to the impartiality-partiality issue have been selected to be given close examination in the thesis. These are an analogy between the nurse-patient relationship and friendship, the relation between trust and impartiality, the question about whether moral obligations can arise from physical proximity and immediacy, the relation between professional detachment and impartiality, and partiality and impartiality in care ethics. The thesis argues that the nursing role is an institutional role as well as a professional role and a role involving a close personal cooperation. Some institutional roles require a high level of impartiality, and the nursing role is one such role. Therefore, the nurse ought to show a high level of impartiality as well as being committed to the good of her particular patient. 11

Ethics in health care is a topic that has been around since ancient times. It was the basis for the Hippocratic Oath. With the development of modern nursing and specialties in nursing, ethics in nursing becomes an important topic for consideration. This article gives an overview of the history of ethics, with particular considerations to nursing ethics. It provides an overview of moral distress within nursing and how ethical decisions affect care. It also provides examples of ethics within radiology nursing.

The International Council of Nurses [ICN] Code for Nurses clearly states that the registered nurse's first obligation is to the patient (ICN, 1973). But, in the clinical setting, multiple loyalties or obligations to the patient, family, physician, employing agency, professional standards, and personal ethical beliefs may conflict. Given the diversity of obligation in nursing practice and the ever expanding array of life sustaining technologies and techniques, a problem arises for nurses when they attempt to employ clinical guidelines offered by the ICN Code. Therefore, in order to ascertain how nurses uphold patient autonomy when responding to conflicts in the empirical setting and to delineate the patterns of reasoning which contribute to the actual response as well as to the preferred response, a qualitative grounded theory methodology was selected. This exploratory approach provided evidence that when conflict occurs, perceptions of relevancy on both a cognitive and affective level, influence the nurses' response. Often nurses with apparently equal cognitive capabilities on a moral developmental level perceived conflict of loyalty situations in vastly different ways and thereby responded with a range of behavior that went from exemplary care, which supported patient autonomy, to unsafe care, which completely denied patients their autonomy. An inductively derived substantive theory outlines this variance in care. The manner in which patient autonomy is upheld in multiple loyalty conflicts can be expressed on a three dimensional categorical basis with perceptions of imposed, bounded and volitional relevance conjoined with three levels of cognitive moral development, including both descriptive and normative explanations of conflict resolution. Principles and their supporting rules for nursing action derived from each category emphasize the little researched but complex relationship between moral cognitions, perceptions and affective valuing.
Applied Science, Faculty of
Nursing, School of
Graduate

During end-of-life care, nurses face ethical dilemmas on a daily basis with minimal operative scholastic preparation and professional expertise. The diverse source of ethical quandaries includes patient care issues related to legalities, inappropriate medical interventions, social roles, and professional and personal values. Ethical discourse in end-of-life care occurs within institutions where policies, professional relationships, and economic factors constrain ethical reflection. Thus, it is imperative that ethics education take into account the professional and social context of nursing, in addition to traditional teachings focused on many principles and theories, codes of conduct, and legal ramifications. The purpose of this research was to explore how experienced nurses' successfully resolved day-to-day ethical dilemmas during end-of-life care. This study utilized narrative analysis to analyze data generated from one-on-one interviews with six hospice nurses. The semi-structured interviews were conducted in two phases. Using core story creation, several different ethical dilemmas were identified divulging struggles with key stakeholders. Thematic analysis was then used to create three main themes: Ethics within Practice, Ethical Knowledge, and Ethical Solutions discussed within the framework of situational context, deliberations, and ethical actions. The results gained from this research provide information on how to improve nursing ethics education through the use of narratives of experienced nurses. The nurses used in this research told their stories depicting a keen awareness of ethical conflicts situated by contextual factors including social, political, and personal issues. Their deliberations were informed through formal, experiential, and intuitive knowledge creating a sense of phronesis as they negotiated the right course of actions. The nurses solved ethical predicaments by either following rules or choosing acts of resistance. It is my contention that the results of this study will empower practicing nurses and nurse educators to appreciate and incorporate context and different forms of knowledge to inform ethical discourse. We can utilize the experienced nurses' wisdom to improve nursing ethics education which ultimately translates to providing better deaths for patients.

Purpose: Within the contemporary socio-political context of palliative care and an aging demography, there is a called-for shift to an upstream provision of palliative care in the form of a palliative approach to care as well as to frame access to palliative care within a health equity perspective. In the literature, there is a paucity of nurses’ experiences in the provision of palliative care within psychiatric settings. Moreover, little is known of the process by which nurses engage in a palliative approach to care for patients experiencing multiple marginalities, including institutionalization, mental health, and advanced age. This research explored how nurses in forensic and geriatric psychiatry engage with aging patients and mortal considerations to discern how ethical dimensions of care, aligned within the palliative approach, are enacted. An ethical lens by which to apprehend dimensions of human finitude, reflective of central elements of the palliative approach and public health palliative care, was proposed to help to delineate a process of recognition through which values can be identified in the care of patients. The purpose of this thesis was to explore the phenomenon by which nurses engaged with mortality as both an antecedent to adopting a palliative approach and as a phenomenon that captures nurses’ continued engagement with patients within this approach. Objectives: There were three objectives to the project: 1) explore nurses’ engagement with mortality within an ethics of finitude; 2) identify enablers and barriers, and related historical and socio-political discourses, to engagement of nurses with their patients within an ethics of finitude, and; 3) articulate and deepen understanding of the palliative approach, including ethical dimensions and considerations. The research was an analytical elaboration of a qualitative study at the University of Ottawa that examined the palliative approach to nursing care in forensic and geriatric psychiatry at a mental health facility in eastern Ontario. Methods: Situated within a constructivist epistemic stance, the analytical framework elaborated for this analysis drew from both interpretive description (ID) and interpretive phenomenological analysis (IPA). Utilizing convenience sampling, eight Registered Nurses (7 women and 1 man) working in forensic or geriatric psychiatry completed interviews. Findings: Engagement of nurses within an ethics of finitude was revealed to surface through a process of recognition (recognition of mortality, recognition of the increased vulnerability of patients, and recognition of a corresponding increased responsibility for vulnerable patients) and through the affirmation of values including human connection, dignity, comfort, family, familiarity, and personhood. Barriers and enablers to this engagement emerged related to the care environment, the psychiatric nurse and patient construction, and factors related to family. The implications of the related discourses in the articulation of the palliative approach emerged in relation to health system considerations and to the language of the palliative approach. Conclusion: The process of recognition explored through the proposed ethical lens and revealed in the findings delineated values that underpin the palliative approach by offering an alternate conceptualization to their identification and enactment. Insights from this project underscore preliminary insights on a process to identify care practices aligned within the palliative approach as well as possibilities for critical questioning related to interconnected axes of an ethics of finitude in both the care of individual patients and in the enactment of health policy.

Illness creates a range of negative emotions in patients including vulnerability, powerlessness and dependence on others for help. The nursing literature is saturated with debate about a 'therapeutic' nurse-patient relationship. However, despite the current agenda regarding patient-centred care, literature concerning the development of good interpersonal responses and the view that a satisfactory nursing ethics should focus on persons and character traits rather than actions, nursing ethics is dominated by the traditional obligation, act-centred theories such as consequentialism and deontology. I critically examine these theories and the role of duty-based notions in both general ethics and nursing practice. Because of well-established flaws, I conclude that obligation-based moral theories are incomplete and inadequate for nursing practice. Instead, the moral virtues and virtue ethics provide a plausible and viable alternative for nursing practice. I develop an account of a virtue-based helping relationship and a virtue-based approach to nursing. The latter is characterized by three features: (1) exercising the moral virtues such as compassion and courage, (2) using judgment and (3) using moral wisdom - moral perception, sensitivity and imagination. Merits and problems of this approach are examined. Following Macintyre, I conceive nursing as a practice; nurses who exercise the virtues and seek the internal goods help to sustain the practice of nursing and thus prevent the marginalization of the virtues. The strong (action-guiding) practice based version of virtue ethics proposed is context-dependent, particularist and relational. Several areas for future philosophical inquiry and empirical nursing research are suggested to develop this account yet further.

Thesis (Ed.D.) -- Teachers College, Columbia University, 1989.
Typescript; issued also on microfilm. Sponsor: Patricia L. Munhall. Dissertation Committee: Victoria J. Marsick. Bibliography: leaves 118-121.

Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Aim: This study aimed to explore the perceptions of third year nursing students regarding the ethics module at Shifa College of Nursing, Islamabad, Pakistan. Methods: Third year nursing students (n=26) completed a retrospective pre/post survey rating their knowledge before and after the ethics module. Focus group discussions (FGDs) addressed the importance of ethics teaching in nursing, the content, teaching and learning strategies of the module as well as whether the application of the concepts learned in the classroom were practiced in the clinical setting. Results: Participants rated their knowledge higher in the post-test (4.00) than the pretest questionnaire (2.26) (p=0.003). The main themes identified during the focus group discussions were: understanding their responsibilities towards the patient; an appreciation of the patient as a human being; applicability of the module to the clinical setting; the role of student nurses in ethical decision making in the clinical setting; and the teaching and learning strategies. The context of the nurse’s practice was also identified as being important. Conclusion: The participants valued the ethics module and its applicability to the clinical setting, but changes in the content of the module and the teaching and learning strategies were suggested.

As the twenty-first century approaches, science and technology in healthcare are making dramatic changes within the healthcare system. These changes are impacting the profession of nursing. Many of the changes included organ-transplants, genetic manipulation, surrogate mothering and other dramatic events that will collide with many of societies concepts of right and wrong. Nursing ethics has been lost in the modern day milieu of science and technology. This dissertation posits a foundation of ethics, axiology and nursing ethics via an historical review of nursing history. Included is a historical review of ethics, axiology and philosophical theories which encompass nursing ethics. This is followed by an analysis of nursing ethics and its historical development through codes of nursing. At the end of the analysis, a conceptualized learning module is presented to allow the nurse to develop an understanding in the area of nursing ethics with an educational foundation for understanding ethics and axiology. The conceptualized module contains theoretical situations which the nurse may encounter followed by an analysis of each situation. Within the context of the analysis, options and choices have been presented to help the nurse make an ethical decision.

The overall aim of this thesis is to explore how nursing is constructed in home-based nursing care from the viewpoint of patients and nurses who are receiving or giving care. Since nursing both constructs and is in turn constructed by the context in which it serves, language plays a central part in those constructions and in this thesis. The thesis has been guided by social constructionism, meaning that the positions the patients and the nurses inhabits have been considered as social phenomenon constructed in discursive processes. There are two ideas that guided this thesis. One idea was that home-based nursing care promotes the association of caring abilities in relation to nursing, women and the private sphere. Another idea was that the place where the care was carried out has ethical implications. Data was collected from interviews with 10 home-based nurses (study I) working in community in the western part of Sweden and 10 patients cared for in their home by these nurses (study II). Nurses and patients were interviewed about their experiences of giving respectively receiving home-based nursing care. The interviews were transcribed verbatim and analyzed with a discourse analytic method in study I and II. The findings in study I show that the nurses described their subject positions as "guests" and "professionals" and that they have to make a choice between these positions, as it is impossible to perform both positions at the same time. Dependent on the situation, both an ethics of care and an ethics of justice were applied by the nurses, that is, to perform according to the subject positions of "guest" or "professional." In study II, the patients describe their own subject position as "safeguard" and the nurses‟ positions as "substitutes". These subject positions provided the opportunities, and the obstacles, for the patients‟ possibilities to receive care in their home which included which kind of strategies, habits and activities the patients described and what tasks and how they considered or expected the nurses to perform. These findings are discussed within a theoretical framework, i.e. a gendered dichotomy of the private spheres versus the public spheres. Inherent in this framework is a discussion of the findings related to the habits that are essential in the nurses‟ and the patients‟ constructions of subject positions. In study III, metaphors used by home-based nurses‟ were explored as a means to discover values and norms held by nurses working in home-based nursing care. Ten interviews with nurses working in home-based nursing care (the same interviews as in study I) were analyzed and interpreted with a metaphor analytic method. In the analysis metaphoric linguistic expressions (MLE) were explored and patterns of MLEs formed two entailments. After exploring MLEs and entailments on an explicit surface level the analysis went to a broader underlying dimension of conceptual metaphors identifying the overall metaphor: "Home-based nursing care is an endless journey". The metaphor "Home-based nursing care is an endless journey" exposed home-based nursing care in constant motion, thereby requiring nurses to adjust to circumstances. This adjustment required ethical maturity based on experience, knowledge, and creativity. The study III focuses on the importance of further developing reflections over experiences related to everyday ethical issues. In study IV, the findings from study I were the starting point for a philosophical exploration of the concept "guest" and its relation to other adjacent concepts such as hosts and hospitality. The question to be answered was as follows: In what ways can home-based nurses‟ description of being "guests" in patients‟ home be understood? The exploration was based on Derrida‟s philosophy of unconditional and conditional hospitality, Levinas‟ philosophy of "face" and "the Other" and Arendt‟s philosophy of "go visiting". The findings indicated that the concept "guest" was not appropriate for the nurses to use when describing their position in home-based nursing care, since the concept was problematic for the content and the complexity of home-based nursing care. The findings also showed that exposing concepts as binaries is fruitful since they show relationship between concepts. Just illuminating the concept "guest" did not reveal the power relationship between the "guest" and the "host" and their relationship to hospitality. The distinction between diverse ethical perspectives could be seen as problematic or as an opportunity. According to this study, the nurses used a plurality of different ethical ideas, such as an ethics of care, an ethics of justice, an ethics of virtue and an "everyday ethics." A possible interpretation could be that this was a sign of a difficulty to maintain distinction between ethical theories in clinical practice.  Ethical issues in the private sphere are less commonly explored compared to ethical issues in the public sphere, for example in hospital care. As showed in this thesis, the distinction between the private and the public spheres was problematic. It does not describe two spatially separate spheres, but rather it describes functionally dependent activities, interests and relations, such as diverse areas of ethical ideas and "feminine" and "masculine" positions. Home-based nursing care is a complex area and discourse analysis of the relation between home-based nursing care, subject positions, ethics and gender is more or less lacking. Exploring home-based nursing care outgoing from discourse analytic perspectives and methods is rewarding for nurses‟ practice, education and research as it opens up new perspectives of home-based nursing care.

This thesis presents an ethical model to guide the nurse in the application of moral standards or principles in the clinical and community setting. The study is concerned with looking at ethics primarily in terms of patients'/events' rights, not ethics in general. The contribution of contemporary nurse theorists and philosophers in the international arena are considered to see how their contributions relate to the present and future developments and trends in the field of nursing, and how they may be translated into action in the daily care of patients/clients in the clinical and community setting. The research methods include an historical review of local, national and international nurse educational, philosophical and ethical literature. The central theme investigates the caring roles of nurses and the commitment to patient/client care which are the basis of the ethical perspective of nursing. The ethical principles inherent in the nursing discipline, such as patients'/clients' rights and autonomy are examined, to see how these principles may be applied at the bedside and in the community. Validation criteria are adapted and this validation tool, together with the ethical constructs/components, are used as a framework to ensure that an ethical perspective is included and utilised in all nursing models. As ethics is concerned with human conduct and relationships, the author concludes that an ethical model is vital and may be used with all models which guide nursing practice currently in use and in future developments. An Ethical Analysis Framework and Model has been developed by the author, to serve as a tool for the inclusion of ethical constructs/components in models which guide the practice of nursing in the clinical and community setting. It also aids in the application of ethical principles. The Ethical Analysis Model will hopefully contribute to the theoretical framework of curriculum development as curriculum is concerned with shaping attitudes towards knowledge and creating a forum for discussion and criticism. Ethical knowledge is part of that subject matter. Through deliberation and judgement the definition and solution of curriculum and ethical problems may be effected as curriculum development, like ethics, is concerned with what is, and what might be. An example is presented of how the Framework and Model can be used, and is strongly recommended for use with any model which guides the practice of nursing. The findings, their limitations and the relevant discussions and recommendations are highlighted, and areas for further research are identified.

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Introduction: bullying is a type of violence in a repetitive and prolonged way, capable of promoting physical and psychological damage to its victims. This dissertation is composed of two articles. Article 1 - Scientific production on bullying and nursing: bibliometric study. Aim: to verify bibliometric indicators of scientific production available in online journals that deal with bullying and nursing. Method: bibliometric study. Bradford’s law was used, and the Zipf’s law was combined with textual statistics (Iramutec). Sample consisting of 111 publications in Portuguese, English and Spanish, available in national and international databases, from 2000 to 2016. Results: production predominantly published in the last ten years and prepared in co-authorship. Main authors linked to 91 institutions, distributed in 24 countries. The United States of America, Brazil and Australia were the countries that published the most. Nursing staff and nursing students made up the main research populations, and the hospital environment was the most investigated scenario. The journals with the largest number of publications (Bradford Nucleus) have international scientific influence. The terms with the highest semantic power and high frequency in the abstracts were bullying, assédio moral and acoso moral. Conclusion: the indicators point out that bullying occurs in the nursing work environment in several countries, and that the number of publications in this area tends to grow. However, it is necessary to expand research involving diverse scenarios, including professionals and nursing students, which will contribute to the better knowledge and face this phenomenon. Article 2 - Workplace bullying: study with members of Nursing Councils about ethical processes. Aim: to investigate bullying based on the positioning of nursing counselors about ethical processes in this topic. Method: exploratory-descriptive study with quantitative approach. Data collection performed through online platform. The sample consisted of 80 counselors from the Federal Nursing Council/Regional Councils, from the five geographic regions of Brazil. Results: from the obtained data, it was observed that 86.25% of the counselors performed judgments of nursing professionals denounced for the practice of workplace bulling. Regarding the processes in this thematic area, 77.5% of the participants mentioned finding some difficulty, among the main ones are the absence of witnesses and evidence of the acts denounced, being the latter, the main (68.52%) reason for filings and acquittals in some cases. The characterization of the phenomenon was not consensual in relation to the frequency of the aggressions and the total time of exposure of the victim to the violence. However, 95% consider that the aggressor can manifest through various behaviors. To prove the assaults, victims can use witness reports, record-keeping, virtual messages, and psychological statements, as they are widely accepted by counselors. The warning penalty for the harasser was considered as insufficient by 68.7% of the counselors. All participants consider important the proposal to create an instrument to assist in the investigation of complaints involving the practice of bullying. Conclusion: ethical processes actively collaborate in tackling workplace bullying, however, it is important that the Nursing Councils support new prevention strategies and adopt instruments that guide the investigation of denouncements, providing greater support for the formation of conviction of counselors in the judgments involving this practice.
Introducción: El acoso moral es un tipo de violencia de modo repetitivo y prolongado, capaz de promover daños físicos y psíquicos en sus víctimas. Esta tesis se compone de dos artículos. Artículo 1 - Producción científica sobre acoso moral y enfermería: estudio bibliométrico. Objetivo: verificar indicadores bibliométricos de la producción científica disponible en periódicos en línea que abordan acoso moral y enfermería. Método: estudio bibliométrico. Se utilizó la Ley de Bradford, y la Ley Zipf combinada a la estadística textual (Iramutec). La muestra consta de 111 publicaciones en portugués, inglés y español, disponibles en bases de datos nacionales e internacionales, en el período 2000 a 2016. Resultados: producción predominantemente publicada en los últimos diez años y elaborada en coautoria. Autores principales vinculados a 91 instituciones, distribuidas en 24 países. Estados Unidos, Brasil y Australia fueron los países que más publicaron. Profesionales y estudiantes de enfermería compusieron las principales poblaciones de las investigaciones, y el ambiente hospitalario fue el escenario más investigado. Los periódicos con mayor número de publicaciones (Núcleo de Bradford) tienen influencia científica internacional. Los términos con mayor poder semántico y alta frecuencia en los resúmenes fueron bullying, assédio moral y acoso laboral. Conclusión: los indicadores apuntan que el acoso moral ocurre en el ambiente de trabajo de enfermería en varios países, y que el número de publicaciones en esta temática tiende a crecer. Sin embargo, es necesaria la ampliación de investigaciones involucrando escenarios diversificados, incluyendo profesionales y estudiantes de enfermería, lo que contribuirá para el mejor conocimiento y enfrentamiento de ese fenómeno. Artículo 2 - Acoso moral en el trabajo: estudio con miembros de Consejos de Enfermería acerca de procesos éticos. Objetivo: investigar el acoso moral a partir del posicionamiento de consejeros de enfermería acerca de procesos éticos en la referida temática. Método: estudio exploratorio-descriptivo con enfoque cuantitativo. Recolección de datos realizada a través de una plataforma en línea. La muestra fue compuesta por 80 consejeros del sistema Consejo Federal de Enfermería / Consejos Regionales, provenientes de las cinco regiones geográficas de Brasil. Los resultados obtenidos, a partir de los datos obtenidos, se observó que el 86,25% de los consejeros realizaron juicios de profesionales de enfermería denunciados por práctica de acoso moral. En cuanto a los procesos en esa temática, el 77,5% de los participantes mencionó encontrar alguna dificultad, destacándose las ausencias de testigos, y de comprobación de los actos denunciados. Siendo ésta última, el principal (68,52%) motivo de archivados y absolviciones en algunos procesos. La caracterización del fenómeno no fue consensuada con relación a la frecuencia de las agresiones y al tiempo total de exposición de la víctima a la violencia. Sin embargo, el 95% considera que el agresor puede manifestarse a través de conductas variadas. Para comprobar las agresiones, las víctimas pueden utilizar los relatos de testigos, registro en el libro de ocurrencia, mensajes virtuales, y atestados psicológicos, ya que son ampliamente aceptados por los consejeros. La penalidad de advertencia para el acosador fue considerada como insuficiente por el 68,7% de los consejeros. Todos los participantes consideran importante la propuesta de creación de instrumento para auxiliar la averiguación de denuncias involucrando la práctica del acoso moral. Conclusión: los procesos éticos colaboran activamente en el enfrentamiento del acoso moral, sin embargo, es importante que los Consejos de Enfermería apoyen nuevas estrategias de prevención y adopten instrumentos que orienten la averiguación de denuncias, proporcionando mayor respaldo para la formación de convicción de los consejeros en los juicios involucrando esta práctica.
Introdução: O assédio moral é um tipo de violência de modo repetitivo e prolongado, capaz de promover danos físicos e psíquicos em suas vítimas. Esta dissertação é composta por dois artigos. Artigo 1 - Produção científica sobre assédio moral e enfermagem: estudo bibliométrico. Objetivo: verificar indicadores bibliométricos da produção científica disponível em periódicos online que abordam assédio moral e enfermagem. Método: estudo bibliométrico. Utilizou-se a lei de Bradford, e a lei de Zipf combinada à estatística textual (Iramutec). Amostra constituída por 111 publicações em português, inglês e espanhol, disponibilizadas em bases de dados nacionais e internacionais, no período de 2000 a 2016. Resultados: produção predominantemente publicada nos últimos dez anos e elaborada em coautoria. Autores principais vinculados a 91 instituições, distribuídas em 24 países. Estados Unidos da América, Brasil e Austrália foram os países que mais publicaram. Profissionais e estudantes de enfermagem compuseram as principais populações das pesquisas, e o ambiente hospitalar foi o cenário mais investigado. Os periódicos com maior número de publicações (Núcleo de Bradford) possuem influência científica internacional. Os termos com maior poder semântico e alta frequência nos resumos foram bullying, assédio moral e acoso laboral. Conclusão: os indicadores apontam que o assédio moral ocorre no ambiente de trabalho de enfermagem em vários países, e que o número de publicações nesta temática tende a crescer. Entretanto, é necessária a ampliação de pesquisas envolvendo cenários diversificados, incluindo profissionais e estudantes de enfermagem, o que contribuirá para o melhor conhecimento e enfrentamento desse fenômeno. Artigo 2 - Assédio moral no trabalho: estudo com membros de Conselhos de Enfermagem acerca de processos éticos. Objetivo: investigar o assédio moral a partir do posicionamento de conselheiros de enfermagem acerca de processos éticos na referida temática. Método: estudo exploratório-descritivo com abordagem quantitativa. Coleta de dados realizada por meio de plataforma online. A amostra foi composta por 80 conselheiros do sistema Conselho Federal de Enfermagem/Conselhos Regionais, provenientes das cinco regiões geográficas do Brasil. Estudo com autorização administrativa (Cofen), e aprovação ética (CAAE) nº: 48398215700005183. Resultados: a partir dos dados obtidos, observou-se que 86,25% dos conselheiros realizaram julgamentos de profissionais de enfermagem denunciados por prática de assédio moral. Em relação aos processos nessa temática, 77,5% dos participantes mencionaram encontrar alguma dificuldade, entre as principais, destacam-se as ausências de testemunhas, e de comprovação dos atos denunciados. Sendo esta última, o principal (68,52%) motivo de arquivamentos e absolvições em alguns processos. A caracterização do fenômeno não foi consensual com relação à frequência das agressões e ao tempo total de exposição da vítima à violência. Contudo, 95% consideram que o agressor pode se manifestar através de condutas variadas. Para comprovar as agressões, as vítimas podem utilizar os relatos de testemunhas, registro em livro de ocorrência, mensagens virtuais, e atestados psicológicos, visto que são amplamente aceitos pelos conselheiros. A penalidade de advertência para o assediador foi considerada como insuficiente por 68,7% dos conselheiros. Todos os participantes consideram importante a proposta de criação de instrumento para auxiliar a averiguação de denúncias envolvendo a prática do assédio moral. Conclusão: os processos éticos colaboram ativamente no enfrentamento do assédio moral, contudo, é importante que os Conselhos de Enfermagem apoiem novas estratégias de prevenção e adotem instrumentos que norteiem a averiguação de denúncias, proporcionando maior respaldo para a formação de convicção dos conselheiros nos julgamentos envolvendo essa prática.

This thesis investigates professional nursing as a practice. Starting from a recognition that nurses have for some time been under pressure to explain their contribution to health care and how it may be differentiated from other health care occupations, it takes as its initial premise the belief that nursing is more than just the skilled performance of a range of tasks. From a consideration of general, colloquial use it would seem that 'to nurse' is to support, protect, preserve and nurture it, and this requires a commitment on the part of the one nursing, an investment of self for the well-being of the object of nursing. A review of the nursing literature suggests that such an understanding is not to be found in the literature of theories and models of nursing, and that much of that literature fails to give a coherent account of nursing. A theme in much of the nursing literature is the importance of the concepts of care and caring, although accounts of the relationship between nursing and caring are problematic. The thesis shows that, while most uses of the concept of care are morally neutral, to refer to someone as a caring person is to ascribe a moral virtue, and this leads to a more detailed consideration of virtue ethics as a perspective from which to understand nursing. In particular the work of MacIntyre is considered, and it is shown that professional nursing can be understood as a practice, in the particular sense that MacIntyre uses that term. However an examination of what is required in a society for a practice to flourish suggests that many features of the organisation and management of health care in recent years have made it increasingly difficult for professional nursing, understood as a practice, to survive.

Pursuit of university education for nurses has been a controversial and poorly understood ideal. It has been difficult to clearly demonstrate and articulate the benefits of higher education for nurses and nursing. In this research the mission of undergraduate education in general, and the Canadian Nurses Association position paper on baccalaureate education served as the basis of inquiry into aspects of university education for nurses and nursing. From these sources and review of the literature it was ascertained that a primary value of education is seen as helping individuals develop intellectual and ethical maturity which allows them to make judgments and commitments in a relativistic world. This theorectical orientation was operationalized through Perry's theory of intellectual and ethical development (1970). The Measure of Epistemological Reflection (MER), a tool based on this theory, was developed to measure a person's level of intellectual and ethical maturity. In this study the MER was administered to diploma and baccalaureate nursing graduates to determine if this construct could be used to differentiate the effects of the two levels of education. The findings indicated that there was no difference between diploma and baccalaureate groups of nurses on their scores on the MER. There was no correlation between scores on the MER and age or experience. There was, however, a significant difference between a group of nurses who participated in university education in addition to their basic nursing program, and a group who had no other university credit outside of their basic nursing program. These findings, and their implications for nursing practice, education, and research are discussed.
Applied Science, Faculty of
Nursing, School of
Graduate

An exploratory, qualitative study on the experiences of Polish older adults who made a transition from independent living to an ethno-specific residential care facility in Toronto is presented. Using the framework of Continuity Theory of Aging, the impact of ethnic/cultural identity on the process of relocation and subsequent adjustment to a nursing home environment was investigated. A purposive sampling strategy was used to select 2 male and 4 female participants. The data was collected using long interviews that were tape recorded and transcribed verbatim. The findings of this study indicate that the subjects employed specific coping strategies that stem from traditional value orientation and life experiences hence suggesting that ethnic/cultural identity may have played a role in their successful adaptation to residential care setting. Although this research study is limited to one group of older adults and cannot be generalized to other ethnic groups, it has a potential to contribute to increasing the body of knowledge about the dynamics of residential care placement among ethnic minority seniors. Implications for social work policy, research and practice are discussed.

This study focused on the experiences of ethnic minority nursing students at a predominately white institution, the Health Sciences University School of Nursing in an attempt to learn more about the stress, appraisal, and coping of this group of individuals. The University School of Nursing was selected as a comparison site as it offered a setting with no predominate ethnic group. Faculty•s perceptions of students stress, appraisal and coping were sought to provide a context for the students• experience. A review of the literature indicated that ethnic minority students in predominately white universities experience alienation. At some universities white and ethnic minority students and faculty differ in their perceptions of what should be offered as support to ethnic minority students. Studying the experiences of students at a health care science university, dedicated to the health and care of individuals provided useful insights. Of particular importance was the investigation of what constituted problematic and nonconstructive relationships and structures. Symbolic interactionism, socialization theory, stress, appraisal and coping theory and attribution theory offered sensitizing concepts from which 23 ethnic minority nursing student and 12 nursing faculty interviews were taped, and analyzed. A constant comparative method of qualitative analysis proposed by Glaser and Strauss offered a systematic approach in developing substantive concepts. Common to most nursing students was the phenomenon of making it in nursing school. Making it was characterized by two main categories, being out of control and gaining control. Being out-of-control was understood as the stress producing threats of conflicting demands of family, work and school and being sanctioned, the evaluation and approval by faculty of ones• professional performance. Gaining control included managing multiple demands, reaffirming ones• choice of nursing and disengaging from the student role to becoming a nurse. A set of experiences unique to ethnic minority students was identified when some aspect of ethnicity was central to the problematic experience. A core phenomenon of exclusion as a threat to identity emerged. Three forms of exclusion were identified: (1) linguistic difficulty; (2) interpersonal disregard; (3) ethno-cultural incongruity. Students 1 acceptance of responsibility for the problematic situation influenced their coping strategies. Holding back, keeping silent, disengaging and giving up were the usual coping responses. Only when the stakes were high, for example passing a course, would students speak out, negotiate or confront to in order to preserve their academic progression. Faculty accurately identified students 1 stresses as: staggering under the load, building a professional identity, experiencing isolation and facing cultural unresponsiveness. Faculty misidentified some of students 1 withdrawal coping behaviors as a cultural norm of being quiet or reserved. In addition, faculty offered descriptions of their own stress in teaching ethnic minority students with English as a second language such as trying to decide when to bend over backwards to help the students and when to draw the line. The most important conclusion reached was that ethnic minority students experienced a set of stressors linked to their perceptions of their ethnic status. A major stressor was exclusion, in that it interfered with the core task of becoming socialized as a nurse. Weak social bonds within the school of nursing and to the profession can hamper the recruitment of others from a particular ethnic group to the school and ultimately into the health care profession. A focus on the interpretation of interpersonal events in health care settings is crucial in surfacing the cultural nuances of understanding and meaning. Recommendations were made to: (1) develop an enriched grounded theory and promote mutual understanding through faculty, nursing staff and student group interviews and (2) increase the comprehensiveness of ethnic minority student retention data bases.

This study describes nurses' ethical perspectives on nursing dying patients in a critical care setting, as well as nurses' responses to their perspectives. The design involved a phenomenological approach, with unstructured interviews with eight critical care nurses used to generate data. The results indicated that nurses' ethical perspectives centered around a theme of senselessness; a senseless decision-making process, the experiences of patients and family members as senseless, and nurses' activities as senseless. Senselessness illustrated the multiple ethical dilemmas inherent in nurses' experiences. Nurses' ethical perspectives also involved their attempts to cope with senselessness by finding new meanings through shifting focus to patient comfort, support of the family, and to nurses' personal philosophies. The situational context of nurses' perspectives was explored in terms of influences on their perspectives. This study supports other recent nursing research identifying prolongation of the process of dying as a significant ethical problem engendering moral distress.
Applied Science, Faculty of
Nursing, School of
Graduate

The purpose of this exploratory study was to measure the cultural competence of nurse educators in accredited baccalaureate (BSN) nursing programs in Tennessee (TN) and investigate the relationship, if any, between nurse educators' cultural competence and the percentage of minority nursing students recruited into and graduated from these schools in the previous 5 years. With the rapid rise of the minority population in the United States, more minority healthcare providers, including nurses, are needed to provide culturally congruent care in underserved communities. Literature has implied that nurse educators' lack of cultural competence and sensitivity regarding minority nursing students' educational needs could be a contributing factor to minority nurses' underrepresentation. Nurse educators in 9 accredited colleges of nursing in TN completed the "Cultural Diversity Questionnaire for Nurse Educators." Some of the participating schools and the American Association of Colleges of Nursing Research Data Center provided the percentage of students recruited and graduated in each school by ethnicity. The findings revealed that the majority of respondents were at least moderately culturally competent. There was no correlation between Tennessee schools' mean cultural competence scores and their percentages of minority students recruited into BSN programs in the past 5 years. But there was a significant statistical correlation between Tennessee schools' mean cultural competence scores and their percentages of minority students graduated from BSN programs in the past 5 years (p = .015). There was a statistically significant difference between the mean cultural competence score of respondents who had lived in a culture different from the United States and those who had not (p = .01). There was also a statistically significant difference between the mean cultural competence score of respondents who had attended multicultural education seminars in the past 5 years and those who had not (p = .0005). The researcher recommended that nursing faculty engage in activities that would increase their cultural competence, enabling them assist students from diverse cultural backgrounds stay in school and graduate.

Thesis (Ed. D.)--Illinois State University, 1986.
Title from title page screen, viewed July 20, 2005. Dissertation Committee: Dent Rhodes (chair), Rodney Riegle, Julie Gowen, Normand Madore. Includes bibliographical references (leaves 209-217) and abstract. Also available in print.

Background: There has been wide interest shown in the manner in which ethical dimensions in nursing practice are approached and addressed. As a result a number of ethical decision making models have been developed to tackle these problems. However, in this thesis it has been argued that the ethical dimensions of nursing practice are still not clearly understood and responded in Brunei. Design and method: This thesis describes a qualitative analysis into the Bruneian nurses’ perceptions of ethical dimensions in nursing practice. Drawing on constructivist grounded theory as a method of inquiry, twenty eight practicing and administrative nurses were individually interviewed. The nurses described how ethical dimensions were perceived in their practice, by means of the difficulties they are facing in the real world of nursing practice; how they have responded to these difficulties, and why they make such responses. Findings: The nurses described three ethical dimensions in their practice, namely ‘nurse at work’ which illustrates the ethical dimensions within the work environment; ‘nurse and doctor’ that elucidates the ethical dimensions in the nurse and doctor relationship and ‘nurse and patient’ which further examines ethical aspects in patient care. ‘Taking responsibility’ and ‘shifting responsibility to others’ were identified as approaches that the nurses took in responding to the ethical dimensions with the aim of avoiding the conflict and maintaining ward harmony. These responses provide new insights into how nurses’ response to ethical dimension in the ward settings where it puts strong emphasis on the nurses’ understanding of responsibility placed upon them as a professional nurse. ‘Negotiating ethical responsibility’ emerged as a core category within the data which illustrate that nurses’ responses to the ethical dimensions form a continuous process, involving constant consideration of the two types of responses. The core category described that ethical dimensions in the nurses’ practice were contextualised in the ‘ethical responsibility’ that is placed upon them within the nursing organisation. This thesis has expanded the current theoretical knowledge of ethical dimensions by elaborating on the concerns experienced in nursing practice and the responses individual nurses utilise to negotiate and discharge their ethical responsibilities at work. The study has also extended emphasis to the reasoning and responses that nurses are engaged in, whilst at the same time, negotiating ethical responsibility regarding the context in which they are placed during their working hours. This core category provides a number of possible implications for future research, nursing practice, education and policy, which would facilitate the exploration of ethical understanding for nurses in Brunei, and enable the provision of an ethical environment, so making ethical dimensions more transparent.

Nigerians are an integral part of the nursing profession, yet there is no literature on their common health risks, such as homesickness, isolation and suicide ideation. The purpose of this study was to investigate the association between lack of acculturation, social support, and self-esteem and mental health among Nigerian nursing students. Berry's model of acculturation was used which identifies individuals perception of self in relation to their ethnic culture and the host culture. A sample of 76 Nigerian nursing students enrolled in Baccalaureate nursing programs from 3 universities in the District of Columbia and Maryland participated in the study. Data were obtained using an online survey of 69 items assessing their acculturation, social support, self-esteem and their mental health. A descriptive cross sectional design was used. Analysis of the data included descriptive statistics, Pearson correlation, multiple regression, and ANOVA. The final regression model revealed that acculturation, companionship construct of social support and self-esteem are predictors of mental health status as shown by the adjusted R squared (R2 = 0.638). Recommendations are for universities to commit to increasing acculturation, social support, and self-esteem among foreign students in an effort to decrease isolation and improve their mental health. It is also recommended that future studies should be conducted on social isolation of subcultures to improve acculturation and reduce incidence of low self-esteem among foreign students within the American society. The strategies would create positive social change for healthcare organizations and nurse educators, resulting in an increase of ethnic diverse nurses and reducing the shortage of nurses in the USA.

It is generally supposed that a supportive family can have an influence on outcomes for an adult with severe brain injury, but there is very little known about what effective families actually do. In this research the families of five such individuals were involved in an ethnographic project that lasted for one year. The literature review brought together insights from brain injury, care ethics, disability studies and anthropology. These insights were combined with a process of reflective equilibrium that was applied to the ethnographic material in order to determine the ethics of the carers. Ethics of care in this setting was conceived of as a positive practice ethic, rather than as a series of negative conundrums posed by the brain injury. The practice ethic shared by carers meant that they all conceived of the need created by brain injury in humanistic terms, rather than in terms of pathology. Carers demonstrated virtues appropriate to their practice as they helped the adult with brain injury to connect with aspects of ordinary life. The best outcomes for the adult with brain injury included being able to engage in productive activity and to make a place in the world. These outcomes could only be achieved with due regard for their safety and subsistence. The practice ethic of carers was demonstrated in the skills and concern that ensured a satisfactory outcome for the adult with brain injury. This research is a departure from recent research about families affected by brain injury, which has focused on the burden involved in care. An examination of what carers achieve suggests that burden may be associated with the development of caring practice. The transformative capacity of care, for both the carer and the adult with brain injury, is emphasized. However contextual factors, such as adequate compensation, are connected to the capacity of the carer to engage in good practice and these are explored also in this thesis. In particular, relevant aspects of the relationship between families and the Accident Compensation Corporation are explored.