Redesigning the nursing care delivery system at Fairfax Hospital

The redesign of the nursing delivery process at Fairfax Hospital is occurring from the top down and the bottom up. Nursing leaders have identified improvement opportunities that all units are addressing, such as reevaluating skill mix. At the same time, each inpatient nursing unit is redesigning its own processes to meet customer requirements. For example, the postpartum unit shifted to a "wellness" approach. Nurses reduced the amount of time spent in reassessing patients and are focusing instead on those things their patients are concerned about, such as teaching new mothers how to care for their babies. Results: Customer research revealed that patients, physicians, and nurses wanted family-centered care from competent, caring clinicians. Flow charts identified many improvement opportunities that were common across all nursing units, such as reducing the time nurses spend reporting between shifts. Nurses are more empowered to make local decisions. Additional quantitative results are being tracked for this relatively recent effort.     

Are submissive nurses ethical?: reflecting on power anorexia

We believe that the notion of power anorexia, which we define as a lack of desire to exercise power, is central to reflections about nursing ethical concerns. Questioning the assumption that nurses are powerless, we argue that nurses can and do exercise power and that their actions and inactions have consequences not only for themselves, but also for those for whom they care. We propose that a feminist ethics perspective be used both to understand and to overcome nurses' power anorexia. Feminist thinkers remind us not only of oppression's psychological impact, but that stereotypical views about women are socially constructed and, therefore, can be changed. Nurses using this framework should explore the implications of a centralized notion of caring to the way we conceive of power relations in health care. Perhaps deconstructing caring by focusing on how nurses exercise power could help us to re-conceptualize nursing and promote new agendas for health and health care.     

Ideas of caring in nursing practice

In nursing practice, awareness of ethical inner values and a common understanding of nursing and caring are needed. It is therefore important to highlight ideas of caring in nursing practice. The aim of this paper was to illuminate nursing, caring and ethical inner values in caring and caring in nursing practice. By being attentive, open, respectful and treating the patient as a person, nurses can enhance both their own and the patient's sense of personal meaning in the caring relationship. Nurses can use self‐reflection to create an awareness of nursing, caring and ethical inner values in caring.     

Assessment of Knowledge and Attitude towards Palliative Care and Associated Factors among Nurses Working in North Wollo Hospitals

BackgroundPalliative care improves the quality of life of patients facing a life-threatening illness. Nurses should improve their caregiving capacity. In Ethiopia, palliative care is underestimated. The availability of data regarding the knowledge and attitude of nurses towards palliative care is critically important. Thus, this study aimed to assess the level of knowledge and attitude of nurses towards palliative care.MethodsInstitution-based, cross-sectional study was conducted in North Wollo hospitals. A simple random sampling technique was used. The data was collected using structured self-administered questionnaires from February to March 2019. The analysis was done using a binary logistic regression model. P-value < 0.05 was considered as statistically significant.ResultsThe result revealed that 59.7% of the respondents had good knowledge and 44.2% had a favorable attitude towards palliative care. Level of education, experience in caring for chronically ill patients, and experience in caring for dying family members within the last 6 months had a significant association with the knowledge of nurses. Monthly income, experience in caring for chronically ill patients, formal palliative care education, and knowledge were found statistically significant with the attitude of nurses towards palliative care.ConclusionMore than half of the nurses had good knowledge, but less than half of the respondents had a favorable attitude towards palliative care. Attention should be given towards palliative care by the health policy and needs to be incorporated into the national curriculum of nursing education.     

护理人员实施关怀护理组织环境因素的质性研究

目的归纳总结护理人员对患者实施关怀护理的组织环境因素,为护理管理者制定合理应对措施,优化实施关怀护理的组织环境提供参考。方法采用质性研究方法,对15名护理人员进行半结构式访谈,用现象学分析法进行资料分析。结果护理人员在实际工作中感知到的对患者实施关怀护理的组织环境因素包括物理环境、心理环境、组织资源、组织制度和组织气氛。结论关怀护理的良好实施需要组织环境的支持。     

Economic downturns and nurse attachment to federal employment

The impact of the financial crisis has been uneven—with differences across industries and occupations. Jobs linked to health care appear better insulated, with nurses specifically showing labor force gains during the recent recession. What is not known is how important public sector employment opportunities are for these national nursing trends. Observing the universe of nurses working for one of the largest (and publicly operated) health care employers, we show that worsening economic conditions lead to stronger job attachment. Relatedly, older nurses also seem more willing to delay retirement and instead transition to part‐time positions during a downturn.     

Virtues of autonomy: the Kantian ethics of care

Abstract The ethics of care, adopted in much of the nursing literature, is usually framed in opposition to the Kantian ethics of principle. Irrespective of whether the ethics of care is grounded in gender, as with Gilligan and Noddings, or inscribed on Heidegger's ontology, as with Benner, Kant remains the philosophical adversary, honouring reason rather than emotion, universality rather than context, and individual autonomy rather than interdependence. During the past decade, however, a great deal of Kantian scholarship – including feminist scholarship – has rendered this series of oppositions questionable, challenging the view that an ethics of care and Kant's moral law are irreconcilable. This paper therefore re‐examines Kant's writings, drawing on recent scholarship, and argues both that they provide the care ethicists with everything they require, and that they offer something beyond an ethics of care, something that repairs the deficits in philosophies of caring. It concludes by suggesting that a Kantian ethics of care has significant implications for the construction of nursing knowledge.     

Surgical Nurses’ need for affect and their caregiving approaches

Aim

Emotions affect the behaviors of people and their cognitively-performed tasks. In surgical clinics that can be seen as emotionally intensive units, nurses may show a tendency to approach and/or avoid affect while they identify and meet patients’ care needs. This study aimed to examine the correlation between surgical nurses’ caregiving roles and approach towrads and/or avoidance of affect.

Subject and methods

This relational study was performed with 118 surgical nurses who volunteered to participate in the study, in a university hospital in north-western Turkey. For data collection, “Need for affect scale”, “Attitude scale for nurses in caregiving roles” and “Data collection form” were used.

Results

It was found that about half of the nurses encountered emotionally intense situations in their clinics;deaths at a younger age and deaths while suffering pain were seen as emotionally intense situations by the nurses. Nurses’ attitudes to their caregiving roles were at a good level, and there is a statistically significant relationship between approach towards affect and these attitudes.

Conclusion

Nurses should examine their own emotions with regard to emotionally intense situations, consider the effects of the emotions on their caregiving activities, and reflect on their skills in terms of recognizing and understanding emotions with regard to the care of their patients. In other clinical settings and special units, the relationship between nurses’ approaches towards affect and their caring activities should be examined in further research.

     

What should other healthcare professions learn from nursing ethics

Abstract  This paper analyses the question what other healthcare professions should learn from nursing ethics, e.g. what should medical ethics learn from nursing ethics. I first analyse and reject all strong versions of the claim that nursing ethics is unique, because nursing is a unique practice. I then move to the question of whether the link between nursing ethics and nursing theory can be a model for other areas of healthcare ethics. I provide an analysis of the possibility of creating a theory of medicine and find that there cannot be a theory of medicine, and I argue briefly that this finding is also applicable to nursing. If there cannot be a theory of nursing, this entails that nursing ethics cannot be justifiably based on such a theory. In the final section, I then analyse the success of nursing ethics in resisting certain of the vices of Anglo-American analytic ethics, in particular the reductionism and individualism that characterizes much of healthcare ethics. I conclude that other healthcare ethics could usefully learn from this aspect of nursing ethics.     

Noddings's caring ethics theory applied in a paediatric setting

Since the 1990s, numerous studies on the relationship between parents and their children have been reported on in the literature and implemented as a philosophy of care in most paediatric units. The purpose of this article is to understand the process of nurses' care for children in a paediatric setting by using Noddings's caring ethics theory. Noddings's theory is in part described from a theoretical perspective outlining the basic idea of the theory followed by a critique of her work. Important conceptions in her theory are natural caring (reception, relation, engrossment, motivational displacement, reciprocity) and ethical caring (physical self, ethical self, and ethical ideal). As a nurse one holds a duty of care to patients and, in exercising this duty, the nurse must be able to develop a relationship with the patient including giving the patient total authenticity in a 'feeling with' the patient. Noddings's theory is analysed and described in three examples from the paediatrics. In the first example, the nurse cared for the patient in natural caring while in the second situation, the nurse strived for the ethical caring of the patient. In the third example, the nurse rejected the impulse to care and deliberately turned her back to ethics and abandoned her ethical caring. According to the Noddings's theory, caring for the patient enables the nurse to obtain ethical insights from the specific type of nursing care which forms an important contribution to an overall increase of an ethical consciousness in the nurse.     

责任制整体护理模式下护士关爱能力影响因素分析

目的分析责任制整体护理模式下护士关爱能力现状及影响因素,为提高护士关爱能力提供依据。方法采用对护士、患者满意度调查等形式,对责任制整体护理病房护士关爱能力进行测试,总结评价效果及存在的问题。结果责任制整体护理病房护士关爱能力偏低,是否独生子女、是否结婚、生育对关爱能力产生主要影响。结论责任制整体护理病房护士关爱能力,需要医院、家庭乃至社会共同参与,建议针对不同职称、学历、聘用形式的护士进行分层次培训,通过为护士提供体验关怀、实践关怀的机会来提高护士关爱能力。     

Towards a strong virtue ethics for nursing practice

Abstract  Illness creates a range of negative emotions in patients including anxiety, fear, powerlessness, and vulnerability. There is much debate on the 'therapeutic' or 'helping' nurse–patient relationship. However, despite the current agenda regarding patient-centred care, the 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. I examine the work of Hursthouse on virtue ethics' action guidance and the v-rules. I argue that the moral virtues and a strong (action-guiding) version of 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; (2) using judgement; and (3) using moral wisdom, understood to include at least moral perception, moral sensitivity, and moral imagination. Merits and problems of the virtue-based approach are examined. I relate the work of MacIntyre to nursing and 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 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.     

Scepticism about the virtue ethics approach to nursing ethics

Nursing ethics centres on how nurses ought to respond to the moral situations that arise in their professional contexts. Nursing ethicists invoke normative approaches from moral philosophy. Specifically, it is increasingly common for nursing ethicists to apply virtue ethics to moral problems encountered by nurses. The point of this article is to argue for scepticism about this approach. First, the research question is motivated by showing that requirements on nurses such as to be kind, do not suffice to establish virtue ethics in nursing because normative rivals (such as utilitarians) can say as much; and the teleology distinctive of virtue ethics does not transpose to a professional context, such as nursing. Next, scepticism is argued for by responding to various attempts to secure a role for virtue ethics in nursing. The upshot is that virtue ethics is best left where it belongs – in personal moral life, not professional ethics – and nursing ethics is best done by taking other approaches.     

Work environment issues and intention-to-leave in Portuguese nurses: A cross-sectional study

This study extends the Registered Nurses Forecasting (RN4CAST) study evidence base with newly collected data from Portuguese nurses working in acute care hospitals, in which the measurement of the quality of work environment, workload and its association with intention-to-leave emerge as of key importance. Data included surveys of 2235 nurses in 144 nursing units in 31 hospitals via stratified random sampling. Multilevel multivariate regression analysis shows that intention-to-leave is higher among nurses with a specialty degree, nurses aged 35–39, and in nursing units where nurses are less satisfied with opportunities for career advancement, staffing levels and participation in hospital affairs. Analysis with moderation effects showed the observed effect of age and of having a specialty degree on intention-to-leave during the regression analysis is reduced in nursing units where nurses are more satisfied with opportunities for career advancement. The most important finding from the study suggests that promoting retention strategies that increase satisfaction with opportunities for career advancement among Portuguese nurses has the potential to override individual characteristics associated with increased turnover intentions.     

A pluralist view of nursing ethics

Abstract  This paper makes the case for a pluralist, contextualist view of nursing ethics. In defending this view, I briefly outline two current perspectives of nursing ethics – the Traditional View and the Theory View. I argue that the Traditional View, which casts nursing ethics as a subcategory of healthcare ethics, is problematic because it (1) fails to sufficiently acknowledge the unique nature of nursing practice; and (2) applies standard ethical frameworks such as principlism to moral problems which tend to alienate or undermine nursing ethical concerns. Alternatively, the Theory View, which aims to build an independent and comprehensive theory of nursing ethics, is also found wanting because it (1) fails to sufficiently acknowledge the heterogeneous nature of nursing practices; (2) overemphasizes the differences and undervalues the similarities between nurses and other health professionals; and (3) assumes that one ethical framework can be meaningfully applied across diverse moral problems and contexts.
My alternative, is to argue that nursing ethics inquiry should take a pluralist and critical stance towards available ethical frameworks and the negotiation of the ethical realm. On this view, the search for moral consensus or a unique ethical framework for nursing is replaced by the task of working strategically with multiple frameworks in order to expand the moral agency of nurses and empower them to positively engage with moral uncertainty as an inevitable feature of living a moral life. I conclude by indicating some of the implications that this has for the teaching of nursing ethics.     

Furthering the sceptical case against virtue ethics in nursing ethics

In a recent article in this journal I presented a sceptical argument about the current prominence of virtue ethics in nursing ethics. Daniel Putman has responded with a defence of the relevance of virtue in nursing. The present article continues this discussion by clarifying, defending, and expanding the sceptical argument. I start by emphasizing some features of the sceptical case, including assumptions about the nature of sceptical arguments, and about the character of both virtue ethics and nursing ethics. Then I respond to objections of Putman's such as that, according to virtue ethics, virtue is relevant to the whole of a human life, including one's behaviour in a professional context; and that eudaimonia should be central in explaining and motivating a nurse's decision to enter the profession. Having argued that these objections are not compelling, I go on to discuss an interesting recent attempt to reassert the role of virtue ethics in the ethics of professions, including nursing. This centres on whether role‐specific obligations – e.g. the obligations that arise for a moral agent qua lawyer or mother – can be accommodated in a virtue ethics approach. Sean Cordell has argued that the difficulty of accommodating role‐specific obligations results in an ‘institution‐shaped gap’ in virtue ethics. He suggests a way of meeting this difficulty that appeals to the ergon of institutions. I endorse the negative point that role‐specific obligations elude virtue ethics, but argue that the appeal to the ergon of institutions is unsuccessful. The upshot is further support for scepticism about the virtue ethics approach to nursing ethics. I end by gesturing to some of the advantages of a sceptical view of virtue ethics in nursing ethics.     

Der Pflegeberuf im Spiegel der Öffentlichkeit

The following article represents the main results of studies in Germany treating the situation of nurses in hospitals and in long term care units focussing the image of nursing work—on the one hand from the public’s and on the other hand from the nurses’ perspectives. The article enters into the question what the general public and the nurses thinks about the nursing work, the nursing work conditions and trust in professional caring. As a result, it can be stated that the rating of nursing work and nursing work conditions in public differs. Nursing work is higher rated in public than the nursing work conditions and the quality of professional caring. In the nursing community a high identification with the nursing profession and nursing work can be determined. But there is lower job satisfaction and esteem for nursing work visible.