Nurses' attitudes to euthanasia: a review of the literature

This article provides an overview of the scarce international literature concerning nurses' attitudes to euthanasia. Studies show large differences with respect to the percentage of nurses who are (not) in favour of euthanasia. Characteristics such as age, religion and nursing specialty have a significant influence on a nurse's opinion. The arguments for euthanasia have to do with quality of life, respect for autonomy and dissatisfaction with the current situation. Arguments against euthanasia are the right to a good death, belief in the possibilities offered by palliative care, religious objections and the fear of abuse. Nurses mention the need for more palliative care training, their difficulties in taking a specific position, and their desire to express their ideas about euthanasia. There is a need to include nurses' voices in the end-of-life discourse because they offer a contextual understanding of euthanasia and requests to die, which is borne out of real experience with people facing death.     

Nurses' attitudes towards computerization: a review of the literature

It is evident that the increased use of computer technology in health care settings is having an impact on the nursing profession. This paper reviews the literature examining the attitudes of nurses to computerization, concluding that, although computers are being increasingly incorporated into the nurse's working environment, the literature lacks adequate research support of the attitudes held by psychiatric nurses toward computerization. A move toward computerization, as with any innovation, can be greatly facilitated if nurses respond to the change in a positive manner. Accordingly, a greater understanding of psychiatric nurses' attitudes toward computerization could be an integral part of the process of computerization within psychiatric settings.     

Nurses' perceptions of sexuality in institutionalized elderly: a literature review

Background

Institutionalized elderly continue to have the need for sexual expression and intimacy. Nurses often display negative responses when they are confronted with the sexual behavior of residents. They feel ashamed and do not know how to react. This generates feelings of discomfort, resulting in the denial of resident's needs and desires for sexual fulfillment.

Objectives

The objective of this review is to thoroughly analyze the literature about the knowledge, attitudes, and experiences of nursing staff toward sexuality in institutionalized elderly. We shed light onto the relationship between knowledge and attitudes, and determined whether certain demographic factors relate to the knowledge and attitudes of nursing home caregivers.

Design

We conducted an extensive search of the electronic databases Medline, Cinahl, Psychinfo, Web of Science, Philosophers Index, Google Scholar, and Invert for papers published between January 1980 and September 2010. A broad range of search keywords was used.

Findings

The quantitative studies revealed nursing staff to show rather positive attitudes toward later-life sexuality. However, the extent of the staff's knowledge regarding sexuality in the aged seemed to be very limited. There was no consensus found about the relationship between knowledge and attitudes. As regards the influence of demographic variables, the results were very ambiguous. The qualitative studies showed that caregivers hold rather conservative attitudes toward sexuality in institutionalized elderly. Feelings of discomfort prevailed. The responses to residents’ sexual behavior were influenced by the staff's own level of comfort related to sexuality issues and the ethos within the institution where they work.

Conclusions

This review gives us a broad outline of the knowledge, attitudes, and experiences of geriatric nurses toward sexuality in institutionalized elderly. If we want the sexual needs of residents to be recognized, more research is needed. Especially needed are more in-depth qualitative studies that explore the experiences of nurses and managers. The development of a more accurate educational program could increase the knowledge of later-life sexuality and cultivate positive and permissive attitudes toward sexuality in the aged.     

Nursing students' ethical decision-making: a review of the literature

Research into education in ethical decision-making in nursing is scarce. This review is an overview of empirical literature published between 1980 and September 2006. The literature was retrieved from the Medline and CINAHL databases. The focus is on the methodology and findings of these studies for identifying knowledge gaps for further research. The methodological approaches and foci of the studies varied rendering the comparison and generalization of the findings difficult. The findings indicate that education has a positive impact on students' moral development. Future research should focus on educators and clinical instructors, and on the cooperation between theoretical and clinical instruction. A review of the theoretical scientific literature would provide valuable knowledge as well. Research in this area might also benefit from more context appreciating qualitative research as well as from the use of longitudinal research designs. Research projects at national and international level should be considered.     

Nursing resistance as ethical action: literature review

BACKGROUND: Much has been written about nursing as a predominantly female profession whose members display passivity, submission, obedience and powerlessness. Alternatively, some authors have presented evidence of nurses' capacity to exercise power, revealing the possible relationship between powerlessness and ethical compromise. Thus, empowerment strategies for nurses can yield ethical action. AIM: The aim of this paper is to use analysis of the literature to demonstrate how the actions and responses of nurses to ethical concerns are examples of nurses exercising power. METHOD: Empirical studies published in the nursing literature between 1990 and 2003 have been analysed to illustrate how nurses' actions of resistance can ensure that moral values are realized in practice. Foucauldian notions of power relations and feminist ethics provide the theoretical framework. CONCLUSIONS: Nurses were found to resist in situations where they experienced moral conflicts in relation to the actions of health professionals; however, instances were cited where they did not. Consequently, strategies for nursing education and management are proposed to increase nurses' understanding of the potential acts of resistance that they could employ in situations of moral conflict or concern.     

Nurses' provision of teaching and counselling on sexuality: a review of the literature

Patients' sexual concerns and problems are a focus for nursing care Research studies with nurses, patients and healthy adults support this assertion However, investigations also identify that specific teaching, supporting and/or counselling interventions aimed at managing the effects of illness and treatment on sexual function are not provided most of the time This discrepancy can be analysed by exploring factors that influence the nursing care behaviours sex teaching and counselling Investigators have studied the influence of the following five factors (sexuality) knowledge and skills, attitude towards sexuality, opinion about professional role and tasks, comfort with sexuality, and participation in continuing education activities Conflicting findings regarding the influence of these five factors upon teaching and counselling on sexuality are found Predicated upon previous investigations, two specific areas for future investigations are identified First is the need to clarify the definition and theoretical basis for the interventions of teaching and counselling on sexuality Second, future investigations could place the problem within the context of theory which helps to explain (nursing) behaviour, such as the Theory of Reasoned Action     

Nurses' codes of ethics in practice and education: a review of the literature

The purpose of this review was to provide an overview of the empirical literature on nurses' codes of ethics in practice and education covering the time from 1980 to August 2007. The focus was on methodological issues, main domains of interest and findings of the studies. The aim of the review was to identify knowledge gaps and to provide recommendations for further research. Research on the codes of ethics in nursing is scarce. The main domains of interest were education, nurses' knowledge and use of the codes, the content and functions of the codes, and moral behaviour and values related to the codes. Education of the codes was important, and it had a positive impact on students' moral behaviour measured by an instrument based on the codes. Nurses' knowledge and use of the codes was deficient. Nurses' practice was guided by environmental contexts and personal experiences rather than the codes. However, nurses' values espoused those of the codes. The nurse–patient relationship was the best known aspect of the codes. Methodological diversity, a small number of studies focusing on several domains of interest warrants care in the interpretation of the findings. Further research should focus particularly on the education of the codes, covering the realization of the teaching process, evaluation of outcomes and organization of education. Cooperation between theoretical education and clinical practice should be explored. Research of the meaning of the codes and their functions for nurses, nurses' moral behaviour and professional values is needed. Research should cover all levels and areas of nursing and reach beyond the nurse–patient relationship to relationships with colleagues, other health professions, organizations and the society. The use of more varied methodological approaches is suggested.     

Nurses’ ethical reasoning and behaviour: A literature review

Background

Today's healthcare system requires that nurses have strong medical-technical competences and the ability to focus on the ethical dimension of care. For nurses, coping with the ethical dimension of care in practise is very difficult. Often nurses cannot act according to their own personal values and norms. This generates internal moral distress, which has a negative impact on both nurses and patients.

Objectives

The objective of this review is a thorough analysis of the literature about nurses’ ethical practise particularly with regard to their processes of ethical reasoning and decision making and implementation of those decisions in practise.

Design

We conducted an extensive search of the electronic databases Medline, Embase, Cinahl, and PsycInfo for papers published between January 1988 and September 2008. A broad range of search keywords was used. The 39 selected articles had a quantitative, qualitative, or mixed-method design.

Findings

Despite the conceptual difficulties that the literature on the ethical practise of nurses suffers, in this review we understand nurses’ ethical practise a complex process of reasoning, decision making, and implementation of the decision in practise. The process of decision making is more than a pure cognitive process; it is influenced by personal and contextual factors. The difficulties nurses encounter in their ethical conduct are linked to their difficult work environment. As a result, nurses often capitulate to the decisions made by others, which results in a conformist way of acting and less individually adapted care.

Conclusions

This review provides us with a more nuanced understanding of the way nurses reason and act in ethically difficult situations than emerged previously. If we want to support nurses in their ethical care and if we want to help them to change their conformist practises, more research is needed. Especially needed are in-depth qualitative studies that explore the experiences of nurses. Such studies could help us better understand not only how nurses reason and behave in practise but also the relationship between these two processes.     

Nurses' views on ethical codes: a focus group study

AIM: This paper reports a study exploring nurses' views on the 'potential' content and functions of an ethical code for nurses in Belgium. The term 'potential' is used, because Belgian nurses do not have experience with an ethical code. BACKGROUND: Ethical codes have been developed to guide nurses' practice and to improve their professional status. Little empirical research, however, has been undertaken to determine nurses' views on the content and functions of these codes. The available quantitative studies merely give some information on nurses' (lack of) knowledge and use of their ethical code. No nursing ethical code currently exists in Belgium. Qualitative research exploring nurses' views, therefore, was needed in order to find out which functions an ethical code could fulfil and what the code's content could be. METHOD: Eight focus groups were conducted with 50 nurses in different healthcare settings in Belgium. Data were generated during 2003. FINDINGS: According to participants, an ethical code could fulfil several functions, including supporting their professional nursing identity (external function) and giving guidelines for nursing practice (internal function). In addition, some aspects of content were mentioned, including nurses' responsibilities in a relational context: particular attention should be paid to the personality of the nurse and to the specificity of nursing as a relational activity. Most agreement was reached on the 'ethical' function of the code, namely guiding nurses' professional moral practice. Regarding disciplinary use and the need for legalization of the ethical code, on the contrary, opinions were divergent. CONCLUSIONS: It is of utmost importance to take into account nurses' views when developing an ethical code for their profession. This study gave a first picture of the views of nurses themselves. These initial findings should be completed with nurses' views on the formulation, dissemination and promotion of the ethical code. Such evidence-based development of an ethical code will probably give more guarantees that the code will meet nurses' expectations and will function optimally.     

Nurses' knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature

AIM: This paper reports a literature review examining factors that enhance retention of knowledge and skills during and after resuscitation training, in order to identify educational strategies that will optimize survival for victims of cardiopulmonary arrest. BACKGROUND: Poor knowledge and skill retention following cardiopulmonary resuscitation training for nursing and medical staff has been documented over the past 20 years. Cardiopulmonary resuscitation training is mandatory for nursing staff and is important as nurses often discover the victims of in-hospital cardiac arrest. Many different methods of improving this retention have been devised and evaluated. However, the content and style of this training lack standardization. METHOD: A literature review was undertaken using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and British Nursing Index databases and the keywords 'cardiopulmonary resuscitation', 'basic life support', 'advanced life support' and 'training'. Papers published between 1992 and 2002 were obtained and their reference lists scrutinized to identify secondary references, of these the ones published within the same 10-year period were also included. Those published in the English language that identified strategies to enhance the acquisition or retention of Cardiopulmonary resuscitation skills and knowledge were included in the review. RESULTS: One hundred and five primary and 157 secondary references were identified. Of these, 24 met the criteria and were included in the final literature sample. Four studies were found pertaining to cardiac arrest simulation, three to peer tuition, four to video self-instruction, three to the use of different resuscitation guidelines, three to computer-based learning programmes, two to voice-activated manikins, two to automated external defibrillators, one to self-instruction, one to gaming and the one to the use of action cards. CONCLUSIONS: Resuscitation training should be based on in-hospital scenarios and current evidence-based guidelines, including recognition of sick patients, and should be taught using simulations of a variety of cardiac arrest scenarios. This will ensure that the training reflects the potential situations that nurses may face in practice. Nurses in clinical areas, who rarely see cardiac arrests, should receive automated external defibrillation training and have access to defibrillators to prevent delays in resuscitation. Staff should be formally assessed using a manikin with a feedback mechanism or an expert instructor to ensure that chest compressions and ventilations are adequate at the time of training. Remedial training must be provided as often as required. Resuscitation training equipment should be made available at ward/unit level to allow self-study and practice to prevent deterioration between updates. Video self-instruction has been shown to improve competence in resuscitation. An in-hospital scenario-based video should be devised and tested to assess the efficacy of this medium in resuscitation training for nurses.     

Nurses' moral strength: a hermeneutic inquiry in nursing practice

Title.  Nurses' moral strength: a hermeneutic inquiry in nursing practice.
Aim.  This paper is a report of a study to interpret nurses' experiences of moral strength in practice.
Background.  Moral strength is said to be beneficial in providing nursing care for patients, thereby contributing to high qualitative care. However, few studies focus on the meaning of nurses' moral strength.
Methods.  This study included eight Registered Nurses working in different aspects of health care in southern Sweden. Individual interviews were conducted in 2006 and 2007. We recorded, transcribed verbatim, and interpreted the interviews by a method grounded in hermeneutics.
Findings.  Three themes were interpreted on three different levels: the action level as 'having courage to act on one's convictions', the relational level as 'being attentive and recognizing vulnerability', and the existential level as 'facing the unpredictable' . Overall, moral strength was understood as a driving force to be someone special in the care of patients, i.e. someone who makes a difference.
Conclusion.  The value of nurses' moral strength in patient care should be recognized. Attention must be given to aspects outside the individual, e.g. professional and institutional processes that influence the work environment. Clinical team supervision can help make such processes visible and supportive.     

Nurses' attitudes towards adult patients who are obese: literature review

AIMS: This paper presents a review of all empirical studies focusing on nurses' attitudes towards adult overweight or obese patients, with the aim of clarifying the dimensions and patterns of these attitudes and the methods by which they have been studied. BACKGROUND: Obesity has become a common condition and a major public health concern, but it is often associated with negative attitudes and discrimination. Nurses play a key role in providing support and care to patients who are obese. METHODS: Electronic searches were carried out on seven databases from inception to December 2004, along with hand-searching of references in relevant studies. The search terms were built around obesity (and related terms), nursing (and its branches) and attitudes (and related terms). Eleven studies met the inclusion criteria. Data were extracted and summarized in tabular form and analysed in relation to the aims of this review during January 2005. FINDINGS: There is relatively little research about nurses' attitudes towards obese patients, and the studies reviewed mostly have weaknesses of sampling and measurement. However, they do consistently suggest that a proportion of nurses have negative attitudes and beliefs, reflecting wider stereotypes within Western cultures. There is also a hint of a more complex mix of attitudes among nurses, some of which may counter the consequences of negative attitudes, but these have not been adequately investigated. A number of variables that influence attitudes of nurses can be identified, including age, gender, experience and the weight/body mass index of the nurse. CONCLUSION: Further research (both qualitative and quantitative) is needed with more rigorous sampling and, where appropriate, more consistency of measurement. A shift in focus towards the sets of attitudes (positive as well as negative) and behaviours that influence health service quality and outcomes for obese persons would be useful.     

Nurses' ethical perceptions of health care and of medical clinical research: an audit in a French university teaching hospital

Very few data exist in France on: (1) nurses' knowledge and behaviour concerning ethical decisions in clinical practice; and (2) their knowledge of ethical rules in clinical research. This questionnaire-based audit tried mainly to assess these questions in a large French university teaching hospital. Of the 257 questionnaires distributed to nurses in 23 clinical units of the hospital, 206 were returned (80% response rate). When responding to the vignette describing a clinical situation requiring an ethical decision to be made, most nurses acted as the patient's advocate although they have had no formal training in ethics. Indeed, 66% of nurses responding considered that the patients themselves should be the primary decision makers in situations that relate to their health and medical care. For children or comatose patients, the decision should be left to the relatives according to 72% of the responses. The results indicated that the role of health care professionals in ethical decisions made for a given patient should be marginal. Nurses' knowledge concerning research protocols, particularly their ethical requirements and consequences, is poor at present and information from and communication with doctors should be improved.     

Toward a safer moral climate

The authors define moral climate in the context of health care as the implicit and explicit values that drive health-care delivery and shape the workplaces in which care is delivered. Over the past six years, their research has focused on describing the moral climates of nurses' workplaces and improving them. In this article, the authors argue that nurses in direct care delivery roles have the insights, expertise and interpersonal skills required to create a much safer moral climate for practice. To make this happen, nurses require opportunities for self-reflection and for true collaboration with their colleagues in management and administration and other health-care disciplines.     

Nurses' role in detecting deterioration in ward patients: systematic literature review

Title.  Nurses' role in detecting deterioration in ward patients: systematic literature review.
Aim.  This paper is a report of a review conducted to identify and critically evaluate research investigating nursing practice in detecting and managing deteriorating general ward patients.
Background.  Failure to recognize or act on deterioration of general ward patients has resulted in the implementation of early warning scoring systems and critical care outreach teams. The evidence of effectiveness of these systems is unclear. Possible mechanisms for low effectiveness may be inconsistent recording of patient observations by ward staff, or inconsistent application of 'calling criteria' for outreach teams, even when observations have been recorded.
Methods.  The literature was searched between 1990 and 2007 using four sources: electronic databases, reference lists, key reports and experts in the field. Three broad search categories were used: nursing observations, physiological deterioration and general ward patients. All research designs describing nursing observations (vital signs) on deteriorating adult patients in general hospital wards were included.
Results.  Fourteen studies met the inclusion and quality criteria. The findings were grouped into four main themes: recognition; recording and reviewing; reporting; and responding and rescuing. The main findings suggest that intuition plays an important part in nurses' detection of deterioration, and vital signs are used to validate intuitive feelings. The process is highly complex and influenced by many factors, including the experience and education of bedside nurses and their relationship with medical staff.
Conclusion.  Greater understanding of the context within which deterioration is detected and reported will facilitate the design of more effective education and support systems.