Relief of suffering and regard for personhood: nurses' ethical concerns in Japan and the USA

The ethical concerns of Japanese nurses are compared with those of previously described nurses from the USA. Patient comfort was a primary concern of nurses from both countries. Participants described an ethical imperative to provide adequate pain medication for patients and prevent unnecessary and uncomfortable invasive tests and procedures, especially at the end of life as the focus changed from 'cure' to 'care'. The notion of regard for personhood varied, based on the communication styles and definition of the self inherent in the different cultures of the nurses. A common meaning centred around knowing patients as persons, listening to their needs and preferences, supporting their everyday choices through advocacy, and maintaining their dignity. Despite background cultural differences, there are common ethical concerns between nurses in Japan and the USA. This article invites readers to reflect on everyday nursing practices that exemplify ethical expertise, and the significance of this expertise in uncovering and articulating nursing ethics across cultures.     

To tell or not to tell: attitudes of Chinese oncology nurses towards truth telling of cancer diagnosis

Aims and objectives. To investigate the attitude of oncology nurses towards whether and how to disclose diagnoses to patients with early‐stage cancer or terminal illness. Background. The attitudes of patients and doctors towards the disclosure of cancer diagnosis differed from culture to culture. However, little research has focused on the attitudes of Chinese oncology nurses. Design. Survey. Methods. A questionnaire investigating nurses’ attitudes towards truth telling was delivered to 243 Chinese oncology nurses. Results. One hundred and ninety‐nine (81?9%) nurses completed the questionnaire. 81?4% of the nurses reported that patients with early‐stage cancer should be informed of the diagnosis, while only 44?2% believed that patients with terminal illnesses should know the truth (p < 0?001). Nurses who preferred truth telling reported that patients with early or terminal stages of cancer should be informed by the doctor in charge (76?5% vs. 73?9%, respectively; p > 0?05), immediately after the diagnosis (75?9% vs. 79?5%, respectively) and in a quiet and undisturbed room (80?9% vs. 70?5%, respectively; p > 0?05). Nurses’ attitudes towards truth telling of terminal cancer were influenced by their educational level and work experience. Conclusion. Oncology nurses differed in their attitudes towards truth telling of different stages of cancer. Nurses who preferred disclosure reported that cancer patients should be informed by the doctor in charge immediately after the diagnosis and in a quiet and undisturbed room. Relevance to clinical practice. Many Chinese doctors, patients and their relatives believed that patients with terminal illness should not know their diagnosis. Thus, oncology nurses need additional training to deal with these situations.     

Global influence of American nursing: some ethical issues.

This article raises some questions about the global influence of nursing in the USA and describes some problems that may come about because of it. Selected American values that are embedded in nursing and ethics are found in American nursing education, practice and research. These can then be exported to countries with very different cultural definitions and values. One such country is Japan. The discrepancy between national cultural norms and imported ideals of nursing practices can create ethical problems for nurses in these countries.     

Ethical issues in practice: A survey of home‐visiting nurses in Japan

Aim: The purposes of this study were to identify specific components and frequencies of ethical issues that home‐visiting nurses encountered in their practice, relationships between ethical issues and demographic data, and experience of ethics education and workplace environment. Methods: A self‐administered questionnaire was distributed to home‐visiting nurses in Japan. Usable data (1961) were analyzed. Results: Item and exploratory factor analysis for the frequency of encountering ethical issues revealed: (i) concern about respecting client or relationships with relevant professionals; (ii) differences in treatment or care‐taking views among home‐visiting nurse and client and family, or relevant professionals; and (iii) discrepancy of intention between family and client or home‐visiting nurse. All factors were significantly positively related to the current position, duration of working experience as a home‐visiting nurse, and type of nursing education; age was significantly negatively related. Home‐visiting nurses noted that programmed continuing education systems and staff‐training programs were not sufficiently available. Conclusion: The findings of this study indicated the characteristics of ethical issues that home‐visiting nurses encountered in their practice and insufficient continuing education system including ethics education. Ethics education programs tailored to home‐visiting nurses ethical concerns and traits and continuing education systems are needed.     

Drug‐seeking: A literature review (and an exemplar of stigmatization in nursing)

Despite its lack of conceptual clarity and uniform definition, the term drug‐seeking is used frequently by nurses from a variety of practice environments. The drugs patients are referred to as seeking are often pain medications. This is important because nursing has widely adopted a patient‐centric definition of pain. Nursing also has a robust ethical code that places high value on human dignity and nurses’ role in patient advocacy. A review of literature was conducted with the aims of describing whether/how the term drug‐seeking has changed over time and to determine whether the use of the term in nursing literature is consistent with nursing values. Use of the term has shifted from objective counts of patient requests for medication to a confusing mixture of observable patient behavior and subjective interpretations of patient motivation. Its use is not consistent with nursing values. It is, in fact, a good illustration of stigmatization in nursing. Stigmatization is contrary to nursing values. Nurses in practice, research, education, authors, reviewers, and editors all have a role in ending this stigmatization.     

Nursing diagnosis taxonomy across the Atlantic Ocean: congruence between nurses' charting and the NANDA taxonomy

Nursing diagnosis taxonomy across the Atlantic Ocean: congruence between nurses' charting and the NANDA taxonomy Purpose and aims . The purpose of this study was to analyse expressions or terms used by nurses in Iceland to describe patient problems. The classification of NANDA was used as reference. The research questions were: (a) Does NANDA terminology represent patient problems documented by Icelandic nurses? (b) If so, what kind of nursing diagnoses does it represent? (c) What kind of patient problems are not represented by NANDA terminology? (d) What are the most frequent nursing diagnoses used? Methods. A retrospective chart review was conducted in a 400 bed acute care hospital in Iceland. The sample was defined as nursing diagnosis statements in charts of patients hospitalized in two 6‐month periods in two separate years. The data were analysed according to a predefined grading system based on the PES format or Problem – (A)aetiology – Signs and symptoms. Results. A total of 1217 charts were used for the study, which yielded 2171 nursing diagnoses statements for analysis. Charts with at least one nursing diagnosis documented were 60·1% and the number of diagnoses per patient ranged from 0 to 10, with 65% of charts with three diagnoses or less. The number of diagnoses correlated with patients' length of stay, but not with increased age of the patients. The average number of statements per patient was 3·28. Almost 60% of the diagnoses were according to NANDA terminology, another 20% were stated as procedures, medical diagnoses or risks for complications. The 20 most frequently used nursing diagnoses accounted for 80% of all diagnoses documented. Discrepancy between nurses' documentation on emotional problems and availability of diagnosis in the NANDA taxonomy was evident. Conclusion. It can be concluded that the NANDA taxonomy seems to be culturally relevant for nurses in different cultures.     

Ethical practice in nursing: working the in-betweens

BACKGROUND: While contemporary ethical theory is of tremendous value to nursing, the extent to which such theory has been informed by the concerns and practices of nurses has been limited. PURPOSE: With a view to complementing extant ethical theory, a study was undertaken to explore, from the perspective of nurses, the meaning of ethics and the enactment of ethical practice in nursing. DESIGN AND METHODS: Located in the interpretive/constructivist paradigm, using an emergent design, this inquiry employed focus groups to collect the data. Eighty-seven nurses from a wide range of practice settings were interviewed in 19 focus groups of three to nine nurses each. FINDINGS: The nurses described ethics in their practice as both a way of being and a process of enactment. They described drawing on a wide range of sources of moral knowledge in a dynamic process of developing awareness of themselves as moral agents. Enacting moral agency involved working in a shifting moral context, and working in-between their own values and those of the organizations in which they worked, in-between their own values and those of others, and in-between competing values and interests. CONCLUSIONS: Analysis of the experiences and concerns of the nurses offered new understanding of ethics in nursing and direction for the development of ethical theory pertinent to nursing practice.     

Swedish and Chinese nurses’ conceptions of ethical problems: a comparative study

Aim. To investigate Swedish and Chinese nurses’ conceptions of ethical problems and workplace stress and ascertain whether there are differences between the nurses in the two countries and between types of clinics. Background. Nursing can be regarded as an ethical practice and ethical problems are one type of problems nurses have to deal with. Design. The research design was comparative and quantitative. Methods. A questionnaire was used. The study was carried out at one hospital in China and two hospitals in Sweden. One hundred and thirty‐six Chinese nurses and 137 Swedish nurses participated. Results. There was a statistical difference between nurses working in the different countries regarding commonest stated ethical problem. The Swedish nurses indicated a greater number of ethical problems than the Chinese nurses. The latter felt irritated, dissatisfied or sad at work or after work more often than the Swedish nurses. Forty‐one per cent of the nurses in both countries thought there was a modest or rather big difference between the current and the desired quality of nursing. Conclusions. The findings were partially the same in the two countries and this underlines the importance of looking at ethical problems from an organisational perspective. Relevance to clinical practice. The findings also show the need for a reduction of nurses’ workload as well as the importance of assuring that nurses have the knowledge they need to carry out their work. The communication between nurses and other members of the health‐care team, patients and relatives also needs to be improved.     

Nurses' responses to ethical dilemmas in nursing practice: meta-analysis

Title. Nurses’ responses to ethical dilemmas in nursing practice: meta‐analysis. Aim. This paper is a report of a study to explore nurses’ responses to ethical dilemmas in daily nursing practice. Background. Concern about nurses’ ethical competence is growing. Most nurses perceived that there were barriers in their work environment to ethical practice, compromising their ability to perform ethically. Since most research focuses on contextual barriers to nurses’ ethical practice, little is known about how nurses involve themselves in ethical decision‐making and action in daily care. Method. A meta‐analysis of nurses’ ethical behaviour was conducted using data from nine studies in four countries (n = 1592 registered nurses). In all studies, the Ethical Behaviour Test was used to measure nurses’ ethical responses, based on an adapted version of Kohlberg’s theory of moral development. Data were analysed using random‐intercept regression analysis. Findings. All groups, except the expert group, displayed a uniform pattern of conventional ethical reasoning and practice. When nurses were faced with ethical dilemmas, they tended to use conventions as their predominant decision‐guiding criteria rather than patients’ personal needs and well‐being. Conclusion. Conformist practice (following conventions rather than pursuing good for the patient) constitutes a major barrier for nurses to take the appropriate ethical actions, as creativity and critical reflection are absent. There is an urgent need to find ways to promote nurses’ ethical development from conventional to postconventional ethical practice. More research is needed to strengthen existing empirical evidence.     

Facilitating the transition of Asian nurses to work in Australia

takeno y. (2010) Journal of Nursing Management 18, 215–224
Facilitating the transition of Asian nurses to work in Australia Aim The purpose of the present study was to explore the perceptions of Korean and Japanese nurses’ about nursing in Australia. Background There are increasing numbers of overseas nurses entering Australian nursing. More nurses educated in Asian countries are arriving. Study design Qualitative research methodology comprised in-depth semi-structured interviews with five registered nurses, who had worked in both Australia and their home country. Results The research participants were mostly satisfied with working conditions, support and continuing nursing education in Australia. However, English language deficits, differences in culture and beliefs about the nurse’s role were found, that could create the potential for misunderstandings. They also recognized that too much help may be a form of covert discrimination. Conclusions The participants had some transition issues, particularly in adjusting to differences in the role of the nurse between Korea or Japan and Australia. This research highlights potential sources of misunderstanding and dissatisfaction which may be worth exploring in relation to other cultures. Implications for nursing management Addressing the findings of this research may help nurse managers better anticipate and address issues which may cause difficulties for overseas nurses’ adjusting to nursing in a new culture.     

A comparative study of Chinese,American and Japanese nurses' perceptions of ethical role responsibilities

This article reports a survey of nurses in different cultural settings to reveal their perceptions of ethical role responsibilities relevant to nursing practice. Drawing on the Confucian theory of ethics, the first section attempts to understand nursing ethics in the context of multiple role relationships. The second section reports the administration of the Role Responsibilities Questionnaire (RRQ) to a sample of nurses in China (n = 413), the USA (n = 163), and Japan (n = 667). Multidimensional preference analysis revealed the patterns of rankings given by the nurses to the statements they considered as important ethical responsibilities. The Chinese nurses were more virtue based in their perception of ethical responsibilities, the American nurses were more principle based, and the Japanese nurses were more care based. The findings indicate that the RRQ is a sensitive instrument for outlining the embedded sociocultural factors that influence nurses' perceptions of ethical responsibilities in the realities of nursing practice. This study could be important in the fostering of partnerships in international nursing ethics.     

The ethical sensitivity of nurses in Turkey

In this study we tried to gain information about the ethical sensitivity (as well as the ethical knowledge) of nurses working at the bedside in our country. Four scenarios were presented to 165 nurses working in hospital wards in Kocaeli. More than half of the nurses can be considered to have made decisions based on beneficence for the first scenario, while more than half of them preferred to make decisions based on autonomy for the second and the fourth scenarios. For the third scenario, most of the nurses (76.4%) can be said to have based their decisions on veracity. These results suggest that these nurses were sensitive to issues of confidentiality, truth telling and beneficence; however, they were not equally sensitive when the right to refuse treatment was concerned.     

Organizational support in the recruitment and transition of overseas‐qualified nurses: Lessons learnt from a study tour

The migration of nurses has been a global phenomenon, and the integration of overseas‐qualified nurses within host countries has led to debate worldwide. Evidence suggests that support provided by organizations can vary and that there is minimal information on the nature and extent of organizational support required to enhance a smooth transition of overseas‐qualified nurses into nursing practice. This explorative study tour examined the organizational support provided to enhance overseas‐qualified nurses' transition into the nursing workforce in two countries. The various support mechanisms provided to overseas‐qualified nurses in different organizations include transition, acculturation, mentoring programs, and initial settlement assistance. The successful transition of overseas‐qualified nurses into a host country is a complex issue. A robust support system for these nurses should be based on ethical considerations and a team approach that is linked to strong leadership. In addition, education and support for existing staff is essential for a successful transition of overseas‐qualified nurses into practice. Lessons learnt from this study tour might also be relevant to the transition of other overseas‐qualified health professionals, such as doctors and allied health professionals, in host countries.     

A comparison of Guatemalan and USA nurses' attitudes towards nursing

BACKGROUND: Student nurses from the United States of America (USA) spent 5 weeks working with Guatemalan nurses in an acute care setting in Guatemala. This experience led to a heightened awareness of the global scope of nurses' discontent and a desire to better understand the driving factors and drawbacks to practising nursing in both the USA and Guatemala. AIM: The purpose of this research was to identify those factors that discourage nurses and those that motivate nurses to continue in their practice despite the drawbacks. METHOD: Qualitative interviews using field notes were conducted with five Guatemalan and five USA nurses. Themes were derived through qualitative content analysis. FINDINGS: Nurses in both the USA and Guatemala had similar reasons for choosing and staying in nursing. The different health care systems presented different problems resulting in different discontents. CONCLUSION: The two groups of nurses had much in common, especially in their reasons for staying in nursing. The Guatemalan nurses were most discontent with the lack of resources to treat patients, while the USA nurses focused on work environment drawbacks. IMPLICATIONS FOR PRACTICE: Strategies to support nurses and nursing in developing countries need to be developed and implemented. As nurses reach out to their colleagues in other nations, understanding our commonalities and differences will help us to support each other in improving health throughout the world.