The significance of nurse supervisors' different ethical decision-making styles

BACKGROUND: The role of the nurse supervisor is very important, because of his/her ability to influence the atmosphere within the clinical nursing supervision group. AIM: To present and interpret nurse supervisors' different ethical decision-making styles. METHOD: A hermeneutic interpretation of three studies on nurse supervisors' different ethical decision-making styles. RESULTS: The significance of the nurse supervisor's ethical decision-making style is reflected in the awareness of their responsibility for creating a relationship with the supervisee. The supervisors focus on ensuring safety, integrating theoretical knowledge and clinical practice, willingness and preparedness to supervise on the substance of nursing, sharing the supervisees' feelings and challenging them, reflecting on the content of clinical nursing supervision as well as promoting justice and integrity in clinical nursing supervision. CONCLUSIONS: The interpretation highlights the importance of the nurse supervisor's style for the outcome of clinical nursing supervision, as they are role models for the supervisees. There is a need for further research to explore the advantages and disadvantages of nurse supervisors' different ethical decision-making styles, especially in relation to the influence of clinical nursing supervision on the quality of care and various support systems.     

Australian clinical nurse supervisors' ethical decision-making style

This paper explores clinical nurse supervisors' ethical styles with regard to supervision in healthcare. Eighty-six registered nurses, all with experience of supervising clinical nurses and students in nursing, completed a specifically designed questionnaire. A qualitative interpretative content analysis identified three core themes: (i) 'Is it safe?'; (ii) 'Is it right?'; and (iii) 'Is it kind?', describing the clinical nurse supervisors' ethical styles. The first core theme 'Is it safe?' covered the supervisors' rules, codes and values that guide their supervisory actions, as well as two sub-themes: (i) empowerment and (ii) integrity. The second core theme 'Is it right?' described the supervisors' responsibility and advocacy as well as the ethical dilemmas experienced in the supervisory process. The third core theme 'Is it kind?' included the supervisors' relationships with patients, professionals and supervisees. The results demonstrate the value of offering a support system, such as clinical supervision, which helps nurses to explore their professional identity for the benefit of the patients.     

What moral requirements cause ethical dilemmas among nurse executives?

Aim: The purpose of the present study is to clarify the moral requirements that cause ethical dilemmas among nurse executives. Ethical dilemmas are defined as situations where moral requirements conflict, and neither requirement is overridden. Methods and Results: Twenty‐five nurse executives were asked to describe the situations where they had faced their most difficult ethical decisions. A total of 41 stories were told. These included disclosure of medical errors (eight cases), performance evaluations (six cases), and discomfort regarding physicians’ behaviour (five cases), as well as other situations. There were 48 ethical dilemmas in 41 cases, and each of these dilemmas represented conflicts among more than two of the 17 kinds of moral requirements. Conclusion: These moral requirements are: protection of one's own pride, doing one's civic duty to society, acceptance of gender roles, treating others in a caring and benevolent fashion, protection of patients’ rights, assurance of nursing quality, protection of nurse's pride, protection of the lives of patients, organizational profit motives, protection of workers’ rights among the staff, representation of the interests of the nursing division, smooth collaboration with physicians, execution of organisational rules, maintenance of Japanese cultural norms, observation of legal standards, respect for community needs, and obedience to political imperatives.     

Nurse supervisors' actions in relation to their decision-making style and ethical approach to clinical supervision

AIM: The aim of the study was to explore the decision-making style and ethical approach of nurse supervisors by focusing on their priorities and interventions in the supervision process. BACKGROUND: Clinical supervision promotes ethical awareness and behaviour in the nursing profession. METHODS: A focus group comprised of four clinical nurse supervisors with considerable experience was studied using qualitative hermeneutic content analysis. FINDINGS: The essence of the nurse supervisors' decision-making style is deliberations and priorities. The nurse supervisors' willingness, preparedness, knowledge and awareness constitute and form their way of creating a relationship. The nurse supervisors' ethical approach focused on patient situations and ethical principles. The core components of nursing supervision interventions, as demonstrated in supervision sessions, are: guilt, reconciliation, integrity, responsibility, conscience and challenge. The nurse supervisors' interventions involved sharing knowledge and values with the supervisees and recognizing them as nurses and human beings. CONCLUSION: Nurse supervisors frequently reflected upon the ethical principle of autonomy and the concept and substance of integrity. The nurse supervisors used an ethical approach that focused on caring situations in order to enhance the provision of patient care. They acted as role models, shared nursing knowledge and ethical codes, and focused on patient related situations. This type of decision-making can strengthen the supervisees' professional identity. The clinical nurse supervisors in the study were experienced and used evaluation decisions as their form of clinical decision-making activity. The findings underline the need for further research and greater knowledge in order to improve the understanding of the ethical approach to supervision.     

护生临床实习中伦理道德行为调查及影响因素分析

目的:了解护生临床实习中伦理道德行为表现及相关影响因素,为临床实习教学及护生伦理道德素质培养提供借鉴与参考。方法:对2010年4月广东省某三级甲等医院实习护生共287名,应用伦理道德行为问卷进行调查,各影响因素分析采用多元线性回归分析。结果:该组护生实习期间伦理道德行为得分为(3.12±0.31)分,"在护理操作中谈论私事或接电话"条目得分最高,为(3.57±0.80)分,得分低的条目依次为"告知病人当天的护理安排",仅为(2.22±0.61)分,"主动及时为病人更换被污染的被服",得分为(2.78±0.65)分,"能及时发现病人的需要并予以帮助,如为病人翻身、盖被、喂水等",为(2.78±0.76)分。多因素分析结果显示,实习护生实习期间伦理道德行为与护生年龄、学历存在正相关,与是否参加高考存在负相关,说明年龄越大、学历越高、参加过高考的护生伦理道德行为水准越高。结论:护生伦理道德行为偏重于教学重视、有规章制度和法律条文规定、行为不慎可导致严重后果的行为,而对于属于自我监督且后果不易观测、教学中强调较少的伦理道德行为表现较差,应针对性地加强护生伦理道德行为培养。     

Job satisfaction of Italian nurses: an exploratory study

AIM: The purpose of this research was to determine the factors that lead to feelings of job satisfaction and dissatisfaction experienced by nurses operating in three Italian hospitals. BACKGROUND: A high level of job satisfaction is related to a feeling of well-being, productivity and patient satisfaction. Furthermore, job satisfaction is considered capable of reducing turnover and absenteeism. METHOD: Data were collected using the narrative interview technique. Sixty-four interviews were undertaken, resulting in the collection of 381 stories: 207 referring to job satisfaction experiences and 174 referring to job dissatisfaction experiences. RESULTS: The five job satisfaction factors are: job content; professional relationships; responsibility, independence and professional growth; relationships with patients and their families; and relationships with coordinators. The four job dissatisfaction factors are: coordinator management style; activity programming and organization; relationships with doctors; and relationships with patients. CONCLUSIONS: Results indicate that the present nursing management techniques should be improved to become more effective in increasing job satisfaction. To be more precise there emerge three separate areas of improvement: investment in professional training and managerial training; renovation of organizational models; and permanent monitoring of job satisfaction.     

护士心理健康状况与应对方式及其相关性的调查研究

目的:了解护士心理健康状况、应对方式及二者之间的相关性,为改善护士群体的心理健康、提高社会适应能力提供科学依据。方法:采用症状自评量表及简易应对方式量表对733名护士进行问卷调查。结果:不同年龄组在焦虑、敌对及偏执症状有统计学差异(P<0.05),30岁以下年龄组焦虑因子得分最高,而40岁以上年龄组焦虑因子得分最低,敌对、偏执因子得分随着年龄的增长而降低;不同年龄、学历及职称护理人员积极应对与消极应对维度得分均无统计学差异,但与全国常模比较,积极应对纬度平均分明显高于全国常模(P<0.05),消极应对纬度平均分明显低于全国常模(P<0.05);积极应对得分与症状自评量表的9个因子呈负相关,而消极应对与症状自评量表所有因子呈正相关,身心症状的反映随着积极应对方式的采取而降低,随着消极应对方式的采取而升高。结论:护士存在一定的心理健康问题,应注重应用积极应对方式提高社会适应能力,促进护士心理健康,从而提高护理质量。     

Instrument validation: hospital nurse perceptions of their Behavioral Health Care Competency

Aim. To report the development and psychometric testing of the Behavioral Health Care Competency survey, designed to measure hospital nurse perceptions of behavioral healthcare competency. Background. Hospital nurses working in general or other non‐psychiatric units may lack behavioral healthcare competency to manage disruptive behaviours associated with mental illnesses. Design. Instrument development. Method. A nurse study team including clinical experts and nurse researchers from three community hospitals in southern California (USA) reviewed content validity of each item and the 31‐item instrument and created a behavioral health care competency conceptual model based on the nursing process. Separate institutional review board permissions were obtained from each hospital. The study team collaborated in the timing of survey administration (November 2010), analysis of the results and survey validation. Results. A total of 844 nurses completed the survey, representing approximately 23–41% of eligible nurses from each hospital. Using principal component analysis with varimax rotation, 23 items led to a factor structure with four components. Four subscales with adequate alpha coefficients were formed: Resource Adequacy, Patient Assessment, Practice/Intervention Competency, and Psychotropic Recommendation. Conclusion. The 23‐item hospital nurse Behavioral Health Care Competency survey is an adequate and valid newly developed instrument. Further testing with diverse samples is needed to strengthen generalizability and address unique and specialized nursing care needs.     

High technology and nursing: ethical dilemmas nurses and physicians face on high-technology units in Norway

Results from two studies of ethical dilemmas nurses and doctors experience on two high-technology units are compared and discussed. The qualitative comparative methodology of grounded theory was used to generate theoretical frameworks grounded in the empirical realities of the units. The ethical dilemmas they faced were related to: treating the one vs. the common good; end of life questions; and resource allocations with inadequate staffing. Similarities were related to intensity and urgency of nursing care and patient treatment, clear nursing ideologies based on treating humans within a framework of hope, embracing technology and scarce resources. Differences between the two study units were patient diagnosis, hierarchical structure on one unit while one had a vertical structure and decision-making processes, and finally how nursing knowledge and autonomy were used. The two studies demonstrated that clinical, ethical and administrative interactions and decisions are highly compounded, stressful and intertwined.     

衡水市护士心理健康状况与其应对方式的相关性研究

目的探讨衡水市临床护士心理健康状况及其与应对方式的关系，为采取有效的措施促进护士心理健康提供依据。方法采用症状自评量表（SCL-90）、特质应对方式问卷（TCSQ）对4所医院的171名护士（护士组）及169名医生（医生组）的心理健康状况及应对方式进行了调查。结果护士组的SCL-90各症状因子评分均高于医生组，其中2组在躯体不适、人际关系、抑郁、焦虑得分及总分比较，差异有统计学意义（均P〈0．05）；护士组的积极应对和消极应对得分与医生组比较，差异有统计学意义，其中护士组消极应对得分高于医生组，而积极应对得分则低于医生组（均P〈0．05）。护士的积极应对与SCL-90的总分及人际关系、焦虑、敌对等多个因子呈负相关，而消极应对与SCL-90总分及各个因子均呈正相关。结论护士的心理健康状况较差，管理者应采取有效的措施提高护士的心理健康水平。     

精神科护士应对方式与心理健康状况的相关性分析

目的 探讨精神科护士应对方式与心理健康水平的相关性.方法 采用应对方式问卷、症状自评量表SCL-90对156名精神科护士进行问卷调查.采用应对量表用来调查护士所采取的应对方式,采用症状自评量表用来调查护士的心理健康水平.对调查结果进行相关性分析.结果 精神科护士的主要应对方式为"解决问题-求助型".精神科护士突出的心理...     

The ideal role of the nurse teacher in the clinical area: a comparison of the perspectives of mental health, learning difficulties and general nurses

This paper reports findings from a study that explored trained nurses' and student nurses' perceptions of the nurse teachers' ideal role in the clinical area. Findings demonstrate a dichotomy of opinion regarding the ideal role of the nurse teacher in the clinical area that relates to the nursing specialities in which trained nurses work. Trained nurses working in general nursing areas favoured a product-focused, inspectorate supervisory role for nurse teachers. Conversely, trained nurses working in mental health and learning difficulties areas favoured a supportive, supervisory role for the nurse teacher that emphasized the learning process and encouraged reflection. The consequence of the different models used for student nurses' experience of supervision are discussed and the issue of nurse teachers' clinical credibility is explored. It is suggested that trained nurses, nurse teachers and student nurses should be involved in negotiating and constructing the role that nurse teachers play in the clinical area.     

心脏外科ICU护士道德困境、伦理决策、职业倦怠现状及其相关性分析

目的:探讨心脏外科重症监护室(ICU)护士道德困境、伦理决策、职业倦怠的现状并分析其相关性。方法:采用中文版护士道德困境量表、护士伦理决策量表和中文版护士职业倦怠量表对武汉市2所三级甲等医院的108名心脏外科ICU护士进行问卷调查。结果:心脏外科ICU护士道德困境总分为(66.46±35.81)分,伦理决策总分为(173.45±19.16)分,职业倦怠总分为(130.76±27.86)分。心脏外科ICU护士的道德困境与其职业倦怠呈正相关(r=0.312,P<0.05),护士伦理决策行动维度与其职业倦怠呈负相关(r=-0.258,P<0.05),且护士的伦理决策与其道德困境呈负相关(r=-0.232,P<0.05)。结论:心脏外科ICU护士的道德困境和伦理决策中的行动维度与其职业倦怠密切相关,且护士的伦理决策与其道德困境也存在明显相关性。护理管理者应该重视心脏外科ICU护士在工作中面临的各种道德困境问题,同时建议护理管理者从多个方面来培养和提高心脏外科ICU护士的伦理决策能力,从而减轻其职业倦怠。     

The impact of expanding the numbers of clinical nurse specialists in cancer care: a United Kingdom case study

In the last few years there has been an increase in the number of clinical nurse specialists (CNSs) working in cancer care throughout the UK. This paper examines the issues raised by the proliferation of site-specific cancer CNS posts, developed to give a 'nursing lead' for a particular tumour type. The issues common to all CNS posts are exacerbated when a number of specialists are involved in the cancer journey, causing potential fragmentation and confusion. Key issues need to be addressed if the role is to remain credible, and ensure clarity for patients and the multiprofessional team. These include role clarification, sensitive integration, interface with other cancer CNSs and the multiprofessional team, evaluation, cost, education and training, recruitment and succession planning and the 'career cul-de-sac'. Cancer nursing's response to these challenges will set the professional agenda for education, training and future models of service delivery.