A cross-cultural comparison of nurses' ethical concerns

The aim of this study was to compare Swedish and Chinese nurses' experiences of ethical dilemmas and workplace distress in order to deepen understanding of the challenges neuroscience nurses encounter in different cultures. Qualitative interviews from two previously performed empirical studies in Sweden and China were the basis of this comparative study. Four common content areas were identified in both studies: ethical dilemmas, workplace distress, quality of nursing and managing distress. The themes formulated within each content area were compared and synthesized into novel constellations by means of aggregated concept analysis. Despite wide differences in the two health care systems, the nurse participants had similar experiences with regard to work stress and a demanding work situation. They were struggling with similar ethical dilemmas, which concerned seriously ill patients and the possibilities of providing good care. This indicates the importance of providing nurses with the tools to influence their own work situation and thereby reducing their work-related stress.     

Addressing nurses' ethical concerns about research in critical care settings

Clinical research with critically ill patients presents numerous ethical issues affecting patients' well-being, research integrity, and nursing practice. Key findings from a survey of critical care nurses' perceptions about research ethical issues in these settings indicated that nurses encounter ethical issues about which they have limited knowledge and they may not seek guidance from the most appropriate resources. The results suggest that nurses, as well as researchers, need not only training about the responsible conduct of research but also visible and highly functional organizational structures to support and oversee clinical research in research-oriented medical centers.     

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.     

Improving information management in ward nurses' practice

The introduction of a national programme for information technology will affect nurses' methods of managing clinical information on hospital wards. Within a healthcare team, information is managed through formal recording mechanisms as well as informal information exchange. Opportunities to combine these two approaches are highlighted through scenarios. Recommendations are made for nurses to adapt their current information systems and better manage their clinical information.     

AIDS: what are nurses' concerns?

The purpose of this research was to study nurses' knowledge about and attitudes toward caring for patients with acquired immunodeficiency syndrome (AIDS) and the relationship of these factors with demographic and professional characteristics. Data were gathered by questionnaires mailed to a random sample of Registered Nurses in Erie County, NY. Results indicated that many of the nurses surveyed are fearful of contracting AIDS and do not have confidence in their ability to meet the intense physical and psychological needs of patients with this illness. Further, the data suggest that caring for individuals with AIDS may be complicated by the fact that a large proportion of these patients are homosexuals who are terminally ill. The findings lead to the conclusion that targeted intervention strategies are necessary to prepare nurses to met the emerging needs of the escalating AIDS epidemic and to help assure that quality of care will be maximized.     

Imperiled infants: nurses' roles in ethical decision-making

Using a case study approach this article explores two critical ethical-emotional issues that arise in the nursing care of imperiled infants. The questions concerning who should decide and what should be decided about the care of these infants are discussed. Roles of the parents, physician, and nurse are examined in relation to decision-making. An emphasis is placed on the role of the nurse with three criteria supporting nursing involvement being identified. Ethical theories, ethics by committee, and guidelines for decision-making are briefly discussed.     

Critical care nurses' participation in ethical decision making

Critical care staff nurses' participation in ethical decision making was studied in relation to the perceptions of environmental social support of 45 female staff nurses. Data obtained measured perceived environmental social support from six organizational subgroups and individual participation in ethical decision making. Validity and reliability testing was done on the instrument. When involved in an ethical situation, critical care nurses perceived low levels of environmental social support from hospital administrators, nursing administrators, and physicians. Co-workers were consistently perceived as most supportive across all aspects of social support. The majority of the nurses surveyed (74%) reported that ethical decisions were made by physicians or with reference to hospital policy, and that there were limited roles for individual, family, or nurse participation in such decision making. It was concluded that critical care nurses perceive a lack of free agency necessary to engage in ethical decision making in hospital environments or to act in an advocacy role in such situations.     

An audit of ward nurses' knowledge of sepsis

Many of the patients with sepsis admitted to intensive care and high dependency units develop severe sepsis/septic shock in general hospital wards. If the Surviving Sepsis Campaign's aim of a 25% reduction in mortality from sepsis is to be achieved by 2009, then it is essential that registered nurses are aware of the standard definitions of sepsis, and the recommendations for its initial management. The aim of this study was to audit ward nurses' knowledge of sepsis against standard definitions and evidence-based management guidelines. An audit was carried out in one acute hospital to assess ward nurses' knowledge of sepsis. Seventy-three registered nurses from medical, surgical and orthopaedic wards completed a questionnaire about the signs and symptoms of sepsis and its initial management. The results showed that some ward nurses appeared to have a poor knowledge of the signs and symptoms of sepsis, severe sepsis/septic shock and some aspects of its initial management. Following the results of the audit, a variety of educational initiatives were introduced to raise awareness of the standard definitions and the surviving sepsis management guidelines. In conclusion, targeted education must be provided for nurses working in general wards if the Surviving Sepsis Campaign is to achieve its aim of a 25% reduction in mortality by 2009.     

Developing nurses' capabilities to deputize for ward sisters

In recent years there has been heated debate on how the training of ward sisters should be conducted in Finland. This is important as in the coming years a large proportion of nurses will be approaching retirement while dramatic changes in mental health organizations during the last two decades have also challenged the role of the ward sister. This paper describes an ongoing project to develop the managerial skills of those nurses working as deputy ward sisters. The project began with a survey of managerial skills, an evaluation of training needs and the necessity for administrative counselling of a group of deputy ward sisters. On the basis of the analysis, a training programme was planned integrating managerial training and administrative counselling in a systematically advancing process.     

A study of changes in the information routines in a neurological ward

The purpose of this study was to investigate whether changes in the method of organizing medical and nursing care in the neurological ward would affect the patients' satisfaction with information during their stay in the ward. The changes consisted of systematic information routines, systematic follow-up and feedback of information which was provided by a 'mentor' system and systematic routines for written communication between informants and 'mentors' about the patients' need for information. A general improvement of the information to the patients occurred. General information was judged almost completely adequate with the aid of the new routines. The effect of the organizational changes upon the patients' satisfaction with medical information could not be fully studied. The physicians continued to give information about diagnosis, prognosis and after-care very late during the patients' hospital stay and this information was not followed up at all during the experimental period.     

Patients' dignity in a rehabilitation ward: ethical challenges for nursing staff

The purpose of this study was to explore the challenges met by nursing staff in a rehabilitation ward. The overall design was qualitative: data were derived from focus interviews with groups of nurses and analyzed from a phenomenological-hermeneutic perspective. The main finding was that challenges emerge on two levels of ethics and rationality: an economic/administrative level and a level of care. An increase in work-load and the changing potential for patient rehabilitation influence the care that nurses can provide in rehabilitating patients, and therefore also affect patients' feelings of self-worth and dignity. Some patients wish to maintain their independence and autonomy, whereas others seem to 'lose themselves'. Independence and autonomy are associated with dignity, but their lack is contrary to it.     

高干病房护士惧怕否定心理调查分析

目的 探求高干病房护士心理压力源及相关对策.方法 应用惧怕否定评价量表(FNE)对高干病房护士(A组)和普通病房护士(B组)进行问卷调查.结果 高干病房护士FNE得分显著高于普通病房护士得分,两者相比有显著性差异(P＜0.05).结论 与普通病房护士相比,高干病房护士有非常明显的惧怕他人否定的心理倾向.