Dutch nurses' views on codes of ethics

This study explored the experiences and views of Dutch nurses on the content, function, dissemination and implementation of their codes of ethics. A total of 39 participants, who differed in age, qualifications, length of work experience and health care setting, took part in focus groups. The findings revealed common unfamiliarity with and a rather implicit use of codes, and negative comments on the growing number of codes available in the Netherlands. Limited dissemination, implementation and functioning of codes of ethics were also identified. The findings were discussed using concepts from the literature, nursing practice and personal experience.     

The value of nurses' codes: European nurses' views

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses' opinions of the content and function of codes and their use in nursing practice. A total of 49 focus groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be 'paper tigers' with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice.     

The ethics of postoperative pain management: Mapping nurses' views

Aim: We explored the positions of nurses working in hospitals regarding the acceptability of refusing to give a repeat dose of painkiller to a postoperative patient who requested it. These positions were compared with that of lay people, physicians, and other health professionals. Design and Methods: Factorial design was used to assess the impact of 6 situational factors: the patient's age, the current level of pain as assessed by the nurse, the number of requests, the level of risk associated with the administration of a repeat dose, the outcome of surgery, and the giving of alternative mild analgesics. We implemented a combination of scenario technique and of cluster analysis. Data were collected from April 2013 to December 2015. Participants: 138 registered nurses, 32 nurse's aides, 33 physicians, 23 psychologists, and 169 lay people participated in the study. Results: We found 4 qualitatively different meaningful positions. A plurality of participants (57% of nurses) considered that refusing was not acceptable, irrespective of circumstances. A substantial minority of participants (but 52% of physicians) considered that refusing was acceptable only if the level of pain was low and the risk was high. Other participants (mostly lay people) considered that refusing was always acceptable each time a risk of side effects, either serious or simply mild, was present.     

Exploring staff nurses' views on professional development

AIM: The aim of this study is to explore senior staff nurses' experiences of continuing professional development. METHOD: A hermeneutic phenomenological methodology was used with a purposive sample of five participants. RESULTS: Four key themes were identified: the experience is about being opportunistic; the experience is about keeping up to date with ongoing advances in nursing practice; the experience is about experiential learning and meeting the demands of the informant's current role. CONCLUSION: CPD enabled the nurses who took part in this study to keep up to date with nursing practice. It also illustrates that engaging with this system of skills enhancement helps to reduce work-related stress among nurses, thereby providing further opportunities to enhance confidence and competence as well as developing a workforce that is 'fit for practice' and 'fit for purpose'.     

Guidelines for clinical practice: development, dissemination and implementation

Clinical guidelines are one of the most promising and effective advances for defining and improving the quality of care (Journal of Nursing Care Quality 11(5) (1997) 48; Medical Care 39(8 Suppl. 2) (2001) II-46). However, their development, dissemination and implementation in practice are rarely straightforward. Within nursing practice, guidelines have the potential to ensure the clinical application of research findings, thus ensuring that the profession rejects ineffective practices while employing those shown to work. Nevertheless, the benefits and limitations of clinical guidelines should be carefully considered by practitioners, managers and consumers of health care alike.     

Palliative care nurses' views on euthanasia

BACKGROUND: In debates on euthanasia legalization in Belgium, the voices of nurses were scarcely heard. Yet studies have shown that nurses are involved in the caring process surrounding euthanasia. Consequently, they are in a position to offer valuable ideas about this problem. For this reason, the views of these nurses are important because of their palliative expertise and their daily confrontation with dying patients. AIM: The aim of this paper is to report a study of the views of palliative care nurses about euthanasia. METHODS: A grounded theory approach was chosen, and interviews were carried out with a convenience sample of 12 palliative care nurses in Flanders (Belgium). The data were collected between December 2001 and April 2002. FINDINGS: The majority of the nurses were not a priori for or against euthanasia, and their views were largely dependent on the situation. What counted was the degree of suffering and available palliative options. Depending on the situation, we noted both resistance and acceptance towards euthanasia. The underlying arguments for resistance included respect for life and belief in the capabilities of palliative care; arguments underlying acceptance included the quality of life and respect for patient autonomy. The nurses commented that working in palliative care had a considerable influence on one's opinion about euthanasia. CONCLUSION: In light of the worldwide debate on euthanasia, it is essential to know how nurses, who are confronted with terminally ill patients every day, think about it. Knowledge of these views can also contribute to a realistic and qualified view on euthanasia itself. This can be enlightening to the personal views of caregivers working in a diverse range of care settings.     

Research publication credit assignment: nurses' views

A national survey of 1,693 persons (primarily nurses) from eight target groups was done to assess views on publication credit assignment. Data were collected using scenarios in a questionnaire based on the instrument developed by Spiegel and Keith-Spiegel (1970). Scenario items and the percentages of 897 respondents selecting each response alternative are presented in an appendix. Response rates indicated that authorship credit assignment is an important issue for nurses functioning primarily in academic settings. Among items selected by 85% or more of 620 nurses in four subsample groups (American Academy of Nursing, Council of Nurse Researchers, authors, and nursing doctoral students) with response rates greater than 50%, 10 points of agreement were found. These points are summarized as possible guidelines for publication credit assignment. Few differences were found among scenario item responses of: (a) subjects classified as high and low publishers, (b) those with research as their major role responsibility and others, and (c) doctoral students and others.     

Patients' views of nurses' competence

This study examines, from the patients' perspective, what is meant by competent nursing and how, with this perspective in mind, patients would view the prospect of assessing the competence of nurses. There is a little empirical research that clarifies professional competence from the patient's perspective. Nursing curricula in the UK have shifted attention to 'competencies' as the outcome of nurse education and, in an era of patient involvement, their views are important to investigate. The study utilises a grounded theory approach. Data were collected in Central Scotland between 2001 and 2003. Twenty-seven patients participated. Data were analysed, in keeping with the grounded theory tradition, utilising the constant comparative method. Patients described the foundation of competent nursing practice as technical care and nursing knowledge. Patients assume that technical care is competent as safe guards are considered to be in place to protect patients. When technical competence is assumed, interpersonal attributes become the most important indicator of the quality of nursing care. The results of this study highlight uncertainty about whether patients feel able to assess the competence of nurses. The results of this study may have implications for nurses internationally when trying to involve patients in the assessment of nurses.     

护理人员对护理伦理认知情况的调查分析

目的:了解护理人员对护理伦理的认知情况并进行分析。方法:采用自行设计问卷,对广西地区388名护理人员发放"护士对护理伦理认知情况调查表",对调查情况进行统计分析。结果:护士的护理伦理认知总得分为(48.04±7.07)分,其中医疗最优化原则、知情同意原则、保密原则和生命价值原则平均得分分别是(12.97±2.37)分(、11.45±2.63)分、(11.74±3.05)分、(11.87±3.34)分;不同职称、护龄的调查对象对护理伦理的认知得分有统计学差异(P<0.01),管理人员与非管理人员间有统计学差异(P<0.01);护士学习护理伦理知识的途径过于单一。结论:要加强低年资及低职称护士的护理伦理知识学习,实现护理伦理教育形式的多样化,从而提高护士的护理伦理知识,为临床护理实践和临床护理人员营造有利的护理伦理氛围。     

Finnish nurses' views on their research activities

The purpose of the study reported here was to describe Finnish nurses' research and publication activities, as well as their views on the availability and utilization of research results in nursing practice. The data were collected using a structured questionnaire in which obstacles to the utilization of research results were measured with a previously developed instrument. A total of 400 nurses from community health centres, a central hospital and a central university hospital took part. Most of the nurses had carried out research on their own. Age, experience, training in research and development and other further training, as well as reading the nursing literature, were associated with doing research. Some of the reasons why the nurses had not carried out research were revealed. Publication of results was very rare. There were problems with the availability of research results. The most common obstacles to research utilization had to do with the presentation of results and the setting. In research utilization, respondents received most support from the ward manager and least support from doctors. If we want to encourage nurses to do research and increase the utilization of research results, greater effort should be invested in teaching research methodology, in introducing more flexible working hours and in developing other support systems.     

Mental health nurses' views on therapeutic optimism

Registered nurses (RN) coordinate acute mental health units on a 24‐hour basis and it behoves researchers to actually ask these nurses what they think contributes to their ability to work with patients in optimistic ways. In this study, 40 RN working in acute mental health settings were asked a series of questions to explore positive aspects of nursing work, which includes therapeutic optimism. Three themes were identified: (i) different ways nurses foster therapeutic optimism; (ii) perceptions of how an optimistic environment is fostered, and (iii) improvement of ward culture. Findings show the pivotal role mental health nurses have in improving teamwork, good communication, sharing, and collaboration, in addition to preceptoring and supervision. Furthermore, effective clinical management is essential to therapeutic optimism and, in this research, is considered to be the aspect of acute mental health nursing most relevant to improving the ward culture.     

Finnish nurses' views on end-of-life discussions and a comparison with physicians' views

This study investigated Finnish nurses' experiences and views on end-of-life decision making and compared them with physicians' views. For this purpose, a questionnaire was sent to 800 nurses, of which 51% responded. Most of the nurses had a positive attitude towards and respect for living wills, more often than physicians. Most also believed that a will had an effect on decision making. Almost all of the nurses considered it their responsibility to talk to physicians about respecting living wills. Do-not-resuscitate (DNR) orders were often interpreted to imply partial or complete palliative (symptom-orientated) care, which may cause confusion. Half of the nurses reported that a DNR decision was discussed always or often with a patient who was able to communicate; physicians were more positive in this respect. Surprisingly, many nurses (44%) stated that active treatment continued too long. Two-thirds thought that their opinions were taken into account sufficiently, even though only half believed that, in general, they had some impact.     

Public health nurses' views on voluntary smallpox vaccination

Between January and June 2003, voluntary smallpox vaccination of healthcare workers and mandatory vaccination of military personnel was an important public health topic. This paper discusses the attitudes of nurses from two county public health departments in an upper-Midwestern state who were asked to volunteer to take the smallpox vaccine and to prepare to assist in the operation of possible mass immunization clinics. The responses of these healthcare professionals are compared to those of physicians and the general public. The public health nurses in this sample were less likely to view smallpox as a potential biological weapon than was the general public or other healthcare workers studied previously.     

Canadian cancer nurses' views on recruitment and retention

bakker d., butler l., fitch m., green e., olson k. & cummings g. (2009) Journal of Nursing Management  18, 205–214
Canadian cancer nurses' views on recruitment and retention Aim The purpose of this study was to explore oncology nurses’ perceptions about recruitment and retention. Background Competition among healthcare organizations to recruit and retain qualified nurses is a real-life challenge. Focusing attention on human resource planning in oncology is highlighted by both the worsening nursing shortage and cancer incidence. Methods A participatory action research approach was used and 12 focus groups with 91 cancer nurses were conducted across Canada to collect data about strategies that could improve recruitment and retention. Results Four themes emerged reflecting oncology nurses’ beliefs and values about organizational practices that attract and retain nurses and they are as follows: (1) recognizing oncology as a specialty, (2) tacit knowledge no longer enough, (3) gratification as a retaining factor, and (4) relationship dependent on environment. Conclusions Participants highlighted leadership, recognition and professional and continuing education opportunities as critical to job satisfaction and organizational commitment. Implications for nursing management Recruitment and retention were viewed as a continuum where organizational investment begins with a well-developed orientation and ongoing mentorship to ensure knowledge development. The challenge for nurse leaders is to use the evidence generated from this study and previous studies to develop professional practice environments that facilitate the cultural changes needed to build and sustain a quality nursing workforce.     

District nurses' views on quality of primary healthcare encounters

Good encounters are fundamental for good and professional nursing care, and can be described as treating patients with respect and protecting their integrity and autonomy. This study describes district nurses' views on quality of healthcare encounters in primary healthcare. A purposive sample of 27 district nurses participated in five focus group interviews. The focus groups interviews were digitally recorded and transcribed verbatim. The interview texts were analysed using a thematic content analysis. The analysis resulted in four themes, including being aware of the importance and difficulties during encounters, being the patient's advocate, being attentive to the unique person and being informed when a meeting turned out poorly. The results show that district nurses believed that encounters formed the basis of their work and it was vital for them to be aware of any difficulties. District nurses found that acting in a professional manner during encounters is the most significant factor, but this type of interaction was sometimes difficult because of stress and lack of time. The district nurses considered themselves to be the patients' advocate in the healthcare system; in addition, the acts of seeing, listening, believing and treating the patient seriously were important for providing good quality care. If a poor encounter occurred between the district nurse and the patient, the district nurses found that it was necessary to arrange a meeting to properly communicate what problems arose during the interaction. The district nurses highlighted that providing an apology and explanation could improve future encounters and establish a better nurse–patient relationship. In conclusion, this study shows the importance of confirming and respecting patients' dignity as the fundamental basis for a good quality encounter in primary healthcare.     

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.