The principles of ethical practice in professional clinical photography

Rules and regulations founded on ethical principles permeate healthcare practice. NHS Trusts formulate policy to govern their activities in which duties and responsibilities are defined to protect patients from harm and protect themselves from potential litigation. Clinical photographers are not immune from the demands of ethical practice and need to have clearly defined duties and responsibilities. This paper maps the dynamics of ethical practice and how this may be expressed in codes of practice related to the principles of professional clinical photography.     

The ethical component of professional competence in nursing: an analysis

The purpose of this article is to initiate a philosophical discussion about the ethical component of professional competence in nursing from the perspective of Brazilian nurses. Specifically, this article discusses professional competence in nursing practice in the Brazilian health context, based on two different conceptual frameworks. The first framework is derived from the idealistic and traditional approach while the second views professional competence through the lens of historical and dialectical materialism theory. The philosophical analyses show that the idealistic view of professional competence differs greatly from practice. Combining nursing professional competence with philosophical perspectives becomes a challenge when ideals are opposed by the reality and implications of everyday nursing practice.     

Cut from the right wood: spiritual and ethical pluralism in professional nursing practice

Today, different cultures and contexts of nursing adhere to different codes of ethics. This pluralism may be traced back to differing beliefs about the nature of man and the world, involving different approaches to, and understandings of, spirituality. How significant is this pluralism of beliefs surrounding spirituality for proper nursing practice? I argue that certain introductory nursing textbooks perceive the significance of spirituality for nursing practice as marginal, because of certain assumptions as to what constitutes a proper, or professional, practice. After arguing that such assumptions are problematic, especially from an ethical point of view, I will advance an alternative understanding of professional practice, by drawing upon Alasdair MacIntyre’s work. The aim is to give the spiritual dimension of nursing care its rightful place.     

Home parenteral nutrition: an ethical decision making dilemma.

Ethics is a hot topic these days. Home health care providers need not be ethicists, however they do need to be able to identify problems quickly, and know how to address them. This paper explores the ethical issues arising from a narrative analysis involving an advanced cancer patient receiving Total Parenteral Nutrition (TPN) at home. It shows how complicated it is today to make nutrition support decisions that would have been customary less than 30 years ago. For and against arguments of TPN for advanced cancer patients are reviewed. Ethical positions adopted by the medical and nursing professions are explored and contrasted. The importance of patient autonomy, within a holistic notion of care, including decisions incorporating quality of life, are affirmed, providing a challenge to monitoring the status quo in approaches to decision making.     

Promoting professional nursing practice: linking a professional practice model to performance expectations

Professional practice models (PPMs) provide the conceptual framework for establishing professional nursing practice. Integrating a PPM requires complex organizational change. One strategy for integrating a PPM is to directly link the PPM with performance expectations to ensure that underlying beliefs are integrated into everyday practice. This article describes the development, implementation, and successful outcomes of a clinical advancement system that was aligned with a PPM.     

Changing professional practice in tuberculosis care: an educational intervention

AIM: This paper describes the development and implementation of an experiential, participatory in-service education programme focusing on patient-centeredness, problem-solving and critical reflection for primary providers delivering care to tuberculosis patients in South Africa. BACKGROUND: Tuberculosis is a major contributor to the disease burden in developing countries. In South Africa, approximately 90% of tuberculosis patients are managed by nurses at the primary level. Despite efforts to improve quality of care for these patients, many fail to complete their treatment as prescribed. Poor rapport between health care providers and patients with tuberculosis is a major reason for non-adherence to treatment. Methods of improving the quality of care delivery and communication between health care providers and patients with tuberculosis is therefore a priority. DISCUSSION: The paper outlines the stages of developing and implementing the education programme and reflects on this process. Data is drawn from an in-depth qualitative evaluation of the delivery and impacts of the intervention. The approach was acceptable to health care providers and adaptable to the needs of specific clinics. Participants evaluated the educational intervention positively, noting that it facilitated critical reflection on their work; encouraged problem-solving; and heightened their awareness of communication with patients and with colleagues. However, important structural barriers to practice change were identified, including conditions of service, relations with colleagues and support from management. CONCLUSIONS: Experiential, participatory in-service education can be implemented on a large scale in primary care settings. However, the process is resource intensive and the impacts of such education may be limited by barriers at other levels of the health system.     

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.     

Accountability in nursing: reflecting on ethical codes and professional standards of nursing practice from a global perspective

The concept of accountability is a concept closely aligned with public trust and confidence with a healthcare discipline. It is of vital importance to the discipline of nursing to define and examine the obligations and duties of professional nurse. The term is referred to and often defined through international and national professional codes of nursing and in standards of nursing practice documents. This column will begin exploration of the concept with offering a definition from a humanbecoming perspective.     

Complementary therapies in practice: the ethical issues

Summary

• ? This article explores some of the ethical issues associated with the use of complementary therapies in practice.
• ? The adopted terminology and related concepts are clarified. The term ‘complementary therapy’ is compared and contrasted with ‘alternative medicine’ and ‘non-conventional therapy’.
• ? The increasing emphasis on holistic nursing care is also discussed.
• ? Ethical issues of patient choice, informed consent and the principle of beneficence are examined in relation to complementary therapies.
• ? The article highlights the obligation of the nurse, midwife or health visitor to provide or facilitate holistic care including complementary therapies, such as massage or aromatherapy, for those clients who request such care, and where it can be demonstrated that there will be benefits for the patient.
• ? It is concluded that nurses should consider the possibility of incorporating or facilitating certain complementary therapies in their practice in order to benefit their patients. There is a corresponding need for an appropriate knowledge base, founded on nursing research, into the effectiveness and outcomes of complementary therapies. In addition, relevant educational courses should be developed.