Ethical challenges in the care of older people and risk of being burned out among male nurses

Aim. The aim of this study was to illuminate the meaning of being in ethically difficult situations when caring for older people, as experienced by male nurses. Background. Nurses and physicians are frequently faced with ethical issues and challenges in their work with older people in hospitals. Male nurses are a minority group in the nursing profession, thus it is important to listen to their lived experiences of the ethical challenges they are faced with in their work. Method. The study is part of a comprehensive investigation into the narratives of female and male physicians and nurses, concerning their experiences of being in ethically difficult care situations in the care of older people. Five male nurses working at gerontology wards at a university hospital in Norway participated in the study. A phenomenological hermeneutical method was applied. Results. The narratives revealed that the nurses were focusing on good nursing, emphasizing what meeting the patient entails. They highlighted what they perceived as barriers to good nursing. A third theme was ethical challenges, which lead to emotional and moral strain and a fear of becoming burned out. Conclusions. Continuous stress, little degree of autonomy and high expectations of oneself are causing the male nurses much moral strain. These factors place them at risk of being burned out. The nurses emphasized that burn out can be counteracted by clinical supervision. Relevance to clinical practice. It is suggested that the male nurses feeling of doing an important and rewarding job may be essential for protection against becoming burned out and why they can endure being in ethically difficult care situations. Other institutional support structures like ethics education and ethics rounds are suggested to reduce the level of moral strain.     

The burned hemophiliac

Reports of the care of burned hemophiliac patients requiring cutaneous autografting are rare. A 28-year-old white male with classic hemophilia A sustained a 30.5% total body surface area burn. The patient received standard topical antimicrobial therapy and the majority of his burn wound healed. While undergoing therapy, multiple tooth extractions were recommended. On postburn day 25 the patient underwent multiple tooth extractions plus excision and grafting of his unhealed burn after preoperative infusion of cryoprecipitate. Despite a maximum factor VIII concentration of only 23%, no remarkable bleeding occurred from the excision sites, the skin graft donor site, or the tooth extraction wounds. Preoperative infusion of cryoprecipitate does not appear to be required for split-thickness skin graft harvest or excision of burns within the dermis.     

Even children have arthritis

Children experience a number of problems related to juvenile rheumatoid arthritis (JRA), including pain, stiffness, and loss of mobility that interferes with normal growth and development. Innovative nursing in a variety of settings is needed to manage the child with this chronic illness.