Questions of ethics in nursing: infants nutrition at the intensive neonatal care unit--nursing between care and autonomy

As comparatively new field of applied ethics, nursing ethics aims at drawing attention to ethical issues in nursing and at reflecting these issues. With a case study, the potential problems comprised in nursing procedures in the nutrition of premature new-borns will be demonstrated. Questions of patient autonomy and care, which are relevant also to other instances of nursing, will be discussed in relation to this concrete case. The article at hand contributes to a definition of what issues nursing ethics addresses.     

Reflective practice in nursing ethics education: international collaboration

BACKGROUND: The Internet provides the opportunity for international comparative study and collaboration when learning about ethics in clinical nursing practice. AIM: This paper aims to discuss Internet links developed between US and UK postregistration nursing students who were reflecting on clinical practice in order to explore how political and organizational structures of the health care system affect ethical decision-making. DISCUSSION: An analysis is presented of the stages in developing an exchange course for students from these countries, which involved various combinations of classroom-based teaching, on-line discussions and international visits by students and teachers during its evolution. The strengths and weaknesses of the different methods are considered, and future developments identified. CONCLUSION: The Internet collaboration resulted in postregistration nursing students using reflection on practice in the study of ethics in clinical practice and an understanding of how systems structures and procedures affect ethical decision making. Internet-assisted teaching offers opportunities for collaboration, and student participants demonstrate sophisticated critical thinking in ethical decision-making. Issues of access barriers and motivation remain challenges to wider use.     

A fundamental ethical approach to nursing: some proposals for ethics education

The purpose of this article is to explore a fundamental ethical approach to nursing and to suggest some proposals, based on this approach, for nursing ethics education. The major point is that the kind of nursing ethics education that is given reflects the theory that is held of nursing. Three components of a fundamental ethical view on nursing are analysed more deeply: (1) nursing considered as moral practice; (2) the intersubjective character of nursing; and (3) moral perception. It is argued that the fundamental ethical view on nursing goes together with a virtue ethics approach. Suggestions are made for the ethics education of nurses. In particular, three implications are considered: (1) an attitude versus action-orientated ethics education; (2) an integral versus rationalistic ethics education; and (3) a contextual model of ethics education. It will also be shown that the European philosophical background offers some original ideas for this endeavour.     

Human dignity: a cornerstone of doctoral education in nursing

Human dignity is foundational to nursing ethics in both the practice and educational arena. It is implicitly and explicitly woven throughout all ethical dialogue. This column offers insight into the ubiquitous nature of human dignity as it surfaced during a doctoral level ethics course. These examples are shared in light of the humanbecoming human dignity ethical tenets: reverence, awe, betrayal, and shame. The prevalence of dignity in ethical discussion serves as a reminder for nurses to carve out time for meaningful discussions regarding its importance to the nursing profession as a whole.     

Does nursing need its own ethics?

In contrast to a medicine and medical ethics dominated by the physician, nurses claim more professional autonomy, domains of independent responsibility and recognition of their own moral judgment and ethical reflection. In my article I endorse these claims, but I object to the widespread opinion that their fulfillment requires a nursing ethics of its own, in the sense of a specific moral theory for nursing. Such a "special ethics" would be counterproductive to the concerns of nurses, and just as mistaken as a special medical or physicians ethics. Instead, a critique of medicine on the basis of a general ethics is required both for nurses and physicians. Part I presents arguments against mistaken conceptions of a special nursing ethics. Part II outlines elements of a general ethics for medicine and nursing. Part III explains my understanding of an ethical critique of medicine, which is founded upon the distinction of three conceptual dimensions of medicine: as science, institution and practice. This critique focuses the ethical attention on the life situation of the patient. Consequences for argumentative support and political fulfillment of the nurses' claims mentioned will thereby become evident.     

临床护士护理伦理认知及教育情况调查分析

目的:了解临床护士护理伦理学知识水平及接受护理伦理学教育的情况。方法:采用自制的调查问卷,对上海市两所三级甲等综合性医院的235名临床护士进行问卷调查。结果:部分护士缺乏护理伦理知识和伦理意识,未能认识到护理伦理对护理实践的指导作用。相关分析表明,护士的教育背景与护士的伦理知识水平呈显著正相关(P<0.01),护士的职称与护士对护理伦理教育意义的认同水平呈显著正相关(P<0.01)。结论:医院应充分重视临床护士的护理伦理学教育,促进临床护士伦理素质的提高;成立护理伦理委员会,为临床护士提供伦理方面的帮助。     

Ethics content in baccalaureate degree curricula. Clarifying the issues

Competency in ethical decision making is an identified expectation of the baccalaureate degree graduate. Values, both personal and professional, do not provide a systematic foundation for ethical decision making. The nurse is a unique health care provider and as such is faced with ethical decision of practice that are derived from and are relevant to that role. An understanding of ethical principles and theories as well as application of them to the role of the professional nurse is essential to ethical decision making in nursing practice. Seventy four per cent of recent graduates stated that the ethical content in their nursing programs most influenced their ethical decision-making skills, yet, only 23% used an ethical model or framework in analyzing and resolving the ethical dilemma of practice. The usual format for presentation of this content is a course in ethics. The content of such courses should include ethical theories and principles and their application to the practice of nursing. Teaching methodologies include guided case analysis and written responses to cases and current issues. Placement of separate required ethics courses remains a problem because of the overwhelming amount of content in baccalaureate degree curricula. Research has tentatively validated the need for a separate required course in nursing ethics. Further studies are necessary. If ethics content is integrated throughout the curriculum, it should be presented early with continual reinforcement and with the use of a specific ethics textbook. Research indicates that students who have completed a nursing ethics course not only know the correct ethical action but are more likely to implement it.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ethics in nursing: the way forward

This series of articles has been developed with the intention of increasing nurses' awareness of ethics and ethical decision-making and clarifying the relationship between ethical thinking and effective nursing practice. A number of issues have been examined to show how ethics affects the professional role, but many other clinical and non-clinical aspects of nursing demand ethical exploration. In the final article in the series, the relevance of ethics to effective nursing is emphasised and suggestions for enhancing the integration of ethical decision-making into practice are made.     

Analysis of the claim to distinct nursing ethics: normative and nonnormative approaches

Nursing ethics has been declared to exist only as a subset of medical ethics. If this statement is to be refuted, any defense of a claim to a discrete nursing ethic must clarify what type of moral theory is being held as distinctly a nursing ethic. Several examples of nursing ethical theory are used to challenge Veatch's view that nursing ethics is a subset of medical ethics. The methodology used to provide the analysis is to group the ethical theories studied under the topics of normative and nonnormative ethics to provide for appropriate inquiry.     

Ethical decision making in clinical practice

Contemporary nursing ethics education focuses on the use of an analytical model of ethical decision making for both its process and its content. Perhaps this is the case because it bears some resemblance to the nursing process, which is taught in a similar fashion. Thus, a deductivist method of ethical decision making fits within the same general schema of the hypotheticodeductive method of decision making that is taught for nursing diagnosis. Ethics requires that nurses respect persons, inform patients and secure their consent, not inflict harm, preserve the patient's quality of life, prevent harm and remove harmful conditions, do good for patients, and minimize risk to themselves. These are among the norms of obligation that guide ethical analysis and judgment in nursing practice and are the substance of the analytical model of ethical decision making. Nursing's ethics has established high ideals and strong demands for nurses. These are demands which nurses have met and ideals which have often been realized. Whatever the strength of our science, nursing is an inherently moral endeavor and is only as strong as its commitment to its ethical obligations and values. Between the grinding edges of the forces that affect it, nursing must establish its priorities among the aspects of its environment that it attempts to control. Ethics must be chief among those priorities.     

护理伦理学教学中运用案例式教学的体会

在护理伦理学教学中,运用案例式教学对学员掌握有关道德理论与原则,增强对医德问题敏感性,提高分析问题和解决问题的能力起到一定的作用,有助于护理人员在具体的护理实践活动中作出合理的选择。本作介绍了护理伦理学教学中运用案例式教学的方法及原则,并对实施效果进行了总结。     

Practice what you teach: a case study of ethical conduct in the academic setting.

Nursing faculty teach ethics and ethical behavior in undergraduate and graduate curriculum. In this article, a case study is presented that illustrates a breach of ethical behavior and conduct in the academic setting by both faculty and students. The decision-making process used to resolve this dilemma by the chair, the associate dean, and a faculty member relied on a dialectic approach that looked at philosophical underpinnings, historical background of nursing ethics, and university- and schoolwide policies and procedures. The conversations facilitated the ethical resolution to the dilemma raised in the case study as well as the recognition of additional issues for consideration. The authors uncovered compelling questions that included, "What is meant by ethical conduct in the classroom?," "How do we teach it?," and "How do we practice it?" The purpose of this article is to begin the dialogue in search of answers to these questions.     

Nursing and the caring metaphor: gender and political influences on an ethics of care.

Gender and politics influence ethics of caring; any such ethical system must therefore be explored in this context. An ethics of caring is a necessary foundation for an ethics of nursing, but its actualization faces conceptual barriers.     

New developments in international nursing ethics

This article has described numerous activities in nursing ethics at international levels. It acknowledges the larger context within which nurses practice by focusing on selected issues involved in resource allocation and death and dying, cross-culturally. The questions raised about universally shared moral principles reflects the larger questions of cultural and ethical relativism. The discussions of new developments in international nursing ethics focuses on international conferences, the teaching of nursing ethics, national nursing associations, and other professional groups that are actively involved in health care or nursing ethics. Finally, the development of international nursing ethics research studies is providing new knowledge about the scope of ethics within nursing and the nature of nursing care worldwide. Nurses are involved in some aspects of these new developments in nursing ethics in all countries. As they examine and reflect on ethical principles, virtues, and on an ethics of caring, they bring a new dimension to their work as nurses. This new dimension stands as one of the oldest and most central foundations in professional nursing.     

Teaching ethics to nursing students

Ethical practice is the responsibility of all nurses. But if they are to understand the principles of ethics and carry them out in their work, nursing curricula must incorporate ethics into course content. Such content requires faculty who understand both ethical theories and their application to nursing. Appropriate methods of evaluating student learning are also needed. The growing complexity of our health care system demands that nurses assume increasing responsibility for ethical decision making. We can no longer ignore the link between ethics and nursing. Ethics education for nurses is mandatory, not elective.     

Nursing fundamentals texts: where's the ethics?

A primary source of information on professional ethics for nursing students is the nursing fundamentals text used in the initial courses. This study systematically evaluated nursing fundamentals texts for their coverage of ethically relevant content. Forty-two nursing fundamentals texts published from 1965 to 1985 were evaluated for: inclusion of a professional code of ethics; interpretive statements, discussion and examples; and guidelines for ethical decision making. Forty-five percent of the texts contained no content on ethics, with the remainder varying in their depth of coverage. Analysis revealed a moderate correlation (r = 0.59) between the year of publication and the average number of pages accorded content on ethics in that year. The results reflect a gradual, although irregular, trend toward inclusion of greater amounts of content on ethics. Recommendations were proposed that would facilitate the inclusion of content on ethics into nursing curricula. These included: greater communication between faculty and text publishers regarding the importance of content on ethics, inclusion of ethics as a curricular thread, small-group workshops to increase faculty sensitivity to the need for preparation in ethical decision making, and an elective course in nursing ethics.     

A proposal for a code of ethics for nurse practitioners

PURPOSE: To review established codes for health care professionals and standards of practice for the nurse practitioner (NP) and to utilize these codes and standards, general ethical themes, and a new ethical triangle to propose an ethical code for NPs. DATA SOURCES: Reviews of three generally accepted ethical themes (deontological, teleological, and areteological), the ethical triangle by Potter, the American Academy of Nurse Practitioners (AANP) standards of practice for NPs, and codes of ethics from the American Nurses Association (ANA) and the American Medical Association (AMA). CONCLUSIONS: A proposal for a code of ethics for NPs is presented. This code was determined by basic ethical themes and established codes for nursing, formulated by the ANA, and for physicians, formulated by the AMA. The proposal was also developed in consideration of the AANP standards of practice for NPs. IMPLICATIONS FOR PRACTICE: The role of the NP is unique in its ethical demands. The authors believe that the expanded practice of NPs presents ethical concerns that are not addressed by the ANA code and yet are relevant to nursing and therefore different than the ethical concerns of physicians. This proposal attempts to broaden NPs' perspective of the role that ethics should hold in their professional lives.     

Uncertainties in the teaching of ethics to students of nursing

Whilst ethics is now commonplace on nursing curricula in the United Kingdom there remains doubt as to how and what to teach This doubt has its origins in interlinked uncertainties within nursing, ethics and education In nursing there are uncertainties about whether we are teaching ethics to professionalize or because we are a profession, and about whether there is something which is uniquely'nursing ethics'In ethics there are competing paradigms of ethical theory and competing theories of moral development In education there are competing epistemologies, theories of learning and models of curriculum planning These uncertainties are interlinked and an understanding of them will help clarify the debate as to what to teach and how to teach it     

Knowledge of professional rules of ethics among professional nurses

During recent years numerous publications on ethical issues appeared in German nursing literature. Nursing theorists repeatedly refer to the Code of Ethics of the International Council of Nursing (ICN). The implementation of codes of ethics is discussed as an indispensable stage within the development of independent nursing ethics. However, it is not clear whether nurses in Germany know about the ICN Code of Ethics or other codes of ethics. The authors' objective is to learn more about how much is known about codes of ethics by practical nurses in four selected hospitals. In addition, it is of interest to know, which advantages nurses might associate with codes of ethics and secondly from which sources nurses prefer to receive ethical education. The study shows that only 25% of the participants know about codes of ethics. It also reveals that further education offered by hospitals or the basic nursing education are seen as the most important source of information related to ethics. The major advantage of codes of ethics seen by the participants is to provide guidance in the decision-making process of ethical dilemma situations in nursing. Secondly the Code of Ethics is regarded as a useful framework to define obligations and rights of nurses in the relationship with patients and relatives. The results of the study indicate that the ICN Code of Ethics is practically unknown among nurses and should be discussed more extensively by practical nurses and nursing theorists.     

The politicization of ethical knowledge: feminist ethics as a basis for home care nursing research.

Increasingly, health-care services are provided within the home. This change has resulted in the emergence of new, largely unexplored ethical concerns for nurses. The current state of ethical knowledge in nursing, however, is not adequate to address these issues. The author describes the development of a new research method to develop this knowledge. First, she examines phenomenological approaches in nursing ethics, which are important because they have rigorously used a philosophical perspective to inform both theoretical and empirical enquiry in nursing ethics. Nevertheless, the author argues that phenomenology is not adequately sensitive to the impact of political constraints upon the moral agency of nurses. Second, she describes the benefits of using feminist ethics as a conceptual basis for nursing ethics inquiry. Third, she describes the development of an alternative method and demonstrates how it can be applied to home care ethics research.