Emotional displays:-Nurse educators engaging and reflecting on their own emotional displays in preparing nursing students for the emotional complexities of nursing practice

In everyday practice nurses including student nurses, face many situations which can trigger a range of their own emotions, but they also deal with a variety of emotions in patients, patients' relatives and colleagues. There is a need for nurses and those involved in nurse education to understand how emotions impact on professional practice. Yet, while nursing practice involves working often in emotional circumstances, there has been little attention by educational institutions and employers on developing the ability of nurses to understand and manage the emotional demands inherent in their role. This paper examines emotions and their relationship to and appropriateness in nursing practice and education. In particular it examines whether self-understanding by attendance to emotions can enhance the role of nurses educators in preparing nursing students for the complexities of modern nursing practice.     

A nursing ethic: the moral voice of experienced nurses

Nursing acts occur in thousands of instances daily, being a major component of professional health care delivery in institutions, communities and homes. It follows that the ethical practice of most nurses is put to the test on an everyday rather than an occasional basis. Hence, within nursing practice there must be a rich and deep seam of reflective interpretation and practical wisdom that is 'embedded' within the experiences of every experienced nurse. This article presents discussion on some of the main findings of a recently completed study on nursing ethics in New Zealand. An interpretation of a nurse's story taken from the study is offered and suggestions are made for nursing ethics education.     

Relational and embodied knowing: nursing ethics within the interprofessional team

In this article we attempt to situate nursing within the interprofessional care team with respect to processes of ethical practice and ethical decision making. After briefly reviewing the concept of interprofessionalism, the idea of a nursing ethic as 'unique' within the context of an interprofessional team will be explored. We suggest that nursing's distinct perspective on the moral matters of health care stem not from any privileged vantage point but rather from knowledge developed through the daily activities of nursing practice. Because of their position vis-à-vis patients and families in everyday clinical care, nurses cultivate ethical knowledge of at least two forms: (1) relational knowledge; and (2) embodied knowledge. Through the integration of these forms of knowledge, nurses develop a unique moral perspective and can make a meaningful contribution to the realm of ethics in interprofessional care.     

Ethical practice in nursing: working the in-betweens

BACKGROUND: While contemporary ethical theory is of tremendous value to nursing, the extent to which such theory has been informed by the concerns and practices of nurses has been limited. PURPOSE: With a view to complementing extant ethical theory, a study was undertaken to explore, from the perspective of nurses, the meaning of ethics and the enactment of ethical practice in nursing. DESIGN AND METHODS: Located in the interpretive/constructivist paradigm, using an emergent design, this inquiry employed focus groups to collect the data. Eighty-seven nurses from a wide range of practice settings were interviewed in 19 focus groups of three to nine nurses each. FINDINGS: The nurses described ethics in their practice as both a way of being and a process of enactment. They described drawing on a wide range of sources of moral knowledge in a dynamic process of developing awareness of themselves as moral agents. Enacting moral agency involved working in a shifting moral context, and working in-between their own values and those of the organizations in which they worked, in-between their own values and those of others, and in-between competing values and interests. CONCLUSIONS: Analysis of the experiences and concerns of the nurses offered new understanding of ethics in nursing and direction for the development of ethical theory pertinent to nursing practice.     

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.     

Nursing and genetics: applying the American Nurses Association's Code of Ethics.

A professional code of ethics is essential for behaviors to be reinforced in any discipline. The American Nurses Association (ANA) has established a code of ethics for nurses to use as a framework for making ethical decisions with all aspects of health care delivered to the public. With the explosion of genetic discoveries, nurses and clients are facing new ethical dilemmas. It is important for nurses to understand how to use the ANA Code of Ethics when faced with the many complexities of ethical issues involving genetics and health care. This article illustrates how the ANA Code of Ethics can be applied in nursing practice to establish professional behaviors related to ethical issues and genetics.     

Recontextualizing learning in nursing education: taking an ontological turn

An ontological focus has been embedded within nursing education since its inception. There has been a strong emphasis on teaching students to become safe, competent nurses by translating knowledge into clinical action. But how would nursing education shift if we were to more intentionally orient the educative process ontologically and explicitly put epistemology at the service of ontology? We consider this question of an ontological turn in nursing education by examining what is commonly referred to in nursing curricula as interpersonal communication. With the goal of providing learning opportunities that can support students to develop confident and competent practice within the shifting, complex terrain of contemporary health care milieus, we explore the possibility of shifting the relationship between epistemology and ontology, and purposefully orienting the educative process in such a way that emphasizes and illuminates the manner in which nursing knowledge and action intersect with subjectivity and context.     

Developing the nurse as a knowledge worker in health — learning the artistry of practice

Nursing in the future will be a promoter of health and well-being. This paper argues that health has been inadequately conceptualised and the knowledge base required by nurses to practice as'knowledge workers'in health gain poorly defined. An epistemology for nursing is proposed that considers knowledge to be a construction of empirical, clinical and personal ways of knowing, contextualised within the activity of the nurse as 'knower'. The difficulties nursing has in defining and developing this unique epistemology are discussed. Lastly, the implications this unique epistemology will have for nursing education are explored. The author draws upon personal experience to explore and propose the use of clinical supervision as a tool which can be used by lecturers to coach nurses in the artistry of reflection in action, thus developing the therapeutic skills and knowledge base necessary to promote health as a holistic, multi-dimensional, dynamic, evolving and transforming process.     

Developing ethical skills: from sensitivity to action

Acute and critical care nurses routinely encounter ethical "quandaries" such as providing perceived futile care. Other everyday ethically important occurrences may go unrecognized, however, thus diminishing their importance to moral nursing practice. This column presents a framework that may assist in developing specific skills to recognize and engage in both critical and everyday ethical situations with confidence. James Rest's Four Component Model addresses the role of the moral practitioner from initial recognition that an ethical situation exists to implementation of a justifiable action. Patient/provider scenarios are used to illustrate components of Rest's model followed by an approach to distinguish ethical from nonethical situations. Practical strategies to enhance ethical skills such as development of nursing ethics groups and providing continuing ethics education also are presented.     

Nursing under the influence: a relational ethics perspective

When nurses have active and untreated addictions, patient safety may be compromised and nurse-health endangered. Genuine responses are required to fulfil nurses' moral obligations to their patients as well as to their nurse-colleagues. Guided by core elements of relational ethics, the influences of nursing organizational responses along with the practice environment in shaping the situation are contemplated. This approach identifies the importance of consistency with nursing values, acknowledges nurses interdependence, and addresses the role of nursing organization as moral agent. By examining the relational space, the tension between what appears to be opposing moral responsibilities may be healed. Ongoing discourse to identify authentic actions for the professional practice issue of nursing under the influence is called upon.     

The challenges of mental health care reform for contemporary mental health nursing practice: delivery of nursing care

This ethnographic account of mental health nursing in a 22-bed acute inpatient facility in New South Wales, Australia, uncovered cultural meaning and cultural realities associated with the delivery of nursing care within the context of current challenges, demands, and influences brought about by service reforms. The findings demonstrate that mental health nurses have been responsive to changes brought about by the reforms. The ability of nurses to readily identify service gaps in their everyday practice provides them with the opportunity to develop strategies to respond to workplace challenges. As such, findings of the study contribute to current discussions concerning acute inpatient mental health nursing practice.     

Issues in nurses' practical skill development in the clinical setting

Generally, it is assumed that nurses are reasonably skilled in the performance of practical nursing actions by the end of their first year of practice. This article contests this assumption based on empirical data from a longitudinal study of newly graduated nurses. Three issues are discussed: the notion that experience (per se) can guarantee a positive development in practical skill performance; the failure to relate to inherent complexities in practical skill performance during evaluation of skill; and the significance of acknowledging differences in skill complexity during skill development. A reinstated focus on practical skill in nursing education and collaboration between education and practice is needed to secure quality in a nurse's actual performance.     

Liberating new talents: an innovative pre-registration community-focused adult nursing programme

The drive for a more community-focused approach to pre-registration nursing education as identified in Modernising Nursing Careers, (Department of Health, 2006a) has continued to gather momentum. The research literature identifies that the community context impacts significantly on care delivery, with student nurses often missing the underlying complexities of working in this context; focusing on the task in hand rather than the broader landscape of care (Carr, 2004). In 2008, a community focused pre-registration adult nursing degree pathway was started at Canterbury Christ Church University (CCCU), to prepare a cohort of 16 nursing students to work in the community and general practice setting at the point of registration. Placement learning has been focused within general practice and community through a hub and spoke approach to enable students to develop a deep understanding of the complexities of care in this setting with particular reference to the management of risk and unpredictability. The pilot is being formally evaluated with a particular emphasis on the meaning and relevance of practice learning within these settings. The emerging data will not only provide evidence to promote the community and general practice agenda within pre-registration curricula, but help to clarify the essential skills and knowledge required to prepare students nurses for working in these settings.     

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。     

Autonomy and advocacy in perinatal nursing practice

Advocacy has been positioned as an ideal within the practice of nursing, with national guidelines and professional standards obliging nurses to respect patients' autonomous choices and to act as their advocates. However, the meaning of advocacy and autonomy is not well defined or understood, leading to uncertainty regarding what is required, expected and feasible for nurses in clinical practice. In this article, a feminist ethics perspective is used to examine how moral responsibilities are enacted in the perinatal nurse-patient relationship and to explore the interaction between the various threads that influence, and are in turn affected by, this relationship. This perspective allows for consideration of contextual and relational factors that impact on the way perinatal nursing care is given and received, and provides a framework for exploring the ways in which patient autonomy, advocacy and choice are experienced by childbearing women and their nurses during labour and birth.     

Admitting hospital patients: a qualitative study of an everyday nursing task

In recent years new modes of nursing work have been introduced globally in response to radical changes in healthcare policies, technology and new ideologies of citizenship. These transformations have redefined orthodox nurse-patient relationships and further complicated the division of labour within health-care. One distinctive feature of the work of registered nurses has been their initial assessment of patients being admitted to hospital, and it is of interest that this area of nursing practice remains central to the registered nurse's role at a time where other areas of practice have been relinquished to other occupational groups. This qualitative study, drawing on conversation analysis and ethnographic techniques, explores this area of everyday nursing work. Initial nursing assessments have attracted considerable interest in the nursing literature, where it is clearly stated that assessments should be patient centred and seen as the important first step on the road to a therapeutic nurse-patient relationship. Results from this study lead to the conclusion that the actual nursing practice of patient assessment on admission to hospital is at odds with the recommendations of the literature and that a more routinised, bureaucratic form of work is devised by nurses as a means of expediting the process of admission.     

Invisibility of the self: Reaching for the telos of nursing within a context of moral distress

Many studies have examined clinical and institutional moral problems in the practice of nurses that have led to the experience of moral distress. The causes and implications of moral distress in nurses, however, have not been understood in terms of their implications from the perspective of virtue ethics. This paper analyzes how nurses reach for the telos of their practice, within a context of moral distress. A qualitative case study was carried out in a private hospital in Brazil. Observation and semi‐semistructured interviews were conducted with 13 nurse participants. With the aid of ATLAS.ti software, the data were analyzed by using thematic content analysis using virtue ethics to theorize the findings. These nurses experienced a loss of their nursing identity as they encountered an ambiguous telos and the domination of institutional values. In their reach for the telos of their practice, nurses found an environment permeated by ethical challenges, which not only created moral distress but also created professional invisibility, a phenomenon referred to as ‘invisibility of the self’.     

Institutional ethics committees: a survey of children's hospitals

Institutional ethics committees first gained national prominence after the 1976 Karen Ann Quinlin decision by the New Jersey Supreme Court. However, it wasn't until the Federal Government promulgated the Baby Doe regulations in 1983 that significant movement occurred toward implementing such committees. Currently, statistics show that the number of ethics committees are increasing in health care institutions across the country. However, the majority of studies have focused on adult institutions. The membership of ethics committees and the objectives under which the committees function are usually addressed by the studies. Very little attention has been given to the nursing representation on the institutional ethics committee and the unique role played by nurses in the deliberation of ethical decision-making. It is the intent of this research to shed some light on the availability and functions of ethics committees within children's hospitals. Attention has also been given to the nurses' involvement on such committees. Additionally, the study takes a separate look at nursing ethics committees, their function within an institution, and the availability of ethics education for nurses. The study offers information not previously acknowledged in past studies of ethics committees. The study also opens up to consideration the unique concerns of nurses and their roles in ethical decision-making.