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.     

How nurses approach ethical problems in Turkey

Previously, nurse's adherence to ethical standards meant obedience to the physician and loyalty to the hospital; now, however, it means following ethical standards and rules set forth by professional codes of ethics. The International Council of Nurses' Code for Nurses (1973) has been the model for professional codes of ethics in countries throughout the world. ⁴ Using ICN's Code as a framework, a study was conducted in 1993 to find out how nurses in Turkey respond to ethical dilemmas. Below, a summary of the findings.     

Neonatal nurses’ professional quality of life: An integrative review

BackgroundNurses working in critical care environments, such as intensive care units, are susceptible to impaired professional quality of life. Those caring for babies and children, even more so.AimTo appraise the extant literature regarding neonatal nurses’ professional quality of life and propose recommendations for neonatal nursing practice, policy, and research.MethodThis integrative review aligns with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and Whittemore and Knafl's five-stage methodology. A systematic search of the CINAHL, Medline, and PsychInfo electronic databases and grey literature was conducted. Peer reviewed articles referring to neonatal nurses’ work-related stressors and satisfiers which had been published in English language between 1990 and 2020 were included.FindingsNeonatal nurses of varying ages, experience levels and cultures, report burnout, secondary and post-traumatic stress; however, the cumulative impacts result in higher prevalence among experienced clinicians. Compassion fatigue is mitigated by compassion satisfaction.DiscussionNeonatal nurses’ report lower resilience and higher emotional exhaustion and sensitivity to organisational change than their medical colleagues. Despite workplace adjustments some nurses may remain disproportionately at risk due to factors associated with their personality traits, affect, and practice environments.ConclusionFurther research exploring the relationships between structural factors impacting neonatal nurses’ professional quality of life and organisational outcomes is required. The generalisability of future studies will be enhanced by longitudinal design, recruitment of heterogeneous samples, and use of scales with psychometric adequacy to capture complex interrelationships between variables.     

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.     

The American Nurses Association Code of Ethics: a reflection on the ethics of respect and human dignity with nurse as expert

The American Nurses Association Code of Ethics for Nurses calls for the nurse to practice with compassion and respect for every individual. What are the ethics and challenges of practicing professional nursing with expertise and educating a new generation of nurses while incorporating the interpretive statements into practice? This column differentiates the traditional biomedical views on human dignity and respect while exploring the embedded ethics of respect and self-determination and what it truly means to be an expert of nursing from the theoretical perspective of the human becoming school of thought.     

An integrative review of Enrolled Nurse recruitment and retention

BackgroundAustralia is facing a severe shortage of Enrolled Nurses. Jurisdictions have introduced strategies in attempts to recruit and retain Enrolled Nurses in the health workforce.AimTo explore factors impacting recruitment and retention of Enrolled Nurses.MethodsA systematic search of literature published in the English language from 2000 to 2018 that addressed the recruitment or retention of aspiring and current Enrolled Nurses (or global equivalents). The search yielded 6955 publications; 20 articles were retained for full-text review and eleven articles were included in the final review.FindingsThree major themes (Nursing work and the EN role, Educational structure and support, and Personal attributes) were identified that covered enablers and barriers to the recruitment of Diploma of Nursing students and Enrolled Nurses. Evidence of the efficacy of programs designed to integrate and retain Enrolled Nurses in the health workforce is scant. Enrolled Nurses viewed participation in a Transition to Practice Program as an integral step in the pathway to becoming a registered nurse.DiscussionContinued debate around scope of practice is contributing to organisational and collegial confusion and discriminatory practices with negative consequences for the recruitment and retention of Enrolled Nurses.ConclusionThe value of Enrolled Nurse Transition to Practice Programs for recruitment and retention is questionable. Greater recognition of Enrolled Nurses’ contributions to patient care is essential and could provide Assistants in Nursing with a career opportunity.     

Public Health Nursing,Ethics and Human Rights

Public health nursing has a code of ethics that guides practice. This includes the American Nurses Association Code of Ethics for Nurses, Principles of the Ethical Practice of Public Health, and the Scope and Standards of Public Health Nursing. Human rights and Rights‐based care in public health nursing practice are relatively new. They reflect human rights principles as outlined in the Universal Declaration of Human Rights and applied to public health practice. As our health care system is restructured and there are new advances in technology and genetics, a focus on providing care that is ethical and respects human rights is needed. Public health nurses can be in the forefront of providing care that reflects an ethical base and a rights‐based approach to practice with populations.     

Applying a Foucauldian lens to the Canadian code of ethics for registered nurses as a discursive mechanism for nurses professional identity

This study examines the Canadian Code of Ethics for Registered Nurses as a discursive mechanism for shaping nurses' professional identity using a Foucauldian lens. Nurses are considered essential in healthcare, yet the nursing profession has struggled to be recognized for its discipline-specific knowledge and expertise and, as such, has remained the subject of and subject to the dominant discourses within healthcare and society generally. Developing a professional identity in nursing begins after the necessary education and training are achieved and embodies the profession's history, values, code of ethics, and expectations of the profession that distinguish it from other professions. Since nurses' professional identity is shaped through discourse, it raises the question of whether there are spaces to reconceptualize nurses' subject position within health care. Since professional identity is considered the embodiment of knowledge and practice, the code of ethics bears examination both for its effect on nurses' professional identity and as a potential site from which to challenge hegemonic assumptions. This article discusses the concept of professional identity in nursing and its development through the discursive formations in the code of ethics. The sources of power/knowledge are examined as both mechanisms of control and as spaces for change.     

Ethical elements in priority setting in nursing care: A scoping review

BackgroundNurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses’ professional and moral values.ObjectiveTo explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses.Design, data sources and methodsA scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis.ResultsNurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients’ daily care needs, prioritising work by essential tasks and participating in priority setting for patients’ access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient’s situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses’ moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise.ConclusionsAnalysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.     

Do healthier nurses make better health promotors? A review of the literature

This discussion paper draws on a review of the literature to explore factors that might promote or inhibit healthier nursing practice. The term healthier nursing practice, used here, refers to the way commitment to health promoting practices at organisational, professional and personal levels is demonstrated and achieved. Health promotion is a holistic concept that calls for the creation of empowered relationships between self, others, and the environment to improve wellness. Nurses have often struggled to achieve this within their patient encounters and even more so within their own personal and professional life experiences. Two factors were identified in the literature review that appear to significantly impact on this situation, the organisational environment within which nurses practice and their educational exposure to health promoting opportunities. There are a number of parallel processes identified that illustrate the difficulties nurses have in their experiences of working with patients and with themselves in promoting healthier lives. Action learning is advocated as an effective way for nurses to address what are sometimes perceived as being insurmountable barriers to developing health promoting opportunities for patients and the individual nurse.     

Nurses’ perspectives regarding the disclosure of errors to patients: A qualitative study

BackgroundThere is often a mismatch between patients’ desire to be informed about errors and clinical reality. In closing the “disclosure gap” an understanding of the views of all members of the healthcare team regarding errors and their disclosure to patients is needed. However, international research on nurses’ views regarding this issue is currently limited.ObjectivesExplore nurses’ attitudes and experiences concerning disclosing errors to patients and perceived barriers to disclosure.DesignInductive, exploratory study employing semi-structured interviews with participants, followed by conventional content analysis in which investigators read and discussed transcribed data to identify important themes.SettingsNursing departments from hospitals in two German-speaking cantons in Switzerland.ParticipantsPurposive sample of 18 nurses from a range of fields, positions in organisational hierarchy, work experience, hospitals, and religious perspectives.MethodsData were collected via individual, face-to-face interviews using a researcher–developed semi-structured interview guide. Interviews were transcribed in German and analysed using the qualitative data analysis software package Atlas-Ti (Berlin) and conventional content analysis. The most illustrative quotes were translated into English.ResultsNurses generally thought that patients should be informed about every error, but only a very few nurses actually reported disclosing errors in practice. Indeed, many nurses reported that most errors are not disclosed to the patient. Nurses identified a number of barriers to error disclosure that have already been reported in the literature among all clinicians, such as legal consequences and the fear of losing patients’ trust. However, nurses in this study more frequently reported personal characteristics and a lack of guidance from the organisation as barriers to disclosure. Both issues suggest the need for a systematic institutional approach to error disclosure in which the decision to inform the patient stems from within the organisation and is not shouldered by individual nurses alone.ConclusionsOur study suggests that hospitals need to do more to support and train nurses in relation to error disclosure. Such measures as hospitals establishing a disclosure support system, providing background disclosure education, ensuring that disclosure coaching is available at all times, and providing emotional support for all parties involved, would likely go a long way to address the barriers identified by nurses.     

Ethics in perioperative practice--values,integrity, and social policy

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and should be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this final article of a nine-part series that is designed to help perioperative nurses relate the ANA code to their own area of practice, the author looks at the ninth provision, which emphasizes the responsibility of professional nursing associations to maintain the value and integrity of the profession. AORN J 76 (Dec 2002) 1047-1053.     

Ethics education in advanced practice nursing: respect for human dignity

Ethics education is an essential component of academic programs that prepare nurses for advanced practice; the concept of respect for human dignity is integral to this education. Sixty-three graduate students enrolled in their first course of a nurse practitioner program completed a researcher-developed Ethics Questionnaire that was designed to elicit their baseline ethics-related knowledge, including their understanding of the concept "respect for human dignity". Qualitative analysis of data yielded findings that validate the importance of using the American Nurses Association Code of Ethics for Nurses with Interpretive Statements as an essential foundation for ethics content and as a framework for understanding the meaning of human dignity in advanced practice nursing. Assessment and learning strategies are recommended.     

A comparative study of professional and interprofessional values between health professional associations

Abstract

The need for effective interprofessional collaboration to ensure safe patient care is crucial. However, health professions are guided by separate professional codes of conduct. To examine whether professional codes are consistent across professions, this review examines 13 key health professional associations in the United States and compares their values to the guiding principles of interprofessional practice defined by the Interprofessional Professionalism Collaborative (IPC). Findings indicate that all six of the IPC’s principles (altruism/caring, excellence, ethics, respect, communication, and accountability) were shared by the majority of professions, with many emphasizing two additional attributes, integrity and justice, suggesting there is room to expand the IPC’s core principles. Few associations included interprofessional communication and collaboration in their professional codes. There is potential for associations to promote greater interprofessional collaboration by reshaping their professional frameworks. With many shared values across professions, establishing a common framework of interprofessional professionalism is feasible.     

Barriers to adequate pain and symptom relief at the end of life: A qualitative study capturing nurses’ perspectives

BackgroundSymptom management remains a critical challenge at the end of life. Barriers to symptom relief predominantly focus on perspectives of physicians, patients or care systems but rarely acknowledge the views of nurses.AimExamine nurses’ perceptions of barriers to adequate end-of-life symptom relief.MethodsSemi-structured interviews with 25 nurses across different settings who routinely prescribed and/or administered symptom relief to patients near the end of life in Queensland and New South Wales, Australia. Data were analysed using a six-stage hybrid thematic analysis technique.FindingsNurses identified five barriers to adequate symptom management. Firstly, fears concerning symptom relief such as hastening death, causing addiction, loss of consciousness, and legal/professional repercussions affected clinical practice. Secondly, lack of knowledge, experience and training hindered symptom management. Nurses discussed knowledge gaps regarding medication and palliative care, symptom assessments, recognition of dying and relevant laws. Thirdly, personal, cultural and religious beliefs influenced staff's willingness to offer pain relief, and patients’ and families’ willingness to accept it. Lack of communication between medical teams, patients and families further challenged symptom management. Lastly, institutional barriers played a considerable role as time constraints, insufficient staff support and difficulties accessing resources prevented end-of-life symptom management.DiscussionThe identified barriers highlight a substantial need for targeted interventions. Setting-specific challenges such as limited access to medication, staff and palliative care services must be addressed.ConclusionsTo provide better end-of-life care, services should acknowledge nurses’ unique insights. Particular attention should be on supporting nurses in aged care facilities, community settings and remote areas.     

Public health nurses’ views on quality measures: A cross-sectional study

BackgroundThe quality indicators program has intended and unintended consequences that may affect nurses’ professional performance and organisational outcomes.AimsTo explore public health nurses’ knowledge, attitudes, and perceptions of the nursing-sensitive quality indicators applied in mother–child health clinics and their associations with organisational quality outcomes: quality of care, burnout, and communication.MethodsA cross-sectional study with a convenience sample. In total, 177 public health nurses completed a self-administered questionnaire measuring their knowledge, attitudes, and perceptions of the quality indicators regarding their performance and organisational outcomes. A structural equation modelling analysis was performed to describe the associations between the variables and to identify the mediating variables.FindingsThe structural equation modelling analysis revealed that the intended (positive) impact on the nurse's professional level was the mediating variable between the nurses’ knowledge and attitudes towards the National Health Quality Measure program, their seniority, and the unintended (negative) impact on the nurse's professional level, and the organisational outcomes.Discussion and conclusionPublic health nurses perceive quality indicators as contributing to and improving their professional work, with a positive impact on organisational outcomes. Nursing leaders and policymakers may promote good organisational outcomes by developing methods that will emphasise the importance of quality indicators in nursing practice.