Development and testing of the ethical reasoning tool (ERT): an instrument to measure the ethical reasoning of nurses

Ascertaining the thinking of professionals as they are confronted with ethical practice issues is a prerequisite to understanding ethical decision making. Before researchers or educators can examine the effectiveness of various approaches to ethics teaching and learning, there is a need for reliable and valid tools to assess practitioners' cognition. A potential problem with the few measuring instruments currently available is the fact that they ask subjects to rank order existing lists of issues. This says little about an individuals' own thinking about ethical issues and may prompt thinking or responses which would not otherwise have occurred. This paper reports the results of a study to test the psychometric properties of a new instrument, the Ethical Reasoning Tool (ERT) that measures ethical reasoning of nurses. The ERT demonstrates a promising way to reveal unprompted ethical thinking about a practice dilemma, thereby clarifying 'real' versus 'assumed' professional reasoning. The tool allows nurse educators to identify areas of student learning/reasoning deficiency that can be addressed by educational interventions. The ERT also allows nurse educators to evaluate the effectiveness of nursing ethics study units in a trustworthy way.     

Perceptions of effective clinical teaching behaviours in a hospital-based nurse training programme

The traditional public health concepts of agent, host, and environment can provide a useful interdisciplinary model for analyzing the current state of knowledge in long term indwelling urinary catheter care. A broad review of literature about urinary catheter care was carried out to identify major areas of research and gaps in knowledge. Most research in the past decade has focused on understanding how catheter encrustations develop and how such encrustations may contribute to leaking/blocking of the catheter and urinary tract infection. Two tables are presented which summarize research related to the development of sediment/encrustation of the catheter and to irrigation of the catheter. Nevertheless, many areas related to catheter care have not been studied extensively. The patient's perspective is one such area. Other areas that have not been studied in depth in depth include care of the drainage bag and the role of fluid intake. These under-studied concerns relate to environmental factors with which the nurse is directly involved, namely, asepsis and hydrokinetic forces. Further conceptualization of the nursing role in long-term urinary catheter care might aid in the development of nursing theories that could be tested to understand how best to help people manage these catheters.     

The use of questioning strategies by clinical teachers

By using questioning and other appropriate teaching strategies, clinical teachers can facilitate the development of critical thinking, decision making and problem solving in students. This study examined clinical teachers' use of questioning and the variations in their use of questioning as a teaching strategy. Although there was a variation in the number of questions asked, predominantly low level questions were asked by 26 clinical teachers at two post-clinical conferences. Based on the findings of this study, it is recommended that clinical teachers are taught how to ask questions, particularly high level questions.     

Gay men''s perceptions and responses to AIDS

Gay men continue to be the largest group in Canada developing AIDS. They have responded to this threat on a personal and community level. The purpose of this study was to explore the perceptions of gay men about AIDS, and how they responded to these perceptions. Data were gathered through unstructured interviews with 34 healthy gay men, from participant observations chosen from logs that described nursing interactions with gay men who had AIDS, and fieldnotes collected during AIDS education programmes with health care workers and gay men. Using constant comparative analysis, a substantive conceptual framework was developed. Trusting was identified as the basic social psychological process that determined how gay men responded to AIDS. AIDS was perceived by all gay men in this study to threaten their own health and their acceptance by society. Variables identified behaviour, ranging from denial of personal risk to taking leadership roles in organizations to fight AIDS related to the trusting theory. This theoretical explanation of gay men's responses provides direction for programmes to educate gay men about HIV-related diseases, as well as to support those who acquire the HIV.     

Jokes and reassurance are not enough: ways in which nurses relate through conversation with elderly clients

An ethnographic study was conducted into the style of conversation registered nurses used with elderly residents during activities of morning care. Speech was analysed into basic components of speech act categories (e.g. explanation, instruction, reassurance). Patterns of speech style were seen to vary in relation to the physical procedure being carried out, and to function as an adjunct to the smooth execution of this physical activity. However, they were also seen to have an important psychological function reflecting a particular way of relating. Some morning-care activities--the journey--were associated with a more personally engaging social interaction which appeared to be mutually beneficial to nurse and resident. Other approaches to morning care--the dissection--appeared to constrain the way the nurse interacted, producing a more formal style of relating. Findings were discussed in terms of optimal use of physical activities of nursing care to achieve greatest benefit in relation to the psychological needs of the resident, as addressed through verbal interaction.     

Falls risk factors in the hospital setting: A systematic review

The objective of this systematic review was to summarize the best available evidence on the factors that increase the risk of patients falling during hospitalization. Studies included in the review were those that involved adult patients in hospital, that attempted to identify risk factors for falling, and used a cohort or case-control research design. The search strategy covered all major databases and including MEDLINE, CINAHL, Current Contents, Psyclit, Embase and the Cochrane Library. Results were summarized by a narrative discussion, identifying risk factors that were commonly identified in a range of practice settings. Eighteen papers met the review inclusion criteria and are reported in this paper. Factors associated with an increased risk of falling include impaired mental status, special toileting needs, impaired mobility, and a history of falling. While findings are contradictory, it appears that both medications and advanced age will also influence a patient's risk of falling.     

Steroids and related studies: Part 88-3-(2-dialkylaminoethoxy)-17α-methyl-17α-aza- -homo-1,3,5(10)-estratriene dimethiodides

Three of the title compounds 15, 16 and 17 were prepared as potential neuromuscular blocking agents. Structurally these partly resemble clinically active chandonium iodide (1). In the in vivo tests, all three compounds were less active than chandonium; however, compounds 16 and 17 were more active in in vitro testings. While preparing the bisquaternary compounds, different steroidal amines were obtained, the hydrochlorides of which when tested showed no significant antiarrhythmic activity.