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Clinical wisdom among proficient nurses.

https://arctichealth.org/en/permalink/ahliterature163922
Source
Nurs Ethics. 2007 May;14(3):387-98
Publication Type
Article
Date
May-2007
Author
Lisbeth Uhrenfeldt
Elisabeth O C Hall
Author Affiliation
Aarhus University, Institute of Public Health, Department of Nursing Science, Høegh-Guldbergsgade 6A, Building 1633, DK-8000 Aarhus C, Denmark. lu@nursingscience.au.dk
Source
Nurs Ethics. 2007 May;14(3):387-98
Date
May-2007
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Clinical Competence - standards
Communication
Comprehension
Cooperative Behavior
Denmark
Health Knowledge, Attitudes, Practice
Humans
Interprofessional Relations
Judgment
Middle Aged
Nurse's Role - psychology
Nursing Methodology Research
Nursing Process - ethics - organization & administration
Nursing Staff, Hospital - ethics - psychology
Patient Advocacy - ethics
Qualitative Research
Questionnaires
Self Efficacy
Social Responsibility
Thinking
Abstract
This article examines clinical wisdom, which has emerged from a broader study about nurse managers' influence on proficient registered nurse turnover and retention. The purpose of the study was to increase understanding of proficient nurses' experience and clinical practice by giving voice to the nurses themselves, and to look for differences in their practice. This was a qualitative study based on semistructured interviews followed by analysis founded on Gadamerian hermeneutics. The article describes how proficient nurses experience their practice. Proficient practice constitutes clinical wisdom based on responsibility, thinking and ethical discernment, and a drive for action. The study showed that poor working conditions cause proficient nurses to regress to non-proficient performance. Further studies are recommended to allow deeper searching into the area of working conditions and their relationship to lack of nurse proficiency.
PubMed ID
17459821 View in PubMed
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Ethical challenges when caring for dying children.

https://arctichealth.org/en/permalink/ahliterature275847
Source
Nurs Ethics. 2015 Mar;22(2):176-87
Publication Type
Article
Date
Mar-2015
Author
Lovisa Furingsten
Reet Sjögren
Maria Forsner
Source
Nurs Ethics. 2015 Mar;22(2):176-87
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Child
Child, Preschool
Critical Care - ethics
Death
Empathy
Humans
Infant
Nurse-Patient Relations - ethics
Nursing Staff, Hospital - ethics - psychology
Sweden
Terminal Care - ethics - psychology
Abstract
Caring for dying children presents special challenges, according to the children themselves, their relatives and healthcare professionals.
The aim of this study was to describe caring as represented in healthcare workers' experiences of caring for dying children.
A phenomenological approach was chosen, in-depth interviews were carried out and data were analysed in four steps focusing on (a) open reading, (b) meaning units, (c) constituents and (d) essence.
Four nurses in a general acute paediatric care setting in Sweden participated after providing written informed consent. Voluntary participation and confidentiality were ensured, and the study was ethically approved.
The essence of caring for dying children was likened to a musically attuned composition, comprising five constituents: presence, self-knowledge, injustice in dying, own suffering and in need of others. Presence was found to be a prerequisite for caring when a child is dying. Self-knowledge and support from others can be of help when struggling with emotional pain and injustice.
Caring for dying children has been found to be a delicate task for healthcare workers all over the world, and the ethical dimension is emphasized in international research. In this study, emotional pain and suffering accompanied caring, but an atmosphere in which it is possible to give and get support from colleagues and to have time to grieve and time to focus on the patient's needs may ease the burden, as can having time to process thoughts about life and death, and a possibility to grow in self-knowledge.
Caring in ethically demanding situations may be facilitated through presence, atmosphere, self-knowledge and time. The challenge does not demand highly technological solutions; these assets are readily available, no matter where on earth. However, there is a need to further investigate these prerequisites for caring, particularly when a child is dying.
PubMed ID
24917270 View in PubMed
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Ethical dilemmas around the dying patient with stroke: a qualitative interview study with team members on stroke units in Sweden.

https://arctichealth.org/en/permalink/ahliterature258547
Source
J Neurosci Nurs. 2014 Jun;46(3):162-70
Publication Type
Article
Date
Jun-2014
Author
Helene Eriksson
Gisela Andersson
Louise Olsson
Anna Milberg
Maria Friedrichsen
Source
J Neurosci Nurs. 2014 Jun;46(3):162-70
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Death
Communication Barriers
Female
Hospice and Palliative Care Nursing - ethics
Humans
Male
Neuroscience Nursing - ethics
Nurses' Aides - ethics - psychology
Nursing Staff, Hospital - ethics - psychology
Nursing, Team - ethics
Palliative Care - ethics
Physical Therapists - ethics - psychology
Qualitative Research
Right to Die - ethics
Stroke - nursing - rehabilitation
Sweden
Terminal Care - ethics
Abstract
In Sweden, individuals affected by severe stroke are treated in specialized stroke units. In these units, patients are attended by a multiprofessional team with a focus on care in the acute phase of stroke, rehabilitation phase, and palliative phase. Caring for patients with such a large variety in condition and symptoms might be an extra challenge for the team. Today, there is a lack of knowledge in team experiences of the dilemmas that appear and the consequences that emerge. Therefore, the purpose of this article was to study ethical dilemmas, different approaches, and what consequences they had among healthcare professionals working with the dying patients with stroke in acute stroke units. Forty-one healthcare professionals working in a stroke team were interviewed either in focus groups or individually. The data were transcribed verbatim and analyzed using content analysis. The ethical dilemmas that appeared were depending on "nondecisions" about palliative care or discontinuation of treatments. The lack of decision made the team members act based on their own individual skills, because of the absence of common communication tools. When a decision was made, the healthcare professionals had "problems holding to the decision." The devised and applied plans could be revalued, which was described as a setback to nondecisions again. The underlying problem and theme was "communication barriers," a consequence related to the absence of common skills and consensus among the value system. This study highlights the importance of palliative care knowledge and skills, even for patients experiencing severe stroke. To make a decision and to hold on to that is a presupposition in creating a credible care plan. However, implementing a common set of values based on palliative care with symptom control and quality of life might minimize the risk of the communication barrier that may arise and increases the ability to create a healthcare that is meaningful and dignified.
PubMed ID
24796473 View in PubMed
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Ethical issues in participatory action research.

https://arctichealth.org/en/permalink/ahliterature178502
Source
Scand J Caring Sci. 2004 Sep;18(3):333-40
Publication Type
Article
Date
Sep-2004
Author
Päivi Löfman
Marjaana Pelkonen
Anna-Maija Pietilä
Author Affiliation
South Carelia Polytechnic, Lappeenranta, Finland. paivi.lofman@mail.scp.fi
Source
Scand J Caring Sci. 2004 Sep;18(3):333-40
Date
Sep-2004
Language
English
Publication Type
Article
Keywords
Arthritis, Rheumatoid - nursing - psychology
Attitude of Health Personnel
Attitude to Health
Confidentiality - ethics
Decision Making - ethics
Ethics, Research
Finland
Health Services Research - ethics
Humans
Informed Consent - ethics
Models, Nursing
Nurse's Role - psychology
Nurse-Patient Relations
Nursing Research - ethics
Nursing Staff, Hospital - ethics - psychology
Orthopedic Nursing - ethics
Ownership - ethics
Patient Advocacy - ethics
Personal Autonomy
Power (Psychology)
Questionnaires
Research Design
Research Personnel - ethics
Abstract
The purpose of this article is to describe the ethical issues arising out of participatory action research (PAR), on the basis of both an empirical study and the research literature, and to discuss how to deal with these issues. The data consist of the experiences and results of three phases of PAR relating to orthopaedic patients with rheumatoid arthritis (RA) and the analysis of 20 articles on the ethics of action research. As a result, the following ethical issues and the ways to treat them were discussed: informed consent, confidentiality and anonymity, protecting an individual from harm, the role of the researcher, the location of 'power' in PAR, and the ownership of the research. The flexibility of PAR in use and its main features are also related to the decisions made and actions taken in response to ethical issues. It is particularly important in PAR to proceed according to the participants, and to involve them from the beginning of the process, in order to insure the equal balance of power between participants and researcher.
PubMed ID
15355529 View in PubMed
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The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses.

https://arctichealth.org/en/permalink/ahliterature30791
Source
Scand J Caring Sci. 2003 Sep;17(3):285-92
Publication Type
Article
Date
Sep-2003
Author
Venke Sørlie
Lilian Jansson
Astrid Norberg
Author Affiliation
Institute of Nursing Science, University of Oslo, Oslo, Norway. venke.sorlie@sykepleievit.uio.no
Source
Scand J Caring Sci. 2003 Sep;17(3):285-92
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological - ethics
Adult
Attitude of Health Personnel
Conflict (Psychology)
Conscience
Decision Making - ethics
Ethics, Nursing
Existentialism - psychology
Female
Hospitals, University
Humans
Loneliness - psychology
Male
Middle Aged
Narration
Norway
Nursing Methodology Research
Nursing Staff, Hospital - ethics - psychology
Patient Advocacy - ethics
Pediatric Nursing - ethics
Questionnaires
Research Support, Non-U.S. Gov't
Self Concept
Abstract
Studies among physicians and nurses in paediatric care reveal experiences of loneliness and lack of open dialogue. The aim of this study was to illuminate the meaning of female Registered Nurses' lived experience of being in ethically difficult care situations in paediatric care. Twenty female Registered Nurses who had experienced being in ethically difficult care situations in paediatric care were interviewed as part of a comprehensive investigation into the narratives of male and female nurses and physicians about being in such situations. The transcribed interview texts were subjected to phenomenological-hermeneutic interpretation. The results showed that nurses appreciated social confirmation from their colleagues, patients and parents very much. This was a conditioned confirmation that was given when they performed the tasks expected from them. The nurses, however, felt that something was missing. They missed self-confirmation from their conscience. This gave them an identity problem. They were regarded as good care providers but at the same time, their conscience reminded them of not taking care of all the 'uninteresting' patients. This may be understood as ethics of memory where their conscience 'set them a test'. The emotional pain nurses felt was about remembering the children they overlooked, about bad conscience and lack of self-confirmation. Nurses felt lonely because of the lack of open dialogue about ethically difficulties, for example, between colleagues and about their feeling that the wrong things were prioritized in the clinics. In this study, problems arose when nurses complied with the unspoken rules and routines without discussing the ethical challenges in their caring culture. The rules and the routines of the caring culture represented structural barriers for creating open dialogue and an ethically justifiable practice, called inauthentic existence, blindness related to our own inauthentic understanding, which focuses on the routines, rules, theories and systems.
PubMed ID
12919464 View in PubMed
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Meeting ethical challenges in acute care work as narrated by enrolled nurses.

https://arctichealth.org/en/permalink/ahliterature181025
Source
Nurs Ethics. 2004 Mar;11(2):179-88
Publication Type
Article
Date
Mar-2004
Author
Venke Sørlie
Annica Larsson Kihlgren
Mona Kihlgren
Author Affiliation
Orebro University Hospital, Sweden. venke.sorlie@sykepleievit.uio.no
Source
Nurs Ethics. 2004 Mar;11(2):179-88
Date
Mar-2004
Language
English
Publication Type
Article
Keywords
Acute Disease - nursing
Attitude of Health Personnel
Conflict (Psychology)
Conscience
Health Facility Environment
Health Knowledge, Attitudes, Practice
Hospitals, University
Humans
Interprofessional Relations - ethics
Middle Aged
Narration
Nurse Administrators - ethics - psychology
Nurse's Role - psychology
Nursing Methodology Research
Nursing Staff, Hospital - ethics - psychology
Nursing, Practical - ethics - methods
Organizational Culture
Philosophy, Nursing
Questionnaires
Sweden
Time Factors
Workload - psychology
Abstract
Five enrolled nurses (ENs) were interviewed as part of a comprehensive investigation into the narratives of registered nurses, ENs and patients about their experiences in an acute care ward. The ward opened in 1997 and provides patient care for a period of up to three days, during which time a decision has to be made regarding further care elsewhere or a return home. The ENs were interviewed concerning their experience of being in ethically difficult care situations and of acute care work. The method of phenomenological-hermeneutic interpretation inspired by the French philosopher Paul Ricoeur was used. The most prominent feature was the focus on relationships, as expressed in concern for society's and administrators' responsibility for health care and the care of older people. Other themes focus on how nurse managers respond to the ENs' work as well as their relationships with fellow ENs, in both work situations and shared social and sports activities. Their reflections seem to show an expectation of care as expressed in their lived experiences and their desire for a particular level and quality of care for their own family members. A lack of time could lead to a bad conscience over the 'little bit extra' being omitted. This lack of time could also lead to tiredness and even burnout, but the system did not allow for more time.
PubMed ID
15030025 View in PubMed
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Meeting ethical challenges in acute nursing care as narrated by registered nurses.

https://arctichealth.org/en/permalink/ahliterature175560
Source
Nurs Ethics. 2005 Mar;12(2):133-42
Publication Type
Article
Date
Mar-2005
Author
Venke Sørlie
Annica Kihlgren
Mona Kihlgren
Author Affiliation
Orebro University Hospital, Sweden. venke.sorlie@medisin.uio.no
Source
Nurs Ethics. 2005 Mar;12(2):133-42
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Acute Disease - nursing - psychology
Adaptation, Psychological - ethics
Adult
Attitude of Health Personnel
Burnout, Professional - prevention & control - psychology
Clinical Competence
Conflict (Psychology)
Conscience
Health Facility Environment - organization & administration
Hospitals, University
Humans
Middle Aged
Narration
Nurse's Role
Nurse-Patient Relations
Nursing Care - ethics
Nursing Methodology Research
Nursing Staff, Hospital - ethics - psychology
Philosophy, Nursing
Qualitative Research
Questionnaires
Self Efficacy
Sweden
Time Management
Workload
Abstract
Five registered nurses were interviewed as part of a comprehensive investigation by five researchers into the narratives of five enrolled nurses (study 1, published in Nursing Ethics 2004), five registered nurses (study 2) and 10 patients (study 3) describing their experiences in an acute care ward at one university hospital in Sweden. The project was developed at the Centre for Nursing Science at Orebro University Hospital. The ward in question was opened in 1997 and provides care for a period of up to three days, during which time a decision has to be made regarding further care elsewhere or a return home. The registered nurses were interviewed concerning their experience of being in ethically difficult care situations in their work. Interpretation of the theme 'ethical problems' was left to the interviewees to reflect upon. A phenomenological hermeneutic method (inspired by the French philosopher Paul Ricoeur) was used in all three studies. The most prominent feature revealed was the enormous responsibility present. When discussing their responsibility, their working environment and their own reactions such as stress and conscience, the registered nurses focused on the patients and the possible negative consequences for them, and showed what was at stake for the patients themselves. The nurses demonstrated both directly and indirectly what they consider to be good nursing practices. They therefore demand very high standards of themselves in their interactions with their patients. They create demands on themselves that they believe to be identical to those expected by patients.
PubMed ID
15791783 View in PubMed
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Nurses' conceptions of decision making concerning life-sustaining treatment.

https://arctichealth.org/en/permalink/ahliterature158815
Source
Nurs Ethics. 2008 Mar;15(2):160-73
Publication Type
Article
Date
Mar-2008
Author
Marit Silén
Mia Svantesson
Gerd Ahlström
Author Affiliation
School of Health Sciences, Jönköping University, Jönköping, Sweden. marit.silen@hhj.hj.se
Source
Nurs Ethics. 2008 Mar;15(2):160-73
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Attitude of Health Personnel
Communication Barriers
Conflict (Psychology)
Cooperative Behavior
Decision Making - ethics
Family - psychology
Humans
Life Support Care - ethics - psychology
Middle Aged
Models, Nursing
Models, Psychological
Nurse's Role - psychology
Nursing Methodology Research
Nursing Staff, Hospital - ethics - psychology
Patient Advocacy - ethics - psychology
Patient Participation - psychology
Physician-Nurse Relations
Power (Psychology)
Qualitative Research
Questionnaires
Sweden
Uncertainty
Abstract
The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician-nurse collaboration, lack of confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed.
PubMed ID
18272607 View in PubMed
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Nurses' ethical perceptions about coercion.

https://arctichealth.org/en/permalink/ahliterature179189
Source
J Psychiatr Ment Health Nurs. 2004 Aug;11(4):379-85
Publication Type
Article
Date
Aug-2004
Author
M. Lind
R. Kaltiala-Heino
T. Suominen
H. Leino-Kilpi
M. Välimäki
Author Affiliation
Department of Nursing Science, University of Turku, FIN-20014, Finland. maarit.lind@utu.fi
Source
J Psychiatr Ment Health Nurs. 2004 Aug;11(4):379-85
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Coercion
Ethics, Nursing
Female
Finland
Hospitals, Psychiatric - standards
Humans
Interprofessional Relations
Male
Middle Aged
Nurse's Role
Nurse-Patient Relations - ethics
Nursing Methodology Research
Nursing Staff, Hospital - ethics - psychology
Organizational Culture
Patient Rights - ethics
Psychiatric Nursing - ethics
Statistics, nonparametric
Violence - prevention & control
Abstract
The purpose of this study was to describe Finnish psychiatric nurses' ethical perceptions about coercive measures in acute psychiatric setting.
The data were collected with a questionnaire developed for this study. The sample included 170 Finnish psychiatric nurses on acute wards in five psychiatric hospitals. The data were analysed using frequency and percentage distributions, mean and standard deviations. The internal consistency of the instrument was explored with Cronbach's alpha. The association between the background variables and the sum score of the items of the questionnaire was tested with Mann-Whitney U-test and Kruskal-Wallis test. The open-ended question was analysed with content analysis.
Some psychiatric nurses perceived coercive measures as ethically problematic. In particular, the implementation of forced medication (18%), four-point restraints (16%) and patient seclusion (11%) were perceived as ethically problematic. Female nurses and nurses who worked on closed wards perceived the measures to be more problematic than male nurses and nurses who did not work on closed wards.
In Finland, special attention has been paid to ethical questions related to the care of psychiatric patients and to the enhancement of patients' rights, yet the majority of the nurses participating in the survey did not perceive coercive measures as ethically problematic. More research on this issue as well as further education of the personnel and more extensive teaching of ethics in nursing schools are needed to support the ability of the psychiatric personnel to identify ethically problematic situations. In addition, it is important to consider new measures for generating genuine moral reflection among the personnel on the usage of coercive measures as well as on their effectiveness and legitimacy in the psychiatric care.
PubMed ID
15255910 View in PubMed
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Nurses' perspectives on the suffering of preterm infants.

https://arctichealth.org/en/permalink/ahliterature268027
Source
Nurs Ethics. 2013 Nov;20(7):798-807
Publication Type
Article
Date
Nov-2013
Author
Anne Korhonen
Annu Haho
Tarja Pölkki
Source
Nurs Ethics. 2013 Nov;20(7):798-807
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Female
Finland
Humans
Infant, Newborn
Infant, Premature - psychology
Intensive Care Units, Neonatal - ethics
Male
Middle Aged
Neonatal Nursing - ethics
Nursing Staff, Hospital - ethics - psychology
Stress, Psychological - nursing - psychology
Abstract
The concept of suffering is discussed among those who are cognitively aware and verbally capable to express their suffering. Due to immaturity, preterm infants' abilities to express suffering are limited. Relieving suffering is an ethical and juridical demand of good nursing care. The purpose of this study is to describe nurses' perceptions of the suffering of preterm infants. A descriptive qualitative approach was selected. Data were collected from essays written by nurses (n = 19) working in the neonatal intensive care unit. Inductive content analysis guided by the research question was performed. The nurses described individually determined suffering of the preterm infants according to four categories: suffering ruled by maturation, existence of suffering, individual threshold of suffering and interpreting the cues of suffering. Suffering of preterm infants is manifested by population-specific features, emphasising the need to develop sensitive interventions for relieving their suffering.
PubMed ID
23442785 View in PubMed
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18 records – page 1 of 2.