bluuebunny/crossref_metadata_2025 huggingface dataset:
Malfeasance and Regaining Nursing’s Moral Voice and Integrity
Authors: Mohr Wanda K , Horton-Deutsch Sara
Published: November 2006

This article discusses some of the most recent developments in US mental health services that follow on the heels of the for-profit hospital scandal that was brought to public attention less than a decade ago. As individuals and as a profession, nurses have a responsibility to uncover, openly discuss and condemn malfeasance when it occurs, yet there has been a collective silence about these developments. The authors explore the reasons for this and make recommendations for regaining nursing’s moral voice and integrity.
Confirmation, Meaning and Self-Awareness as Core Concepts of the Nursing Supervision Model
Authors: Severinsson Elisabeth I
Published: November 2006

The general objective of nursing supervision is to support the development of the super-visee’s job identity, competence, skills and ethics. This can be achieved through the stages of the supervision process. The aim of this article is to describe and discuss such a nursing supervision model, as well as the supervisor’s competence and moral responsibility, by analysing the interpretation of nursing supervision. Three main concepts are described: confirmation, meaning and self-awareness. The findings suggest that these concepts need to be established in the nursing supervision process by the supervisor, who is morally responsible for applying the process and for establishing a relationship with the supervisees.
Empowerment of Cancer Patients: from a Chinese perspective
Authors: Mok Esther
Published: November 2006

The philosophy of empowerment, which is based on the premises that clients must be active, equal and collaborative participants, who are aware and commited to change, has guided research in empowerment interventions. This article reports on a small part of a research study that sought to understand Chinese cancer patients’ conceptualization of empowerment. Qualitative delineation of the concept of empowerment by means of in-depth interviews was carried out with 12 Chinese patients with cancer. The findings showed that empowerment is a process whereby patients develop a sense of inner strength through connection with others, including families, friends and health care professionals. It is also a process of transformation through which they actively develop new perspectives by reframing and reinterpreting their illness. Acceptance of illness was shown to result from a realization of a lack of control in the situation, which is then enhanced by the beliefs of Confucianism and Taoism. In the cancer context, personal control comprises both primary and secondary processes. Active involvement, awareness of the situation, partnership, self-determination and self-reliance are important values in empowerment. The concept and therapeutic foundations of empowerment provide ample legitimacy for its vigorous pursuit in nursing.
Using The Human Rights Paradigm in Health Ethics: the problems and the possibilities
Authors: Austin Wendy
Published: November 2006

Human rights may be the most globalized political value of our times. The rights paradigm has been criticized, however, for being theoretically unsound, legalistic, individualistic and based on the assumption that there is a given and universal humanness. Its use in the area of health is relatively new. Proponents point to its power to frame health as an entitlement rather than a commodity. The problems and the possibilities of a rights approach in addressing health ethics issues are explored in this article.
The UK Human Rights Act 1998: implications for nurses
Authors: McHale Jean , Gallagher Ann , Mason Isobel
Published: November 2006

In this article we consider some of the implications of the UK Human Rights Act 1998 for nurses in practice. The Act has implications for all aspects of social life in Britain, particularly for health care. We provide an introduction to the discourse of rights in health care and discuss some aspects of four articles from the Act. The reciprocal relationship between rights and obligations prompted us to consider also the relationship between guidelines in the United Kingdom Central Council’s Code of professional conduct and the requirements of the Human Rights Act 1998. We conclude with the recommendation that the new legislation should be welcomed for its potential to support good practice and to urge critical and reflective practice rather than as yet another burdensome bureaucratic imposition.
Nurses and Requests for Female Genital Mutilation: cultural rights versus human rights
Authors: Sala Roberta , Manara Duilio
Published: November 2006

In this article we focus on female genital mutilation. We analyse this problem as one of the most important issues of multiculturalism, which is also coming to the attention of the public in Italy as a consequence of the growing number of immigrants from African countries. The fundamental problem is about the acceptability of this practice: can female genital mutilation be permitted and, if so, on what basis? We will try to cope with this as a genuine conflict between culture-relative values and universal values, such as human rights. Some attention will be drawn to Italian law. Finally, the impact on nurses of requests for genital mutilation will be described.
Prenatal Screening, Ethics and Down’s Syndrome: a literature review
Authors: Alderson Priscilla
Published: November 2006

This article reviews the literature on prenatal screening for Down’s syndrome. To be evidence based, medicine and nursing have to take account of research evidence and also of how this evidence is processed through the influence of prevailing social and moral attitudes. This review of the extensive literature examines how appropriate widely-held understandings of Down’s syndrome are, and asks whether or not practitioners and prospective parents have access to the full range of moral arguments and social evidence on the matter. Highly valued ideals of justice, personal autonomy, parental choice, women’s control over their reproduction and of avoiding harm can all tend towards negative rather than neutral approaches to Down’s syndrome. This article considers how ethics and prenatal screening policies and practice that take greater account of social evidence of disability could use moral arguments that inform rather than determine the choices of people who use prenatal services.
Balancing Rights and Duties in ‘Life and Death’ Decision Making Involving Children: a role for nurses?
Authors: Woods Martin
Published: November 2006

In recent years, increasing pressures have been brought to bear upon nurses and others more closely to inform, involve and support the rights of parents or guardians when crucial ‘life and death’ ethical decisions are made on behalf of their seriously ill child. Such decisions can be very painful for all involved, and may easily become deadlocked when there is an apparent clash of moral ideals or values between the medical team and the parents or guardians. This article examines a growing number of such cases in New Zealand and analyses the moral parameters, processes, outcomes and ethical responses that must be considered when life and death ethical decisions involving children are made. The article concludes with a recommendation that nurses should be recognized as perhaps the most suitable of all health care personnel when careful mediation is needed to produce an acceptable moral outcome in difficult ethical situations.
The Principle of Respect for Autonomy in the Care of Nursing Home Residents
Authors: van Thiel Ghislaine JMW , van Delden Johannes JM
Published: November 2006

Respect for autonomy is well known as a core element of normative views on good care. Most often it is interpreted in a liberal way, with a focus on independence and self-determination. In this article we argue that this interpretation is too narrow in the context of care in nursing homes. With the aim of developing an alternative view on respect for autonomy in this setting we described four interpretations and investigated the moral intuitions (i.e. moral judgements) of caregivers regarding these approaches. We found that these caregivers seemed to value different notions relating to respect for autonomy under different circumstances. There was no significant difference in moral judgements between men and women or between doctors and nurses. We conclude that a multidimensional understanding of this principle would best fit this context. We end this article with a description of a modest theory of respect for autonomy in nursing homes.
Fundamentalism, Multiculturalism and Problems of Conducting Research with Populations in Developing Nations
Authors: Crigger Nancy J , Holcomb Lygia , Weiss Joanne
Published: November 2006

A growing number of nurse researchers travel globally to conduct research in poor and underserved populations in developing nations. These researchers, while well versed in research ethics, often find it difficult to apply traditional ethical standards to populations in developing countries. The problem of applying ethical standards across cultures is explained by a long-standing debate about the nature of ethical principles. Fundamentalism is the philosophical stance that ethical principles are universal, while the anthropologically-based ‘multicultural’ model claims the philosophical position that principles are culturally bound. The authors explicate the two philosophical stances and advocate a morally sensitive but moderate position of ‘ethical multiculturalism’ rather than favouring either of the above philosophical positions. The final section suggests ways to promote ethical multiculturalism while planning and conducting nursing research.
Nurses' and Midwives' Views on Approaches to Hymen Examination
Authors: Gürsoy Elif , Vural Gülsen
Published: November 2006

Premarital sexual relations are unacceptable for women within Turkish society's understanding and perception of honour. If there is any suspicion about virginity, young girls are forced to undergo hymen examination against their will, which frequently results in attemped suicide. The most frequent cause of suicide in young Turkish girls is hymen examination. Nurses and midwives are always involve in this procedure. The purpose of this study was to determine the views of and approaches to hymen examination by nurses and midwives. Of those who participated in this study, 80.2% had been present during a hymen examination, 40.4% indicated that virginity had a special significance in the society owing to social pressures, and 37.5% indicated that they agreed with the view that the idea of virginity puts restraints on a woman's sexual life, whereas sexual activity is a physiological need. They also indicated their opposition to hymen examination imposed without the individual's consent. They agreed that stopping this practice depended more on the social structural changes required than on legal measures.
The Virtues in the Moral Education of Nurses: Florence Nightingale Revisited
Authors: Sellman Derek
Published: November 2006

The virtues have been a neglected aspect of morality; only recently has reference been made to their place in professional ethics. Unfashionable as Florence Nightingale is, it is nonetheless worth noting that she was instrumental in continuing the Aristotelian tradition of being concerned with the moral character of persons. Nurses who came under Nightingale’s sphere of influence were expected to develop certain exemplary habits of behaviour. A corollary can be drawn with the current UK professional body: nurses are expected to behave in certain ways and to display particular kinds of disposition. The difference lies in the fact that, while Nightingale was clear about the need for moral education, current emphasis is placed on ethical theory and ethical decision-making.
Nursing Students’ Responses to Ethical Dilemmas in Nursing Practice
Authors: de Casterlé Bernadette Dierckx , Grypdonck Mieke , Vuylsteke-Wauters Magda , Janssen Piet J
Published: November 2006

In literature as well as in nursing practice a growing concern about nurses’ ethical competence can be observed. Based on the cognitive theory of moral development by Kohlberg, this research examined nursing students’ ethical behaviour in five nursing dilemmas. Ethical behaviour refers not only to the ethical reasoning of nursing students but also to the relationship between reasoning and behaviour. Kohlberg’s definition of morality was refined by adding a care perspective. The results show that the majority of students can be located in the fourth moral stage according to Kohlberg’s theory, that is, the conventional level of moral development. This finding implies that students are still guided by professional rules, norms and duties, and have not (yet) succeeded in making personal ethical decisions on the basis of their own principles and acting according to such decisions.
Moral Crisis, Professionals and Ethical Education
Authors: Hunt Geoffrey
Published: November 2006

Western civilization has probably reached an impasse, expressed as a crisis on all fronts: economic, technological, environmental and political. This is experienced on the cultural level as a moral crisis or an ethical deficit. Somehow, the means we have always assumed as being adequate to the task of achieving human welfare, health and peace, are failing us. Have we lost sight of the primacy of human ends? Governments still push for economic growth and technological advances, but many are now asking: economic growth for what, technology for what? Health care and nursing are caught up in the same inversion of human priorities. Professionals, such as nurses and midwives, need to take on social responsibilities and a collective civic voice, and play their part in a moral regeneration of society. This involves carrying civic rights and duties into the workplace.
Teaching Ethics: Effect on Moral Development
Authors: Krawczyk Rosemary M
Published: November 2006

The purpose of this study was to determine the development of moral judgement in first-year and senior baccalaureate nursing students. These students were enrolled in three separate nursing programmes, each of which differed significantly in ethical content. The sample totalled 180 students enrolled in three New England programmes. Programme A included an ethics course taught by a professor of ethics. Programme B integrated ethical issues into all nursing theory courses. Programme C did not include ethical content in theory courses. The design was of a developmental cross-sectional study. The dependent variable was the development of moral judgement, as measured by Rest’s Defining Issues Test. The independent variable was the amount of ethics taught in the nursing programmes and the level of academic education. The senior nursing students from programme A scored significantly higher than the other senior groups on the Defining Issues Test. The conclusion is that an ethics course with group participation and a decision-making element significantly facilitated nursing students’ development of moral judgement.
The Relationship Between Role Conception and Ethical Behaviour of Student Nurses in Hong Kong
Authors: Yung Hilary Ha-ping
Published: November 2006

This paper was designed to explore the relationships of three role conception types (the professional, bureaucratic and service role conceptions) to the ethical behaviour of student nurses from the apprenticeship and degree nursing programmes in Hong Kong. The effect of role discrepancy on ethical behaviour will also be explored. A nonprobability convenience sampling of 140 certificate students from a hospital-based training course and 81 degree nursing students from a tertiary programme were selected. Role conception and role discrepancy were measured by the modified Nursing Role Conception scale originally developed by Corwin. For ethical behaviour, the Judgement About Nursing Decisions scale developed by Ketefian was used. Multiple regression analyses showed that the ideal professional role conception was a significant predictor, accounting for 17% of the variance in the ideal ethical score of the degree students. Actual service role conception was a better predictor of the actual ethical score, explaining 10% and 14% of its variance for the certificate and degree students respectively. Professional and bureaucratic role discrepancies together were found to have a negative effect on the actual ethical behaviour of the degree students. These results suggest that professional values that have been developed through socialization in nurse education programmes could benefit patients only when degree students, in particular, could adapt successfully to the demands of bureaucratic organization.
Compromise and Its Limits
Authors: Scott P A
Published: November 2006

Compromise as a notion is frequently met in discussion and debate regarding many everyday decisions, including health care. It therefore seems that it may be of interest and value to try to give this some careful consideration. In the following pages, an attempt is made to discuss what one might mean when one uses this concept. Consideration is then given to some possible uses of compromise in health care. Having suggested that in certain situations compromise is a morally valuable process, the author also considers some of the possible limits of compromise.
Efficiency and Health
Authors: Hussey Trevor
Published: November 2006

Efficiency has become of central importance in health care and is seen as wholly laudable. It appears to offer a precise and objective means of evaluating and comparing institutions, practices and individuals, and is a principle that underlies techniques of cost-benefit analysis and other methods of option appraisal. However, there is a need to examine the concept of efficiency and explore the problems of its application within health care. Efficiency is a value laden notion and it cannot be used as a means of making value judgements from purely factual premises. We have to choose the inputs and outputs in our calculations, and what limits to set on their scope. Efficiency calculations may require us to measure what cannot be quantified, and to treat as commensurable what is incommensurable. There are circumstances in which considerations of efficiency are inappropriate or even immoral.
Competing Ideologies in Health Care: a personal perspective
Authors: Young Ann P
Published: November 2006

With the introduction of general management and then of planned markets into the National Health Service (NHS), health care in the UK has gone through a massive amount of change. The effect on those working for the NHS has been ‘challenging’ and often confusing.

This paper aims to clarify what is happening by taking an ideological perspective: what ideologies exist, how they are changing and the strategies being used to ensure their survival. Ideologies are basically about power. The relationship between market, managerial and professional ideologies is analysed using charters, codes of conduct and other associated documents.

A tentative conclusion is reached that professional ideologies are able to adjust to the overriding market/consumerist ideology. However, the managerial ideology is having difficulty in gaining any real ground against the professional ideology and is having to move strategically by using audit, not just of finance, but also of clinical judgement, to gain power.
Developing Moral Imagination and the Influence of Belief
Authors: Pask Elizabeth J
Published: November 2006

Moral imagination has been described by Murdoch as ‘a way of seeing’. The focus of concern here is the influence of belief upon moral imagination and those attitudes that are needed if moral imagination is to be developed. The perspective adopted endorses a Humean recognition of the potent influence of personal experience upon those beliefs that are held, and therefore upon how we see the world. Kantian commitment to the power of the will, and to the ability of individuals to choose who they wish to be, allows room for optimism, a view which is supported by the findings of Liaschenko.
Nursing Ethics Into the Next Millennium: a context-sensitive approach for nursing ethics
Authors: Lützén Kim
Published: November 2006

The aim of this article is to argue for the need for a context-sensitive approach to the understanding of ethical issues in nursing practice as we face the next millennium. This approach means that the idea of universalism must be questioned because ethics is an interpersonal activity, set in a specific context. This view is based on issues that arise in international collaborative research as well as in research focused on ethical problems in nursing practice. Moral values are indigenous to a particular culture and influence beliefs about health and illness as well as what priorities are to be made in providing health care. Nursing practice must include thoughtful reflection on the meaning of moral concepts and principles in terms of culture. Theoretical developments in nursing ethics must be based on empirical research focusing on contextual aspects of health care.
The Nurse Shortage Problem in Japan
Authors: Sawada Aiko
Published: November 2006

This article discusses the serious problem of the shortage of about 50 000 nurses in Japan today. If efficient measures to solve it are not adopted by administrators, it is clear that the shortage will become still more alarming in the future, in a society with more people in advanced years and in which the numbers in the younger generation will decrease from now on.

The main factors behind the Japanese nursing labour shortage are, among others: a rapid increase in the number of hospital beds between 1986 and 1989; poor working conditions; and nurses’ low social position in their places of work. Behind these factors, there has always been a contempt for the art of nursing in our society.

Why has Japanese society made light of nursing? Three points can be identified: traditional discrimination against women; our disregard for a religious mentality; and our short history of hospital nursing.

To overcome these problems, we must first of all change fundamentally our sense of values, such as love for one another and compassion. We must now reconstruct a caring culture in our society.
Not Just a Labour of Love: industrial action by nurses in Australia
Authors: Strachan Glenda
Published: November 2006

Deciding to take industrial action or go on strike has been an issue of great concern for nurses. While it is typical for most groups of workers to undertake industrial action in the pursuit of better wages and working conditions or improved quality of services, historically, nurses have found this a difficult course to pursue. Frequently, nurses have been caught between acceptance of themselves as ordinary workers and a professional model, which has carried with it the implication that a profession does not engage in industrial action (although, in reality, professions, including medical practitioners, have undertaken industrial action). Nurses in Australia have gone on strike, although widespread industrial action was not undertaken until the 1980s, when lengthy industrial campaigns, including strikes, were used in an effort to achieve enhanced status for the profession, improved career paths and increased salaries. While debate remains about the efficacy of this course of action, large numbers of nurses have been involved in these campaigns. Significant changes in salaries and status were achieved in the 1980s.
Nurses and Strikes: a perspective from the United States
Authors: Ketter Joni
Published: November 2006

In the United States, there has been a continuous debate between those who favour collective bargaining for nurses and those who believe it is not professional. Likewise, the controversy over whether nurses should strike has been longstanding and continues today. Those who oppose the idea of nurses striking often state that they are abandoning their patients, and that it is not ethical, even though federal legislation requires a 10- day strike notice so that management can make patient care arrangements. The American Nurses Association (ANA) has supported the right of nurses to strike, as a last resort and after careful consideration of every factor. This support has divided the membership of ANA and the nursing profession, even though the strikes have been used sparingly and effectively by nurses in this country; and so the debate continues.
Suffering and Ethical Caring: incompatible entities
Authors: Leners Debra , Beardslee Nancy Q
Published: November 2006

Ethical problems are continuing to expand in health care due to conflicts of technology and value. This study investigated what kind of ethical problems nurses face in clinical situations and what process they use in deciding on actions to take. Ethical theories in justice and caring were explored. Qualitative research was used and ethnographic analysis was conducted with six staff nurses from three clinical areas. An analysis of the data yielded an overarching theme of ‘Suffering and ethical caring: incompatible entities’. Six domains were identified: informant definitions, preceding conditions, actions taken, intervening variables, risks and recommendations. Future research is needed in the field of client and family suffering and pain.
Extending the Theory of Awareness Contexts by Examining the Ethical Issues Faced by Nurses in Terminal Care
Authors: Morrissey Matthew V
Published: November 2006

The breaking of bad news in a hospital setting, particularly to patients in a terminal condition, highlights some complex and often emotive ethical issues for nurses. One theory that examines the way in which individuals react to bad news such as a terminal illness, is the theory of awareness contexts. However, this theory may be limited by failing to recognize the complexity of the situation and the ethical issues involved for nurses caring for terminally ill patients. Furthermore, contexts of awareness are influenced to a much greater extent by relationships with nurses than simply by the delivery of medical information. Even when information is given to the client and the family, the nurse is involved in helping them to know the meaning of this information. In a hospital, the nurse is faced with emotional demands by clients, families and colleagues, complex issues of advocacy, and professional boundaries and responsibilities. It is the author’s wish to examine the reality of clinical practice for nurses, thus further extending the theory of awareness contexts.
Moral Orientation of Elderly Persons: considering ethical dilemmas in health care
Authors: Pinch W J Ellenchild , Parsons Mary E
Published: November 2006

Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons ( n = 20) in order to explore and describe their moral orientation based on the paradigms of justice (Kohlberg) and care (Gilligan). The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men’s moral reasoning was dominated by caring, but justice dominated the reasoning of four women. The implications for ethical decision-making and future research are discussed.
Self-Image, Self-Values and Interpersonal Values Among Newly Graduated Nurses
Authors: Sivberg Bengt , Petersson Kerstin
Published: November 2006

This longitudinal study (1994-1996) used the Gordon Personality Inventory to measure nursing students’ self-image (Gordon A), self-values (Gordon B) and interpersonal values (Gordon C). It was performed with students from three colleges of health in the south of Sweden: Jönköping ( n = 54), Växjö ( n = 24) and Kristianstad ( n = 38). The null hypothesis of the study was that the new academic three-year programme did not have the power to change significantly the students’ self-image and professional values. The hypothesis was tested by paired sample Student’s t-test. The result was that, at Jönköping, self-image changed and increased significantly in the dimensions of ‘cautiousness’ and ‘personal relations’, and decreased in ‘sociability’, and increased in the self-value ‘order’. At Växjö the self-image dimensions of ‘original thinking’ and ‘personal relations’ increased, and, at Kristianstad, the students increased their self-image scores in ‘responsibility’.
Using Clients
Authors: Cain Paul
Published: November 2006

An important part of the student nurse’s training involves reflection on practice, as expressed in written assignments and seminar discussions. In this, students make use of material drawn from their work with clients. A key ethical question is, therefore: should clients’ permission be sought by students for this use of case material in coursework assignments. This article examines in some detail the arguments both for and against seeking clients’ permission and concludes that, in view of the principle of respect for autonomy, there is a moral obligation to gain consent. It is argued, however, that there may be legitimate exceptions to this.
Moral Sensitivity in Psychiatric Practice
Authors: Lützén Kim , Evertzon Mats , Nordin Conny
Published: November 2006

This study reports the results of a study of Swedish psychiatrists’ responses to moral statements related to decision making in the psychiatric context. Use was made of the Moral Sensitivity Questionnaire, a modified instrument previously constructed from a theory of moral sensitivity. This Likert-type scale contains 30 items constructed from the following categories: interpersonal orientation, structuring moral meaning, benevolence, modifying autonomy, experiencing moral conflict, and trust in medical knowledge and principles of care. The purpose was to identify possible differences in responses rather than to evaluate right or wrong responses. The analysis is based on 754 completed questionnaires. The results of the study showed some significant differences in the item and category levels; for example, male psychiatrists experienced more conflicts than female psychiatrists and agreed to a greater extent that medical knowledge was most important in deciding what was best for the patient. The results also showed that more female than male psychiatrists thought that the relationship with the patient was most important in psychiatric practice.
Suicide: a statement of suffering
Authors: Long Ann , Long Aishlinn , Smyth Angus
Published: November 2006

This article is designed to focus on the provision of nursing care in general medical wards following the admission of persons who have attempted suicide or who have a previous history of attempting suicide. The authors explore, analyse and synthesize how nurses, as key players in the health care team, may begin by recognizing the uniqueness of the individual, and by cotravelling therapeutically with the person on part of his or her journey towards recovery and healing. Efforts are made to demonstrate how nurses can influence the health gain of this group of people and their families. Professional attitudes and related ethical aspects, such as autonomy, respect for autonomy and paternalism, are also examined within the context of the nursing care of people who have attempted suicide. The need to enhance sensitive and caring communication skills for nurses who work with this group of people is tentatively considered. Some reasoning about why there may be difficulties in specific areas of communication such as empathy are contested and explored.
Requests for Assisted Suicide: a nursing issue
Authors: Kopala Beverly , Kennedy Susan Lorraine
Published: November 2006

At the heart of the debate over assisted suicide is the recognition that not all persons can be healed and not all suffering can be relieved. This article addresses the ethical, professional and legal issues to be considered by the nurses in the United States who are facing patients’ requests for assisted suicide. Both personal and professional risks, and the consequences of an action must be evaluated. Ultimately, a decision is based on some ranking of: patient values; personal values and beliefs; professional codes, standards and other guidelines; and societal laws and regulations.
Myths, Magic and Reality in Nursing Ethics: a personal perspective
Authors: Tschudin Verena
Published: November 2006

Ethics, especially in nursing, tends to be surrounded by myths and ideas that have more in common with magic than reality. This article argues from quotes of two medieval men, Thomas Aquinas and Meister Eckhart, that ethical behaviour among nurses is not something difficult or far-fetched, but something immediate, everyday, and often very simple. The more weighty ethical dilemmas are not diminished by this. Aspects of justice, compassion and courage are discussed from the point of view of relationships with clients and colleagues, and the need for (helpful) myths is stressed.
Challenges to Nursing Values in a Changing Nursing Environment
Authors: Gastmans Chris
Published: November 2006

The aim of this paper is to analyse how the broad context of nursing practice plays a stimulating and/or a restricting role in the process of ethical caring. Three areas of special attention are noted. First, on the societal level, some developments that influence the state of affairs in the caring sector are indicated. Secondly, concerning the nursing and medical professions, an interprofessional dialogue based on specific competence is outlined. Thirdly, there is a discussion of how health care institutions can evolve from a business undertaking to a pedagogic-moral area where nurses can learn the moral attitudes that are essential to achieve ‘good care’.
Practical Dignity in Caring
Authors: Shotton Leila , Seedhouse David
Published: November 2006

It is difficult to understand the meaning of ‘dignity’ in human rights, bioethics and nursing literature because the word is used so vaguely. Unless dignity’s meaning is spelt out it can disappear beneath more tangible priorities. In this article we define dignity and show how this can help health workers to maintain the dignity of people in their care.
Physical Restraint: a descriptive study in swiss nursing homes
Authors: Hantikainen Virpi
Published: November 2006

This article focuses on the reasons for using physical restraints, their prevalence and nurses’ experiences of their use. The data were collected by means of a questionnaire from nurses, trained nurse’s aids and auxiliary staff ( n = 173) in seven Swiss nursing homes. The results showed that physical restraints are used in nursing units, the mean number of restrained residents in each being 3.7 (SD 3.9). However, nursing staff did not necessarily understand and consider the term ‘restraint’ as a restrictive device in its negative sense. The most common reasons indicated for the use of restraint were related to the protection and safety of the residents themselves, the prevention of disturbance of other residents, and the residents’ restlessness and aggressiveness. As for the reasons related to staffing, reference was made to understaffing, a lack of competence on the part of nurses, and the demands of residents, their next of kin and doctors. It was not common practice to inform the elderly residents that they would be restrained, and therefore they were not always aware of what was happening to them and why. Twenty-nine per cent of the respondents reported that the flexibility of their work was affected by the use of physical restraint.
Information Disclosure: the moral experience of nurses in China
Authors: Pang Mei-che Samantha
Published: November 2006

While the movement to ensure patient’s rights to information and informed consent spreads throughout the world, patient rights of this kind have yet to be introduced in mainland China. Nonetheless, China is no different from other parts of the world in that nurses are expected to shoulder the responsibility of safeguarding patients’ best interests and at the same time to uphold their right to information. This paper expounds on the principle of protectiveness grounded in traditional Chinese medical ethics concerning the practice of informed consent. Nurses in China have a moral obligation to treat patients with sincerity. This notion carries a strong sense of parental protectiveness. As far as information-giving is concerned, nurses in China are ambivalent about the notion of truthfulness. The findings of an empirical study undertaken in seven Chinese cities reveal that nurses in China experience similar difficulties related to the disclosure of information as their counterparts in other parts of the world. A nurse’s narrative, the Chan case, is used to illustrate the typical difficult situation that nurses in China often encounter in looking after vulnerable patients who would like to learn more about their therapeutic regimens. The moral tension embedded in nursing practice is analysed. It is found that most nurses would prefer to tell the truth to patients, but their primary ethical justification is not that of respect for patients’ autonomy or safeguarding patients’ right to self-determination. Rather, it is basically beneficent in nature; that is, they base their decision to reveal the truth on whether or not patients will receive more relevant treatment and better nursing care.
Sensitive Judgement: an inquiry into the foundations of nursing ethics
Authors: Nortvedt Per
Published: November 2006

This article considers the foundation of nursing as a moral practice. Its basic claim is that all nursing knowledge and action reside on a moral foundation. The clinical gaze meets vulnerability in the patient’s human condition. To see a patient’s wound is to see his or her hurt and discomfort; it is a concerned observation. To see the factual and pathophysiological is at the same time to see the ethical: the moral realities of suffering, pain and discomfort. A nurse’s emotional sensitivities are central to understanding a patient’s experiences of illness. Emotions reveal value and ascribe moral importance to certain situations; they are addressed centrally by vulnerability and the moral realities of illness. Hence, the essence of nursing knowledge and nursing performance cannot be understood merely as ontology (i.e. as being-with-the-other). Nursing is basically being-for-the-other; it is responsibility; it is ethics.
The art of nursing: an aesthetics?
Authors: de Raeve Louise
Published: November 2006

This article explores the question of whether or not the ‘art’ of nursing can properly be described as an ‘aesthetics’. The author concludes that, although much nursing literature on the subject is confused and even incoherent, there is nevertheless some justification for seeing a connection between the art of nursing and aesthetics. The philosophical writings of Martha Nussbaum and Iris Murdoch are used to support this position.
The Utility of Futility: the construction of bioethical problems
Authors: Carnevale Franco A
Published: November 2006

The aim of this article is to analyse the contemporary ‘futility discourse’ from a constructivist perspective. I will argue that bioethics discourse typically disregards the con text from which controversies emerge and the processes that inform and constrain such discourse. Constructivists have argued that scientific knowledge is expressive of the dominant paradigm within which a scientific community is working. I will outline an analysis of ‘medical futility’ as a construction of biomedical and bioethical communities (and their respective paradigms). I will trace the emergence and utilization of futility in the literature. My analysis of the context (i.e. the historical circumstances, the particular actors involved) within which the futility discourse emerged suggests that medical futility was constructed, in part, as a means of enhancing physician domination of a context wherein medical authority was threatened. The actors in this debate express widely divergent frameworks of ‘the good’, arguing from distinctive representations of moral agency. At times, this controversy has been argued from incommensurate moral horizons wherein the discussants debate incomparable problems. This discussion is related to a study of the ‘practice’ of futility in the clinical context. Further studies on the construction of bioethical problems are a necessary condition for supporting the truth claims of bioethical arguments.
Intimacy - Meeting Needs and Respecting Privacy in the Care of Elderly People: what is a good moral attitude on the part of the nurse/carer?
Authors: Mattiasson Anne-Cathrine , Hemberg Maja
Published: November 2006

This article explores notions of intimacy in the caring context. The aspects discussed are: privacy and intimacy; intimacy as emotional and/or physical closeness; intimacy as touch; sexual intimacy and normal ageing; sexual intimacy and patients suffering from dementia; and intimacy as trust. Examples are given and problems are identified, with reflection on the attitude and behaviour of the carer. It is suggested that when trying to make moral decisions in concrete situations it is imperative that the carer is aware of the values upon which his or her own thinking is based. It is argued that the guiding principle should be the moral assumption that the carer’s responsibility can never be interpreted as a right to disregard the wishes of the patient. Hence, the key word in daily care is ‘respect’.
The Authenticity and Ethics of Phenomenological Research: How to Overcome the Researcher's Own Views
Authors: Häggman-Laitila Arja
Published: November 2006

This article is based on the assumption that the researcher cannot detach from his or her own view in phenomenological research. The researcher is assumed to be able to understand the experiences of an individual only through the points of departure created by the researcher's own view. The goal of this article is to describe practical aspects and their theoretical grounds that are of crucial importance in overcoming a researcher's views in data gathering and analysis. Its purpose is to clarify the authenticity and ethical standards concerning the views of the researcher in phenomenological research.
Living with Dementia: Communicating with an Older Person and Her Family
Authors: Long Ann , Slevin Eamonn
Published: November 2006

This article is designed to explore and examine the key components of communication that emerged during the interactional analysis of a role play that took place in the classroom. The ‘actors’ were nurses who perceived the interaction to reflect an everyday encounter in a hospital ward. Permission to tape the interaction was sought and given by all persons involved. The principal ‘players’ in the scenario were: the patient, a 70-year-old-woman who had been admitted with dementia, her son and daughter, and the nurse in charge of the ward. The fundamental dynamics of the use of power and restriction, truth telling, family stress, interpersonal conflict, ageism, sexism, empathy and humanism surfaced during the analysis. The findings show that therapeutic communication should be the foundation on which nursing should stand.

The article continues with an exploration of the theoretical frameworks that guided the analysis of interaction and concludes by suggesting tentatively some meaningful implications for nursing practice. It plans to furnish provocative new insights into the sometimes covert communication dynamics occurring within the nurse-patient relationship. Finally, it aims to generate discussion on this little-charted realm of human social interaction.
The Person in Abortion
Authors: Clarke Liam
Published: November 2006

The issue of what constitutes a person is examined in relation to whether or not the fetus or newborn has qualities of personhood. The discussion also dwells on birth and viability as determining factors in decisions concerning terminations. Such decisions are stated to be constrained by both biological and social factors, particularly in the way in which the fetus can possess personhood only through the ‘absorption’ of such froni its mother; both mother and fetus together are ‘the person’. This article also considers whether, on Piagetian grounds, one can make personhood comparisons between infants and adults and suggests that such comparisons are a mistake. A social critique of Piagetian principles shifts the emphasis from individualism towards consideration of school, family and environmental factors. Equally, it is not feasible to view the fetus as an entity that is separate from its mother's perceptions of its social as well as its physical status. Finally, because termination decisions occur against ‘real life’ (and highly charged) backgrounds, we must reject any notion that such decisions are only an intel-lectual exercise. It is assumed that nurses would implicitly understand this and some attempt is made to state why this is so.
Health Needs of Lone Elderly Chinese Men with Heart Disease during Their Hospitalization
Authors: Shih Slhaw-Niw , Shih Fu-Jin
Published: November 2006

Hospitalization is a unique health-illness transition for most elderly people. Whether the patient's health-related needs are met or not often iiifluence his or her appraisal of quality of life during hospitalization. This qualitative study explored the health needs of elderly Chinese male cardiac patients during their hospitalization. Eighteen subjects were recruited from a veterans' hospital in northern Taiwan. These men all lived alone before their hospital admission. Data were gathered using semistructured interviews and then analysed by content analysis. Ninety-four per cent of the subjects described up to three categories of needs: met needs (72%), unmet needs (78%), and expected needs (50%0). Needs that participants believed were met were those for psychological support, spiritual support, tangible support and information. Unmet needs were those for participation in decision making, maintaining daily activities and resuming a preadmission lifestyle. The expected needs included those for learning self-care strategies to maintain their daily activities after discharge from the hospital. The factors that framed the participants' perceptions of different health needs were identified to be lack of family support and locus of control. Finally, a discussion of the context background of this phenomenon, as well as some suggestions for its implications, are provided from a culturally sensitive ethical aspect.
Promoting a Good Death: an agenda for outcomes research - a review of the literature
Authors: Mak June Mui Hing , Clinton Michael
Published: November 2006

Outcomes research is topical in discussions about health-related research. Its emphasis on effectiveness creates an important opportunity for nurse researchers to strengthen the linkages between theory, outcomes research and nursing practice but, before care can be more effective, it is logical to establish patients’ desired outcomes. A thorough review of the implications of this requirement for the care of hospice patients is needed, but is lacking in the literature. Therefore, the literature on a ‘good death’ is reviewed as a step towards assisting hospice patients to achieve what they regard as an acceptable death. The starting point is to define more clearly what it means to die a good death. The relationship between hospice care and achieving a good death is then examined.
Physician-Assisted Suicide and Voluntary Euthanasia: is it time the UK law caught up?
Authors: Griffiths Pauline
Published: November 2006

People who wish to end their lives when they consider that they cannot endure further pain and suffering cannot legally obtain help to produce a peaceful death. The reality of practice seems to be that, covertly, physician-assisted suicide and voluntary euthanasia do take place. The value of personal autonomy in issues of consent has been clarified in the courts in that a competent adult person has the right to refuse or choose alternative treatments even if death will be the outcome. This issue needs open discussion and regulation in order to protect those vulnerable people in our society.