bluuebunny/crossref_metadata_2025 huggingface dataset:
Intimate Partner Violence
Authors: Robertson Kirsten , Murachver Tamar
Published: November 2006

The present study compared the communication behavior of individuals with and without histories of intimate partner violence (IPV). Specifically, the authors examined participants’ use of and accommodation toward facilitative and nonfacilitative language features as a function of their abuse histories. The findings revealed that perpetrators and victims of IPV used fewer facilitative and polite language features. Additionally, men with histories of IPV were more likely to use nonfacilitative language features. The examination of accommodation behavior revealed that perpetrators of psychological abuse were more likely to accommodate toward nonfacilitative language features and were less likely to accommodate toward facilitative language features. In all other instances, participants modified their speech toward the manipulated styles. In light of these findings, recommendations are made for IPV treatment initiatives.
‘You’ve got a friend’: African American men’s cross-sex feminist friendships and their influence on perceptions of masculinity and women
Authors: White Aaronette M.
Published: November 2006

Twenty African American men’s cross-sex feminist friendships were studied using the self-expansion model of close personal relationships. Narrative analyses supported the self-expansion model by revealing how feminist insider perspectives shaped men’s constructions of masculinity and their interactions with women. Specifically, two themes emerged from the men’s narratives concerning the advantages of these friendships, namely their affirmative quality and strong emotional bonds. A cognitive dissonance theme also emerged when a man did not act in ways consistent with feminist insider perspectives. Furthermore, a practising ground theme emerged when he resolved the dissonance by changing his behavior. Cross-sex feminist friendships often transcend prevailing expectations about man-woman relationships and offer support to men who challenge mainstreams ideas about masculinity, women, and gender relations.
How women make custody decisions and manage co-parenting with abusive former husbands
Authors: Hardesty Jennifer L. , Ganong Lawrence H.
Published: November 2006

This grounded theory study examined the processes by which women make custody decisions and manage co-parenting after divorce with abusive former husbands. Nineteen women who left abusive husbands were interviewed. Fears, pragmatic concerns, and family ideology pushed them toward custody agreements that continued their involvement with former husbands after divorce. Men who were controlling during marriage were very involved with children postdivorce and continued to exert control over mothers. As a result, women managed conflict, set boundaries, and resisted control in the context of ongoing fear. Postdivorce abuse, positive changes in fathers, and children’s recognition of abuse influenced how women co-parented over time. Fears, pragmatic concerns, and family ideology continued to influence their decisions as they planned for the future.
Predicting unwanted pursuit: Attachment, relationship satisfaction, relationship alternatives, and break-up distress
Authors: Dutton Leila B. , Winstead Barbara A.
Published: November 2006

We examined attachment and relationship variables as predictors of unwanted pursuit behavior (UPB) as reported by targets of pursuit and by pursuers. Factor analyses revealed two dimensions, Pursuit and Aggression, on Spitzberg and Cupach’s measures of UPB for targets and pursuers. Results indicated no sex differences in reports of UPB by either targets or pursuers for Pursuit or Aggression, although female pursuers reported engaging in more ‘monitoring’ and ‘physically hurting’ their targets than male pursuers. For pursuers, anxious attachment and distress at break-up were the most robust predictors of both Pursuit and Aggression. Targets reported more instances of UPB than did pursuers. Among targets, none of the variables predicted Pursuit, but anxious attachment and relationship dissatisfaction predicted Aggression.
Family communication patterns, family environment, and the impact of parental alcoholism on offspring self-esteem
Authors: Rangarajan Sripriya , Kelly Lynne
Published: November 2006

This study examined the role of perceptions of family environment and family communication as mediators of the effects of parental alcoholism on the self-esteem of adult children of alcoholics. Participants (N = 227) completed self-reports of parental alcoholism, family environment, family communication patterns (FCP), and self-esteem. Results indicated a negative relationship between the seriousness of both maternal and paternal alcoholism and self-esteem. Paternal and maternal alcoholism were related to the two dimensions of family environment, family stressors and parental disregard, although the effect for paternal alcoholism was larger. The relationship between maternal alcoholism and offspring self-esteem was partially mediated by parental disregard, whereas the relationship between paternal alcoholism and self-esteem was mediated by parental disregard and perceptions of a conversation-orientation FCP.
The Governance of Nonprofit Organizations: Empirical Evidence From Nongovernmental Development Organizations in Spain
Authors: de Andrés-Alonso Pablo , Cruz Natalia Martín , Romero-Merino M. Elena
Published: November 2006

To verify the existence and relevance of control mechanisms that impede the expropriation of resources by the managers of nonprofits and that improve efficiency, we use a representative sample of Spanish nongovernmental development organizations (NGDOs). The authors study how the donors’ structure and board of trustees relates to organizational efficiency. Results show that the presence of an active institutional donor provides a control mechanism for these NGDOs, thus favoring the efficient allocation of resources, and that the structure of the board of trustees is irrelevant in this respect. Results are robust to alternative measures of technical and allocative efficiency.
Advocacy Organizations and the Field of Youth Services: Ongoing Efforts to Restructure a Field
Authors: Scott W. Richard , Deschenes Sarah , Hopkins Kathryn , Newman Anne , McLaughlin Milbrey
Published: November 2006

The field of youth services has undergone many changes in the past few decades, and advocacy organizations play a pivotal role in reconceptualizing this field by promoting better and more coordinated services to youth in need. This article examines how advocacy organizations bring about new conceptions of youth, influence the organization of the field, and ultimately change the way public policy addresses youth’s needs. The authors first describe the field of youth services, a highly fragmented field that has historically focused on youth as problems and targets for intervention. Next, they describe the current reform movement that instead promotes positive youth development. Focusing on the concept of restructuration, they then highlight some of the ways in which three advocacy organizations in San Francisco and Oakland, California, influence the field, and they propose early indicators that suggest how this field is being reorganized.
Prehistoric farming and the postglacial expansion of beech and hornbeam: a reply to Gardner and Willis
Authors: Küster Hansjörg
Published: November 2006

It is argued that the views put forward by Gardner and Willis are compatible with the opinions expressed in Küster (1997) if consideation is given to the distinctive aspects of the expansion of tree species in Central Europe and the different ecological conditions elsewhere.
Women Physicians’ Narratives About Being in Ethically Difficult Care Situations in Paediatrics
Authors: Sørlie Venke , Lindseth Anders , Udén Gigi , Norberg Astrid
Published: November 2006

This study is part of a comprehensive investigation of ethical thinking among male and female physicians and nurses.

Nine women physicians with different levels of expertise, working in various wards in paediatric clinics at two of the university hospitals in Norway, narrated 37 stories about their experience of being in ethically difficult care situations. All of the interviewees’ narrations were concerned with problems relating to both action ethics and relation ethics. The main focus was on problems in a relation ethics perspective. The most common themes in an action ethics perspective were overtreatment and withholding treatment. The more experienced physicians reasoned differently from the group of less experienced physicians and they coped with pressure in different ways. The less experienced physicians disclosed their professional experience yet seemed uncertain, while putting on an air of certainty, but the more experienced physicians disclosed both their professional and personal experience of caregiving and they seemed to allow themselves to feel uncertain in their certainty. Both groups emphasized a need for deep discussion between colleagues about their being in ethically difficult care situations.
Can Nurses Contribute to Better End-of-Life Care?
Authors: Shotton Leila
Published: November 2006

In this article I will argue that futile medical and nursing care is not only inefficacious but that it may be harmful to the patient and also to health professionals, who may be diminished both as clinicians and as persons if they are not able to give appropriate care to dying patients and their families. I discuss futile care in intensive care units because the opportunities and the temptation to provide futile care in these settings is higher than, for instance, in internal medicine and nursing home care. I argue, following two nurse ethicists, Carol Taylor and Colleen Scanlon, that, even if nurses are not the initiators of futile care, they play an important role in its prevention because of their clinical expertise. They can do this by convening ‘patient care conferences’ when they recognize the need to bring together the various parties that have conflicting expectations. These conferences would then result in appropriate palliative care. The nurses providing this care would demonstrate their understanding of the process whereby living becomes the process of dying.
Biomedicine, Genetics and Disability: reflections on nursing and a philosophy of holism
Authors: Newell Christopher
Published: November 2006

This article critically explores the notion of those sociopolitical spaces that are ‘disability’, ‘holism’ and ‘genetics’, arguing from the perspectives of someone who identifies as having a disability. Medical genetics is seen to reflect the ideology and dominant biomedical reductionist thought. In contrast with this, it is proposed that disability and health are inherently social. A nursing approach is seen to recognize the social and holistic nature of the human person and to present a critical reflection on the reductionistic applications of medical genetics.
Ethical Issues in Public Health Nursing
Authors: Oberle Kathleen , Tenove Sandra
Published: November 2006

This qualitative study was designed to explore ethical issues in public health nursing in the Canadian context, and to begin to identify strategies to support ethical practice. Twenty-two public health nurses, 11 in rural and 11 in urban settings, were asked to describe ethical problems they had experienced in the course of their work. These participants most often described situations that required a relational response rather than an active choice between options. Their goal was to optimize the good, while at the same time maintaining a supportive relationship. Analysis revealed five interrelated themes, each with several subthemes: relationships with health care professionals; systems issues; character of relationships; respect for persons; and putting self at risk. It was clear that all aspects of public health nursing have ethical components.
An African Ethic for Nursing?
Authors: Haegert Sandy
Published: November 2006

This article derives from a doctoral thesis in which a particular discourse was used as a ‘paradigm case’. From this discourse an ethic set within a South African culture arose. Using many cultural ‘voices’ to aid the understanding of this narrative, the ethic shows that one can build on both a ‘justice’ and a ‘care’ ethic. With further development based on African culture one can take the ethic of care deeper and reveal ‘layers of understanding’.

Care, together with compassion, forms the foundation of morality. Nursing ethics has followed particular western moral philosophers. Often nursing ethics has been taught along the lines of Kohlberg’s theory of morality, with its emphasis on rules, rights, duties and general obligations. These principles were universalistic, masculine and noncontextual. However, there is a new ethical movement among Thomist philosophers along the lines to be expounded in this article.

Nurses such as Benner, Bevis, Dunlop, Fry and Gadow - to name but a few - have welcomed the concept of an ‘ethic of care’. Gilligan’s work gave a feminist view and situated ethics in the everyday aspects of responsiveness, responsibility, context and concern.

Shutte’s search for a ‘philosophy for Africa’ has resulted in finding similarities in Setiloane and in Senghor with those of Thomist philosophers. Using this African philosophy and a research participant’s narrative, an African ethic evolves out of the African proverb: ‘A person is a person through other persons’, or its alternative rendering: ‘I am because we are: we are because I am.’ This hermeneutic narrative reveals ‘the way affect imbues activity with ethical meaning’ within the context of a black nursing sister in a rural South African hospital. It expands upon the above proverb and incorporates the South African constitutional idea of ‘Ubuntu’ (compassion and justice or humanness).
Are Nursing Codes of Practice Ethical?
Authors: Pattison Stephen
Published: November 2006

This article provides a theoretical critique from a particular ‘ideal type’ ethical perspective of professional codes in general and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) Code of professional conduct (reprinted on pp. 77-78) in particular.

Having outlined a specific ‘ideal type’ of what ethically informed and aware practice may be, the article examines the extent to which professional codes may be likely to elicit and engender such practice. Because of their terminological inexactitudes and confusions, their arbitrary values and principles, their lack of helpful ethical guidance, and their exclusion of ordinary moral experience, a number of contemporary professional codes in health and social care can be arraigned as ethically inadequate. The UKCC Code of professional conduct embodies many of these flaws, and others besides. Some of its weaknesses in this respect are anatomized before some tentative suggestions are offered for the reform of codes and the engendering of greater ethical awareness among professionals in the light of greater public ethical concerns and values.
Hidden and Emerging Drama in a Norwegian Critical Care Unit: ethical dilemmas in the context of ambiguity
Authors: Bunch Eli Haugen
Published: November 2006

The study presented in this article is based on field observations over one year on a critical care unit in Norway. Data were analysed according to Glaser’s grounded theory and generated a theory of hidden and emerging drama in the context of ambiguity while the nurses routinized the handling of complex technology. To the untrained eye the unit presented a picture of calm competence, while under the surface one finds hidden drama full of difficult interacting clinical and ethical problems. The nurses identified six ethical dilemmas: (1) end of life issues; (2) whether there should be an age limit for coronary surgery; (3) distributing limited resources; (4) resource allocation in terms of better staffing; (5) situations in which is it more harmful than beneficial to continue treatment; and (6) transferring patients to other facilities. The six problems overlap and have clinical as well as ethical components, but it was the ethical dimensions that the nurses identified and discussed. The significance for nursing is the importance of well-educated and well-qualified nurses and how they find viable solutions to complex ethical and clinical problems.
Cancer Patients’ Views and Experiences of Participation in Care and Decision Making
Authors: Sainio Carita , Lauri Sirkka , Eriksson Elina
Published: November 2006

The purpose of this study was to explore the views and experiences of adult cancer patients about patient participation in care and decision making and the preconditions for this participation. The data were collected by means of focused interviews; in addition the patients completed depression and problem-solving instruments. The sample comprised 34 cancer patients from the haematological and oncological wards of one university hospital in Finland. The results revealed considerable variation in the patients’ views on their participation in care and decision making. Some of the patients understood participation either in terms of contributing to the decision making or in terms of expressing their views on treatment options. Some considered that their participation in care was impossible.

Patient participation in care and decision making was promoted by good health, access to information, assertiveness, good interactive relationships with nurses and physicians, and encouragement by nurses and physicians to participate. Factors restricting such patient participation were poor health, ignorance, anxiety, age, time pressures of staff, lack of time, high staff turnover and poor interactive relationships.

With regard to participation in medical decision making, the patients were divided into three groups: (1) active participants ( n = 7), (2) patients giving active consent ( n = 9), and (3) patients giving passive consent to medical decisions ( n = 18).
Ethical Dilemmas in Nonclinical Health Research from a UK Perspective
Authors: Grinyer Anne
Published: November 2006

This article examines the ethical dilemmas faced by professional and academic researchers in the health field who undertake nonclinical or social research among patients or staff. The experiences of health researchers and health professionals in the UK are directly relevant to those undertaking similar health-related research in other parts of the world at a time when nonclinical research in health care is becoming widespread in all countries and cultures. This article addresses ethical dilemmas as they relate to researchers’ ability to maintain confidentiality, their commitment to the welfare of respondents, and the tensions that arise from undertaking research for an employer. In addition, the danger of conducting covert research inadvertently may present unexpected ethical problems, which are discussed. Although it is impossible to provide a policy document to address all ethical dilemmas, this article does attempt to address the question of how best to approach health-related research in order to minimize the possibility of running into ethical problems at a later stage.
The Ethical Sensitivity of Nurses in Turkey
Authors: Ersoy Nermin , Göz Fügen
Published: November 2006

In this study we tried to gain information about the ethical sensitivity (as well as the ethical knowledge) of nurses working at the bedside in our country. Four scenarios were presented to 165 nurses working in hospital wards in Kocaeli. More than half of the nurses can be considered to have made decisions based on beneficence for the first scenario, while more than half of them preferred to make decisions based on autonomy for the second and the fourth scenarios. For the third scenario, most of the nurses (76.4%) can be said to have based their decisions on veracity. These results suggest that these nurses were sensitive to issues of confidentiality, truth telling and beneficence; however, they were not equally sensitive when the right to refuse treatment was concerned.
The First Nurse-Patient Encounter in a Psychiatric Setting: discovering a moral commitment in nursing
Authors: Sjöstedt Elisabet , Dahlstrand Anita , Severinsson Elisabeth , Lützén Kim
Published: November 2006

The aim of this study was to deepen nurses’ understanding of the importance of carefully managing the first nurse-patient encounter in a psychiatric setting according to each patient’s suffering and future hopes. The study was carried out using an action research approach. The action planned was the implementation of a conceptual model reflecting Eriksson’s caring theory. Data were collected by interviews with nurses and observational notes kept in a research diary. The data analysis followed the procedure of qualitative content analysis. A generalization of the entire learning process shows the first nurse-patient encounter to be a moral commitment in nursing. A theoretical framework of nursing assessment conveying knowledge about the patient as unique and being a whole person can support the nurse in encouraging the patient to enter into a relationship. This insight stimulated the nurses in this study to reflect on the moral responsibility of continuing the relationship and initiating an ongoing nursing process. Awareness of this responsibility made them reflect more on the possibility of nurses taking autonomous actions in order not to abandon the patient and to avoid feeling guilty.
Applying Ethical Guidelines in Nursing Research on People with mental illness
Authors: Koivisto Kaisa , Janhonen Sirpa , Latvala Eila , Väisänen Leena
Published: November 2006

This article describes how ethical guidelines have been applied while interviewing psychiatric patients who were recovering from mental illness, especially from psychosis, to allow nurses to understand these patients’ experiences. Because psychiatric patients are vulnerable, their participation in research involves ethical dilemmas, such as voluntary consent, legal capacity to consent, freedom of choice, and sufficient knowledge and comprehension. The first part of this article describes the most important ethical guidelines concerning human research. These have been published by different organizations, departments, committees and commissions for the purpose of protecting human rights and dignity whenever research participants are vulnerable persons or their capacity to consent is limited. At present, however, no special regulations govern research involving adults who have been diagnosed with a condition characterized by mental impairment. Furthermore, a relatively small body of research has documented the effects of various disorders (e.g. psychiatric conditions) on decision-making capacity per se. One basic moral and policy question is whether these individuals should ever be involved in research. The second part of this article concentrates on how the investigator made sure that participating patients had understood their role in this particular piece of nursing research. During the interviews the investigator noticed that some ethical dilemmas required further study and debate because of the lack of consensus on the proposed regulatory provisions on research involving institutionalized persons and their ability to make an informed and voluntary decision.
Ethical Issues in Rural Nursing Practice in Botswana
Authors: Akinsola Henry A
Published: November 2006

The concern for ethical principles and values is not limited to health professionals alone. However, ethical principles in nursing act as safety valves for social control to prevent professional misconduct and abuse of the rights of clients. As a result of colonial experience, developing countries like Botswana usually follow the European lead, especially examples from the UK. This article examines the ethical problems and dilemmas associated with rural nursing practice in Botswana, a developing country in sub-Saharan Africa. The major ethical problems identified are related to the distribution of and access to health resources in rural communities. It is proposed that nurses must assume responsibility in the field of access and allocation by working collaboratively with governments and other professional bodies, and that nurses as a global community must work together as a team to support each other.
An Analysis of How The Irish Times Portrayed Irish Nursing During the 1999 Strike
Authors: Clarke Jean , O’Neill Catherine S
Published: November 2006

The aim of this article is to explore the images of nursing that were presented in the media during the recent industrial action by nurses and midwives in the Republic of Ireland. Although both nurses and midwives took industrial strike action, the strike was referred to as ‘the nurses’ strike’ and both nurses and midwives were generally referred to by the generic term ‘nurses’.

Data were gathered from the printed news media of The Irish Times over a period of one month - 4 October to 4 November 1999 - which included the nine days of the strike. Although we limited the source of our data to just one newspaper, the findings do provide an image of how nurses and nursing care are viewed by both health professionals and the public. This image appeared to give a higher value to masculine cultural codes and the performance of technical skills, whereas acts associated with feminine cultural codes of caring were considered of lower value.
Needs During Hospitalization: definitions and descriptions made by patients
Authors: Hallström Inger , Elander Gunnel
Published: November 2006

Patients are supposed to be given care according to their needs. This concept is, however, difficult to define and patients and caregivers may have different opinions about a patient’s needs. Twenty patients were interviewed and asked to give a definition of need, describe their needs while hospitalized and depict what they do to make sure their needs are fulfilled. Ten groups of needs were identified: communication, basic care, contact with other people, behaviour of staff, empathy, competent caregivers, continuity, integrity, participation in decision making, and pain relief. The descriptions patients gave of how they ensured their needs were met could be divided into two groups: openly seeking attention; or not wanting to disturb the staff. Interviews with patients emphasized the importance of recognizing that they have individual needs and varying abilities to see that their needs are fulfilled.
Nursing Students’ Experience of Ethical Problems and Use of Ethical Decision-Making Models
Authors: Cameron Miriam E , Schaffer Marjorie , Park Hyeoun-Ae
Published: November 2006

Using a conceptual framework and method combining ethical enquiry and phenomenology, we asked 73 senior baccalaureate nursing students to answer two questions: (1) What is nursing students’ experience of an ethical problem involving nursing practice? and (2) What is nursing students’ experience of using an ethical decision-making model? Each student described one ethical problem, from which emerged five content categories, the largest being that involving health professionals (44%). The basic nature of the ethical problems consisted of the nursing students’ experience of conflict, resolution and rationale; 85% of the students stated that using an ethical decision-making model was helpful. Although additional research is needed, these findings have important implications for nursing ethics education and practice.
Satisfying Patients’ Rights: a hospital patient survey
Authors: Merakou Koula , Dalla-Vorgia Panagiota , Garanis-Papadatos Tina , Kourea-Kremastinou Jeny
Published: November 2006

The aim of this project was to study the way in which patients’ rights are being exercised in everyday hospital practice in Greece. Data were collected by using questionnaires and structured interviews with 600 patients.

These patients were found to ignore the fact that special regulations exist regarding their rights. They considered their right to information was being respected, albeit to different degrees. Many patients allowed their doctors to make decisions. The right to confidentiality was not considered as a major priority by these patients because they doubted its applicability. They hesitated to protest when their rights were being violated. They thought that the most effective way of protecting their rights is either through the existence of someone with specialized knowledge or an internal hospital committee.

These Greek patients appeared to be relatively satisfied with the way in which their rights were being exercised in hospital. However, a number of improvements could increase patient satisfaction regarding this issue.
Patient Autonomy and Medical Paternity: can nurses help doctors to listen to patients?
Authors: Breier-Mackie Sarah
Published: November 2006

Nurses are increasingly faced with situations in practice regarding the prolongation of life and withdrawal of treatment. They play a central role in the care of dying people, yet they may find themselves disempowered by medical paternalism or ill-equipped in the decision-making process in end-of-life situations. This article is concerned with the ethical relationships between patient autonomy and medical paternalism in end-of-life care for an advanced cancer patient. The nurse’s role as the patient’s advocate is explored, as are the differences between nursing and medicine when confronted with the notion of patient autonomy. The impetus for this discussion stems from a clinical encounter described in the following scenario.
Deprivation of Liberty in Psychiatric Treatment: a Finnish perspective
Authors: Välimäki Maritta , Taipale Johanna , Kaltiala-Heino Riittakerttu
Published: November 2006

This article is concerned with the deprivation of patients’ liberty while undergoing psychiatric treatment, with special reference to the situation in Finland. It is based on a review of Finnish law, health care statistics, and empirical and theoretical studies. Relevant research findings from other countries are also discussed. In Finland, it is required that patients are cared for by mutual understanding with themselves; coercive measures may be applied only if they are necessary for the treatment of the illness, or for safeguarding patients’ safety or the safety of others. Involuntary psychiatric hospitalization is closely regulated by the Mental Health Act. However, the rules concerning the deprivation of liberty during inpatient treatment (by seclusion, restraint and restricted leave) are formulated in very general terms. Therefore, Finnish psychiatric hospitals have their own policies concerning when and how seclusion may be used. The practice of seclusion and the use of restraint therefore vary among the psychiatric hospitals in Finland.
A Model of Consolation
Authors: Norberg Astrid , Bergsten Monica , Lundman Berit
Published: November 2006

Consolation is needed when a human being suffers (i.e. feels alienated from him-or herself, from other people, from the world or from his or her ultimate source of meaning). The aim of this study was to illuminate the meaning of consolation. Tape-recorded narrative interviews were carried out with 18 professionals from various spheres. The transcribed interviews were interpreted hermeneutically. A model of consolation is outlined in a drawing. It states that the mediator and the receiver of consolation must become ready for consolation before it can take place. To be ready means to be present and available. Availability means expressing suffering and listening respectively, and thereby opening up for communion and consoling dialogue. Communion brings about contact with the sacred dimension that human beings share and thus with goodness, light, joy, beauty and life. Consolation involves a shift of perspective and an experience of meaning in spite of suffering.
Philosophical Counselling
Authors: Savage Peter
Published: November 2006

Philosophical counselling is an approach that aims to assist people to deal with life events in an effective manner. As such, it is of interest to nurses who are concerned with helping clients who require assistance effectively to manage life events. The approach utilizes both ancient and contemporary philosophical promises and theories. On the promise side, it offers the belief that philosophy can be concerned with providing answers to the question of how people ought to live a good or healthy life. On the theory side, it offers the belief that philosophical inquiry and theory can help people towards such answers. Thus the theory and practice of philosophical counselling is relevant to nurses whose practice aims to promote in their clients a good or healthy lifestyle.

The practice of philosophical counselling, in a substance abuse centre, will be explored to demonstrate the theory and methods of the approach.
Immoral Behaviour in Medicine
Authors: Carmon Pnina , Tabak Nili
Published: November 2006

The purpose of this paper is to emphasize a social phenomenon that exists in Israel: immoral medicine.

In recent years, nurses have been exposed to many instances of immoral medicine in hospitals. We want to protest about the demands for money from patients who are waiting for surgical intervention, arouse the medical community’s conscience concerning these immoral activities, and improve professional and moral behaviour.
Reflective Practice: Decoding Ethical Knowledge
Authors: Durgahee Taleb
Published: November 2006

This article analyses reflective practice by exploring ethical knowledge-in-use and the influence of context on professional nursing practice. Is ethical knowledge used in an appropriate context? The author identifies and discusses the theoretical underpinnings of reflective practice and offers an alternative paradigm to the generation and use of ethical knowledge in practice. The message to teachers and practitioners is decoded to facilitate teaching and learning.
A Right to Strike?
Authors: Jennings Karen , Western Glenda
Published: November 2006

During 1995, there was a major shift in the United Kingdom in the debate of whether it is right for nurses to strike. The Royal College of Nursing, the former advocate of a non-industrial action policy, moved towards the UNISON position that industrial action is ethical in some circumstances, as well as the necessary thing to do. The authors, both nurses and UNISON officials, look at the reasons for this change and why UNISON’s historical position sees industrial action as an effective weapon in defending services, as well as wages and jobs. It can be right to strike.
Strikes - an Appropriate Action for Health Care Employees? a personal perspective
Authors: Benn-Rohloff Nicole
Published: November 2006

In this article I would like to express my personal ideas and points of view about strike action, which I think many colleagues will share. I am a qualified paediatric nurse, currently working in the central operating theatre of a university hospital in Germany. At the same time, I am also finishing my studies in health care sciences. Apart from two short protest strikes, I have not taken part in any strike, because there have not been any during my whole professional career at the hospitals where I have worked. I am personally deeply convinced that strikes are important and are a good and useful tool, in particular to protest against ‘rationalizations’, which so far have led only to lower salaries and fewer jobs for nurses, and have brought no improvement in the conditions for staff or patients.
Ethical Issues Experienced by HIV-Infected African-American Women
Authors: Smith Katharine V , Russell Jan
Published: November 2006

The epidemic of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has led to many ethical problems. Most studies have focused on the ethical issues faced by nurses who provide care to persons with AIDS (PWA), rather than the ethical issues faced by PWAs themselves. The purpose of this study, therefore, was to explore the ethical issues faced by five HIV/AIDS-infected African-American women. An analysis of interview data revealed that these women deal with four broad categories of ethical issues: diagnosis; disclosure; treatment by, and of, others; and future pregnancies. The results of this study provide an initial description of the ethical issues faced by HIV/AIDS-infected African-American women, and begin to lay the foundation necessary for nurses appropriately to facilitate and support their decisions.
Patients’ Rights in Laboratory Examinations: do they realize?
Authors: Leino-Kilpi Helena , Nyrhinen Tarja , Katajisto Jouko
Published: November 2006

This article discusses the rights of patients who are attending hospital for the most common laboratory examinations and who may also be taking part in research studies. A distinction is made between five kinds of rights to: protection of privacy, physical integrity, mental integrity, information and self-determination. The data were collected ( n = 204) by means of a structured questionnaire specifically developed for this study in the clinical chemistry, haematological, physiological and neurophysiological laboratories of one randomly selected university hospital in Finland. The analysis of the data was statistical. On the whole, patients’ rights were realized reasonably well. This was most particularly the case with protection of privacy, as well as with the rights of physical and mental integrity. The rights to information and self-determination were less well realized. There are various steps that health care professionals and organizations can take to make sure that patients can enjoy their full rights, by counselling the patient, by giving opportunities to plan the examinations in advance, and by arranging a sufficient number of small examination rooms.
The Human Condition of the Professional: discretion and accountability
Authors: Hunt Geoffrey
Published: November 2006

This article takes issue with procedural reductionism, which is the inclination to reduce all matters of judgement and responsibility to the following of some procedure or rule. Two scenarios provide content for a discussion of professional discretion in the context of accountability. The author shows that in professional life there will always be situations that stand beyond the rules of procedures and require the unique judgement of the professional at the time. While this judgement may be determined by the facts available in a situation of uncertainty, it cannot be reduced to the facts (including facts about rules and procedures). The moral judgement will still have an essential indeterminancy about it.
Emotional and Motivational Tendencies: the key to quality nursing care?
Authors: Glen Sally
Published: November 2006

The question of how to improve the quality of nursing care is quite properly perceived to be at the heart of the contemporary nursing debate. Yet it is not clear what quality in health care is; nor is it clear what quality nursing care is. This article will explore why quality issues are such a matter of concern in public and political debate and how different concepts of quality determine different definitions of nursing. The former definitions constitute a developmental continuum of nursing from minimally acceptable levels of competence to excellence. It is argued that the quality of nursing cannot be assessed in terms of performance referenced criteria, but only in terms of the personal qualities displayed in the performance. The key to improvement in practice may be the improvement of emotional and motivational tendencies. In essence, professional development implies personal development.
Self-Perception and Value System as Possible Predictors of Stress
Authors: Sivberg Bengt
Published: November 2006

This study was directed towards personality-related, value system and sociodemographic variables of nursing students in a situation of change, using a longitudinal perspective to measure their improvement in principle-based moral judgement (Kohlberg; Rest) as possible predictors of stress. Three subgroups of students were included from the commencement of the first three-year academic nursing programme in 1993. The students came from the colleges of health at Jönköping, Växjö and Kristianstad in the south of Sweden. A principal component factor analysis (varimax) was performed using data obtained from the students in the spring of 1994 ( n = 122) and in the spring of 1996 ( n = 112). There were 23 variables, of which two were sociodemographic, eight represented self-image, six were self-values, six were interpersonal values, and one was principle-based moral judgement.

The analysis of data from students in the first year of a three-year programme demonstrated eight factors that explained 68.8% of the variance. The most important factors were: (1) ascendant decisive disorderly sociability and nonpractical mindedness (18.1% of the variance); (2) original vigour person-related trust (13.3% of the variance); (3) orderly nonvigour achievement (8.9% of the variance) and (4) independent leadership (7.9% of the variance). (The term ‘ascendancy’ refers to self-confidence, and ‘vigour’ denotes responding well to challenges and coping with stress.) The analysis in 1996 demonstrated nine factors, of which the most important were: (1) ascendant original sociability with decisive nonconformist leadership (18.2% of the variance); (2) cautious person-related responsibility (12.6% of the variance); (3) orderly nonvariety achievement (8.4% of the variance); and (4) nonsupportive benevolent conformity (7.2% of the variance). A comparison of the two most prominent factors in 1994 and 1996 showed the process of change to be stronger for 18.2% and weaker for 30% of the variance.

Principle-based moral judgement was measured in March 1994 and in May 1996, using the Swedish version of the Defining Issues Test and Index P. The result was that Index P for the students at Jönköping changed significantly (paired samples t-test) between 1994 and 1996 ( p = 0.028), but that for the Växjö and Kristianstad students did not. The mean of Index P was 44.3% at Växjö, which was greater than the international average for college students (42.3%); it differed significantly in the spring of 1996 (independent samples t-test), but not in 1994, from the students at Jönköping ( p = 0.032) and Kristianstad ( p = 0.025). Index P was very heterogeneous for the group of students at Växjö, with the result that the paired samples t-test reached a value close to significance only.
An Enquiry into a Combined Approach for Nursing Ethics
Authors: Lipp Allyson
Published: November 2006

A definitive theory for ethical decision making in nursing is still only conjecture. The literature confirms that there have been numerous examinations of ethical decision making in nursing, with most proposing either the justice or the care orientation, or a combination of both.

In the absence of a definitive theory, this exploratory work sets out, via grounded theory, to shed some light on the methods used every day by nurses to make ethical decisions in the clinical area. The data show that some factors, such as doctors, colleagues and the organization, profoundly influence ethical decision making. The informants used both care and justice to formulate decisions, which is known as the combined approach. As a result of these findings, this article concludes with tentative suggestions and recommendations for practice.
Racism and its Implications in Ethical-Moral Reasoning in Nursing Practice: a tentative approach to a largely unexplored topic
Authors: Shaha Maya
Published: November 2006

Nursing as a profession seems to avoid considering the problem of racism. There is, however, a need to address this topic and to evaluate its implications for nursing practice. This article attempts to establish a rationale for nursing to address racism and introduce it into academic discourse. The results of a small-scale study by the author are analysed and the implications for ethical-moral reasoning in nursing practice are discussed in relation to professional codes of conduct developed by nurses’ professional organizations in the UK and elsewhere.
Communication Breakdown or Ideal Speech Situation: the problem of nurse advocacy
Authors: Martin Geoffrey W
Published: November 2006

The issue of advocacy has dominated discussion of the ethical dilemmas facing nurses. However, despite this, nurses seem to be no further towards a solution of how they can be effective advocates for patients without compromising their working identity or facing conflicts of loyalty. This article considers some of the problems around advocacy and, by the use of critical incidents written by nurses involved in a diploma module, attempts to highlight where the problem could lie. A communications model is outlined, using a theoretical framework taken from the work of Jürgen Habermas, and applied to nursing practice. Finally, two examples are given from the research, which illustrate how the model could be used, highlighting the problems and pitfalls that still have to be overcome. The conclusion is a positive one, in that it suggests that advocacy is possible if nurses re-examine their practice in the light of the model proposed.
Comment
Authors: Wilkinson John
Published: November 2006

A recent article published in Nursing Ethics, written by Professor Bridgit Dimond, highlighted the topic of noncompliance by patients and attention was drawn to a number of issues relevant to health care professionals. In this response, some specific challenges facing nurses are considered in the light of Professor Dimond’s arguments. In doing so, the notion of compliance as an appropriate concept in modern nursing practice is questioned. The recommendations to emerge include strategies to consider patient response to treatment regimens in the form of adherence to health care advice through negotiated therapy. The claimed benefits of health care recommendations are considered and caution about iatrogenesis is advised.
Ethical Issues for Neonatal Nurses
Authors: Spence Kaye
Published: November 2006

This article examines the involvement of neonatal nurses in ethical issues, achieved through a survey of Australian neonatal nurses. The aim was to discover if nurses were involved in ethical decisions, to examine various categories of neonates and the concerns that nurses felt about them, and to determine the extent to which nurses saw themselves as advocates. A response rate of 65% was achieved from nurses in two states who worked in intensive care and special care nurseries. The findings show that nurses were more likely to be involved in clinical decision making than in ethical decision making, showed the greatest concern for infants who had an uncertain prognosis, and saw themselves as advocates for their patients. The issues surrounding these findings are examined.
Ethics in Health Care Management: developing an instrument to assess humane caring
Authors: Töyry Eeva , Herve Ritva , Mutka Riitta , Savolainen Pirkko , Seppänen Marja
Published: November 2006

The care of patients should be professional, human and humane. This is an ethical issue. The words human (inhimillinen) and humane (ihmisläheinen) have different meanings in the Finnish language. At Kuopio University Hospital (1200 beds), in Finland, it was decided to provide patients with professional and humane caring. Ethical values differ for different groups of people. Therefore humane caring was assessed by questioning both hospital patients ( n = 160) and staff ( n = 196). The data were subjected to content analysis. The result was that the values obtained for both patients and staff were similar. Five descriptive categories of humane caring emerged. To discover what kind of caring was provided for patients, the categories were operationalized into 66 criteria and a questionnaire was drawn up on the basis of these criteria.

The data for evaluation of the quality of caring were collected from patients ( n = 1708). The data were analysed using cross-tabulations and the chi-squared test; sum variables were calculated for the five standards. The results suggest that special attention should be paid to vulnerable patient groups (e.g. the elderly and the young). One means of ethical management is to support our staff to care more humanely by discussing with them the results of this study, setting standards and criteria for humane caring and what this means in practice. It is hoped our caring will therefore be more humane.