Nursing Ethics

In China, the conventional family-based ageing care model is under pressure from social transitions, raising the question of whether and to what extent families are still capable of dealing with the care of the aged.

This article examines the vulnerability and inadequacy of families to bear responsibility for the care of the aged against a backdrop of socioeconomic transformation and diminishing institutional support in rural China.

This article adopts an empirical ethical approach that integrates empirical investigation with ethical inquiry.

The empirical component of this article focuses on the lived experiences of caring for a wife and mother with dementia in one rural Chinese family, collected from a 6-month fieldwork study conducted at one primary hospital.

Approval was obtained from the university ethics committee.

The empirical study highlights a conflicted family process of managing and negotiating care that indicates the inadequacies and limited ability of families to deal with aged care tasks. In addition, inadequate structures and institutional deficiencies exacerbate the vulnerability of rural families and their inability to offer adequate care.

Acknowledging the vulnerability of families as ageing care providers, this article calls for a socially supported family care model for rural older people in China and also proposes policy recommendations.

Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff.

The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events.

A hermeneutic-phenomenological qualitative study was performed.

Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim.

Ethical approval was obtained from the Institutional Review Hospital Board.

Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured.

In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients’ last requests. According to our findings, the concept of ‘good’ end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events.

Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.

Family presence during invasive procedures and cardiopulmonary resuscitation (FPDR) is a highly controversial issue, with divergence of opinion among health professionals, with clinical evidence in favor, and with barriers to its implementation in comprehensive patient care. Many international organizations support health policies for its implementation, but it is not a widespread practice. Little research has been conducted on this subject from the perspective of patients and families.

To learn opinions, perceptions, and desires of family members and patients in terms of family presence during invasive procedures and cardiopulmonary resuscitation.

Qualitative descriptive study, using semi-structured interviews with relatives and patients regarding their experiences and perceptions about FPDR (n = 18) from 8 October 2017 to 8 March 2018. The interviews were recorded and transcribed verbatim for later analysis using the method of content analysis.

This study has the approval of the Clinical Research Ethics Committee of the Fundació Unió Catalana d’Hospitals and ethical considerations were carefully regarded throughout the study.

Three significant categories were identified: knowledge, respect for rights, and accompaniment of the patient, relating FPDR to courage, emotional support, and trust in professionals.

FPDR is an unusual practice; it is not offered to patients or their families, and it is not considered a patient’s right, although most of the interviewees support it. The desire for accompaniment is conditioned by the courage and knowledge of the accompanying persons, as well as the degree of invasiveness of the procedures. The results of this study provide information for a change of vision in patient-centered care.

It is stated that the communication and disease experiences of paediatric patients, especially paediatric oncology patients, with healthcare professionals are completely different from those of adults.

The aim of this study was to determine the definitions of a good physician and good nurse provided by elementary school-age oncology patients.

In this qualitative research, data were collected through semi-structured individual interviews. The data were evaluated thorough thematic analysis.

Eighteen children hospitalised due to cancer in paediatric oncology and haematology clinics of a university hospital in Turkey.

Permission to conduct the study was obtained from the Institution’s Ethics Committee. The objectives of this study were explained to the participants and families, and written consent was obtained from them. Also, participants were assured that necessary measures would be taken to protect their anonymity and confidentiality.

The definitions of children were based on five main themes: interpersonal relationships, virtues, professional responsibility, security and individual characteristics.

Children conveyed important messages to health professionals. They emphasised that a good physician and good nurse should communicate well, not only with themselves but also with their family. In addition, children were sensitive about health professionals who played with them and actively participated in the treatment by informing them about the disease. Meeting the expectations of children can be possible by improving the communication skills of physicians and nurses and by adding games and activities to the treatment and care plan.

Legal assisted dying is a rare event, but as legalisation expands, requests for it will likely increase, and the nurse most often receives the informal, initial request.

To assess the effects of attitude in interaction with normative and control beliefs on an intention to respond to a request for legal assisted dying.

The study had the lead author’s institutional ethics approval, and participants were informed that participation was both anonymous and voluntary.

This was a cross-sectional correlational study of 377 Australian registered nurses who completed an online survey. Generalised linear modelling assessed the effects of independent variables against intended responses to requests for legal assisted dying.

Compared to nurses who did not support legal assisted dying, nurses who did had stronger beliefs in patient rights, perceived social expectations to refer the request and stronger control in that intention. Nurses who did not support legal assisted dying had stronger beliefs in ethics of duty to the patient and often held dual intentions to discuss the request with the patient but also held an intention to deflect the request to consideration of alternatives.

This study advances the international literature by developing quantified models explaining the complexity of nurses’ experiences with requests for an assisted death. Attitude was operationalised in interaction with other beliefs and was identified as the strongest influence on intentions, but significantly moderated by ethical norms.

The complex of determinants of those intentions to respond to requests for an assisted death suggests they are not isolated from each other. Nurses might have distinct intentions, but they can also hold multiple intentions even when they prioritise one. These findings present opportunities to prepare nurses in a way that enhances moral resilience in the face of complex moral encounters.

Moral distress is a significant concern for nurses as it can lead to burnout and intentions to leave the profession. Pediatric nurses encounter stressful and ethically challenging situations when they care for suspected victims of child maltreatment. Data on pediatric nurses’ moral distress are limited, as most research in this field has been done in adult inpatient and intensive care units.

The purpose of this study was to describe pediatric nurses’ moral distress and evaluate the impact of caring for suspected victims of child maltreatment on nurses’ moral distress, burnout, and intention to leave. Design and method: This descriptive cross-sectional correlational study was conducted in a mid-Atlantic, urban area Magnet pediatric level I trauma center that cares for over 1800 cases of suspected child maltreatment annually. An anonymous electronic survey was sent to all the nurses working at the hospital.

Institutional Review Board approval was received from the first author’s university and the hospital where the study was conducted.

Overall, nurses (N = 146) reported low levels of moral distress with a mean score of 59.54 (SD = 49.22) and a range of 0–300 on the Moral Distress Scale Neonatal–Pediatric version. Although the frequency of caring for suspected child maltreatment victims did not affect nurses’ moral distress, caring for victims with fatal maltreatment contributed to nurses’ intention to leave, χ² (1) = 5.35, p = 0.02.

The results of this study add to the understanding of moral distress in pediatric nursing. Caring for victims with fatal maltreatment impacts pediatric nurses’ intention to leave.

The therapeutic itinerary is not limited to the identification and availability of health services offered, but relates to the different individual searches and sociocultural and economic possibilities of each patient. In this study, we discuss the therapeutic itinerary of transsexual people seeking healthcare, from the user’s perspective.

The aim of this study was to discuss the therapeutic itinerary of transsexual people seeking healthcare, from the user’s perspective.

Individual interviews were performed with 10 transsexuals at the Trans Space of a University Hospital of Pernambuco, using the Universal Declaration of Human Rights as the theoretical reference and the Bardin’s thematic content analysis as the reference methodological framework.

This study was approved by the Human Research Ethics Committee at the Federal University of Pernambuco under protocol no. 91284218.5.0000.5208.

The comprehensive care for transsexual people was evidenced through four categories analyzed: low demand of transsexuals in health services; use of social name in health services; care permeated by prejudiced and discriminatory attitudes; and health system and professionals who are not able to meet transgender health issues.

Transsexual people are stigmatized and experience prejudice in their daily health, in a way they do not enjoy fundamental rights, as if they had fewer rights, or infringe the principle of universality of access to health. Thus, for effective and comprehensive care, the health team must keep up to date on the public policies existing in the healthcare of transsexual people and reconstruct what they understand by gender.

Knowledge about the therapeutic itinerary of transgender people may support evaluation processes of health service networks to ensure the access to and reorganization of these services. Understanding this dynamic allows fostering discussions about the structure of health services at all care levels for the care of this population.

Nursing turnover is a very serious problem, and nursing managers need to be aware of how ethical climates are associated with turnover intention.

The article explored the effects of ethical climates on nurses’ turnover intention, mediated through trust in their organization.

A cross-sectional survey of 285 nurses from three Indian hospitals was conducted to test the research model. Various established Likert-type scales were used to measure ethical climates, turnover intention and trust in organization. Hierarchical regression analysis and mediation analysis were used to test the model.

Hierarchical regression analysis and mediation analysis were used to test the model. The indirect effect of benevolent ethical climate on turnover intention through trust in organization was –0.20 with a 95% bootstrap confidence interval of lower level = –0.31 and upper level = –0.01. The indirect effect of principled ethical climate on turnover intention through trust in organization was –0.39 with a 95% bootstrap confidence interval of lower level = –0.58 and upper level = –0.17.

The study adheres to the ethical standards recommended by the American Psychological Association for conducting research with informed consent, confidentiality and privacy.

Both benevolent and principled ethical climates decreased turnover intention indirectly through trust in organization. Only principled ethical climates were directly associated with turnover intention. Our results suggest that nurse managers and leaders should try and establish principled and benevolent climates in order to engender trust in organization and to reduce turnover intention.

Vulnerability is a concept frequently encountered in the bioethical literature, particularly in the context of research ethics. It can be said that the usage of the concept expanded in the 2000s and started to be used in many new contexts in the literature. However, there appears to be no systematic review that examines the definition of the concept of vulnerability.

The rationale for this study constitutes the questions regarding how vulnerability is defined and which components are used to define the concept of vulnerability in the bioethics literature.

The integrative review method was conducted to reach various definitions of the concept of vulnerability in bioethics. Whittemore and Knafl’s revised framework for integrative reviews guided the analysis. ‘Vulnerability’ and ‘vulnerable’ keywords, intercrossing with the words ‘bioethics’ and ‘medical ethics’, were searched in three different databases (PubMed, Web of Science and Scopus). Collected data were analysed thematically and a taxonomy was developed.

A total of 1287 studies obtained through search were reduced to 123 that kept the definition of vulnerability. As a result of the review, a comprehensive taxonomy of vulnerability has been proposed. The proposed taxonomy of vulnerability has two categories, ontological and circumstantial, with three subcategories each, which might provide a multidimensional perspective.

Publication dates, origins and contexts of included publications were discussed. Specifications of the term vulnerability and components of its definition and factors that constitute these components provided from the view were evaluated and also discussed.

The proposed taxonomy provides a useful classification for assessing vulnerability in bioethics. It is hoped that the taxonomy we put forward as a result of the review will increase awareness on the issue and also take into account the factors that create vulnerability in the context of research, healthcare and nursing care policies.

The review was conducted in accord with ethical and scientific standards.

Moral courage as a part of nurses’ moral competence has gained increasing interest as a means to strengthen nurses acting on their moral decisions and offering alleviation to their moral distress. To measure and assess nurses’ moral courage, the development of culturally and internationally validated instruments is needed.

The objective of this study was to validate the Dutch-language version of the four-component Nurses’ Moral Courage Scale originally developed and validated in Finnish data.

This methodological study used non-experimental, cross-sectional exploratory design.

A total of 559 nurses from two hospitals in Flanders, Belgium, completed the Dutch-language version of the Nurses’ Moral Courage Scale.

Good scientific inquiry guidelines were followed throughout the study. Permission to translate the Nurses’ Moral Courage Scale was obtained from the copyright holder, and the ethical approval and permissions to conduct the study were obtained from the participating university and hospitals, respectively.

The four-component 21-item, Dutch-language version of the Nurses’ Moral Courage Scale proved to be valid and reliable as the original Finnish Nurses’ Moral Courage Scale. The scale’s internal consistency reliability was high (0.91) corresponding with the original Nurses’ Moral Courage Scale validation study (0.93). The principal component analysis confirmed the four-component structure of the original Nurses’ Moral Courage Scale to be valid also in the Belgian data explaining 58.1% of the variance. Confirmatory factor analysis based on goodness-of-fit indices provided evidence of the scale’s construct validity. The use of a comparable sample of Belgian nurses working in speciality care settings as in the Finnish study supported the stability of the structure.

The Dutch-language version of the Nurses’ Moral Courage Scale is a reliable and valid instrument to measure nurses’ self-assessed moral courage in speciality care nursing environments. Further validation studies in other countries, languages and nurse samples representing different healthcare environments would provide additional evidence of the scale’s validity and initiatives for its further development.

Predatory publishing poses a fundamental threat to the development of nursing knowledge. Previous research has suggested that authors of papers published in predatory journals are mainly inexperienced researchers from low- and middle-income countries. Less attention has been paid to contributors from high-income countries.

To describe the prevalence and characteristics of Swedish authors publishing in predatory nursing journals.

Quantitative descriptive case study.

Descriptive statistics were used to analyse the academic positions and academic affiliations of the authors of 39 papers published in predatory nursing journals during 2018 and 2019. Predatory nursing journals with Swedish contributors were identified by searching public listings of papers and applying a set of criteria. Journal site archives were used to identify additional papers with Swedish authors.

This study was conducted in accordance with national regulations and ethical principles of research.

Almost two-thirds of Swedish authors publishing in predatory nursing journals hold senior academic positions. A small group of higher education institutions account for a majority of academic affiliations. Findings suggest that higher education institutions and experienced nursing researchers from Sweden make substantial contributions to predatory nursing journals, but that predatory publication habits might be concentrated in a limited number of academics and research milieus. A year-to-year comparison indicates that the prevalence of publishing in predatory journals might be diminishing.

Swedish nurse researchers help legitimize predatory journals, thus jeopardizing the trustworthiness of academic nursing knowledge. Substandard papers in predatory journals may pass as legitimate and be used to further academic careers. Experienced researchers are misleading junior colleagues, as joint publications might become embarrassments and liabilities.

While the academic nursing community needs to address the problem of predatory publishing, there is some hope that educational efforts might have an effect on combating predatory publishing in nursing.