Nursing Ethics - Volume 29, Number 7-8

Volume 29, Issue 7-8, December 2022

Select all

Editorial
Available accessEditorialFirst published December, 2022pp. 1547-1548
Laughter and humour in nursing: A matter of ethics?
Bernadette Dierckx de CasterléLinus Vanlaere
Other
Available accessOtherFirst published December, 2022pp. 1549-1552
Citations for the Human Rights and Nursing Awards 2022
Research article
Available accessResearch articleFirst published December, 2022pp. 1553-1561
Empowerment as an alternative to traditional patient advocacy roles
Clare ColeORCIDJane MummeryBlake Peck
Abstract
There has long been acceptance within healthcare that one of the roles that nurses fulfil is to do with patient advocacy. This has historically been positioned as part of the philosophical and inherent requirements of the nursing profession at large and is supported through shared conceptualisations of the nursing profession. Such conceptualisations are communicated to nursing professionals by way of first their education, and second their professional codes, guidelines and standards for practice. The focus on advocacy is further embedded within patient-centred care frameworks and concepts of the nurse–patient therapeutic relationship. Nurses have also been considered ideally placed to undertake the work of patient advocacy due to the 24/7 nature and intimacy of the care provided. What this means is that nurses are under the impression that that they must be an advocate for their patients through their nursing practice. However, for a fundamental concept of nursing, advocacy is poorly defined, and practices commonly associated with advocacy are undercut by the professionalisation of nursing and other constraints. In addition, nursing standards and frameworks of care are being actively reframed around ideas of empowerment which do not necessarily fit well with those of advocacy. This article thus suggests that it is time to recognise that the work of advocacy is no longer representative of what nurses (can) do in practice, and to explicitly reorient conceptualisations of nurse practice around empowerment. This article will further analyse what this may look like in practice.
Research article
Open accessResearch articleFirst published December, 2022pp. 1562-1577
CURA: A clinical ethics support instrument for caregivers in palliative care
Suzanne MetselaarORCIDMalene van SchaikGuy Widdershoven
View All
Abstract
This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss how a case was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA.
Research article
Open accessResearch articleFirst published December, 2022pp. 1578-1588
Towards democratic institutions: Tronto’s care ethics inspiring nursing actions in intensive care
Annie-Claude LaurinORCIDPatrick MartinORCID
Abstract
Care as a concept has long been central to the nursing discipline, and care ethics have consequently found their place in nursing ethics discussions. This paper briefly revisits how care and care ethics have been theorized and applied in the discipline of nursing, with an emphasis on Tronto’s political view of care. Adding to the works of other nurse scholars, we consider that Tronto’s care ethics is useful to understand caring practices in a sociopolitical context. We also contend that this vision can be used specifically to politicize nurses, by encouraging them to think critically about the context in which they work and how they can participate to change the status quo, notably by prompting the democratization of care in institutional settings. We illustrate this by demonstrating how moral distress that can occur with aggressive or futile treatments in the intensive care unit can be reduced if nurses are systematically included in the decision-making process. By showing some ways in which nursing political actions can begin to change the status quo as it pertains to futile treatments at the end of life, we can help empower nurses to strive to be included in political spaces and voice their concerns to have their professional needs met.
Research article
Available accessResearch articleFirst published December, 2022pp. 1589-1599
Is deception defensible in dementia care? A care ethics perspective
Yuanyuan HuangORCIDHui LiuYali Cong
Abstract
Deception is common in dementia care, although its moral legitimacy is questionable. This paper conceptually clarifies when does dementia care involve deception and argues that care ethics is an appropriate ethical framework to guide dementia care compared with the mainstream ethical theories that emphasize abilities. From a perspective of care ethics, this paper claims that morally defensible deception is context-specific, embodied as a caring process that needs to be identified through instant, creative and interactive care procedures. According to this argument, it further analyses and concludes the moral rationality of deception in five common cases. While deception is morally justified in many situations, another concern is that it is usually not the last resort but a means of convenience. As the ability to interact, autonomy and dignity of persons with dementia (PWDs) are generally ignored; nurses need more training and education to master the essential procedures to ensure that the value of authenticity and autonomy is maintained and considered throughout dementia care.
Research article
Open accessResearch articleFirst published December, 2022pp. 1600-1614
Dignity at stake in educational relations - The significance of confirmation
Tone StikholmenORCIDDagfinn NådenHerdis Alvsvåg
Abstract
Introduction
It is a goal in nursing education to promote students’ dignity and facilitate this core value. Students’ experience of dignity is shaped by the student–supervisor relationship. Literature shows limited knowledge about how nursing students experience their own dignity during education.
Research aim
The aim of the study is to develop an understanding of how nursing students experience their own dignity in relation to supervisors, and what significance these experiences have in education.
Research design
Gadamer’s philosophical hermeneutics was chosen as the approach, and narratives and qualitative interviews were conducted. The interpretation process was inspired by Fleming, Gaidys and Robbs.
Participants and research context
Nineteen nursing students in the final year of their education were included in the study. They represented six different campuses at three different educational institutions. The qualitative interviews took place at the educational institutions.
Ethical considerations
The research recommendations of the Declaration of Helsinki were followed. Access to the students was given by the educational institutions. All interested students signed a continuous informed consent.
Findings
Students’ dignity was at stake in encounters with supervisors during education. Decisive for experience of dignity was the supervisor’s ability to confirm the student through acknowledgment, reassurance and seeing them as individuals. Experienced dignity had a crucial impact on students’ life courage and their ability to be present.
Discussion
The discussion emphasizes the vulnerable dignity of students, the importance of confirmation and the significance perceived dignity has.
Conclusion
Students’ experiences tilted between perceived dignity and offense, and placed students’ dignity in a vulnerable position. Crucial for perceived dignity was the confirmation the students received from their supervisors. Perceived dignity gave the students courage and increased their ability to be present, which provided better opportunities for learning and development.
Research article
Available accessResearch articleFirst published December, 2022pp. 1615-1633
Nurses' attitudes toward,perceptions of,and experiences with conscientious objection
Seyhan Demir KarabulutORCIDŞenay GülORCIDŞükrü KeleşORCID
View All
Abstract
Background
Conscientious objection is a person’s refusal to fulfill a legal duty due to their ethical values, religious beliefs, or ideological affiliations. In nursing, it refers to a nurse’s refusal to perform an action or participate in a particular situation based on their conscience. Conscientious objection has become a highly contested topic in recent years.
Research objectives
This study had four objectives: (1) eliciting information on how Turkish nurses perceive conscientious objection, (2) revealing whether their moral beliefs affect the care they provide, (3) determining their experiences with conscientious objection, and (4) identifying existing or potential issues of conscientious objection.
Research design
This qualitative study collected data through semi-structured interviews. The data were analyzed using thematic content analysis.
Participants
The sample consisted of 21 nurses.
Ethical considerations
The study was approved by an ethics committee. Confidentiality and anonymity were guaranteed. Participation was voluntary.
Findings
The analysis revealed four themes: (1) universal values of nursing (professional values), (2) experiences with conscientious objection (refusing to provide care/not providing care), (3) possible effects of conscientious objection (positive and negative), and (4) scope of conscientious objection (grounded and groundless).
Conclusion
Participants did not want to provide care due to (1) patient characteristics or (2) their own religious and moral beliefs. Participants stated that conscientious objection should be limited in the case of moral dilemmas and accepted only if the healthcare team agreed on it. Further research is warranted to define conscientious objection and determine its possible effects, feasibility, and scope in Turkey.
Research article
Open accessResearch articleFirst published December, 2022pp. 1634-1646
Paradoxes,nurses’ roles and Medical Assistance in Dying: A grounded theory
Maude HébertORCIDMyriam Asri
Abstract
Background
In June 2016, the Parliament of Canada passed federal legislation allowing eligible adults to request Medical Assistance in Dying (MAID). Since its implementation, there likely exists a degree of hesitancy among some healthcare providers due to the law being inconsistent with personal beliefs and values. It is imperative to explore how nurses in Quebec experience the shift from accompanying palliative clients through “a natural death” to participating in “a premeditated death.”
Research question/aim/objectives
This study aims to explore how Quebec nurses personally and professionally face the new practice of MAID and their role evolution.
Research design
A grounded theory design was used.
Participants and research context
We recruited 37 nurses who participated in or coordinated at least one MAID. Semi-structured interviews and focus groups were conducted and audiotaped. Data collection and analysis followed Strauss and Corbin steps.
Ethical considerations
Ethics approval was received from the investigator’s affiliated University. Participants were informed regarding the research goal, signed a written consent, and were assigned pseudonyms.
Findings/results
Results show that nurses experienced the wide range of paradoxe during MAID centering around the following eight elements: 1) confrontation abouth death, 2) choice, 3) time of death, 4) emotional load, 5) new Bill, 6) relationship with the person, 7) communication skills, and 8) healthcare setting. The shifting of views and values in this new role is presented by the contradiction of opposites.
Conclusions
A better understanding of the paradox experienced by nurses involved with MAID paves the way for the development of interventions.
Research article
Available accessResearch articleFirst published December, 2022pp. 1647-1659
Threats to the dignity of COVID-19 patients: A qualitative study
Farideh NamadiORCIDLeyla AliluMasumeh Hemmati Maslakpak
View All
Abstract
Background: Dignity is a fundamental concept that has been threatened by the COVID-19 pandemic. Several factors threaten the dignity of COVID-19 patients, whether in palliative care departments, medical or surgery wards, intensive care units, or long-term care facilities. This threat is exacerbated by the increasing number of affected patients, the high transmission of the virus and problems such as limited resources, shortage of workforce, and ineffective communication. Recognizing the threats and challenges that currently affect the patients’ dignity and managing them can help maintain the patients’ dignity and increase their satisfaction. Research objective: This study seeks to explain the threats to the dignity of hospitalized COVID-19 patients. Research design: This qualitative study was conducted using conventional content analysis. Data were collected through in-depth, semi-structured, face-to-face interviews with 21 COVID-19 patients with maximum variation. Data were analyzed using Graneheim and Lundman’s conventional content analysis and encoded with MAXQDA-10 software. The participants had already recovered from COVID-19 when the interviews were held. Ethical considerations: The study protocol was approved by the Research Ethics Committee of medical universities in northwestern Iran (IR.UMSU.REC.1399.345). Ethical principles were observed during the study. Findings: The analysis of the interviews revealed three main categories and 11 subcategories for the threats to the dignity of COVID-19 patients. The main categories included facing imposed conditions (five subcategories), facing unprofessional performance (four subcategories), and ineffective communication (two subcategories). Conclusion: The findings of the present study can help health officials and policymakers in taking positive steps to maintain patients’ dignity by designing and implementing beneficial programs.
Research article
Open accessResearch articleFirst published December, 2022pp. 1660-1669
Dignity in fragile older women receiving daily municipality care
Kari KaldestadORCIDDagfinn Nåden
Abstract
Background:Dignity is an important ideal in the nursing of older women who need municipal care. Dignity can be challenged when health is impaired by feeling grief and suffering associated with bodily changes and impaired functions.

Aim and research questions:The study aimed to deepen the understanding of the meaning of dignity in the life of fragile older women who daily needed help from municipal care service. The research questions are: What is older women’s experience of dignity, and what is it not to be met with dignity when needing service from municipality care?

Research design: The study has a qualitative design, and the methodology is based on Gadamer’s ontological hermeneutics. Ten women receiving municipal care, aged from 66 to 91 were interviewed in their home environments. Kvale and Brinkmanns’ three levels of interpretation were applied in the analysis of the interviews: self-understanding, a critical understanding based on common sense, and theoretical understanding.

Ethical considerations: The study follows the guidelines for good scientific practice according to the Declaration of Helsinki and was approved by the Norwegian Centre for Research Data.

Results: The interviews revealed fragments of the women’s unique life history. Two themes emerged from the interpretation: Confirming encounters provide human dignity; and Not being confirmed as a human being violates human dignity.

Conclusions:For the women, dignity is about feeling seen and understood by the individual nurse and this takes place both in conversation and in bodily care. Not being seen or confirmed gives rise to suffering. The reason for this seems to be lack of competence on the part of the staff or little continuity.
Research article
Available accessResearch articleFirst published December, 2022pp. 1670-1682
Factors affecting the formation of nurses’ moral sensitivity in cardiopulmonary resuscitation settings: A qualitative study
Farshad MohammadiORCIDHossein HabibzadehORCIDNader Aghakhani
Abstract
Background: Certain factors may facilitate or inhibit the formation of moral sensitivity in nurses performing cardiopulmonary resuscitation (CPR). The identification of these factors in the context can help develop strategies to promote nurses’ moral sensitivity and offer new insights into the consequences of their moral decisions.

Objective: Taking into account the possibly multi-factorial nature of moral sensitivity, this study aimed to identify the factors affecting the formation of nurses’ moral sensitivity in CPR settings.

Research design and methods: This study performed a conventional qualitative content analysis. Twenty-one participants were selected via purposive and theoretical sampling. The data were collected through in-depth semi-structured interviews and simultaneously analyzed via content analysis.

Participants and research context: In total, twenty-one participants (fourteen clinical care nurses, three head nurses, two educational supervisors, and two faculty members) from different cities of Iran were interviewed.

Ethical considerations: The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran (IR.UMSU.REC.1399.337).

Findings: Four categories (underlying factors, professional factors, organizational inhibitors of ethics, and professional limitations) and 13 sub-categories were extracted.

Discussion: The formation of moral sensitivity requires a range of ethical standards and their maintenance, not only at the individual level but also at the profession, organization, and community levels. So eliminating inhibitors of ethics in these contexts can improve nurse’s ethical performance in CPR settings.

Conclusion: Any measures taken or decisions made by nurses in CPR are driven by numerous ethical issues to which nurses must be morally sensitive. Some factors facilitate and some inhibit the formation of moral sensitivity in nurses.
Research article
Available accessResearch articleFirst published December, 2022pp. 1683-1696
Intensive care unit dignified care: Development and validation of a questionnaire
Andong LiangORCIDWenxian XuYucong Shen
View All
Abstract
Background
Patient dignity is sometimes neglected in intensive care unit (ICU) settings, which may potentially cause psychological harm to critically ill patients. However, no instrument has been specifically developed to evaluate the behaviors of dignified care among critical care nurses.
Aim
This study aimed to develop and evaluate ICU Dignified Care Questionnaire (IDCQ) for measurement of self-assessed dignity-conserving behaviors of critical care nurses during care.
Methods
The instrument was developed in 3 phases. Phase 1: item generation; phase 2: a two-round Delphi survey and a readability pilot study; phase 3: cross-sectional survey with model estimation. The questionnaire was evaluated by item analysis, exploratory and confirmatory factor analysis, assessment of internal consistency reliability, and test-retest reliability. The investigation was conducted using a convenience sample of 392 critical care nurses from 6 cities in Zhejiang Province, China, of which 30 participated in the test-retest reliability survey 2 weeks later.
Ethical considerations
The study was approved by ethics committee. All participants provided written informed consent before the survey. The questionnaire survey was anonymous.
Results
The results showed acceptable reliability and validity of the IDCQ. The 17-item final version questionnaire was divided into 2 dimensions: absolute dignity and relative dignity. These two factors accounted for 62.804% of the total variance, and model fitting results were acceptable. The Cronbach’s alpha coefficient of the questionnaire was 0.94, and the test-retest intraclass correlation coefficient (ICC) was 0.88 after 2 weeks.
Conclusions
This study developed a brief and reliable instrument (IDCQ) to assess dignified care in ICU nursing. It can help critical care nurses identify their behaviors in maintaining patient dignity and discover their deficiencies. It may also serve as a clinical nursing management tool to help reduce patient disrespect experience in ICU.
Research article
Available accessResearch articleFirst published December, 2022pp. 1697-1708
Moral distress in clinical research nurses
Brandi L ShowalterORCIDAnn MalechaSandra Cesario
View All
Abstract
Background: Clinical research nurses experience unique challenges in the context of their role that can lead to conflict and moral distress. Although examined in many areas, moral distress has not been studied in clinical research nurses.

Research aim: The aim of this study was to examine moral distress in clinical research nurses and the relationship between moral distress scores and demographic characteristics of clinical research nurses.

Research design: This was a descriptive quantitative study to measure moral distress in clinical research nurses using the Measure of Moral Distress – Healthcare Professionals (MMD-HP) administered electronically. Demographic data were also collected.

Participants and research context: Registered nurses working in the clinical research nurse role (N = 322) were recruited through use of social media, emails, digital flyers, and snowball recruitment. Data was analyzed using SPSS. Pearson’s correlation, independent t-test, and one-way ANOVA were performed to explore differences among the demographic variables.

Ethical considerations: This study was approved by the Institutional Review Board at Texas Woman’s University. A consent statement was included, and completion of the questionnaire was construed as consent.

Findings/results: Analysis revealed a mean overall moral distress score of 79.58 (SD = 64.27) and median of 67, with a range of 0–354. Moral distress scores were negatively correlated with clinical research nurse age (r = 0-.156, p < 0.05). Reliability of the MMD-HP was demonstrated with a Cronbach’s alpha of 0.93.

Conclusions: The findings demonstrate that clinical research nurses do experience moral distress and revealed a wide range of scores. Further research is necessary to determine potential patient impact due to moral distress and to develop processes to minimize moral distress in the clinical research setting. This study was conducted during the COVID-19 pandemic, and the digital recruitment methods proved effective in recruiting a wide range of clinical research nurses, both nationally and internationally.
Research article
Available accessResearch articleFirst published December, 2022pp. 1709-1720
Postgraduate nursing students’ experiences of practicing ethical communication
Catarina Fischer GrönlundORCIDMargareta BrännströmORCID
Abstract
Background
Ethics communication has been described as a pedagogical form, promoting development of ethical competence among nursing students. The ‘one to five method’ was developed by this research group as a tool for facilitating ethical communication in groups among healthcare professionals but has not yet been evaluated.
Aim
To explore post-graduate nursing students’ experiences of practicing ethical communication in groups
Research design
The study design is qualitative.
Participants and research context
The study comprised 12 nursing students on a post-graduate course for Registered Nurses focusing on palliative care. After education the students engaged as participants and facilitators in ethics communication in groups, with support from the ‘one to five method’. Data were derived from the students written reflections and subjected to thematic analysis.
Ethical considerations
The study was performed in accordance with the ethical standards in the 2013 Helsinki Declaration and approved by the Ethics Committee of the Medical Faculty at Umeå University
Results
An overall theme was identified, ‘being supported to achieve a democratic dialogue concerning ethical problems’ and five themes, related to each step of the ‘one to five method’. The themes concerned: putting the experience of an ethical dilemma into words; being confirmed by shared emotions; defining the value conflict using ethical principles; expressing virtues of empathy and raised awareness; jointly finding various action approaches.
Discussion
Regular ethics communication in groups encourages nursing students to actively seek understanding and clarification of ethically difficult situations.
Conclusions
The results indicate that ethics communication in groups could be a way of developing virtues during education. Interventions using the ‘one to five method’ need to be further studied among student groups from other healthcare contexts.
Research article
Available accessResearch articleFirst published December, 2022pp. 1721-1738
Opinions of nurses regarding Euthanasia and Medically Assisted Suicide
Tamara Raquel Velasco SanzORCIDAna María Cabrejas CaseroYolanda Rodríguez González
View All
Abstract
Background
Safeguarding the right to die according to the principles of autonomy and freedom of each person has become more important in the last decade, therefore increasing regulation of Euthanasia and Medically Assisted Suicide (MAS).
Aims
To learn the opinions that the nurses of the autonomous region of Madrid have regarding Euthanasia and Medically Assisted Suicide.
Research design
Cross-sectional descriptive study.
Participants and research context
All registered nurses in Madrid. The study was done by means of a self-completed anonymous questionnaire. The variables studied were social-demographic, giving opinions about Euthanasia and MAS.
Ethical considerations
Each participant was assured maximum confidentiality and anonymity, ensuring the ethical principles set out in the Declaration of Helsinki, as well as in the Organic Law 3/2018, on Personal Data Protection and guarantee of digital rights.
Findings
A total of 489 nurses answered the questionnaire. In total, 75.7% of the nurses confirmed that Euthanasia should be regulated in Spain. 66.3% indicated that information on Euthanasia should be provided jointly by doctors and nurses, and 42.3% considered that it could be applied by both medical and nursing professionals. A total of 87.2% advocated the participation of nurses in health policy, influencing the drafting of the law. In the face of possible regulation, 35% would request Conscientious Objection, being closely related to their religious beliefs.
Discussion
Different authors point out that nurses’ perceptions and attitudes towards Euthanasia are conditioned by different factors, such as religion, gender, poor palliative care, legality and the patient's right to die.
Conclusion
Nurses are positioned in favour of the regulation and practice of Euthanasia and MAS, depending on their age, years of experience, training, model of care and especially religious beliefs.
Research article
Available accessResearch articleFirst published December, 2022pp. 1739-1749
Written and computer simulation on the moral sensitivity of nurses
Faezeh ParchamiAlun C JacksonFarshad Sharifi
View All
Abstract
Background: Moral sensitivity is the first step towards ethical decision-making. This sensitivity should form a basic attitude in healthcare team members, particularly nurses, toward providing effective and ethical care. This is highlighted in intensive care units (ICUs) where close attention should be paid to patient rights and moral or ethical decision-making.

Objective: The present study aimed at determining and comparing the effect of written simulation and computer simulation of a virtual patient on the development of moral sensitivity of ICU nurses.

Research design: Randomized controlled trial with one control arm and two experimental arms.

Participants and content: This study involved 204 ICU nurses working in hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran, from 2019 to 2021 using a random allocation method. The participants were allocated to three groups comprising virtual patient computer simulation, written simulation, and the no simulation control group. After training based on a Patient Rights Charter, five scenarios, with themes reflecting the clauses of the Patient’s Rights Charter, were written as a computer program and text for the computer simulation and written simulation groups, respectively. Finally, nurses' moral sensitivity was assessed using the Lützén moral sensitivity questionnaire as pre- and post-tests (immediately and 2 months after the intervention).

Ethical considerations: Ethical permission was obtained for the study. All the participants signed the informed consent before the study onset.

Results: The study results showed a significant difference in moral sensitivity among the three groups before the intervention (p = 0.003). Immediately after the intervention compared to pre-intervention, the three groups showed no significant differences in this regard (p = 0.056), however a significant difference among the three groups was found 2 months post-intervention (p < 0.001).
Research article
Available accessResearch articleFirst published December, 2022pp. 1750-1760
Ethical challenges experienced by care home staff during COVID-19 pandemic
Helen YL ChanORCIDYa-Yi ZhaoLi Liu
View All
Abstract
Background
Care homes have been disproportionately affected during the COVID-19 pandemic. Practical challenges of enacting infection control measures in care home settings have been widely reported, but little is known about the ethical concerns of care home staff during the implementation of such measures. .
Objectives
To understand the ethical challenges perceived by care home staff during the early months of the COVID-19 pandemic.
Research design
An exploratory qualitative study.
Participants and research context
A purposive sample of 15 care home staff in different roles and ranks in Hong Kong was recruited to take part in semi-structured interviews between June and August 2020.
Ethical considerations
Ethical approval for this study was obtained. Participation was voluntary and anonymous. Participants had the right to withdraw from the study at any time without reprisal.
Findings
Three themes were identified: unclear legitimacy regarding infection control measures, limited autonomy in choices over infection control measures and inevitable harms to residents’ well-being. While the participants expected that they would have legitimated power to implement infection control measures, they were resistant when their right to self-determination of testing and vaccination was infringed. They also felt trapped between ethical duties to protect care home residents from infection risk and the anticipated detrimental effects of infection control measures.
Conclusions
The findings of this study reveal tensions among the ethical obligations of care home staff in response to a public health emergency. They highlight the importance of strengthening ethical sensitivity and ethical leadership in identifying and resolving the challenges of pandemic responses.
Research article
Open accessResearch articleFirst published December, 2022pp. 1761-1772
Dignity in relationships and existence in nursing homes’ cultures
Arne RehnsfeldtORCIDÅshild SlettebøVibeke Lohne
View All
Abstract
Introduction:
Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture.
Background:
The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of existence, as well as compassion in relieving suffering, and ontological interdependency.
Aim:
To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers.
Research design:
The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data.
Participants and research context:
Focus group interviews with caregivers in nursing homes.
Ethical considerations:
The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons.
Findings:
Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture.
Discussion:
Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture.
Conclusions:
Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others.
Research article
Open accessResearch articleFirst published December, 2022pp. 1773-1791
The moral experiences of children with osteogenesis imperfecta
Yi Wen WangORCIDFranco A CarnevaleMaria Ezcurra
View All
Abstract
Background
Serious ethical problems have been anecdotally identified in the care of children with osteogenesis imperfecta (OI), which may negatively impact their moral experiences, defined as their sense of fulfillment towards personal values and beliefs.
Research aims
To explore children’s actual and desired participation in discussions, decisions, and actions in an OI hospital setting and their community using art-making to facilitate their self-expression.
Research design
A focused ethnography was conducted using the moral experiences framework with data from key informant interviews; participant observations, semi-structured interviews, and practice-based research (art-making) with 10 children with OI; and local documents.
Participants and research context
The study was conducted at a pediatric, orthopedic hospital.
Ethical considerations
This study was approved by McGill University Institutional Review Board.
Findings/results
Children expressed desires to participate in their care, but sometimes lacked the necessary resources and encouragement from healthcare providers. Art-making facilitated children’s voice and participation in health-related discussions.
Conclusions
Healthcare providers are recommended to consider the benefits of art-making and educational resources to reduce discrepancies between children’s actual and desired participation in care and promote positive moral experiences.