Nurses and ethicists worry that the implementation of care at a distance or telecare will impoverish patient care by taking out ‘the heart’ of the clinical work. This means that telecare is feared to induce the neglect of patients, and to possibly hinder the development of a personal relation between nurse and patient. This study aims to analyse whether these worries are warranted by analysing Dutch care practices using telemonitoring in care for chronic patients in the Netherlands. How do clinical (...) practices of nursing change when telecare devices are introduced and what this means for notions and norms of good nursing? The paper concludes that at this point the practices studied do not warrant the fear of negligence and compromised relations. Quite the contrary; in the practices studied, telecare lead to more frequent and more specialised contacts between nurses and patients. The paper concludes by reflecting on the ethical implications of these changes. (shrink)

Abstract In the last few decades, a growing number of commentators have questioned the appropriateness of the 'justice view' of ethics as a suitable approach in health care ethics, and most certainly in nursing. Essentially, in their ethical deliberations, it is argued that nurses do not readily adopt the high degree of impartiality and objectivity that is associated with a justice view; instead their moral practices are more accurately reflected through the use of alternative approaches such as relational or care-based (...) ethics. Yet, it has also been argued that this viewpoint does not necessarily 'do justice' to the broader moral responsibilities of nurses towards humanity in general, i.e. to the wider socio-cultural and socio-political issues in society, and to the concept of social justice in particular. This criticism has triggered a much closer examination of relational and care-based ethics in nursing at levels beyond individual responsiveness within relationships and brought into the spotlight the need for a more ethically refined nursing response to an increasingly complex set of socio-cultural inequalities. This article explores a relational ethic within nursing practices with contemporary ideas regarding social justice. In particular, it is argued that the synergy between the two actually produces an ethic that is capable of not only challenging the continuing predominance of justice-based ethics within health care, but of replacing it. Subsequently, in the discussion that follows, it is suggested that a combined social justice and relational care-based approach, as a social ethic, should guide the moral deliberations and actions of nurses. It is maintained that such an approach is not only possible, but crucial if nurses are to realize their full potential as ethical agents for individual and social good. © 2011 Blackwell Publishing Ltd. (shrink)

The purpose of this article is to re-examine an ethic of care as the main ethical approach to nursing practice in light of past and present developments in nursing ethics, and to briefly speculate whether or not it will survive within nursing in the future. Overall, it is maintained throughout that the terms ?caring?, ?nursing? and an ?ethic of care? are inextricably linked. This is because, it is argued, professionally focused nursing practices are based predominantly on a well-recognised moral commitment (...) to deliver expert care, and that a care-based ethic is the major factor in the construction and maintenance of these practices. Subsequently, the influences and developments of a caring ethic in nursing are firstly re-examined, and the discussion is supported by evidence from more recent nursing research and theoretical developments. Consideration is given to the philosophical underpinnings of both care theory and caring ethics, and the fundamental importance of caring in nursing, as an interpersonal relationship and as an appropriate ethical response, is made transparent. Finally, an outline of the future possibilities that may affect an ethic of care in nursing is offered. (shrink)

Abstract Truth-telling is a key issue within the nurse–patient relationship. Nurses make decisions on a daily basis regarding what information to tell patients. This paper analyses truth-telling within an end of life scenario. Virtue ethics provides a useful philosophical approach for exploring decisions on information disclosure in more detail. Virtue ethics allows appropriate examination of the moral character of the nurse involved, their intention, ability to use wisdom and judgement when making decisions and the virtue of truth-telling. It is appropriate (...) to discuss nursing as a 'practice' in relation to virtue ethics. This is achieved through consideration of the implications of arguments made by Alasdair MacIntyre who believes that qualities such as honesty, courage and justice are virtues because they enable us to achieve the internal goods of practices. (shrink)

patient care at the rural academic medical center. The purpose of this study was to (1) identify and describe the ethical issues perceived by registered nurses employed at a rural academic medical center and (2) analyze the variables influencing the registered nurses' ethical decision making and the process used by these registered nurses when resolving ethical issues. The 17 registered nurses who completed the survey identified a total of 21 ethical issues that they had experienced during the last year. The (...) ethical issues that nurses recalled were significantly more likely to be relationship issues, whereas issues documented within the ethics consultation service were significantly more likely to involve limiting treatment. Communication was a major variable influencing nurse's ethical decision making. Nurses felt the ethical issue resolved satisfactorily when the patient's needs were met, communication occurred with the patient and/or family, the entire healthcare team was involved and in agreement, and there was sufficient time available to make a decision. The nurses did not feel that the ethical situation was resolved satisfactorily when not handled from the patient's perspective; the patient suffered; there was a lack of teamwork, agreement, and/or support; and the process took too long. The nurses' recommendations for resources needed to assist with the resolution of ethical issues included accessible ethics mechanisms, education, improved interprofessional relationships and collaboration, and unbiased support for patient and family decision making. Implications for nurse managers are discussed and future research questions are identified.... (shrink)

Background: Ethics is a founding component of the nursing profession; however, nurses sometimes find it difficult to constantly adhere to the required ethical standards. There is limited knowledge about the factors that cause a committed nurse to violate standards; moral disengagement, originally developed by Bandura, is an essential variable to consider. Research objectives: This study aimed at developing and validating a nursing moral disengagement scale and investigated how moral disengagement is associated with counterproductive and citizenship behaviour at work. Research design: (...) The research comprised a qualitative study and a quantitative study, combining a cross-validation approach and a structural equation model. Participants and research context: A total of 60 Italian nurses (63% female) involved in clinical work and enrolled as students in a postgraduate master’s programme took part in the qualitative study. In 2012, the researchers recruited 434 nurses (76% female) from different Italian hospitals using a convenience sampling method to take part in the quantitative study. Ethical considerations: All the organisations involved and the university gave ethical approval; all respondents participated on a voluntary basis and did not receive any form of compensation. Findings: The nursing moral disengagement scale comprised a total of 22 items. Results attested the mono-dimensionality of the scale and its good psychometric properties. In addition, results highlighted a significant association between moral disengagement and both counterproductive and citizenship behaviours. Discussion: Results showed that nurses sometimes resort to moral disengagement in their daily practice, bypassing moral and ethical codes that would normally prevent them from enacting behaviours that violate their norms and protocols. Conclusion: The nursing moral disengagement scale can complement personnel monitoring and assessment procedures already in place and provide additional information to nursing management for designing interventions aimed at increasing compliance with ethical codes by improving the quality of the nurses’ work environment. (shrink)

This article discusses findings from a mixed method literature review that investigated cancer patients’ perceptions of what constitutes a good nurse. To find pertinent articles, we conducted a systematic key word search of five journal databases (1998—2008). The application of carefully constructed inclusion criteria and critical appraisal identified 12 relevant articles. According to the patients, good nurses were shown to be characterized by specific, but inter-related, attitudes, skills and knowledge; they engage in person-to-person relationships, respect the uniqueness of patients, and (...) provide support. Professional and trained skills as well as broad and specific nursing and non-nursing knowledge are important. The analysis revealed that these characteristics nurtured patient well-being, which manifests as optimism, trust, hope, support, confirmation, safety and comfort. Cancer patients’ perceptions of what constitutes a good nurse represent an important source of knowledge that will enable the development of more comprehensive and practice-based views on good nursing care for such patients. These perceptions help us to understand how nurses effectively make a difference in cancer patient care. (shrink)

The aim of a previous study was to describe nursing in Slovenia generally, and to identify the most appropriate nursing model for that country. One specific finding was the issue of partner-like relationships; this article deals with that issue only. An interpretive paradigm and qualitative research design were used with a modified grounded theory approach. Interviews were carried out with selected nursing leaders ( n = 24) and other professionals (n = 6) in order to draw on their knowledge and (...) experience to describe the reality of nursing phenomena. The results of this research suggest that participants wish to use a theory that emphasizes clients and treats them as equal partners in nursing, promotes health, and rests on interpersonal relationships. The participants described the missing or obscure parts in nursing and their own beliefs and values about human beings and nursing. Descriptions of and the need for partner-like relationships, and the specific elements of such relationships, were of main concern. The participants argued that nurses need high quality and continuing education to ensure competent nursing practice. The indication is that Slovenia should move to graduate and undergraduate nurse education to foster expert reflective practice in order to abolish routinized care carried out in a hierarchical system. (shrink)