Die Entscheidung für oder gegen lebensverlängernde Behandlungsmaßnahmen geht inzwischen der Hälfte aller Todesfälle in Europa voraus. Sie wird im klinischen Alltag häufig als ethische Herausforderung wahrgenommen, zudem sind unter Klinikern juristische Unsicherheiten und Fragen der korrekten Vorgehensweise verbreitet. Die hier vorgestellte Münchner Leitlinie zu Entscheidungen am Lebensende soll rechtliche Unsicherheit reduzieren, Klinikumsmitarbeiter für die ethische Dimension von Therapieentscheidungen am Lebensende sensibilisieren und ethisch begründete Entscheidungen fördern. Aus organisationsethischer Perspektive soll mit der Leitlinie eine Reflexion und Meinungsbildung zu einem ethisch relevanten (...) Themenbereich erfolgen und ein Beitrag zur Qualitätssicherung der Patientenversorgung und damit auch zur Patientenzufriedenheit geleistet werden. Die Prozesse der Leitlinienentwicklung, -aktualisierung und -implementierung werden vorgestellt. Die wesentlichen inhaltlichen Elemente der Leitlinie mit Darstellung der Rechtslage, der Definition zentraler Begriffe und Klärung medizinischer Entscheidungskriterien werden an Hand eines Entscheidungsalgorithmus dargestellt. Inhalt und Prozess der Leitlinienentwicklung werden auf die folgenden organisationsethischen Qualitätskriterien hin überprüft: deliberativer Prozess, inhaltliche Transparenz, repräsentative Zusammensetzung der Arbeitsgruppe, Implementierung und Evaluation der Leitlinie. Institutionen, die diese Leitlinie übernehmen wollen, sollten diese von einem autorisierten Gremium überprüfen lassen und auf die spezifischen Bedürfnisse ihrer Institution adaptieren. Hierfür ist eine vorgeschaltete Bedarfserhebung hilfreich. In dem Gremium sollten all diejenigen vertreten sein, die in der Folge mit der Leitlinie arbeiten werden. (shrink)

Background: Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today’s hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual’s dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses’ options to act on the basis of ethical and (...) moral grounds in the individual care situation. Aim: The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today. Method: The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas. Ethical consideration: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. Results: The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse–patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses. Conclusion: Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses’ professional decision-making and forcing them to compromise basic nursing values. (shrink)

Recent findings suggest that medical students’ moral competence decreases throughout medical school. This pilot study gives preliminary insights into the effects of two educational interventions in ethics classes on moral competence among medical students in Munich, Germany. Between 2012 and 2013, medical students were tested using Lind’s Moral Competence Test prior to and after completing different ethics classes. The experimental group participated in principle-based structured case discussions and was compared with a control group with theory-based case discussions. The pre/post C-scores (...) were compared using a Wilcoxon Test, ANOVA and effect-size calculation. The C-score improved by around 3.2 C-points in the EG, and by 0.2 C-points in the CG. The mean C-score difference was not statistically significant for the EG or between the two groups. There was no statistical significance for the teachers’ influence on C-score. In both groups, students with below-average C-scores improved and students with above-average C-scores regressed. The increase of the C-Index was greater in the EG than in the CG. The absolute effect-size of the EG compared with the CG was 3.0 C-points, indicating a relevant effect. Teaching ethics with PBSCDs did not provide a statistically significant influence on students’ moral competence, compared with TBCDs. Yet, the effect size suggests that PBSCDs may improve moral competence among medical students more effectively. Further research with larger and completely randomized samples is needed to gain definite explanations for the results. (shrink)

Much attention has been paid to the role of the nurse in recognizing and addressing ethical dilemmas. There has been less emphasis, however, on the issue of whether or not nurses understand the ethical nature of everyday practice. Awareness of the inherently ethical nature of practice is a component of nurse ethical sensitivity, which has been identified as a component of ethical decision-making. Ethical sensitivity is generally accepted as a necessary precursor to moral agency, in that recognition of the ethical (...) content of practice is necessary before consistent action on behalf of patient interests can take place. This awareness is also compulsory in ensuring patient good by recognizing the unique interests and wishes of individuals, in line with an ethic of care. Scholarly and research literature are used to argue that bolstering ethical awareness and ensuring that nurses understand the ethical nature of the role are an obligation of the profession. Based on this line of reasoning, recommendations for education and practice, along with directions for future research, are suggested. (shrink)

Background: Exploring the concept of ethical competence in the context of healthcare is essential as it pertains to better quality of care. The concept still lacks a comprehensive definition covering the aspects of ethical expertise, ethical knowledge and action of a health professional. Objective: This article aims to report an analysis of the concept of ethical competence. Method: A modified strategy suggested by Walker and Avant was used to analyse the concept. Results: As a result, the concept of ethical competence (...) can be defined in terms of character strength, ethical awareness, moral judgement skills and willingness to do good. Virtuous professional, experience of a professional, human communication, ethical knowledge and supporting surroundings in the organisation can be seen as prerequisites for ethical competence. Ethical competence results in the best possible solutions for the patient, reduced moral distress at work and development and democratisation of society. Conclusion: The results of the analysis establish a basis for an instrument to evaluate health professionals’ ethical competence. It will guide educators, as well as managers in healthcare, to support the development of ethical conduct in healthcare. (shrink)

Background: Nursing practice takes place in a social framework, in which environmental elements and interpersonal relations interact. Ethical climate of the work unit is an important element affecting nurses’ professional and ethical practice. Nevertheless, whatever the environmental circumstances, nurses are expected to be professionally competent providing high-quality care ethically and clinically. Aim: This study examined newly graduated nurses’ perception of the ethical climate of their work environment and its association with their self-assessed professional competence, turnover intentions and job satisfaction. Method: (...) Descriptive, cross-sectional, correlational research design was applied. Participants consisted of 318 newly graduated nurses. Data were collected electronically and analysed statistically. Ethical considerations: Ethical approval and permissions to use instruments and conduct the study were obtained according to required procedures. Data were rendered anonymous to protect participant confidentiality. Completing the questionnaire was interpreted as consent to participate. Findings: Nurses’ overall perception of the ethical climate was positive. More positive perceptions related to peers, patients and physicians, and less positive to hospitals and managers. Strong associations were found between perceived ethical climate and self-assessed competence, turnover intentions in terms of changing job, and job satisfaction in terms of quality of care. Nurses at a higher competence level with positive views of job satisfaction and low turnover intentions perceived the climate significantly more positively. Conclusion: Nursing management responsible for and having the power to implement changes should understand their contribution in ethical leadership, as well as the multidimensional nature of nurses’ work environment and the interaction between work-related factors in planning developmental measures. Future research should focus on issues in nurse managers’ ethical leadership in creating ethical work environments. There is also a need for knowledge of newly graduated nurses’ views of factors which act as enhancers or barriers to positive ethical climates to develop. Interventions, continuing education courses, and discussions designed to promote positive ethical climates should be developed for managers, nurses, and multi-professional teams. (shrink)

The purpose of this article is to explore a fundamental ethical approach to nursing and to suggest some proposals, based on this approach, for nursing ethics education. The major point is that the kind of nursing ethics education that is given reflects the theory that is held of nursing. Three components of a fundamental ethical view on nursing are analysed more deeply: (1) nursing considered as moral practice; (2) the intersubjective character of nursing; and (3) moral perception. It is argued (...) that the fundamental ethical view on nursing goes together with a virtue ethics approach. Suggestions are made for the ethics education of nurses. In particular, three implications are considered: (1) an attitude versus action-orientated ethics education; (2) an integral versus rationalistic ethics education; and (3) a contextual model of ethics education. It will also be shown that the European philosophical background offers some original ideas for this endeavour. (shrink)

Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and (...) distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change. (shrink)

Background: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. Objective: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators’ selection and use of published texts and film. Methodology: This study employed discourse analysis. Participants and research context: A total (...) of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. Findings: The desire to understand others and how to care compassionately characterised educators’ choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance of connecting with others as a central component of compassionate caring, 10 identified the burden of caring, 24 identified themes of abandonment and of failure to see the suffering person and 15 narratives showed a discourse of only showing compassion to those ‘deserving’ often understood as the suffering person doing enough to help themselves. Discussion: These findings are mostly consistent with work in moral philosophy emphasising the particular or context and perception or vision as well as the necessity of emotions. The narratives themselves are used by nurse educators to help explicate examples of caring and compassion (or its lack). Conclusion: To feel cared about people need to feel ‘visible’ as though they matter. Nurses need to be alert to problems that may arise if their ‘moral vision’ is influenced by ideas of desert and how much the patient is doing to help himself or herself. (shrink)

Background: Ethical sensitivity has been identified as a foundational component of ethical action. Diminished or absent ethical sensitivity can result in ethically incongruent care, which is inconsistent with the professional obligations of nursing. As such, assessing ethical sensitivity is imperative in order to design interventions to facilitate ethical practice and to ensure nurses recognize the nature and extent of professional ethical obligations. Aim: To review and critique the state of the science of nurse ethical sensitivity and to synthesize findings across (...) studies. Research design: Whittemore and Knafl’s revised framework for integrative reviews guided the analysis. Research context and data sources: A comprehensive, computer-assisted search of literature published in Cumulative Index of Nursing and Allied Health Literature and PubMed was performed. A systematic approach was used to extract, reduce, and synthesize the data. Findings: Four major conceptualizations of ethical sensitivity emerged from the literature. A sample of 25 reports met inclusion criteria, including 17 empirical reports and 8 theoretical reports. Discussion: Despite the existence of a concept analysis and a validated tool, ethical sensitivity remains a highly theoretical concept with multiple, and at times competing, conceptualizations. Ethical sensitivity has been assessed extensively in the context of ethical dilemmas; however, little attention has been paid to the way the concept operates in day-to-day practice. Conclusion: Future research should focus on better ways to operationalize and assess the concept, with particular attention to nurse awareness of the ethical content of everyday practice. (shrink)

ZusammenfassungEine wichtige Aufgabe empirischer Sozialforschung in der Medizinethik besteht darin, bisher unbekannte ethische Probleme zu identifizieren und zu beschreiben. Die Frage, welche Sachverhalte in den Gegenstandsbereich der Medizinethik fallen, ist jedoch sowohl aus wissenschaftlicher Sicht voraussetzungsreich als auch in der Praxis umstritten. Im Beitrag werden theoretische, methodologische und forschungspraktische Aspekte der Identifikation und Auswahl ethischer Probleme diskutiert und das Vorgehen am Beispiel einer konkreten empirisch-ethischen Studie illustriert. Der Schwerpunkt des Artikels liegt hierbei auf den Vorbedingungen sowie dem konkreten Vorgehen bei (...) der Integration von Laien- und Expertenperspektive. Im ersten Teil wird zunächst vorbereitend die Frage nach der Abgrenzung zwischen ethischen Problemen und anderen praktischen Herausforderungen adressiert. Dies geschieht unter Rückgriff auf die philosophisch-ethische Systematik sowie unter Berücksichtigung des stark praxisorientierten Charakters von Medizinethik. Anschließend wird ein Vorschlag zur Unterscheidung zweier Typen ethischer Probleme gemacht und die Frage nach der Definitionsmacht zur Auszeichnung ethischer Probleme auf den spezifischen Kontext empirisch-ethischer Forschung übertragen. Aufbauend auf diesen theoretischen Überlegungen wird im dritten Abschnitt des Beitrags schließlich ein Vorgehen zur Identifikation ethischer Probleme am Beispiel des ETHICO-Projektes als einer empirisch-ethischen Interventionsstudie im Bereich der Onkologie vorgestellt. Zusammenfassend vertritt der Beitrag die These, dass die Identifikation ethischer Probleme in der Medizin ein theoretisch komplexes und methodisch anspruchsvolles Unterfangen ist, bei dem nicht allein die Perspektive philosophischer Theorie eingenommen werden sollte, sondern vielmehr Formen der Integration von Laien- und Expertenperspektive entwickelt werden müssen. (shrink)

Much research is currently being conducted on health care practitioners' experiences of moral distress, especially the experience of nurses. What moral distress is, however, is not always clearly delineated and there is some debate as to how it should be defined. This article aims to help to clarify moral distress. My methodology consists primarily of a conceptual analysis, with especial focus on Andrew Jameton's influential description of moral distress. I will identify and aim to resolve two sources of confusion about (...) moral distress: the compound nature of a narrow definition of distress which stipulates a particular cause, i.e. moral constraint, and the distinction drawn between moral dilemma and moral distress, which implies that the two are mutually exclusive. In light of these concerns, I argue that the definition of moral distress should be revised so that moral constraint should not be a necessary condition of moral distress, and that moral conflict should be included as a potential cause of distress. Ultimately, I claim that moral distress should be understood as a specific psychological response to morally challenging situations such as those of moral constraint or moral conflict, or both. (shrink)

ABSTRACTThis paper explores the role of exemplarity in education through a conceptualisation of two different dimensions of exemplarity in educational practice. Pedagogical exemplarity, which relates to the pedagogical and ethical dimension of educational practice. In other words, this dimension explores the educational moments when someone takes up an exemplary function in educational practice. Didactical exemplarity, which relates to the exemplary function of subject matter or educational content. In other words, this dimension explores the educational moments when something takes up an (...) exemplary function in educational practice. Through an initial conceptual exploration of these two dimensions, via the works of Linda Zagzebski and Martin Wagenschein, the paper sets out to lay the foundation for a deeper understanding of the role of exemplarity in education. (shrink)

Aim: The aim of this review is to examine the ways in which the concept of moral distress has been delineated and deployed in the argument-based nursing ethics literature. It adds to what we already know about moral distress from reviews of the qualitative and quantitative research. Data sources: CINAHL, PubMed, Web of Knowledge, EMBASE, Academic Search Complete, PsycInfo, Philosophers’ Index and Socindex. Review methods: A total of 20 argument-based articles published between January 1984 and December 2013 were analysed. Results: (...) We found that like the empirical literature, most authors in this review draw on Jameton’s original definition and describe moral distress in psychological–emotional–physiological terms. They also agree that moral distress is linked to the presence of some kind of constraint on nurses’ moral agency, and that it is best understood as a two-staged process that can intensify over time. There is also consensus that moral distress has an important normative meaning, although different views concerning the normative meaning of moral distress are expressed. Finally, the authors generally agree that moral distress arises from a number of different sources and that it (mostly) affects negatively on nurses’ personal and professional lives and, ultimately, harms patients. However, despite this consensus, many authors take issue with the way in which moral distress is conceptualized and operationalized. Moreover, while some worry that identifying nurses as a group of health professionals whose voices are ignored or marginalized might disempower nurses and encourage them to avoid their moral responsibilities, others take situations involving moral distress as indicative of more fundamental, structural inequities at the heart of contemporary healthcare provision. Conclusion: We conclude that research on moral distress in nursing is timely and important because it highlights the specifically moral labour of nurses. However, we suggest that significant concerns about the conceptual fuzziness and operationalization of moral distress also flag the need to proceed with caution. (shrink)

Ethische Entscheidungssituationen im pflegeberuflichen Handlungskontext sind oft vielfältig und komplex. Die Komplexität ergibt sich aus der situativen Vielgestaltigkeit der pflegeberuflichen Handlungssituationen und ist insbesondere in der jeweils individuellen Vulnerabilität der Betroffenen und Beteiligten begründet. Aufgrund der Heterogenität gesellschaftlicher und professioneller Wertvorstellungen gestalten sich ethische Entscheidungen als beziehungsreich und spannungsvoll. In dieser Situation sind strukturierte und ethisch begründete Reflexions- und Entscheidungsfindungsprozess hilfreich. Der hierfür notwendige, inhärent interprofessionelle Dialog ist ein wichtiges Element professionellen Pflegehandelns. Strukturierte ethische Reflexion und systematisierte Prozesse der ethischen (...) Entscheidungsfindung – das heißt Ethikarbeit in einem interprofessionellen und transdisziplinären Setting und Verständnis – werden in diesem Kapitel als unterstützende Elemente verstanden und deren zentrale Eckpunkte und Elemente ausgeführt. (shrink)

Die Wissensvermittlung in Gesundheitsethik ermöglicht es Auszubildenden der Pflege, sich in ihrer zukünftigen Tätigkeit bei Entscheidungsprozessen des Behandlungsteams hinsichtlich pflegeethischer Fragestellungen einzubringen. Vor diesem Hintergrund wurde anhand der vorliegenden Studie die Entwicklung moralischer Positionen sowie pflegeethischer Kenntnisse von Pflegeauszubildenden sichtbar gemacht. An zwei Krankenpflegeschulen (Berlin und Fürth) wurden im Rahmen einer Panelstudie von August 2010 bis März 2011 Daten einer ersten Querschnittserhebung von Auszubildenden in der Pflege erhoben. Für die Studie wurde ein strukturierter Fragebogen verwendet. Die Studienteilnahme erfolgte freiwillig. Alle (...) Auszubildenden hatten vor der Befragung in unterschiedlichem Umfang Unterricht in Gesundheitsethik erhalten. An beiden Standorten zeigten die Teilnehmenden einen Zuwachs an pflegeethischen Kenntnissen. Auszubildende, die bislang keine praktische Erfahrung mit Sterbehilfe gemacht hatten, zeigten Schwierigkeiten in der theoretischen Handhabung dieser Maßnahmen. Für alle Auszubildenden zeigte sich ein allgemeiner Trend zu einer Befürwortung des partizipativen Interaktionsmodells und damit zu einer Förderung der Patientenselbstbestimmung. Zugleich schätzten die Studienteilnehmenden die Fähigkeiten von Patienten, medizinisch richtige Therapieentscheidungen zu treffen, als gering ein. Die Ausbildung in Gesundheitsethik besitzt ein großes Potential, Kenntnisse zu vermitteln und dadurch die ethische Kompetenzentwicklung zu befördern. Unsere Ergebnisse werfen die Frage auf, inwieweit es einer Integration praktischer Erfahrungen mit Fragestellungen der Gesundheitsethik bedarf, um eine praxisrelevante und wissenschaftlich fundierte Wissensvermittlung zu gewährleisten. (shrink)

Ethics education in the professions has become close to compulsory with continuing education following suit. What is the de facto as opposed to the de jure function of an ethics education program? Have they increased compliance with laws and codes of conduct? Is that the goal? What would an ethics education program look like that was not primarily concerned with compliance with relevant laws or professional codes and not merely an exercise in good public relations? I argue that, ultimately, ethics (...) education is about happiness… not happiness as we generally think of it today, but in the Aristotelian sense of “fulfillment” and the collateral good that is generated for clients and the profession. As a result of this point of view I argue that ethics is not a subject in the normal sense of the term but a meta-subject which implies that teaching ethics as a class or stand alone module in a law, policy or practice management course is usually ineffective. Another implication is that the richest source for moral reflection within a profession are case studies generated by students in clinical assignments, despite the inherent risks associated with making these cases prominent. (shrink)

Background: Ethics, being a fundamental component of nursing practice, must be integrated in the nursing education curriculum. Even though different bodies are promoting ethics and nursing researchers have already carried out work as regards this concept, it still remains difficult to clearly identify the components of this competence. Objective: This integrative review intends to clarify this point in addition to better defining ethical competence in the context of nursing practice. Method: An integrative review was carried out, for the 2009–2014 period, (...) in the CINAHL, MEDLINE, and EMBASE databases and in the journal Nursing Ethics. The keywords nursing ethics or ethical competence were used in order to make sure to widely encompass the concept of “ethical competence” in the case of a university curriculum in nursing. In the end, 89 articles were selected. Ethical consideration: We have respected the ethical requirements required regarding the sources and authorship. There is no conflict of interest in this literature review. Results: Ethical sensitivity, Ethical knowledge, Ethical reflection, Ethical decision-making, Ethical action, and Ethical behavior are the most frequently used terms with regard to ethical competence in nursing. They were then defined so as to better ascertain the possible components of ethical competence in nursing. Conclusion: Even though ethical competence represents a sine qua non competence in nursing practice, no consensus can be found in literature with respect to its definition. The identification of its components and their relationships resulting from this integrative review adds to the clarification of its definition. It paves the way for other studies that will contribute to a better understanding of its development, especially among nursing students and practicing nurses, as well as the factors that may exert an influence. More adapted education strategies can thus be put forward to support its development. (shrink)

Nurses are encountering an increasing number of ethical dilemmas in clinical practice. Ethics courses for baccalaureate nursing students provide the opportunity for the development of critical thinking skills in order to deal with these effectively. The purpose of this descriptive qualitative study was to describe ethical reasoning in 70 baccalaureate nursing students enrolled in a nursing ethics course. Reflective clinical journals were analyzed as appropriate for qualitative inquiry. The overriding theme emerging from the data was `in the process of becoming', (...) which includes: practicing as a professional, lacking the confidence as a student nurse to take an ethical stand, advocating for patients, being just in the provision of care, identifying the spiritual dimensions of nursing practice, confronting the `real world' of health care, making a commitment to practice with integrity, and caring enough to care. The development of critical thinking and ethical reasoning within the framework of knowing and connecting is essential in nursing education. (shrink)

Recent UK reports have revealed extensive evidence of unethical care practices. Older and vulnerable patients in some British health services have experienced appalling and avoidable suffering. Explanations for, and solutions to, these care failures have been proposed with wide-ranging recommendations. Many of these have direct implications for clinical ethics with additional frameworks for ethical values proposed, a heightened awareness of the moral culture of organisations acknowledged and a renewed interest in the ethics component of professional education debated. In this paper, (...) I suggest that we integrate insights from the slow movement into clinical ethics practice. Distinctions are made between fast and slow healthcare practice and between fast and slow ethics. I argue that, whilst there is a place for both, slow ethics enables us to assume a more positive stance in relation to ‘crisis’, and requires that we learn from past accounts and scholarship and consider the role of clinical ethics in sustaining caring cultures. (shrink)

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within health care (...) practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested. (shrink)

Background: Today’s healthcare environment is often characterized by an ethically demanding work situation, and nursing students need to prepare to meet ethical challenges in their future role. Moral sensitivity is an important aspect of the ethical decision-making process, but little is known regarding nursing students’ moral sensitivity and its possible development during nursing education. Objectives: The aims of this study were to investigate moral sensitivity among nursing students, differences in moral sensitivity according to sample sub-group, and the relation between demographic (...) characteristics of nursing students and moral sensitivity. Research design: A convenience sample of 299 nursing students from one university completed a questionnaire comprising questions about demographic information and the revised Moral Sensitivity Questionnaire. With the use of SPSS, non-parametric statistics, including logistic regression models, were used to investigate the relationship between demographic characteristics and moral sensitivity. Ethical considerations: The study followed the regulations according to the Swedish Ethical Review Act and was reviewed by the Ethics Committee of South-East Sweden. Findings: The findings showed that mean scores of nursing students’ moral sensitivity were found in the middle to upper segment of the rating scale. Multivariate analysis showed that gender (odds ratio = 3.32), age (odds ratio = 2.09; 1.73), and parental status (odds ratio = 0.31) were of relevance to nursing students’ moral sensitivity. Academic year was found to be unrelated to moral sensitivity. Discussion and conclusion: These demographic aspects should be considered when designing ethics education for nursing students. Future studies should continue to investigate moral sensitivity in nursing students, such as if and how various pedagogical strategies in ethics may contribute to moral sensitivity in nursing students. (shrink)

Policy work is often cited as one of the primary functions of Hospital Ethics Committees (HECs), along with consultation and education. Hospital policies can have far reaching effects on a wide array of stakeholders including, care providers, patients, families, the culture of the organisation and the community at large. In comparison with the wealth of information available about the emerging practice of ethics consultation, relatively little attention has been paid to the policy work of HECs. In this paper, we hope (...) to advance the development of best practices in HEC policy work by describing the quality improvement process that we undertook at Hamilton Health Sciences, Hamilton, Ontario, Canada. In the first section of the paper we describe the context of our HEC policy work, and the shortcomings of our historical review process. In subsequent sections, we detail the quality improvement project we undertook in 2010, the results of the project and the specific tools we developed to enhance the quality of HEC policy work. Our goal in sharing this organisational case study is to prompt other HECs to publish qualitative descriptions of their policy work, in order to generate a body of knowledge that can inform the development of best practices for ethics policy review. (shrink)

Background: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students’ perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. Research design: An Italian national cross-sectional study design was performed in 2015–2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous (...) clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 – ‘never’ to 3 – ‘very much’). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Findings: Overall, 4707 (49%) perceived to have discussed ethical issues ‘much’ or ‘very much’; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, ‘enough’ or ‘never’ ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues. Conclusion: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice. (shrink)

Background: Ethics in nursing care are traditionally discussed in terms of moral norms or principles. When taking an ontological approach to ethics, ethics is about ethos. Ethos involves both an internal and an external side of ethics. Considering ethics and health from an ontological perspective can provide a different understanding of ethics and health in caring and nursing. Aim and research question: The aim of this study is to deepen the ontological understanding of ethics and health in caring and nursing. (...) The research question is as follows: What is the ontology of health and ethics in caring and nursing? Research design: The study follows a hermeneutical design inspired by Gadamer. Participants and research context: essays about ethics and health were gathered from PhD students in nursing and caring sciences. Ethical considerations: The research follows Responsible conduct of research guidelines provided by the Finnish Advisory Board on Research Integrity. Findings: An ethos with the values of freedom and responsibility seem to ontologically be important for ethics and health. These values allow a movement between the internal and the external sides of ethics that is important for health. Discussion: The ethos of freedom and responsibility that is essential for ethics and health can provide the current ethical debate a new starting point that previous research asks for. Conclusion: Ontologically, an ethos of freedom and responsibility is essential for ethics and health in nursing and caring. (shrink)

Aims: The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress. Background: Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon. Design: Systematic literature (...) review and narrative synthesis (November 2015–March 2016). Data sources: Ovid MEDLINE® In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO® 1967–Present, CINAHL® Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts. Review methods: Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis. Results: In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity. Conclusion: We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress. (shrink)

Aims: To review the literature on perceptions of nursing students and/or educators on the contribution of ethics education to ethical competence in nursing students. Background: Nurses do not always demonstrate the competencies necessary to engage in ethical practice. Educators continue to debate about the best ways to teach ethics to nurses so that they can develop ethical competencies. Data sources: MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science. Review methods: A total of 15 articles with a quantitative, qualitative, or mixed-methods (...) design published between January 1992 and March 2012 were analyzed. Results: According to students and educators, ethics education increases ethical perception of nursing students and the development of reflective and analytical skills. However, its contribution to the development of ethical behavior was barely mentioned. The accounts of students and educators revealed essential features of effective ethics education: active involvement of students in case study discussions and use of ethical frameworks. The use of activating educational strategies requires a safe learning environment where students can openly reflect on values at stake in their care practice. Conclusion: A better understanding of how students learn to develop ethical skills and of influencing factors can guide educators to develop ethics courses for nursing curriculum. Future research needs to focus on the methodological accuracy of sampling and measuring instruments. (shrink)

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s moral sensitivity. The (...) nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

ZusammenfassungDie aktuellen Entwicklungen und Anforderungen in der pflegeberuflichen Bildung, das Ausbildungsziel im Pflegeberufegesetz vom 17. Juli 2017 und die Explikationen in der dazugehörigen Ausbildungs- und Prüfungsverordnung für die Pflegeberufe fordern eine stärkere Ausrichtung auf die Entwicklung ethischer Kompetenzen explizit ein. Bislang liegen tendenziell übergreifende Definitionen und Darlegungen zu ethischen Kompetenzen in der Pflege vor, deren Verdienst es ist, das Spezifische der Pflegeethik zu konturieren und erstmals ethische Kompetenzen für das Feld zu konkretisieren. In methodischer und didaktischer Hinsicht ist indes eine (...) spezifische Differenzierung gemäß unterschiedlicher Bildungsniveaus relevant. Lehrende werden ihre Lehre nicht mehr nur im Sinne einer allgemeinen Förderung ethischer Kompetenz entwickeln können, sondern müssen dabei den jeweiligen Verantwortungsbereich und das angezielte Qualifikationsniveau der Lernenden berücksichtigen. Ziel der Darlegungen ist es, konkrete Kompetenzniveaus für die Anbahnung professionsethischer Kompetenzen zu operationalisieren, die einerseits die Anforderungen aus dem zukünftigen Pflegeberufegesetz aufgreifen und andererseits anstehende curriculare Entwicklungsprozesse unterstützen. (shrink)

Nurses are frequently confronted with ethical dilemmas in their nursing practice. As a consequence, nurses report experiencing moral distress. The aim of this review was to synthesize the available quantitative evidence in the literature on moral distress experienced by nurses. We appraised 19 articles published between January 1984 and December 2011. This review revealed that many nurses experience moral distress associated with difficult care situations and feel burnout, which can have an impact on their professional position. Further research is required (...) to examine worksite strategies to support nurses in these situations and to develop coping strategies for dealing with moral distress. (shrink)

Vulnerabilität gilt als zentrales Konzept jeglicher pflegeprofessionellen Handlungspraxis. Es macht die menschliche Verletzlichkeit und den daran gebundenen besonderen Schutzanspruch von hilfe- und pflegebedürftigen Menschen zum primären Bezugspunkt aller pflegefachlichen wie pflegeethischen Reflexions-, Entscheidungs- und Handlungsprozesse. Der professionelle Umgang mir den im Kern häufig ähnlichen, in der konkreten Lebenssituation aber höchst unterschiedlichen Vulnerabilitätskonstellationen ist als eine zentrale Forderung an Pflegende aller beruflicher Handlungsfelder beachtlich. Dieser Beitrag konturiert das facettenreiche Vulnerabilitätskonzept und verdeutlicht exemplarisch zentrale, daran gebundene ethische Dimensionen und Spannungsfelder. Der Schwerpunkt (...) liegt hierbei auf dem besonderen Schutzanspruch pflegebedürftiger Kinder. (shrink)

The objective of the present research was two-fold: to provide a new definition of ethical competence, and to clarify the influence of empathy, personal values, and the five-factor model of personality on ethical competence. The present research provides a comprehensive overview about recent approaches and empirically explores the interconnections of these constructs. 366 German undergraduate students were examined in a cross-sectional study that investigated the relationship of empathy, personal values, and the five-factor model of personality with moral judgment competence and (...) counterproductive work behavior as indicators of moral judgment and behavior. We found self-transcendence values to be related to both, high levels of empathy and ethical competence, in contrast to self-enhancement values. Multiple mediation analysis revealed unique effects of empathy on ethical competence through values as mediators. Affective empathy transmitted its effect on ethical competence through benevolence, conformity, tradition, power, and hedonism. Most importantly, perspective taking lost its predictive power when investigated alongside affective empathy dimensions. These results converge to an important role of affective empathy, in particular empathic concern, with regard to personal values and ethical competence. Furthermore, the five-factor model of personality explained variance in measures of ethical competence. Our research suggests that organizational decision makers should consider the role of empathy, personal values, and the five-factor model in their human resource management in order to select employees with high ethical competence. (shrink)

‘This class is so [insert expletive] depressing.’ I overheard a student communicating this to a friend upon exiting one of my ethics courses and I wondered how my classes could generate a sense of empowerment rather than depression, a sense of hope rather than despair. Drawing from David Hume's and Martin Hoffman's work on the psychology of empathy and sympathy, I contend that dominant Western philosophical pedagogy is inadequate for facilitating morally empowered students. Moreover, I stipulate that an adequate analysis (...) of the role emotion should play in pedagogy requires tending to the politics of emotional expression and how oppression functions. I argue that ethical educators have a moral responsibility to facilitate not only critical moral thinking but critical moral agency. Part of ethical education should involve the provision of tools for effective citizen engagement, and reasoning alone is insufficient for this goal. The role of emotion in ethical decision-making and action remains devalued and u.. (shrink)

In this paper, we put forward the view that emotions have a legitimate and important role in health professional ethics education. This paper draws upon our experience of running a narrative ethics education programme for ethics educators from a range of healthcare disciplines. It describes the way in which emotions may be elicited in narrative ethics teaching and considers the appropriate role of emotions in ethics education for health professionals. We argue there is a need for a pedagogical framework to (...) productively incorporate the role of emotions in health professional ethics teaching. We suggest a theoretical basis for an ethics pedagogy that integrates health professional emotions in both the experience and the analysis of ethical practice, and identify a range of strategies to support the educator to incorporate emotion within their ethics teaching. (shrink)

This article explores emerging ethical questions that result from knowledge development in a complex, technological age. Nursing practice is at a critical ideological and ethical precipice where decision-making is enhanced and burdened by new ways of knowing that include artificial intelligence, algorithms, Big Data, genetics and genomics, neuroscience, and technological innovation. On the positive side is the new understanding provided by large data sets; the quick and efficient reduction of data into useable pieces; the replacement of redundant human tasks by (...) machines, error reduction, pattern recognition, and so forth. However, these innovations require skepticism and critique from a profession whose mission is to care for and protect patients. The promise of technology and the new biological sciences to radically and positively transform healthcare may seem compelling when couched in terms of safety, efficiency, and effectiveness but their role in the provision of ethical nursing care remains uncertain. Given the profound moral and clinical implications of how today’s knowledge is developed and utilized, it is time to reconsider the relationship between ethics and knowledge development in this new uncharted area. (shrink)

Ethics is a prominent subject in almost all academic fields. However, the teaching of ethics is a controversial matter in terms of its aim, scope, method, and so on. Besides these points, the issue of quality in ethics education is another essential consideration which needs to define the concept of quality and determine its indicators as well as its measurement. Therefore, establishing certain standards and principles in ethics education may benefit all ethics programs across the world and create a global (...) standardization at some points. Nevertheless, prior to proposing any method, model, standard, or indicator, looking at the existing situation of the current ethics programs would give opportunity to detect good practices, shortages, and shortcomings. In this sense, the aim of this paper was to review the literature on ethics education to exhibit the features of the present ethics programs and benefit from their experiences to determine what quality in ethics education is. The findings demonstrated that both students and educators believe that ethics education generates positive impact on ethical awareness, knowledge, and reasoning. However, the reviewed studies did not indicate explicit and adequate clues to draw a conclusion about what quality in ethics education is and which teaching method is the most effective. (shrink)

Background: In health, ethics is an essential aspect of practice and care and guarantees a better quality of life for patients and their caregivers. Objective: To outline a conceptual analysis of quality of life and ethics, identifying attributes, contexts and magnitudes for health. Method: A qualitative design about quality of life and ethics in health, considering the evolutionary approach in order to analyse the concept. To collect the data, a search was done using the keywords ethic*, quality of life and (...) health. After, in total, 152 studies were found, finalizing seven relevant studies for the proposed concept analysis. Findings and discussion: Of seven studies analysed, their main results were shown by means of antecedents, consequences and attributes of the concepts. The three final attributes that synthesize the concept of quality of life and ethics in health were highlighted: Ethics dilemmas and quality of life; Human ethics and quality of life; and Ethics of care and quality of life. In fact, the attributes and context clearly reveal that ethics and quality of life influence the ability to solve ethical dilemmas, guarantee human ethics in healthcare and impact ethics in healthcare for the production of effective health policies and care that encompasses professional quality of life as well. Conclusion: The magnitude of ethical knowledge in each professional discipline permits cultivating a solidary attitude and developing the willingness to improve healthcare. The right to access, dignity and respect in care delivery are rooted in behaviours and are spontaneously applied in practice to the extent that they play an ethical role. (shrink)

Background: Ethics development is one of the most important aspects of professional practice in health sciences students. Understanding factors affecting ethics development can enhance clinical and professional performance in students. Objective: This study was conducted to explore students’ perceptions about factors affecting professional ethics development. Research design: This study is a conventional content analysis. Data were collected through 20 semi-structured interviews and two focus group interviews (12 students) during 2017–2018. Data were analyzed concurrently with data gathering, using the conventional content (...) analysis approach of Graneheim and Lundman. Participants and research context: In total, 8 students of nursing, 5 medical students, 4 students of anesthesia and 3 operating room students in individual interviews, and 12 students in two focus group interviews from one university in the south of Iran were selected through purposive sampling. Ethical considerations: The research was approved by the Ethics Committee of one university in the south of Iran. Findings: The findings revealed two themes: personal and background factors. Personal factors consisted of the two categories of individual motivation and tendencies and interpersonal interactions. Background factors consisted of the two categories of role and function of teachers and environmental agents. Discussion and conclusions: According to the findings, both background and individual factors affect development of professional ethics in students. Understanding these factors along with reinforcement of educational planning in this field can improve healthcare services. (shrink)

Ethische Leitlinien für die klinische Praxis erfreuen sich zunehmender Beliebtheit. Damit klinisch-ethische Leitlinien aber überhaupt erfolgreich wirksam werden können, ist noch Pionierarbeit zu leisten. Solche Leitlinien müssen wissenschaftlich stärker fundiert und ihre praktische Anwendbarkeit muss verbessert werden. In dieser Arbeit werden die ersten Schritte des Projekts METAP zur methodischen Entwicklung und praktischen Implementierung einer Leitlinie für eine patientengerechte Versorgung am Krankenbett beschrieben und zur Diskussion gestellt. Das Projekt orientiert sich methodisch an der Entwicklung medizinischer Leitlinien und generiert damit eine forschungs- (...) und konsensgestützte Leitlinie, die systematischer Evaluation und Modifikation unterliegt und Rechenschaft über ihre wissenschaftliche Fundierung gibt. Zusätzlich zur Leitlinie bietet das Projekt in der Form eines Handbuchs ein Entscheidungsfindungsverfahren an, welches unter anderem deliberative Aspekte unterstützt. Das Handbuch konzentriert sich auf ethische Fragen der Mikroallokation und liefert darüber hinaus Informationen über empirische, ethische und rechtliche Grundlagen für Therapieentscheidungen. Anhand eines Eskalationsmodells können unterschiedliche Instrumente nach Bedarf als ethische Lösungsstrategien eingesetzt werden, von der Kurzfassung im Kitteltaschenformat („Leporello“) mit den wichtigsten Fakten, weiterführenden Texten und Empfehlungen mit normativen und prozeduralen Hinweisen, über stationsinterne Lösungsversuche bis hin zum Ethikkonsil. Klinische Partner sind von Beginn an aktiv in den Entwicklungsprozess eingebunden und verbessern so die Praxistauglichkeit und Akzeptanz sowie die Ausrichtung des Instrumentariums an den tatsächlichen Bedürfnissen. Dieses partnerschaftliche, partizipative Vorgehen scheint eine wichtige Voraussetzung dafür zu sein, dass METAP in der Klinik Fuß fassen konnte. (shrink)

Recently, ethical guidelines for clinical practice have gained increased popularity, but in order to become useful they require more pioneer’s work. Clinical-ethical guidelines need to be based on a scientific foundation and their practicability must be improved. We present and put to discussion the initial steps of the METAP Project about the development and practical implementation of a clinical-ethical guideline dedicated to a fair resource-allocation at the bedside. -/- With its methodological orientation, the project represents a guideline which is based (...) on both research and consensus-building, undergoing systematic evaluation and modification. In addition to the guideline, the project comes with a manual (a tool kit) including a procedural instrument for making decisions supporting deliberative aspects. It focuses on issues of micro-allocation; furthermore, it provides empirical, ethical and legal basics for making fair treatment decisions that should help to prevent overtreatment, undertreatment or discrimination in patient care. We propose an Escalation Model with various instruments serving as problem solving strategies that correspond to the respective needs; these instruments include a pocket-summary (“Leporello”) with the most important facts; further reading material; normative and procedural recommendations; ward-specific strategies, and also the option of clinical ethics consultation. -/- Clinical partners have been actively involved in the developmental process from the beginning and contributed to the practical applicability, acceptance and a valid need-orientation of the whole tool kit. This partnership and the participatory approach seem to have helped METAP to gain a foothold in the clinic. (shrink)

Die Bearbeitung des Themas „Ethik in der Pflege“ erfolgt in mehreren Schritten. Ausgehend von einem Fallbeispiel werden Charakteristika und fachliche Herausforderungen eines inzwischen stark technisch vermittelten pflegerischen Handelns aufgezeigt. Von besonderer Bedeutung für die Wahrnehmung ethischer Probleme erweisen sich zunächst die Art und Weise der Gestaltung pflegerische Beziehungen, die ihrerseits die Richtungen persönlicher Aufmerksamkeit bestimmen. Aufgrund des Selbstverständnisses der Medizin drängen sich andere ethisch relevante Fragestellungen in den Vordergrund als jene, die aus bestimmten Wahrnehmungs- und Aufmerksamkeitsrichtungen der Pflege resultieren. Auch (...) bestimmte anthropologische Vorannahmen haben Einfluss auf die Formulierung ethisch relevanter Probleme. Schließlich wird der Blick auf tugendethische Aspekte als motivationale Grundlage eines ethisch akzeptablen pflegerischen Handelns gelenkt und damit ein Übergang zu Elementen einer Ethics of Care geschaffen. (shrink)

Die Pflegepraxis ist auf systematisierte Verfahren und Methoden angewiesen, die sie bei den zunehmend geforderten ethischen Abwägungs- und Reflexionsprozessen unterstützen, diese strukturieren und die Entscheidungsfindung im Rahmen der Ethikberatung absichern. Diesbezüglich sind insbesondere ethische Fallbesprechungen und Ethik-Leitlinien maßgeblich. Der Beitrag konkretisiert das Instrument der Ethik-Leitlinie und dessen Bedeutung im Kontext der Ethikberatung sowie die zentralen Entwicklungsschritte hin zu einer unterstützenden Ethik-Leitlinie. Den zusammenfassenden Abschluss bildet die Darlegung möglicher Synergien, die sich bei der Erstellung einer Ethik-Leitlinie hinsichtlich der Entwicklung von Ethikkompetenzen (...) abbilden lassen und die als Paralleleffekte bewusst mitgedacht werden können. (shrink)

Background: Moral distress occurs when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Moral distress was found to cause negative feelings, burnout, and/or resignation. Not only external factors such as lack of staff but also internal ones affect moral distress. Moral sensitivity, which is thought of as an advantage of nurses, could effect moral distress, as nurses being unaware of existing ethical problems must feel little distress. Objectives: (...) To examine the impact of moral sensitivity on moral distress among psychiatric nurses, and affirm the hypothesis that nurses with higher moral sensitivity will suffer moral distress more than nurses with less moral sensitivity in two different samples. Ethical consideration: The study obtained ethical approval from the Research Ethics Committee of the Faculty of Medicine at Mie University (# 1111, 20.4.2010), and by the Turku University Ethics Board (29.5.2012). Permissions to undertake the study was obtained from the in two hospital districts and in one city (§ 48/4.10.2012, § 63/4.9.2012, 51/2012 27.8.2012). Informed consent was not formally obtained, because the questionnaire was anonymously reported by the participants who volunteered to answer. The participants responded voluntarily and anonymously. Methods: An anonymous questionnaire containing the Revised Moral Sensitivity Questionnaire and the Moral Distress Scale for Psychiatric nurses was conducted to 997 nurses in 12 hospitals in Japan, and 974 nurses in 10 hospitals in Finland after obtaining of approval by research ethics committees. Data were analyzed using a multi-group structural equation model analysis. Findings: A set of analyses imply that the association of moral sensitivity with moral distress is significant and similar between Japan and Finland, whereas the factor structures of moral sensitivity and moral distress may be partially different. Discussion: The result of this study may indicate that nurses with high moral sensitivity can sense and identify moral problems, but not resolve them. Therefore, supporting nurses to solve ethical problems, not benumbing them, can be important for better nursing care and prevention of nurses’ resignation. Conclusion: Moral sensitivity and moral distress were positively correlated among psychiatric nurses in both Japan and Finland, although the participating nurses from the two countries were different in qualification, age, and cultural background. Nurses with high moral sensitivity suffer from moral distress. (shrink)

Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and (...) a thematic analysis. Each line of the data was reviewed and coded, and the codes were collapsed into themes. Methodological rigor was established. Forty-nine nurses responded to the survey. The majority of nurses had experienced moral distress, and the majority of situations that caused nurses to experience moral distress were related to end of life. The nurses described negative consequences for themselves, patients, and families. (shrink)