Nursing Ethics最新文献

{"title":"Transparency and Authority Concerns with Using AI to Make Ethical Recommendations in Clinical Settings.","authors":"Jeffrey Byrnes, Michael Robinson","doi":"10.1177/09697330241307317","DOIUrl":"10.1177/09697330241307317","url":null,"abstract":"<p><p>In response to recent proposals to utilize artificial intelligence (AI) to automate ethics consultations in healthcare, we raise two main problems for the prospect of having healthcare professionals rely on AI-driven programs to provide ethical guidance in clinical matters. The first cause for concern is that, because these programs would effectively function like black boxes, this approach seems to preclude the kind of transparency that would allow clinical staff to explain and justify treatment decisions to patients, fellow caregivers, and those tasked with providing oversight. The other main problem is that the kind of authority that would need to be given to the guidance issuing from these programs in order to do the work set out for them would mean that clinical staff would not be empowered to provide meaningful safeguards against it in those cases when its recommendations are morally problematic.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1749-1760"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dignity of women with systemic lupus erythematosus: A qualitative study.","authors":"Zinat Mohebbi, Samaneh Bagherian, Marion Eckert, Banafsheh Tehranineshat","doi":"10.1177/09697330241299537","DOIUrl":"10.1177/09697330241299537","url":null,"abstract":"<p><p><b>Background:</b> The nature of systemic lupus erythematosus (SLE) and the far-reaching unpleasant consequences of this disease and the treatments can put the dignity of the women with the disease at risk. Yet, the dignity of this population of patients has not been the subject of much research.<b>Objective:</b> The present study aims to define and describe the concept of dignity of women with SLE.<b>Research design:</b> This is a qualitative descriptive study in which data were collected via individual, in-depth, semi-structured interviews. The collected data were analyzed using methods of content analysis in MAXQDA 2010.<b>Participants and research context:</b> In total, 29 individuals (14 patients, 8 family caregivers, and 7 nurses) were selected by purposeful sampling from the internal wards of a teaching hospital located in the south of Iran. The study was conducted between June 2023 and February 2024. Sampling continued until the data were saturated.<b>Ethical considerations:</b> The Institutional Review Board of the university has verified that the study complies with research ethics.<b>Findings:</b> Analysis of the data extracted from the interviews resulted in three themes: respect for identity, compassion in care and treatment, and fulfillment of support needs.<b>Conclusions:</b> The women with SLE who were surveyed in the present study needed to have their feminine identity and social identity respected and be comprehensively supported by their treatment team and family caregivers. In such a context, care characterized by compassion and empathy and treatment teams' respectful and professional interactions with the patients contribute to maintaining the patients' dignity. Nursing managers and staff can use the findings of the present study to create a supportive clinical environment in order to better maintain the dignity of women with SLE.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1829-1847"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality improvement in palliative care: A review of the ethics.","authors":"Fearon David, Knights Felicity, Ratiram Cherisse, Grant Liz, Fallon Marie","doi":"10.1177/09697330241305546","DOIUrl":"10.1177/09697330241305546","url":null,"abstract":"<p><p>IntroductionQuality improvement is the systematic seeking of improvements in care and experience. This discussion paper will explore how the principles of good clinical care and the established ethical frameworks for research can help guide its practice, using examples from palliative care.Quality improvement in palliative carePalliative care is well positioned to be at the vanguard of quality improvement in healthcare. But it holds ethical particularities which require specific considerations, that are helpful for other specialities. The experiences of two improvement activities in palliative care, the Liverpool Care Pathway and Do Not Attempt Resuscitation status reviews, illustrate potential dangers of QI.Implications for ethical practiceRecommendations for ethically sound quality improvement projects in palliative care include paying attention to the burden of time, viewing informed consent as a tool, monitoring for vulnerability and coercion and transparency in the use of data. The ethics and practices in clinical encounters provide a framework for approaching consent and protecting those with palliative care needs who are deemed as vulnerable. It is explicit in palliative care that time and energy are precious and finite resources. These must be valued and respected in any quality improvement projects. Respect for beneficence and autonomy is essential to avoid coercion and for any project to be ethically sound.ConclusionQuality improvement processes are an integral part of good healthcare practices. High ethical standards, a supportive culture, transparency and candour are needed for the promotion and sustainability of quality improvement in palliative care.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1740-1748"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A care ethical perspective on family caregiver burden and support.","authors":"Maaike Haan, Jelle van Gurp, Marianne Boenink, Gert Olthuis","doi":"10.1177/09697330251324294","DOIUrl":"10.1177/09697330251324294","url":null,"abstract":"<p><p>Family care-when partners, relatives, or other proxies care for each other in case of illness, disability, or frailty-is increasingly considered an important pillar for the sustainability of care systems. For many people, taking on a caring role is self-evident. Especially in a palliative care context, however, family care can be challenging. Witnessing caregivers' challenges may prompt compassionate nurses to undertake actions to reduce burden by adjusting tasks or activities. Using a care ethical approach, this theoretical paper aims to provide nurses with an alternative perspective on caregiver burden and support. Drawing on the concepts of relationality and contextuality, we explain that family care often is not a well-demarcated or actively chosen task. Instead, it is a practice of responding to an all-encompassing \"call\" to care flowing from a relationship, within a social and cultural context where norms, motivations, and expectations shape people's (sometimes limitless) care. We consider relational interdependence at the root of persisting in care provision. The question is then whether self-sacrifice is a problem that nurses should immediately solve. In ideal circumstances, self-sacrifice is the result of a conscious balancing act between values, but family care in the context of serious illness barely provides room for reflection. Yet, instant attempts to alleviate burden may overlook family caregivers' values and the inherent moral ambiguities and/or ambivalent feelings within family care. Family care is complex and highly personal, as is finding an adequate balance in fulfilling one's sometimes conflicting values, motivations, and social expectations. Therefore, we suggest that caregiver experiences should always be interpreted in an explorative dialogue, focused on what caring means to a particular family caregiver. Nurses do not have to liberate family caregivers <i>from</i> the situation but should support them <i>in</i> whatever overwhelms or drives them in standing-by their loved ones until the end.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1873-1885"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racism during clinical placement, the perpetrators, impact, advocating and reporting.","authors":"Hila Ariela Dafny, Nicole Snaith, Christine McCloud, Nasreena Waheed, Paul Cooper, Stephanie Champion","doi":"10.1177/09697330251317675","DOIUrl":"10.1177/09697330251317675","url":null,"abstract":"<p><p><b>Background:</b> The experience of racism in healthcare is particularly challenging to address due to misunderstandings of the definition, the complex interplay of other potential discriminations and, at some level, the denial that it occurs. Limited studies have reported racism as an aspect of workplace violence toward nurses and nursing students from both patients and staff.<b>Research aims:</b> To understand nursing students' experience of unethical behaviour, including racism during clinical placement, the perpetrators, impacts, advocating and reporting.<b>Research design:</b> An interpretive, qualitative design was used, and 15 nursing students were interviewed using semi-structured interview guides. The interview recordings were transcribed and thematically analysed.<b>Participants and research context:</b> Nursing students voluntarily participated and completed the interviews for this study from one undergraduate nursing student cohort in metropolitan South Australia.<b>Ethical considerations:</b> This study received ethical approval from the University Social and Behavioural Research Ethics Committee.<b>Findings/results:</b> The two major themes with subthemes of the findings include (1) The multi-faceted student nurse experience of racism: sub themes - racism from patients to nurses, from nurses to nursing students' and racism towards patients. (2) The pervasive influence and limited reporting of racism by nursing students: sub themes-feeling disempowered, and barriers to reporting racism.<b>Conclusions:</b> The findings of this study highlight the registered nurse students' experience of racism in various forms within the clinical environment and the significant negative impact it has on RNS during placements. This evidence calls for systemic changes to create a more inclusive and supportive environment for all RNS.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1886-1899"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical analysis of the change of values in healthcare.","authors":"David Hansen, Silviya Aleksandrova-Yankulovska, Florian Steger","doi":"10.1177/09697330251319374","DOIUrl":"10.1177/09697330251319374","url":null,"abstract":"<p><p>What people value today can differ from what they have valued. But what does this value variability mean in the context of healthcare? We ethically analyze the current state of research on the change of embedded values in healthcare systems and the driving processes behind it. Starting with a systematic literature review and a content analysis, we subject the selected articles to an ethical analysis through three ethical theories: principlism, value ethics, and utilitarianism. The included papers demonstrated how moral dissonance between individual values and behavior leads to moral distress. The occurrence of moral distress was related to current healthcare practices. Beneficence and non-maleficence played a central role where principlism was considered, virtue ethics was criticized for not addressing the structural problems in the healthcare system, and consequences of value change for healthcare professionals and the society were analyzed. Further, principlism cannot fully cover the value change in medical care with its top-down and bottom-up processes leading to consequences for the patients, healthcare professionals, and society as a whole. We found correlations between top-down value change processes in the healthcare system and the quality of care. Health professionals are forced to develop an attitude that does not adhere to traditional medical values any longer and eventually leads to low-value care. Accompanying phenomena like moral distress cause dropout of healthcare workers. These can be hardly slowed down from the bottom-up by the development of resilience and moral courage. More effectively, structural changes through value interventions have the potential to improve working conditions and the quality of care.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1926-1939"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-fidelity simulation training for improving nursing professional values acquisition.","authors":"Oscar Arrogante, Ismael Ortuño-Soriano, Ana Sofia Fernandes-Ribeiro, Marta Raurell-Torredà, Diana Jiménez-Rodríguez, Ignacio Zaragoza-García","doi":"10.1177/09697330251313782","DOIUrl":"10.1177/09697330251313782","url":null,"abstract":"<p><p>BackgroundNursing professional values form the basis of nursing interventions and serve as a guide for professional practice, reflecting in all interactions with patients and other healthcare professionals. As nursing professional values constitute powerful influencers in nursing practice, a strong commitment to these values is essential for nursing students to provide high-quality care.AimTo evaluate the impact of high-fidelity simulation training on first-year nursing students' nursing professional values acquisition.Research designQuasi-experimental study using a longitudinal design with a single group pre- and post-intervention evaluation.Participants and research context202 first-year nursing students at the Complutense University of Madrid (Spain) participated in the study between September 2023 and May 2024. Their nursing professional values were compared at baseline and after the simulation experience using the \"Nurses Professional Values Scale-Revised\" (NVPS-R). The acquisition of these values was also evaluated using a verification list during simulation sessions. Five simulated scenarios recreated ethics dilemmas, where students should manage conflictive situations with a standardized patient.Ethical considerationsThe study was approved by the Research Ethics Committee from the Complutense University of Madrid (reference code: CE_20231116_18_SAL).ResultsMost of the students (84.87%) acquired the nursing professional values needed to manage adequately simulated ethical dilemmas. Nursing students significantly improved their nursing professional values after the simulation sessions. The effect size was medium for the \"professional expertise\" and \"professional mastery\" dimensions, and the total score of NVPS-R, whereas the obtained effect size was small for the \"ethics\" dimension.ConclusionHigh-fidelity simulation training using standardized patients allows first-year nursing students to acquire and improve nursing professional values. The inclusion of simulation training programs in nursing study plans to foster nursing professional values is needed to train undergraduate nursing students, providing them with the necessary ethical concepts and principles for their future clinical practice and ensuring high-quality care.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1728-1739"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses on the outside, problems on the inside! The duty of nurses to support unions.","authors":"Paul Neiman, Tammy Neiman","doi":"10.1177/09697330241312381","DOIUrl":"10.1177/09697330241312381","url":null,"abstract":"<p><p>Healthcare is increasingly impacted by chronic short staffing of nurses, which causes and is caused by increased nurse burnout and decreased retention. Nurses' unions seek to address these problems by proposing safer nurse-to-patient ratios, retention bonuses for working through the COVID-19 pandemic, Personal Protective Equipment (PPE) stockpiles, sabbatical leaves, measures aimed at reducing workplace violence, and maintaining or increasing wages and benefits to keep nurses at the bedside. Chronic short staffing and burnout directly affect the quality and availability of patient care-as the International Council of Nurses has pointed out, there is no healthcare without healthcare workers. This article draws on Neiman's argument that the US healthcare system is best understood as a system of competing interests aimed at fulfilling the community's obligation to provide access to quality healthcare. Nurses' unions use contract negotiations, legislative advocacy, and strikes to pressure other members of the healthcare community to address chronic short staffing, burnout, and retention. Nurses' unions in the US thus play a unique role in the system of competing interest as an organized group whose primary interest aligns with the community's obligation to provide access to quality healthcare. This article argues that nurses' professional duty to care for patients includes a duty to support nurses' unions as an important way to address the factors outside of nurses' direct practice that impacts the quality and accessibility of the care that nurses provide to patients. This duty to support unions applies to unionized and non-unionized nurses in the US, and includes duties to participate in union activities, to not cross picket lines, and to avoid work for strikebreaking nurse agencies.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1799-1812"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient privacy investigation in the emergency departments in teaching hospitals.","authors":"Mohammad Enayati Rangbar Ghorbanabadi, Samaneh Mirzaei, Mehdi Bagherabadi, Khadijeh Nasiriani","doi":"10.1177/09697330241307316","DOIUrl":"10.1177/09697330241307316","url":null,"abstract":"<p><p>BackgroundPatient privacy is important as one of the most principle components of quality healthcare and safe care. In teaching hospital emergency rooms, it is a challenge for staff to respect for privacy.Research aimRecognizing the importance of this issue, this study aims to assess the privacy status of patients in emergency departments.Research designThis study employs a cross-sectional design.Participants and research contextThis study was conducted in patients of the four emergency departments of the teaching hospitals. 426 patients completed the demographic and clinical profile, as well as a privacy questionnaire, in four teaching hospitals selected based on quota sampling after obtaining informed consent. The data were analyzed with SPSS 26 and independent t-tests and one-way ANOVA.Ethical considerationsThis study was approved by the ethical committee and the designated authority within hospitals.FindingsAccording to the findings, the majority of the respondents were married (65.05%), with a diploma level (30.25%), self-employed (37.5%), and female (50/50%). The most frequent hospitalizations were also for internal emergencies (45.1%), night shifts (42.3%), and workdays (63.8%), with mean age of 41.78 (years and a duration of hospitalization of 6.34 hours). The patient privacy score in the emergency department was 67.61 ± 13.30 and in the physical, psychosocial, and spiritual/religious dimensions was reported as 3.31 ± 15.37, 6.97 ± 36.72, and 6.18 ± 15.50, respectively. The patient privacy showed a significant difference by type of emergency, number of beds, and nurses to bed ratio (<i>p</i> = .001).ConclusionsBased on the results of the study, as the level of patient privacy was average for patients, in order to increase patient trust and improve the services provided, it is suggested that more focus be placed on structural changes, the development of guidelines, training in medical and nursing ethics, and the establishment of hospital ethics committees.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1761-1770"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical considerations in the UK-Nepal nurse recruitment: Nepali nurses' perspectives.","authors":"Animesh Ghimire, Yunjing Qiu, Mamata Sharma Neupane, Purushottam Ghimire","doi":"10.1177/09697330241305574","DOIUrl":"10.1177/09697330241305574","url":null,"abstract":"<p><p>BackgroundThe global migration of nurses from resource-constrained to affluent nations raises complex ethical concerns, often rooted in historical power imbalances and neocolonial legacies. The Nepal-UK Memorandum of Understanding (MoU) on nurse recruitment, while presented as a solution to workforce shortages, exemplifies this complex dynamic, prompting critical questions about its implications for individual nurses and the healthcare systems involved.AimThis qualitative study explored the ethical complexities and dilemmas associated with the Nepal-UK nurse recruitment Memorandum of Understanding (MoU). This bilateral agreement has sparked debate about its potential impact on both individual nurses and the healthcare systems of Nepal and the UK.Research DesignA qualitative exploratory design utilizing semi-structured interviews was employed. Data were analyzed using reflexive thematic analysis.Participants and Research ContextTwelve Nepali nurses from two private hospitals in Kathmandu, Nepal, participated in the study.Ethical ConsiderationsThe study was approved by the Nepal Health Research Council. All participants provided informed consent and were assured of confidentiality and anonymity.ResultsFour themes emerged from the data: (1) The lingering legacy of colonialism casts a shadow on the Nepal-UK relationship, raising concerns about potential exploitation and unequal power dynamics. (2) Nepali nurses grapple with the ethical dilemmas of pursuing personal dreams while acknowledging their responsibilities towards their communities and Nepal's healthcare system. (3) The MoU's claims of ethical recruitment are scrutinized, with nurses questioning its fairness and sustainability. (4) The agreement is challenged as a potential band-aid solution that may perpetuate global health inequities rather than fostering a genuine partnership.ConclusionsThe Nepal-UK MoU, while offering opportunities for individual nurses, also raises alarms about brain drain, exploitation, and the perpetuation of global health disparities. The study underscores the urgent need for a paradigm shift in international nurse recruitment practices, prioritizing genuine partnership, equitable distribution of benefits, and sustainable solutions that address the root causes of healthcare workforce challenges in both source and destination countries.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1813-1828"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}