Nursing Ethics最新文献

{"title":"Nursing vaccine mandates: Ethically justified, an infringement on autonomy, or both?","authors":"Christopher M Charles, Aimee B Milliken","doi":"10.1177/09697330241262319","DOIUrl":"10.1177/09697330241262319","url":null,"abstract":"<p><p>After almost a year and a half of the COVID-19 pandemic, many healthcare institutions in the United States announced that they would mandate COVID-19 vaccination, with medical and religious exceptions, as a term of employment. The mandates resulted in widely publicized protests from hospital staff, including some nurses, who argued that these medical institutions violated the ethical principle of autonomy. As the world enters the \"post-pandemic period,\" decisions such as these, made during times of crisis, must be reviewed to provide clarity for when the next pandemic occurs. In this paper, we support the argument that such mandates are ethically justifiable. We explore the framework of objections that were brought forward by dissenters of this vaccine mandate. Next, we provide an analysis of conflicting ethical principles present when such mandates were deployed. Utilizing the American Nurses Association's Code of Ethics for Nurses, notably provisions 2, 3, and 6 we argue that it is an ethical duty of the nurse to be vaccinated. Specifically, we turn to provision two, which most explicitly underscores the necessity of vaccination as a function of the nurse's primary commitment to the patient. Next, we highlight the International Council of Nurses Code of Ethics which provides similar guidance internationally. Finally, we examine the applicability of the principles of public health, care ethics, and the nursing role as frameworks to underpin such mandates both for the current and for potential future pandemics, arguing that the nurse's ethical duty to be vaccinated spans these contexts.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"629-635"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443602","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":"Moral foundations, moral emotions, and moral distress in NICU nurses.","authors":"Peter Barr","doi":"10.1177/09697330241262468","DOIUrl":"10.1177/09697330241262468","url":null,"abstract":"<p><strong>Background: </strong>Moral distress is common in neonatal intensive care unit (NICU) nurses.</p><p><strong>Purpose: </strong>The purpose of this study was to evaluate the relationships between NICU nurses' moral foundations, moral emotions, and moral distress.</p><p><strong>Research design and method: </strong>This is an observational cross-sectional self-report questionnaire study.</p><p><strong>Participants and research context: </strong>One hundred and forty-two (24%) of 585 Level 3-4 NICU nurses completed pen-and-paper self-report measures of moral foundations (harm, fairness, ingroup, authority, and purity) (Moral Foundations Questionnaire-20), proneness to self-conscious moral emotions (guilt and shame) (modified Personal Feelings Questionnaire-2), and moral distress (futile care, compromised care, and untruthful care) (modified Revised Moral Distress Scale).</p><p><strong>Ethical considerations: </strong>Participation was voluntary and anonymous. The ethics committees of the participating hospitals approved the study protocol (HREC Reference: LNR/18/SCHN/316).</p><p><strong>Results: </strong>Non-parametric statistical analyses showed medium to large correlations between moral foundations and moral emotions. Moral foundations and moral emotions had trivial to small correlations with moral distress. Using a liberal <i>p-</i>value of <.10 for statistical significance because of the small sample size, harm (<i>r</i>_s = 0.22) and fairness (<i>r</i>_s = 0.16) predicted futile care, ingroup predicted compromised care (<i>r</i>_s = 0.19) and untruthful care (<i>r</i>_s = 0.15), and purity predicted untruthful care (<i>r</i>_s = 0.15). Guilt-proneness predicted futile care (<i>r</i>_s = 0.15). Shame-proneness did not predict moral distress.</p><p><strong>Conclusion: </strong>The correlations between moral foundations and moral emotions were significant. Moral foundations and guilt-proneness predicted one or more dimensions of moral distress. The smaller than expected effect sizes may have been owing to how moral foundations, moral emotions, and moral distress were conceptualized and measured, or to moral disengagement, including NICU nurses' possible reluctance to countenance aversive but morally warranted feelings of guilt and especially shame. Understanding the nature of these relationships may complement the efforts of NICU administrators, educators, counsellors, and nurses themselves to mitigate moral distress.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"636-647"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443601","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":"Moral resilience protects nurses from moral distress and moral injury.","authors":"Petros Galanis, Katerina Iliopoulou, Aglaia Katsiroumpa, Ioannis Moisoglou, Michael Igoumenidis","doi":"10.1177/09697330251324298","DOIUrl":"https://doi.org/10.1177/09697330251324298","url":null,"abstract":"<p><p><b>Background:</b> The relationship between moral resilience, moral distress, and moral injury among nurses during the COVID-19 pandemic has been widely investigated; however, the literature in the post-COVID-19 era is scarce. <b>Research aim:</b> To examine the impact of moral resilience on moral distress and moral injury among nurses after the COVID-19 pandemic.<b>Research design:</b> Cross-sectional study.<b>Participants and research context:</b> We obtained a convenience sample of 1118 nurses in Greece. We collected demographic data (gender, age) and work-related data (understaffed wards, shift work, clinical experience). We measured moral resilience with the revised \"Rushton Moral Resilience Scale\", moral distress with the \"Moral Distress Thermometer\", and moral injury with the \"Moral Injury Symptom Scale-Healthcare Professionals\" version. We adjusted all multivariable models for demographic variables.<b>Ethical considerations:</b> The Ethics Committee of the Faculty of Nursing, National and Kapodistrian University of Athens approved our study protocol (approval number; 474, approved: November 2023). Our study followed the Declaration of Helsinki.<b>Findings/results:</b> Multivariable linear regression analysis showed that moral resilience reduced moral distress and moral injury. In particular, we found that increased response to moral adversity was associated with decreased moral distress (adjusted coefficient beta = -1.81, 95% confidence interval [CI] = -2.07 to -1.54). Moreover, we found that increased response to moral adversity (adjusted coefficient beta = -8.24, 95% CI = -9.37 to -7.10) and increased moral efficacy (adjusted coefficient beta = -3.24, 95% CI = -5.03 to -1.45) were associated with reduced moral injury.<b>Conclusions:</b> Moral resilience can reduce the level of moral distress and moral injury among nurses. However, the persistence of moderate moral resilience among Greek nurses does not guarantee its sustainability. To ensure that this resilience is maintained and potentially enhanced, it is imperative for nurse leaders and policymakers to strategically design interventions to address issues at the organizational, team, and individual levels.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330251324298"},"PeriodicalIF":2.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525087","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":"Violence facing nurses and the threats they pose to autonomy and justice.","authors":"Tony Chackal, Cassandra Mitchell","doi":"10.1177/09697330251317671","DOIUrl":"https://doi.org/10.1177/09697330251317671","url":null,"abstract":"<p><p>Nurses experience various types of violence in healthcare. This violence can be perpetrated by doctors, other nurses, patients, and their families, as well as other members of the healthcare team. While traditionally thought of as physical, violence may also be non-physical, that is, verbal, emotional, and psychological in nature. In this paper, we outline three categories of violence experienced by nurses: vertical, lateral, and angular. When violence occurs by someone in a position of authority like physicians, it is vertical, when occurring by someone in an equal position like other nurses, it is lateral, and when violence occurs by someone in an adjacent position like patients, it is angular. Violence may carry violations of autonomy and justice for nurses. Autonomy and justice are two principles of healthcare ethics, which have traditionally been applied primarily to patients. We expand the application of these principles to healthcare workers and highlight how violence obstructs autonomy and justice for nurses. Some instances of violence obstruct autonomy by undermining nurses' everyday decision-making while aggregate violence obstructs autonomy by causing some to leave the field altogether. Some instances of violence violate justice by undermining nurses' epistemic capacities while others concern unfairness produced by unjust distributions of resources.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330251317671"},"PeriodicalIF":2.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442595","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":"Care shortages and duties to age abroad.","authors":"Bouke de Vries","doi":"10.1177/09697330251315938","DOIUrl":"https://doi.org/10.1177/09697330251315938","url":null,"abstract":"<p><p>Many higher-income countries have shortages of care-workers, which is unlikely to change in the foreseeable future as virtually all of these societies are ageing. The philosophical literature on this problem has concentrated mostly on the merits and demerits of different policy solutions, especially on the recruitment of foreign care-workers and on investments in care robots and other relevant technologies. However, the question of what moral duties, if any, <i>private individuals</i> have to help address care-worker shortages has been entirely neglected. In this article, I help to fill this lacuna by arguing that some inhabitants of higher-income countries have moral duties to age abroad in order to reduce the pressure on the aged care-systems of their current societies, whereby 'ageing abroad' is defined narrowly as moving to a foreign country to receive residential or non-residential aged care. As I show, these duties are dependent on a number of conditions being met, including the requirement that the host populations not be made worse off.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330251315938"},"PeriodicalIF":2.9,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434298","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":"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":"https://doi.org/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":"9697330251317675"},"PeriodicalIF":2.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing healthcare professionals' moral distress: A descriptive qualitative analysis.","authors":"Adam T Booth, Kathryn L Robinson","doi":"10.1177/09697330251317672","DOIUrl":"https://doi.org/10.1177/09697330251317672","url":null,"abstract":"<p><p><b>Background:</b> The Measure of Moral Distress - Healthcare Professionals (MMD-HP) is a 27-item survey that quantifies moral distress. The MMD-HP was distributed to healthcare professionals (HPs), and analysis of a free-text response item revealed information-rich descriptions of morally distressing situations. <b>Research question:</b> What are HPs' perceptions of their experiences of morally distressing situations? <b>Research design:</b> A descriptive, qualitative approach explored respondents' free-text responses to the following open-ended response item: \"If there are other situations in which you have felt moral distress, please write and score them here.\" <b>Participants and research context:</b> Eligible participants were HPs (<i>N</i> = 8206) working in a large, multi-site healthcare system located in a major, urban city in the Southeastern United States. <b>Ethical considerations:</b> The Institutional Review Board provided approval for this research. A survey preamble supplied information, and consent was presumed with survey completion. <b>Findings:</b> Three themes were identified from 282 free-text responses: Theme 1: Compromised Quality of Care, Theme 2: Hostile Work Environment, and Theme 3: Ineffective Leadership. <b>Conclusions:</b> This study is unique because it provided in-depth qualitative analysis of morally distressing situations in a free-text response item across a wide array of HPs within multiple settings. Responses revealed that moral distress impacted the quality of patient care and provided descriptions of powerlessness to act.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330251317672"},"PeriodicalIF":2.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371365","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":"Ethically challenging situations in eldercare: A cross-sectional study.","authors":"Kirsikka Selander, Eveliina Korkiakangas, Risto Nikunlaakso, Tiina Koivisto, Jaana Laitinen","doi":"10.1177/09697330251317673","DOIUrl":"https://doi.org/10.1177/09697330251317673","url":null,"abstract":"<p><strong>Background: </strong>Ethically challenging situations are one of the many stressors that strain eldercare employees.</p><p><strong>Aim: </strong>The study aimed to examine (1) the mean levels of ethically challenging situations among eldercare employees in different Finnish eldercare service types and (2) the associations between organizational constraints and poor work-unit collaboration with ethically challenging situations.</p><p><strong>Research design: </strong>Cross-sectional survey in 2020 including 4,347 Finnish eldercare employees (response rate 67%). These employees provide care and support to older adults, such as assist with daily activities and manage medical needs. Employees were classified into four categories based on the eldercare service type: home care (<i>n</i> = 1,683), service housing (<i>n</i> = 1,649), outpatient and ward care (<i>n</i> = 650), and guidance and activity services (<i>n</i> = 365). The data was analyzed with variance analysis, t-tests, and linear regression analysis.</p><p><strong>Ethical considerations: </strong>The study was approved by the ethical board of the Finnish Institute of Occupational Health. Respondents' provided informed consent for participation.</p><p><strong>Findings: </strong>Analyses showed that the level of ethically challenging situations was highest in service housing, among nurses, and among practical nurses. Organizational constraints-job strain and organizational injustice-had the strongest positive association with ethically challenging situations. Poor work-unit collaboration, instead, had a minor positive association with ethically challenging situations.</p><p><strong>Conclusions: </strong>Organizational constraints, especially job strain and organizational injustice, are important to identify to alleviate ethically challenging situations among eldercare workers.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330251317673"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257150","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":"Care leaders' moral distress in older adult care: A scoping review.","authors":"Fanny Ahokas, Marit Silén, Anna T Höglund, Jessica Hemberg","doi":"10.1177/09697330251315939","DOIUrl":"https://doi.org/10.1177/09697330251315939","url":null,"abstract":"<p><p>Moral distress among nurses is well researched and well documented, but there is limited research on the moral distress experienced by care leaders, who serve as intermediaries between patient care nurses and higher levels of administration. Healthcare professionals experience moral distress daily in the context of older adult care. The aim of this scoping review was to evaluate recent literature on moral distress in older adult care with the goal of revealing how care leaders' experiences of moral distress in older adult care have been conceptualized in earlier studies. The research questions were: How is the concept of moral distress as experienced by care leaders in older adult care defined in the existing literature? How is the concept of moral distress conceptualized in the literature? The research has been conducted in accordance with the guidelines set forth by the Finnish National Advisory Board on Research Ethics TENK. We saw that consensus on how moral distress is defined is lacking. Care leaders in older adult care experience substantial moral distress, which could be linked to the duality of their leadership role. Moral distress can be caused by a complex interplay of individual and structural factors and the challenging complex moral issues inherent to older adult care. Moral distress could impact care leaders' emotional health, job performance, overall job satisfaction and result in higher turnover rates, absenteeism, decreased quality of patient care, and increased organizational costs. Addressing moral distress on the individual, team, and organizational levels is crucial for enhancing care leaders' well-being and improving the overall quality of care for older adults. A focus on the identification of strategies whereby care leaders can be supported, exploration of the long-term effects of moral distress on healthcare professionals in general, and the organizational outcomes associated with moral distress should be included in future research.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330251315939"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257143","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":"Nurse misinformation and the digital era: Abrogating professional responsibility.","authors":"Christopher M Charles, Pamela J Grace","doi":"10.1177/09697330251317674","DOIUrl":"https://doi.org/10.1177/09697330251317674","url":null,"abstract":"<p><p>In the current digital era, reliance on technology for communication and the gathering and dissemination of information is growing. However, the information disseminated can be misleading or false. Nurses tend to be trusted by the public, but not all information brought to the public forum is well-informed. Ill-informed discussions have resulted in harm to individuals who take such information as fact and act on it. As technology continues to evolve and fact versus fiction becomes more challenging to discern, it is critical that nurses recognize their ethical responsibility to the public in providing information for which sound evidence exists. This analysis will explore medical misinformation through concepts such as confirmation bias and the politicization of science. Also, the impact of nurses not recognizing the power and responsibility associated with using their credentials in public fora, even when the central motivator is that they believe they are helping other individuals. Using nursing goals and perspectives, we will discuss the ethical responsibility of nurses to be aware of the soundness of what they think they know. Utilizing ideas of professional responsibilities, as outlined by professional codes of ethics as well as the ethical principles of non-maleficence and veracity, we explore the problem of nurses propagating misinformation and suggest strategies to enhance nurse awareness of their ethical responsibilities for veracity and transparency regarding what is known and what is not.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330251317674"},"PeriodicalIF":2.9,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191004","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}