Moral courage and understanding of its meaning are essential when nurses face ethical conflicts in their practice. This integrative review aimed to explore moral courage in nursing and possible ...associated individual and organizational factors. A database search in January 2020 identified 1308 scientific articles of which 25 were selected for the review. Inductive analysis with clear steps for defining and synthesizing themes in research reviews revealed three categories concerning moral courage in nursing: definition and descriptions of moral courage, characteristics of the morally courageous nurse, and skills and acts of the morally courageous nurse. Individual and organizational factors, such as positive personal experiences, commitment to ethical principles, supportive work environment and teamwork, were associated with moral courage in nursing, contributing to a more comprehensive description of nurses' moral courage. Findings indicate that in nursing practice, there is a need for promoting multi‐professional collaboration and discussion of ethical dilemmas to provide opportunities to enhance moral courage. Developing care environments in which hierarchy does not inhibit nurses' moral courage seems justified. Further research on moral courage with varying methodologies and multi‐disciplinary and international approaches is needed.
Aim
The aim of this study was to report a systematic and psychometric review.
Background
The Nurse Competence Scale is currently the most widely used generic instrument to measure Registered Nurses’ ...competence in different phases of their careers. Based on a decade of research, this review provides a summary of the existing evidence.
Design
A systematic literature review of research evidence and psychometric properties.
Data sources
Nine databases from 2004 ‐ October 2015.
Review methods
We retrieved scientific publications in English and Finnish. Two researchers performed data selection and appraised the methodological quality using the COnsensus‐based Standards for the selection of health status Measurement INstruments checklist.
Results
A total of 30 studies reported in 43 publications were included. These consisted of over 11,000 competence assessments. Twenty studies were from Europe and 10 from outside Europe. In addition to experienced nurses, the Nurse Competence Scale has been used for the competence assessment of newly graduated nurses and nursing students, mainly in hospital settings. Length of work experience, age, higher education, permanent employment and participation in educational programmes correlated positively with competence. Variables including empowerment, commitment, practice environment, quality of care and critical thinking were also associated with higher competence. The Nurse Competence Scale has demonstrated good content validity and appropriate internal consistency.
Conclusion
The value of Nurse Competence Scale has been confirmed in determining relationships between background variables and competence. The instrument has been widely used with experienced and newly graduated nurses and their managers. Cross‐cultural validation must be continued using rigorous methods.
Wrongdoing and whistleblowing in health care Pohjanoksa, Johanna; Stolt, Minna; Suhonen, Riitta ...
Journal of advanced nursing,
July 2019, 2019-Jul, 2019-07-00, 20190701, Letnik:
75, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Aim(s)
To describe healthcare professionals’ experiences of observed wrongdoing and potential whistleblowing acts regarding it. The main goal is to strengthen the whistleblowing process described ...based on the existing literature and to make it more visible for future research.
Design
A descriptive cross‐sectional survey.
Methods
Data were collected between 26 June 2015–17 July 2015 from the Finnish trade union's membership register, electronically using one open question. A total of 226 healthcare professionals participated providing written narratives, which were analysed using inductive content analysis.
Findings
The whistleblowing process in health care was strengthened, identifying the content of observed wrongdoings and whistleblowing acts regarding them. Three themes were identified: wrongdoing related to patients, healthcare professionals, and healthcare managers. Whistleblowing acts were performed internally, externally, or left undone. Three main paths: internal, external, and no whistleblowing, between an observation of wrongdoing and whistleblowing act were identified.
Conclusion
The whistleblowing process should be further developed and ethically effective programmes and interventions should be developed for increasing whistleblowing and preventing wrongdoing in health care.
摘要
目的
描述医疗专业人员看到不法行为的经历以及与之相关的潜在举报行为。本文主要目的是基于现有文献加强举报流程描述,以期对未来研究有所助益。.
设计
本研究采用描述性现况调查。
方法
2015年6月26日至2015年7月17日,通过电子形式采用一个公开问题借助芬兰工会成员名册收集数据。总计226名医疗专业人员参与其中,提供了书面陈述以供分析,分析方法采用归纳内容法。
发现
确认所观察到的不法行为以及与之相关的举报行为内容后,医疗中的举报流程得到加强。确定了三个主题:与病人相关的不法行为、与医疗专业人员相关的不法行为以及与医疗管理人员相关的不法行为。举报行为主要分为内部举报、外部举报以及不了了之。三个主要途径:在看到不法行为和举报行为之间,主要有内部、外部以及无举报三种采取方式。
结论
举报流程还应进一步发展,道德性有效规划和干预措施应得到发展,从而促进举报行为,预防医疗中的不法行为。
Patients' right to know: A scoping review Inkeroinen, Saija; Virtanen, Heli; Stolt, Minna ...
Journal of clinical nursing,
August 2023, 2023-Aug, 2023-08-00, 20230801, Letnik:
32, Številka:
15-16
Journal Article
Recenzirano
Odprti dostop
Aims and Objectives
To analyse research‐based evidence about patients' right to know from their own perspective to promote ethically high‐quality nursing and to identify future research areas.
...Background
Patients' right to know is a fundamental right. Although of topical research interest, the current state of scientific evidence on patients' right to know has not been reviewed.
Design
A scoping review according to the methodological framework by Arksey & O'Malley and the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews.
Methods
In June 2022, a literature search was conducted in the Ovid Medline, CINAHL and Cochrane Library databases. The inclusion criteria were peer‐reviewed, empirical studies on the right to know with samples comprising adult patients. Data were analysed with inductive content analysis, and methodological quality was assessed with Mixed Methods Appraisal Tool.
Results
Out of 2658 identified reports, 12 were selected for analysis. Based on the results, the research on patients' right to know can be classified into two main content categories: (1) expectations of the right and (2) realisation of the right. In the quality assessment, most of the reports did not meet all the quality criteria, the most common deficits being related to instrumentation and risk of bias.
Conclusions
Research‐based evidence on patients' right to know provided a general insight into expectations and realisation of the right to know and not to know. The results indicate a need for continued efforts for novel approaches with high‐quality methodological choices in future studies.
Relevance to Clinical Practice
Nurses make constantly ethical decisions: The findings of this study can be useful for their decision‐making and understanding of the patient's perspective on knowledge issues, and therefore, support ethically high‐quality patient education.
Patient or Public Contribution
No direct patient or public contribution to the review.
flinkman m., leino‐kilpi h. & salanterä s. (2010) Nurses’ intention to leave the profession: integrative review. Journal of Advanced Nursing 66(7), 1422–1434.
Title. Nurses’ intention to leave the ...profession: integrative review.
Aim. This paper is a report of a study conducted to (1) review and critique the published empirical research on nurses’ intention to leave the profession and (2) synthesize the findings across studies.
Background. Lack of nurses and nurse turnover represent problems for the healthcare system in terms of cost, the ability to care for patients and the quality of care. At a time of current nursing shortage, it is important to understand the reasons why nurses intend to leave the profession.
Data sources. A review was conducted through an initial search of MEDLINE, CINAHL and PsycINFO computerized databases for the period from 1995 to July 2009. The keywords for the search were: Nurs* AND (Personnel turnover OR Career Mobility). Research on nurses’ organizational turnover was excluded.
Review methods. An integrative literature review was carried out using Cooper’s five‐stage methodology provided a framework for data collection, analysis and synthesis.
Results. A total of 31 studies matching the inclusion criteria were identified. Variety in samples, measurement instruments and measures of intention to leave led to difficulties when attempting to compare or generalize study findings. A number of variables influencing nurses’ intention to leave the profession were identified, including demographic, work‐related and individual‐related variables.
Conclusions. Further research is needed using sound measurement instruments, consistent measures of leaving intention and more rigorous sampling. More in‐depth research is needed to give nurses opportunities to explain in their own words the reasons for their intentions to leave.
Reasoning for whistleblowing in health care Wiisak, Johanna; Suhonen, Riitta; Leino‐Kilpi, Helena
Scandinavian journal of caring sciences,
June 2023, 2023-Jun, 2023-06-00, 20230601, Letnik:
37, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Background
Whistleblowing is recognised as part of solving wrongdoing. It requires individual reasoning as it is a potentially complicated process with a risk of possible negative consequences for ...oneself. Knowledge on how individuals reason for whistleblowing in healthcare context is lacking.
Aim
This study aimed to create a theoretical construct to describe individual reasoning for whistleblowing.
Methods
The methodology was grounded theory, with 244 nurses as informants. The data consisted of nurses' written narratives in response to a wrongdoing situation presented in a video vignette. To ensure the heterogeneity of the population and variation in nurses' professional expertise, experiences and geographical locations in health care to capture the multidimensionality of the responses, nurses were invited to participate, and data were collected electronically from the membership register of the Finnish Nurses' Association on a national level. Constant comparison was used to analyse the open data.
Results
The core category of the theoretical construct, ‘The formation of morally courageous intervening’, was discovered, reflecting individual's values and beliefs. It forms mentally as an integration of cognition and emotion for recognising one's own strengths and limits to act to do the right thing despite the risk of negative consequences for oneself. The core category consists of three dimensions of reasoning: (1) Reasoning Actors, (2) Reasoning Justifications and (3) Reasoning Activities, their categories and three patterns of reasoning connecting the dimensions and their categories with each other: (I) Individual Reasoning, (II) Collaborative Reasoning and (III) Collective Reasoning.
Discussion and conclusion
The theoretical construct indicate that reasoning is a multidimensional phenomenon. In future, a theoretical construct could be further developed. In health care, managers could use the theoretical construct to support employees in their whistleblowing.
Aim
To analyse the ethical pathway as perceived by individuals with stroke (IwS) in the first three post‐stroke months. In the novel concept of ethical pathway, dignity, privacy, and autonomy are ...considered as dimensions of the ethical pathway while the pathway illustrates their potential change in the post‐stroke time. Furthermore, the focus of interest was on whether the perceived realisation of values is associated with the life situational factors of symptoms diminishing functioning, social environment, and self‐empowerment.
Methodological Design and Justification
A follow‐up study with a descriptive correlational design was used to capture the changes in the perceived realisation of values.
Ethical Issues and Approval
The study followed the ethical principles of research involving human participants. The study was approved by the ethics committee of the university and one of the university hospitals following national standards. Permission to conduct the study was obtained from the university hospitals.
Research Methods and Instrument
Data were collected from IwS after the onset of stroke and 3 months post‐stroke with the Ethical Pathway of Individuals with Stroke instrument and background questions and were analysed statistically.
Results
Thirty‐six participants completed the questionnaire at both measurement points. Wide variety in the ethical pathway was detected. IwS' perceived dignity decreased and autonomy increased. Privacy did not change significantly. Of the life situational factors, IwS perceived less symptoms diminishing functioning and stronger self‐empowerment while social environment was perceived as rather stable. Only one association was detected between the dimensions of the ethical pathway and life situational factors: autonomy had a low negative correlation with social environment of health care professionals.
Conclusions and Study Limitations
The results provide preliminary evidence of the dynamic nature of the ethical pathway. The ethical pathway was incompletely realised for most participants and requires special attention and improvement in health care. The sample size is small and the results are therefore not generalisable.
Aims and objectives
To describe the nursing student–patient relationship in terms of three types of relationships—mechanistic, authoritative and facilitative—and analyse the factors related to the ...type of relationship.
Background
As future professionals, nursing students have a central role in facilitating patient autonomy while working in partnership with patients. Supporting student–patient relationship throughout the nursing education may result in positive outcomes for both students and patients.
Design
A cross‐sectional study.
Methods
The data were collected from a convenience sample of Finnish nursing students using a structured web survey. Statistical data analysis was performed using chi‐square test, two‐sample t test, one‐way analysis of variance and multinomial logistic regression. The STROBE Statement — Checklist for cross‐sectional studies was used (Appendix S1).
Results
Students most often assessed their relationship with the patients as facilitative, followed by authoritative and mechanistic relationships. The results revealed three predictors for facilitative relationship: students’ older age, long enough contact time with the patient and higher competence in ensuring quality. In authoritative and facilitative relationships, students had significantly more positive perceptions of the contextual factors and consequences of the relationship and higher ratings of self‐assessed competence levels than students in a mechanistic relationship.
Conclusions
It seems that the facilitative student–patient relationship is connected to the professional competence of nursing students, especially in the area of ensuring the quality of patient care. Therefore, sustaining clinical learning environments and pedagogical approaches that value and support facilitative relationships in students’ clinical learning should be enhanced.
Relevance to clinical practice
Efforts aimed at contributing to facilitative student–patient relationships have a crucial role in shaping students’ competency and in promoting high‐quality patient care. Thus, supervision of students organised around establishing mutual student–patient relationships with the preceptors acting as facilitators will benefit both students and patients.
Aim
This review aimed to identify validated self‐reported instruments used to measure nurses' competence or attribute(s) of competence in empowering patient education, to describe their development ...and main content and critically appraise and summarize the quality of the instruments.
Design
Systematic review.
Data Sources
Electronic databases of PubMed, CINAHL and ERIC were searched from January 2000 to May 2022.
Review Methods
Data was extracted following predetermined inclusion criteria. With the support of the research group, two researchers performed data selection and appraised the methodological quality using the COnsensus‐based Standards for the selection of health status Measurement INstruments checklist (COSMIN).
Results
A total of 19 studies reporting 11 instruments were included. The instruments measured varied attributes of competence and the contents were heterogenous reflecting the complex nature of both empowerment and competence as concepts. Overall, the reported psychometric properties of the instruments and methodological quality of the studies were at least adequate. However, there was variation in the testing of the instruments' psychometric properties and lack of evidence limited the evaluation of both the methodological quality of the studies and quality of instruments.
Conclusion
The psychometric properties of the existing instruments assessing nurses' competence in empowering patient education need to be tested further, and future instrument development should be built on a clearer definition of empowerment as well as on more rigorous testing and reporting. In addition, continued efforts to clarify and define both empowerment and competence on the conceptual level are needed.
Impact
Evidence on nurses' competence in empowering patient education and its valid and reliable assessment instruments is scarce. Existing instruments are heterogenous and are often missing proper testing of validity and reliability. These findings contribute to further research on developing and testing the instruments of competence in empowering patient education and strengthening nurses' empowering patient education competence in the clinical practice.
Internationally, nurses serve a broad spectrum of the community through the provision of healthcare. The nursing profession is generally trusted by this community. Trust is achieved through ethical ...nursing practice. Recently, in 2021, the ICN published the revised edition of the Code of Ethics for Nurses. The ICN Code of Ethics for Nurses is a ‘statement of the ethical values, responsibilities and professional standards of nurses’. It guides nurses to acknowledge the vulnerability of the people that we serve. It emphasizes the fundamental importance of being aware, and appropriately responding to ethical issues and concerns is commensurate with professional practice. Specifically, for nurse leaders and managers, the ICN code advocates that leaders seek to create environments where ethical conduct is sustained. By this, reference is made to leaders being sensitive to others needs, encouraging open dialogue and providing support to their teams (https://www.icn.ch/system/files/2021-10/ICN_Code-of-Ethics_EN_Web_0.pdf).
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