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Creating a Culture of Ethical Practice in Health Care Delivery Systems
Abstract
Undisputedly, the United States' health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty-five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create ethical questions about the balance of benefits and burdens associated with these advances. Every day on every shift, nurses at the bedside feel an intense array of ethical issues. At the same time, administrators, policy-makers, and regulators struggle to balance commitments to patients, families, staff members, and governing boards. Ethical responsibilities and the fiduciary, regulatory, and community service goals of health care institutions are not mutually exclusive; they must go hand in hand. If they do not, our health care system will continue to lose valued professionals to moral distress, risk breaking the public's trust, and potentially undermine patient care. At this critical juncture in health care, we must look to new models, tools, and skills to confront contemporary ethical issues that impact clinical practice. The antidote to the current reality is to create a new health care paradigm grounded in compassion and sustained by a culture of ethical practice.
... Literature on healthcare management contends that everyday ethical issues and institutional processes shaping and constraining ethical dialogue and practice have been overlooked. 1,5 In this regard, systemic concerns and the ethics of high-profile medical cases have a prominent role in the provision of care. 6 Healthcare organizations increasingly find themselves facing a new set of business-oriented ethical issues due to changes in the delivery and financing of healthcare. ...
... We moved from the literature on healthcare management, 1,5 contending that in healthcare there is growing need to address everyday ethical issues, interdisciplinary tensions, and systemic concerns, in addition to the ethics of high-profile medical cases. Policies concerning employee well-being might consider the differences existing per workers category, especially in the healthcare context where the risk of low employee well-being might have reflections on patient care. ...
This paper aims to explore what aspects of work-life affect healthcare professionals’ well-being and if these aspects may explain a possible categorization considering different professional status. We administered a slightly altered version of the Copenhagen Psychosocial Questionnaire to assess the well-being of patient care workers in a government-funded healthcare organization in Southern Italy. Then, we run an analysis of variance test to explore the aspects affecting the well-being of patient care workers, and to understand if these aspects vary per different professional status (physicians, nurses, and health technicians). Results show important differences among the various professional categories of patient care workers, thus providing the basis for reflections and interventions to improve employee well-being, relevant from a theoretical, practical, and above all policy-making perspectives.
... The profession of nursing focusses on the protection, promotion and optimisation of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities and populations (Rushton, 2016a). Registered nurses practice in a range of health care settings including hospitals, medical offices, ambulatory care centres, community health centres, residential aged care facilities, prisons, schools and retail clinics. ...
... Nightingale and others articulated the ethical foundations of nursing and over the years, the field of nursing ethics has evolved with an expanded presence in scholarship, research, clinical practice and education (Rushton, 2016a • Discussion of the increasing complexity of ethical issues in nursing practice globally ...
Aims and objectives:
To develop a framework to enable discussion, debate and the formulation of interventions to address ethical issues in nursing practice.
Background:
Social, cultural, political and economic drivers are rapidly changing the landscape of health care in our local environments but also in a global context. Increasingly, nurses are faced with a range of ethical dilemmas in their work. This requires investigation into the culture of healthcare systems and organisations to identify the root causes and address the barriers and enablers of ethical practice. The increased medicalisation of health care; pressures for systemisation; efficiency and cost reduction; and an ageing population contribute to this complexity. Often, ethical issues in nursing are considered within the abstract and philosophical realm until a dilemma is encountered. Such an approach limits the capacity to tangibly embrace ethical values and frameworks as pathways to equitable, accessible, safe and quality health care and as a foundation for strengthening a supportive and enabling workplace for nurses and other healthcare workers.
Design:
Conceptual framework development.
Methods:
A comprehensive literature review was undertaken using the social-ecological framework as an organising construct.
Results:
This framework views ethical practice as the outcome of interaction among a range of factors at eight levels: individual factors (patients and families); individual factors (nurses); relationships between healthcare professionals; relationships between patients and nurses; organisational healthcare context; professional and education regulation and standards; community; and social, political and economic.
Conclusions:
Considering these elements as discrete, yet interactive and intertwined forces can be useful in developing interventions to promote ethical practice. We consider this framework to have utility in policy, practice, education and research.
Relevance to clinical practice:
Nurses face ethical challenges on a daily basis, considering these within a social-ecological framework can assist in developing strategies and resolutions.
... Furthermore, ethical practices and value-driven employees may be supported by an organisation that cultivates an ethical culture by highlighting the importance of ethics in the organization's mission and philosophy. Significant organizational changes though are required for establishing such a culture and provide as such a platform for future ethical leaders to raise moral concerns and find moral solutions [36]. This is even more challenging in the present highly demanding organisational environment, in which interdisciplinary and cross-organisational strains require rigorous evaluation methods. ...
Leadership styles are closely related to policy-making decisions and management of human resources. Services’ efficiency, organisational sustainability, quality improvement and staff retention are affected by the leadership practices and the specific attributes that leaders possess. Ethical leadership is valued for its components of moral excellence, authenticity and integrity. It is suitable for the development of staff and organization and has a positive influence on employees and service users. The aim of this review is to identify and synthesize the key concepts of ethical leadership as well as issues of practicing ethical leadership in the contemporary organisational and social contexts. A literature search was performed in PubMed and Google Scholar to identify studies published from 2014 to 2023. The keywords used were “ethical leadership”,“leadership styles”, and “ethical leaders”. Following the examination of the relevant literature, three main categories emerged, namely: a) Ethical leadership in the era of change, b) Key-elements of ethical leadership, and c) Preparing ethical leaders. The results highlighted that elements of ethical leadership are valued more in our contemporary era where ethical principles are strongly challenged in working and social environments. Development of ethical leaders is a priority for higher education institutions and for organisations that intend to promote ethical practices, value-driven employees and an ethical culture in their mission and philosophy.
... Knowing that your coworkers support what is important to you provides the power to speak, which in turn improves conversation. 27 Organizations also need major changes to create such harmonious connection, including change from silence to the voice of all stakeholders, from hierarchy to cooperation, from inequality to fairness, from victimization to principled ethics, 28 and from a topdown look to respect and appreciation. 25 Nurses in this study, after experiencing a morally stressful situation, sought to improve their moral agency. ...
Background:
There are many studies that indicate moral distress is a widespread problem in health care systems. However, some nurses are able to moderate moral distress and show competence and resilience in morally tense situations.
Aim:
The aim of this study is to explain the concept of moral resilience using the experiences of nurses working in intensive care units.
Study design:
This is a qualitative study with a content analysis approach guided by the method of Elo and Kyngäs in 2008 and based on the theoretical framework of Defilippis et al. in 2020.
Participants and research context:
The study sample included all nurses working in intensive care units, who were selected by purposeful sampling. Data were collected through 17 in-depth, individual, and semi-structured interviews with 17 nurses. Elo and Kyngäs method was used to analyze the data. Data management was also performed by MAXQDA software version 20.
Ethical considerations:
This project was approved by the Ethics Committee of Tehran University of Medical Sciences. All ethical guidelines in research were followed.
Results:
The results of present study support the theory of Defilippis et al., while adding another category to it. Four categories of awareness and self-awareness, harmonious connection, improvement of moral agency, and moral well-being were extracted from the data.
Discussion:
Explanatory theory resulted from the study of Defilippis et al. can be used as a guide to cultivate and improve moral resilience skills in nurses working in intensive care units. Nurturing and improving individual capacities such as self-awareness, self-efficacy, and self-confidence in nurses to maintain and promote morality and also establishing a harmonious connection between the treatment team members help to foster moral resilience in the intensive care unit nurses. Acquiring the moral resilience skills can lead to positive consequences, while preventing the negative consequences of moral distress.
... 13,14 esta observación de la complejidad en la que se ve inmerso los sistemas de salud y la práctica de las enfermeras debe poner énfasis en la degradación moral que se vive en los distintos campos de trabajo debido a la complejidad misma de los sistemas de salud y de organización social. 15 Esta complejidad indudablemente recae en la condición humana que se estudia desde las ciencias del espíritu, 1 y que tiene efectos ineludibles en el ser-enfermera. 14 Bibliografía ...
Enfermería es una profesión que requiere conocimiento ético para guiar la práctica. Cualquiera que sea la experiencia de la enfermera o su lugar de trabajo los resultados de la práctica dependen de la ética y la moral. Los últimos tiempos han sido muy sensibles debido a las dificultades de elección que deben tomarse dentro del contexto tan complejo de la salud.1 Estos hechos tienen que ver con aspectos fundamentales de lo que es moralmente correcto en conexión con el cuidado de la salud. El código moral que guía la conducta ética de las en-fermeras se basa en el principio primario de obligatoriedad emanado del concepto de servicio a la gente, respeto por la vida humana y autonomía de las personas. 2 Lo moral y lo ético se confunden muchas veces y se utili-zan también como sinónimos en la literatura de enfermería. La distinción entre estos dos términos refleja la tensión entre la epistemología y la ontología, y la dificultad de separar lo que se sabe o se conoce de lo que se es
... Moral resilience enables nurses to respond to moral adversity situations in ethically competent ways to sustain their moral integrity. Moral resilient nurses are shown to positively influence ethical care and mitigate moral distress (Lachman, 2016;Rushton, 2016b;Rushton et al., 2017). Ethics education is among many strategies that can help cultivate nurses' moral resilience (Lachman, 2016;Monteverde, 2013;Monteverde, 2016;Rushton, 2016a). ...
Introduction:
Moral resilience has recently been proposed as one strategy to address moral distress in nurses and nursing students. Central to nursing students' capacity for moral resilience is how they understood and enact resilience with an element of realism, suggesting an ethical, ideological influence. Resilience is shown to differ significantly across students, and possibly because of a disconnect between a students' perceived resilience and their ethical ideology. Yet, resilience seldom has been explored in relation to ethical ideology.
Objective:
This study aims to explore self-reported resilience in relation to ethical ideology in undergraduate nursing students, compare differences in scores, and explore relationships between study variables and selected demographic characteristics.
Methods:
A descriptive cross-sectional research design was followed. An online encrypted survey was conducted among a convenient sample of nursing undergraduates who met the eligibility criteria and provided implied informed consent. This study complied with ethical principles outlined in the Canadian Tri-Council Policy Statement for research with human subjects. Ethical approval was secured from the University's Research Ethics Board. Data were analyzed using mean scores, standard deviations, independent sample t-test, variance analysis with post hoc-testing, and Pearson correlation to explore differences in perceptions and associations between study and selected demographic variables.
Results:
Undergraduate students have a high level of self-reported resilience. Statistically significant differences in self-reported resilience across selected demographic variables were observed. The association between resilience and ethical ideology was not significant. Ethical relativism was significantly correlated with age and year of study.
Conclusion:
Findings suggest that faculty cultivating resilience in nursing students pays attention to gender's influence discourses in students' perceptions of resilience and ethical ideology and provides students with opportunities for ethical self-reflection and dialogue to critically examine their ethical ideological perspectives and the influence these may have on moral resilience development. Implications for future research are discussed.
... Physicians' own professional values are often congruent with their employer's, but these can conflict sometimes with care needs or can compromise care. These policies include excessive administrative guidelines, national or local overregulation and legislation of care practices, provision of futile care as required by medical procedures, receiving intense pressure from insurers or employers to reduce costs, or increasing unfairness and demand imposed by certain patients at the expense of other weaker patients, who cannot stand up for themselves (Abbasi et al., 2014;Austin et al., 2017;Axelsson et al., 2019;Berlinger, 2016;Dodek et al., 2016Dodek et al., , 2019Aasland, 2007, 2013;Howe, 2017b;Iglesias et al., 2012;Lamiani et al., 2018;Rosenwohl-Mack et al., 2020;Rushton, 2016;Traudt and Liaschenko, 2017;Whitehead et al., 2015). These external constraints can all contribute to the occurrence of moral distress. ...
Moral distress is a negative emotional response that occurs when physicians know the morally correct action but are prevented from taking it because of internal or external constraints. Moral distress undermines a physician’s ethical integrity, leading to anger, poor job satisfaction, reduced quality of care and burnout. Scarce literature exists on the ethical aspects of moral distress in medicine. We conducted an ethical analysis of moral distress as experienced by physicians and analysed it from the literature using two predominant ethical theories: principlism and care ethics. Finally, we consider the emergence of moral distress in medicine during the COVID-19 pandemic.
... Distress-specific Burnout [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] Compassion fatigue [74][75][76][77][78][79][80][81][82][83][84][85][86][87][88] Moral distress [89][90][91][92][93][94][95] Programmatic Caregiver support team 96,97 "Care of the Caregiver" [98][99][100] Peer/colleague support [101][102][103][104] Crisis intervention [105][106][107][108][109][110] Peri-death support [111][112][113][114][115][116][117][118] Support groups 119 Retreats/distancing [120][121][122][123][124][125][126] De-briefing [127][128][129][130][131][132][133][134][135] Schwartz Rounds [136][137][138][139][140][141] Meaningful recognition [142][143][144] Empathy enhancement 145 ...
Stress in nurses is multifocal, pervasive, and persistent. They practice in a contemporary heath care environment characterized by rapid change, the ongoing integration of novel technologies, and interpersonal challenges. Relationships with patients and families pose unique dilemmas related to witnessing anguish and trauma over time. Interventions are needed to counter the affective demands of nurse caregiving. To this end, national initiatives have been proposed to outline general work setting enhancements promoting well-being. Stressor-specific interventions have also been identified. The goal of this article is to provide an overview of the macro (organizational) recommendations for change and a micro (practice setting) blueprint of potential interventions to promote nurse well-being.
... The authors have also learned that factors such as ethical pricing, promotion, and marketing ethics are vital and have a direct influence on brand image. If companies can use these factors suitably, they can have a positive brand image [25]. ...
The healthcare sector is one of the most important industries in the economy of a country. Ethical practices in this sector are crucial for organizations to follow. The main aim of this paper is to analyze and evaluate the impact of business ethics on the brand image in the healthcare sector. The authors have chosen Evercare Hospital which is situated in Bangladesh as their case to carry out the research for this paper. Primary data for this research has been collected from a sample size of 110 respondents, which includes both employees and customers of Evercare Hospital, with the help of a structured set of survey questions. The data collected has been analyzed using SPSS as per the purposes of the current research. The research has revealed that carrying out ethical practices has a positive impact on the brand image of a company. Therefore, Evercare Hospital needs to focus on its ethical practices and carry them out properly to further strengthen its brand image.
... It allows us to bring our best to our work every day," Rushton says. [13,17,18,19] Strategies to build up moral resilience Rushton identified few preliminary requisites which contributes to create a culture of ethical practice which builds and strengthens individual moral resilience. These are such as, creating selfawareness, developing self-regulatory capacities for individuals, developing ethical competence, speaking up with clarity and confidence, to find meaning amid despair, engaging with others, to participate in transformational learning, and to contribute to a culture of ethical practice. ...
Nursing is considered as a noble profession in the world, which is also very demanding in its nature and thus leading to stress among many. The very challenging nature of the profession in combination with a lot of moral dilemmas put nurses at risk for developing many emotional and psychological complications. Helping the nurses to build a resilient attitude for combating these distressing circumstances is must and the need of the hour. Developing self-awareness, self-confidence, personal integrity, being resolute, empathetic and building trustworthy relationships with others are few of the many strategies to build moral resilience.
... Nursing students are selected in large part for their patient care values, and nursing education strengthens their capacity for empathy with patients and families. For the past 15 years, the Gallup poll has found that nurses are rated highest among all surveyed professions for their honesty and ethics! 3 As Rushton writes elsewhere, 4 in the hospital environment where they "practic[e] at the point of care, nurses are intimate witnesses to the pain, suffering, and hope of the people they serve." In their caretaking roles, nurses are perilously poised between the patients and families they empathize with and the hospital systems that give them directives -whether in the form of "doctor's orders" or "policies and procedures." ...
Moral distress is a major problem for nurses, other clinicians, and the health system itself. But if properly understood and responded to, it is also a promising guide for healthcare improvement. When individuals experience moral distress or burnout, their reports must be seen as crucial data requiring careful attention to the individuals and to the organization. Distress and burnout will often point to important opportunities for system improvements, which may in turn reduce the experience of distress. For this potential virtuous cycle to happen, individuals must be able to articulate their concerns without fear of retribution, and organizational leaders must be able to listen in an undefensive, improvement-oriented manner.
Over the last few decades, healthcare business and ethical values have been the focus of legal changes, especially in the Greek Healthcare System. The purpose of this chapter was to examine in both a quantitative and qualitative way what the Greek healthcare experts think and feel about ethics and healthcare services and to present the factors that shape attitudes towards ethical values from the viewpoint of the healthcare professionals. For this reason, 34 semi-structured interviews, accompanied by the administration of perceived cohesion scale, generalized immediacy scale, job affect scale, state anxiety inventory, Maslach burnout inventory, and the attitude towards business ethics questionnaire revealed that healthcare professionals in Greece do have knowledge of ethical values and moral responsibility, but no connections with specific emotional aspects were found. The chapter concludes with a discussion of the implications, and future directions on how business ethics can be further examined and applied.
Background
Nursing faculty and clinicians are leaving the profession due to increased workload and burnout. Evidence-based interventions to build skills in resilience and well-being are encouraged; however, strategies to implement them in nursing curricula and nurse residency programs (NRPs) are not well known.
Purpose
To understand the current state of resilience, well-being, and ethics content in the curriculum in schools of nursing and NRPs in the state of Maryland as part of a statewide initiative for Renewal, Resilience and Retention of Maryland Nurses (R ³ ).
Methods
A descriptive survey was distributed to leaders of all Maryland nursing schools and NRP directors.
Results
Respondents (n = 67) reported minimal resilience, well-being, and ethics content. Teaching modalities included lecture, journaling, mindfulness, and the code of ethics. Barriers included lack of faculty knowledge, low priority, time constraints, and limited resources.
Conclusion
Resilience, well-being, and ethics content is limited in nursing curricula. Developing educator skills and best practices to foster resilience and ethical practice are needed.
Ethical challenges are inherent in nursing practice. They affect patients, families, teams, organizations, and nurses themselves. These challenges arise when there are competing core values or commitments and diverse views on how to balance or reconcile them. When ethical conflict, confusion, or uncertainty cannot be resolved, moral suffering ensues. The consequences of moral suffering in its many forms undermine safe, high-quality patient care, erode teamwork, and undermine well-being and integrity. My experience as a nurse in the pediatric intensive care unit and later as a clinical nurse specialist in confronting these moral and ethical challenges has been the foundation of my program of research. Together we will explore the evolution of our understanding of moral suffering-its expressions, meanings, and consequences and attempts to measure it. Moral distress, the most described form of moral suffering, took hold within nursing and slowly within other disciplines. After 3 decades of research documenting the existence of moral distress, there were few solutions. It was at this juncture that my work pivoted toward exploring the concept of moral resilience as a means for transforming but not eliminating moral suffering. The evolution of the concept, its components, a scale to measure it, and research findings will be explored. Throughout this journey, the interplay of moral resilience and a culture of ethical practice were highlighted and examined. Moral resilience is continuing to evolve in its application and relevance. Many vital lessons have been learned that can inform future research and guide interventions to harness the inherent capabilities of clinicians to restore or preserve their integrity and to engage in large-scale system transformation.
Background:
The COVID-19 pandemic has been a defining event for the next generation of the nursing workforce. Complex pandemic practice environments have raised concerns for the preparation and support of novice nurses, even as a multitude of nurses leave the profession.
Purpose:
Researchers sought to examine nursing students' and new graduate nurses' impressions of the nursing profession in contrasting regions of New York State during the first wave of the COVID-19 pandemic.
Methods:
Inductive content analysis was performed on narrative text responses (n = 295) drawn from a larger multisite mixed-methods survey.
Results:
Five subconcepts were abstracted, leading to the main concept of shocked moral distress.
Conclusion:
Nursing students and new graduate nurses have experienced high levels of moral distress but remain committed to the profession. Building moral resilience, fostering ethical decision making, and implementing protective policies can reduce the incidence of moral distress.
Background:
Moral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience.
Aim:
The aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil.
Research design:
The research design is the qualitative study with discursive textual analysis.
Participants and research context:
: 44 nurse managers and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions.
Ethical considerations:
The Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity.
Findings:
Personal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation.
Conclusion:
From the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience.
Resilience is a complex construct that is not universally defined, but reflects the ability of a person, community, or system to positively adapt to adversity in a way that promotes growth and well-being. Developing resilient nurses is a promising strategy to reduce nurse burnout and improving retention. The purpose of this paper is to review selected literature, synthesize, and interpret the findings that point toward promising practices that educators can employ to support student resilience. Four prominent prelicensure nursing student internal protective factors associated with resilience and derived from the literature include self-efficacy, optimism, emotional intelligence, and self-stewardship/self-care. Interventions to promote nursing student resilience is not well developed, however, there are promising evidence to inform concepts and interventions to guide the development, skills, practices, and strategies for nurse educators. Educational strategies to enhance student nurse internal protective factors include reflection, positive reframing, problem-based learning, and mindfulness. Specific examples of each educational modality applied to prelicensure student nurse resilience are provided. Integrative strategies to support and cultivate internal protective factors to strengthen student resilience are paramount to nursing education and clinical nursing practice.
Background
Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic.
Objective
To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency.
Research design
A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for Covid-19 patients in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020.
Ethical considerations
We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore.
Results
We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies.
Discussion/Conclusion
Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences.
Ethically challenging situations are an increasing phenomenon in the nurse's environment, and literature on the subject is growing. Morally challenging experiences common in the critical care environment include end-of-life situations, barriers to providing the best care possible, and lack of organizational resources. These experiences can lead to moral distress and subsequent negative impacts on the clinician. Emerging in the literature are strategies to address the impact of moral distress through the development of moral resilience. Moral resilience is gained through personal commitment and organizational support.
Over the last few decades, healthcare business and ethical values have been the focus of legal changes, especially in the Greek Healthcare System. The purpose of this chapter was to examine in both a quantitative and qualitative way what the Greek healthcare experts think and feel about ethics and healthcare services and to present the factors that shape attitudes towards ethical values from the viewpoint of the healthcare professionals. For this reason, 34 semi-structured interviews, accompanied by the administration of perceived cohesion scale, generalized immediacy scale, job affect scale, state anxiety inventory, Maslach burnout inventory, and the attitude towards business ethics questionnaire revealed that healthcare professionals in Greece do have knowledge of ethical values and moral responsibility, but no connections with specific emotional aspects were found. The chapter concludes with a discussion of the implications, and future directions on how business ethics can be further examined and applied.
Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise. Though dilemmas and challenging situations create the most obvious, dramatic risks to patients, routine nursing actions have implications for patients as well. Ethical awareness involves recognizing the ethical implications of all nursing actions. Developing ethical awareness is one way to empower nurses to act as moral agents in order to provide patients with safe and ethical care. The aim of this article is to provide an overview of the concept of ethical awareness and the role it plays in patient care. Background information is provided; three everyday scenarios highlight the importance of ethical awareness in everyday nursing practice; followed by additional discussion; and strategies for heightening ethical awareness are suggested.
This chapter provides a review not only of classic literature on healthcare business and ethics, but also an introduction to the legal changes in the Greek healthcare system with ethical values on focus. A study examining in both a quantitative and qualitative way what the Greek healthcare experts think and feel about ethics and healthcare services presents the factors that shape attitudes towards ethical values from the viewpoint of the healthcare professionals. For this reason, 34 semistructured interviews, accompanied by the administration of perceived cohesion scale, generalized immediacy scale, job affect scale, state anxiety inventory, Maslach burnout inventory, and the attitude towards business ethics questionnaire revealed that healthcare professionals do have knowledge of ethical values and moral responsibility, but no clear connections with specific emotional aspects were found. The chapter concludes with future directions on how business ethics can be further examined and applied.
Jane, a nurse in the cardiac intensive care unit, is caring for a patient during an overnight shift when the patient's blood pressure starts to drop. The patient's mean arterial pressures are consistently low and the hypotension does not improve with fluid resuscitation. The resident on call makes the decision to start a norepinephrine drip; however, the patient only has peripheral intravenous (IV) lines. Jane lets the resident know that the patient will need a central line as per hospital policy. The resident tells Jane that he does not want to wake up the attending physician and that infusing the norepinephrine peripherally is an acceptable course of action. Jane is not sure how to proceed but does not discuss the issue further with the resident. She is uncomfortable with his decision and is concerned that infusing the norepinephrine through a peripheral IV puts her patient at risk for a dangerous infiltration and extravasation. She knows that a central line would be safer and that her hospital's policy requires it; however, Jane is unsure whether calling the attending physician herself would be appropriate. Not wanting to cause trouble with the resident, Jane decides to let it go and continues the norepinephrine infusion through the peripheral IV for the rest of the night.
Aims and objectives:
The aim of this qualitative descriptive study was to describe common characteristics and themes of the concept of moral resilience as reported by inter-professional clinicians in healthcare.
Background:
Research has provided an abundance of data on moral distress with limited research to resolve and help negate the detrimental effects of moral distress. This calls for much needed research on how to mitigate the negative consequences of moral distress that plague nurses and other healthcare providers. One promising direction is to build resilience as an individual strategy concurrently with interventions to build a culture of ethical practice.
Design/methods:
Qualitative descriptive methods were used to analyze descriptive definitions provided by 184 inter-professional clinicians in healthcare attending educational programs in various locations as well as a small group of 23 professionals with backgrounds such as chaplaincy and non-healthcare providers.
Results:
Three primary themes and three sub-themes emerged from the data. The primary themes are Integrity-personal and relational, and buoyancy. The subthemes are self-regulation, self-stewardship and moral efficacy.
Conclusions:
Individual healthcare providers and healthcare systems can use this research to help negate the detrimental effects of moral distress by finding ways to develop interventions to cultivate moral resilience. This article is protected by copyright. All rights reserved.
Decades of research have documented the frequency, sources, and consequences of moral distress. However, few studies have focused on interventions designed to diminish its negative effects. The cultivation of moral resilience - the ability to respond positively to the distress and adversity caused by an ethically complex situation - is proposed as a method to transform moral distress.
The experience of unaddressed moral distress can lead to nurse attrition and/or distancing from patients, compromising patient care. Nurses who are confident in their ethical decision making abilities and moral agency have the antidote to moral distress for themselves and their colleagues and can act as local or institutional ethics resources. We describe a grant-funded model education program designed to increase ethics competence throughout the institution.
Moral resilience is a concept that is gaining prominence and is deserving of our consideration as a way to transform the profound despair and powerlessness associated with morally distressing situations. These preliminary ideas are offered to stimulate further dialogue and refinement. These beginning observations and recommendations can help to stimulate greater conceptual clarity and form the basis of a research agenda to develop an evidence base for interventions aimed at cultivating moral resilience.
This study investigated the impact of age, race, and functional status on decisions not to offer cardiopulmonary resuscitation (CPR) despite patient or surrogate requests that CPR be performed.
This was a retrospective cohort study of all ethics committee consultations between 2007 and 2013 at a large academic hospital with a not offering CPR policy.
There were 134 cases of disagreement over whether to provide CPR. In 45 cases (33.6%), the patient or surrogate agreed to a do-not-resuscitate (DNR) order after initial ethics consultation. In 67 (75.3%) of the remaining 89 cases, the ethics committee recommended not offering CPR. In the other 22 (24.7%) cases, the ethics committee recommended offering CPR. There was no significant relationship between age, race, or functional status and the recommendation not to offer CPR. Patients who were not offered CPR were more likely to be critically ill (61.2% vs 18.2%, P < .001). The 90-day mortality rate among patients who were not offered CPR was 90.2%.
There was no association between age, race, or functional status and the decision not to offer CPR made in consultation with an ethics committee. Orders to withhold CPR were more common among critically ill patients.
Copyright © 2014 Elsevier Inc. All rights reserved.
Registered nurse turnover is an important indicator of the nurse job market. Despite its wide use as a measure for health-care system analysis, there is a lack of consistency in the definition of turnover. Some definitions include any nurse leaving an organization; others may include involuntary and voluntary leaving. These inconsistent definitions also result in various turnover rates. The RN Work Project is a 10-year panel study of new nurses. Data were collected from the new nurses, rather than from a specific organization. About 17.5% of new nurses leave their first job within 1 year of starting their jobs. Consistent and accurate measurement of turnover is an important step in addressing organizational work environments and policies about the nursing workforce.
The literature is replete with evidence about the effects of the work environment on nurses' stress levels, interdisciplinary collaboration, workload, job conflict, job satisfaction, and anticipated turnover. Healthcare leaders have been challenged by the American Association of Critical-Care Nurses (AACN), other professional organizations, and regulatory agencies to develop and sustain healthy work environments that support the professional practice of nursing. Magnet designation, the Beacon award, and other organizational structures and cultures led by authentic and transformational leaders have been the stimulus to ensure that workplaces are both healthy and healthful. The positive effect of healing environments on patient and provider outcomes has caused many healthcare leaders to strive to develop healing attributes within their philosophies of care and organizational cultural initiatives.
The causes of nurses' exodus from acute health care delivery practice may lie more in intrinsic factors rather than the heretofore overtly expressed reasons. This article examines bureaucratic factors, issues related to the medical profession and medical/scientific discourse, and factors within the nursing profession itself that may contribute to a nurse's unhappiness and dissatisfaction that causes him or her to leave. Nursing as emotional work and the implications for the individual nurse, and nursing as moral and moral distress are discussed. Suggestions to facilitate retention are made for changing the work environment to feel valued for their skillfully applied humanness.
Nurses frequently experience conflict regarding healthcare decisions, yet are expected to implement actions which they perceive to be morally wrong. Research has described the deleterious effects of this moral incongruency, coined moral distress, on nurses' well being and has identified it as a causative agent in nursing turnover, burnout, and nurses leaving the profession. Thus, it is known that moral distress has significant consequences for nurses, but does moral distress affect nurses' provision of care, and if so, how?
Americans Rate Nurses Highest on Honesty, Ethical Standards
- Gallup
Integrated Ethics: Improving Ethics Quality in Health Care ” National Center for Ethics in Health Care Veterans Health Administration accessed
- E Fox