Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence

This critical reflection on the ethical concerns of current practice is underpinned by a systematic synthesis of current evidence focusing on why and how children are held or restrained for clinical procedures within acute care and the experiences of those present when a child is held against their wishes. Empirical evidence from a range of clinical settings internationally demonstrates that frequently children are held for procedures to be completed; younger children and those requiring procedures perceived as urgent are more likely to be held. Parents and health professionals express how holding children for procedures can cause feelings of moral distress expressed as uncertainty, guilt and upset and that this act breaches the trusting and protective relationship established with children. Despite this, children’s rights and alternatives to holding are not always respected or explored. Children’s experiences and perceptions are absent from current literature. Children and young people have a moral right to have their voice and protests heard and respected and for these to inform judgements of their best interests and the actions of health professionals. Without robust evidence, debate and recognition that children are frequently held against their wishes in clinical practice for procedures which may not be urgent, children’s rights will continue to be compromised

Bearing witness and being bounded; the experiences of nurses in adult critical care in relation to the survivorship needs of patients and families

Aim: To discern and understand the responses of nurses to the survivorship needs of patients and family members in adult critical care units. Background: The critical care environment is a demanding place of work which may limit nurses to immediacy of care, such is the proximity to death and the pressure of work. Design: A constructivist grounded theory approach with constant comparative analysis. Methods: As part of a wider study and following ethical approval, eleven critical care nurses working within a general adult critical care unit were interviewed with respect to their experiences in meeting the psychosocial needs of patients and family members. Through the process of constant comparative analysis an overarching selective code was constructed. EQUATOR guidelines for qualitative research (COREQ) applied. Results: The data illuminated a path of developing expertise permitting integration of physical, psychological and family care with technology and humanity. Gaining such proficiency is demanding and the data presented reveals the challenges that nurses experience along the way. Conclusion: The study confirms that working within a critical care environment is an emotionally charged challenge and may incur an emotional cost. Nurses can find themselves bounded by the walls of the critical care unit and experience personal and professional conflicts in their role. Nurses bear witness to the early stages of the survivorship trajectory but are limited in their support of ongoing needs. Relevance to Clinical Practice: Critical care nurses can experience personal and professional conflicts when caring for both patients and families. This can lead to moral distress and may contribute to compassion fatigue. Critical care nurses appear bounded to the delivery of physiological and technical care, in the moment, as demanded by the patient's acuity. Consequentially this limits nurses’ ability to support the onward survivorship trajectory. Increased pressure and demands on critical care beds has contributed further to occupational stress in this care setting

What's Philosophical About Moral Distress?

Moral distress is a well-documented phenomenon in the nursing profession, and increasingly thought to be implicated in a nation-wide nursing shortage in the US. First identified by the philosopher Andrew Jameton in 1984, moral distress has also proven resistant to various attempts to prevent its occurrence or at least mitigate its effects. While this would seem to be bad news for nurses and their patients, it is potentially good news for philosophical counselors, for whom there is both socially important and philosophically interesting work to be done. In an effort to encourage such work, this paper explicates the philosophical (as opposed to more purely psychological or institutional) contours of the problem. A subsequent paper, titled 'A Philosophical Counseling Approach to Moral Distress,' will highlight ways in which such a response would differ from the strategies so far deployed within the nursing profession

Empathy for others' suffering and its mediators in mental health professionals

Empathy is a complex cognitive and affective process that allows humans to experience concern for others, comprehend their emotions, and eventually help them. In addition to studies with healthy subjects and various neuropsychiatric populations, a few reports have examined this domain focusing on mental health workers, whose daily work requires the development of a saliently empathic character. Building on this research line, the present population-based study aimed to (a) assess different dimensions of empathy for pain in mental health workers relative to general-physicians and non-medical workers; and (b) evaluate their relationship with relevant factors, such as moral profile, age, gender, years of experience, and workplace type. Relative to both control groups, mental health workers exhibited higher empathic concern and discomfort for others' suffering, and they favored harsher punishment to harmful actions. Furthermore, this was the only group in which empathy variability was explained by moral judgments, years of experience, and workplace type. Taken together, these results indicate that empathy is continuously at stake in mental health care scenarios, as it can be affected by contextual factors and social contingencies. More generally, they highlight the importance of studying this domain in populations characterized by extreme empathic demands.Fil: Santamaria Garcia, Hernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: Báez Buitrago, Sandra Jimena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: García, Adolfo Martín. Instituto de Neurología Cognitiva. Laboratorio de Psicología Experimental y Neurociencia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; Argentina. Universidad Nacional de Cuyo. Facultad de Educación Elemental y Especial; ArgentinaFil: Flichtentrei, Daniel. Intramed; ArgentinaFil: Prats, Lucía María. Intramed; Argentina. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; ArgentinaFil: Mastandueno, Ricardo. Intramed; ArgentinaFil: Sigman, Mariano. Universidad Torcuato di Tella; ArgentinaFil: Matallana, Diana. Pontificia Universidad Javeriana; ColombiaFil: Cetkovich Bakmas, Marcelo Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: Ibanez Barassi, Agustin Mariano. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; Argentin

The Art of Compassion: Educating Nurses for the World (Chapter in Awaken the Stars: Reflections on What We Really Teach)

Excerpt: A unique and perhaps subtle difference exists between educating the best nurses in the world and educating the best nurses for the world. There is a distinction between the two that is at the heart of what makes caring for someone in their time of need an incredible vocation. Think upon a time when you experienced the knowledge, skills, and care of a nurse! think each of us can identify or recall nurses who were proficient and effective coordinators of care. They were nurses who were professionals in the world, protecting and promoting health and safety for ind ividuals, families, and populations. You might also have vivid recollections of unforgettable, highly venerated nurses who were someth ing more for you; their presence seemed to make all the difference. There was something about them that activated the transition from good to great. That something, I believe, was compassion made alive by the nurse\u27s ability to engage in meaningful and transformative human connections. In nursing, compassion involves seeing the patients as more than the sum of their diagnosis, vita l signs, and laboratory results. A nurse who personifies compassion has cultivated a deep-rooted concern for the total well-being of others while also striving to alleviate their suffering

Exploring the Relationship Between Moral Distress and Coping in Emergency Nursing

Background: Emergency Department (ED) nurses practice in environments that are highly charged and unpredictable in nature and can precipitate conflict between the necessary prescribed actions and the individual’s sense of what is morally the right thing to do. As a consequence of multiple moral dilemmas ED staff nurses are at risk for experiencing distress and how they cope with these challenges may impact their practice. Objectives: Is to examine moral distress in ED nurses and its relationship to coping in that specialty group. Methods: Using survey methods approach. One hundred ninety eight ED nurses completed a moral distress, coping and demographic collection instruments. Advanced statistical analysis was completed to look at relationships between the variables. Results: Data analysis did show that moral distress is present in ED nurses (M=80.19, SD=53.27) and when separated into age groups the greater the age the less the experience of moral distress. A positive relationship between moral distress and some coping mechanisms and the ED environment were also noted. Conclusion: This study’s findings suggest that ED nurses experience moral distress and could receive some benefit from utilization of appropriate coping skills. This study also suggests that the environment with which ED nurses practice has a significant impact on the experience of moral distress. Since health care is continuing to evolve it is critical that issues like moral distress and coping be studied in ED nurses to help eliminate human suffering

Exploring Neonatal Intensive Care Nurses’ Affective Responses to Providing End-of-Life Care

Significance. The Joint Commission established standards to evaluate comprehensive end-of-life infant care and the positive outcomes of such care are well documented. However, findings from multiple studies conducted over the last decade indicate that end-of-life care in the neonatal intensive care unit is not provided consistently or holistically to all dying infants. Because nurses are the healthcare professionals most often responsible for providing this care, anything that detracts from their ability to provide it, including their own affective responses, needs to be addressed. Aim. The purpose of this study was to explore—through lived and told stories—the affective, interactional, and meaning-related responses that NICU nurses have while caring for dying infants and their families. Sample, Design, and Methods. Neonatal intensive care nurses were recruited through the online membership discussion boards of the National Association of Neonatal Nurses. Participants were asked to access an online survey link and provide a written narrative describing an end-of-life care situation in which they experienced strong emotions. Demographic data also were collected. Findings. Narrative analysis revealed many affective responses, but three were the most frequent: responsibility, moral distress, and identification. Feelings of responsibility included (a) a commitment to deliver the best end-of-life care possible, (b) professional inadequacy, (c) disbelief, and d) advocacy. Feelings associated with moral distress were quite common and often related to conflicts between nurses, physicians, and families. Nurses reported feelings of identification with families of dying infants through (a) sharing their grief, (b) forming excess attachments, and (c) experiencing survivor-like guilt. Implications. Nurse educators are encouraged to discuss more extensively and perhaps through the use of simulation, the positive and negative emotions that may be experienced by nurses who are involved in end-of-life care situations. Nurse leaders are encouraged to promote supportive environments in NICUs and ensure debriefing opportunities for nurses who have recently cared for a dying infant. Significant associations, such as NICU nurses not perceiving their EOLC education as being helpful in providing that care clinically and the percentage of NICU nurses reporting the presence of an end-of-life care policy in their units of employment, also merit further examination

Exploring the Relationship Between Moral Distress and Coping in Emergency Nursing

Background: Emergency Department (ED) nurses practice in environments that are highly charged and unpredictable in nature and can precipitate conflict between the necessary prescribed actions and the individual’s sense of what is morally the right thing to do. As a consequence of multiple moral dilemmas ED staff nurses are at risk for experiencing distress and how they cope with these challenges may impact their practice. Objectives: Is to examine moral distress in ED nurses and its relationship to coping in that specialty group. Methods: Using survey methods approach. One hundred ninety eight ED nurses completed a moral distress, coping and demographic collection instruments. Advanced statistical analysis was completed to look at relationships between the variables. Results: Data analysis did show that moral distress is present in ED nurses (M=80.19, SD=53.27) and when separated into age groups the greater the age the less the experience of moral distress. A positive relationship between moral distress and some coping mechanisms and the ED environment were also noted. Conclusion: This study’s findings suggest that ED nurses experience moral distress and could receive some benefit from utilization of appropriate coping skills. This study also suggests that the environment with which ED nurses practice has a significant impact on the experience of moral distress. Since health care is continuing to evolve it is critical that issues like moral distress and coping be studied in ED nurses to help eliminate human suffering

Ethical conflict in critical care nursing: correlation between exposure and types

Background: Ethical conflicts in nursing have generally been studied in terms of temporal frequency and the degree of conflict. This study presents a new perspective for examining ethical conflict in terms of the degree of exposure to conflict and its typology. Objectives: The aim was to examine the level of exposure to ethical conflict for professional nurses in critical care units and to analyze the relation between this level and the types of ethical conflict and moral states. Research design: This was a descriptive correlational study. Central and dispersion, normality tests, and analysis of variance were carried out. Participants and research context: A total of 203 nurses were from two third-level teaching hospitals in Spain. Both centers are part of the University of Barcelona Health Network. Participants filled out the Ethical Conflict in Nursing Questionnaire. Critical Care Version. Ethical considerations: This investigation received the approval of the ethical committees for clinical investigation of the two participating hospitals. Participants were informed of the authorship and aims of the study. Findings: The index of exposure to ethical conflict was x ¼ 182:35. The situations involving analgesic treatment and end-of-life care were shown to be frequent sources of conflict. The types of ethical conflict and moral states generally arranged themselves from lesser to greater levels of index of exposure to ethical conflict. Discussion: The moderate level of exposure to ethical conflict was consistent with other international studies. However, the situations related with family are infrequent, and this presents differences with previous research. The results suggest that there is a logical relationship between types of conflict and levels of exposure to ethical conflict. Conclusion: The types of ethical conflict and moral states were related with the levels of exposure to ethical conflict. The new perspective was shown to be useful for analyzing the phenomenon of ethical conflict in the nurse