Nurses contribution to the resolution of ethical dilemmas in context

Background: New nursing roles and advances in care and treatments have resulted in nurses facing increasingly complex ethical dilemmas in practice; nurses are therefore required to engage effectively in ethical decision-making. Prior to commencing this empirical study a literature review was undertaken, the databases CINAHL, Science Direct, Medline, Web of Science and British Nursing Index were searched. Peer reviewed papers were systematically reviewed. Emerging themes were moral distress, codes of ethics, conflict within ethical decision-making and policy. The literature included international studies and indicated that ethical decision making is a concern amongst nurses globally. Aim: To identify how nurses contribute to the resolution of ethical dilemmas in practice. Method: An Interpretive Qualitative study was undertaken, between March and December 2012, using a flexible approach to analysis. The National Research Ethics Committee provided Ethical approval. Eleven registered nurses were interviewed using semi-structured interview, focusing on how participants addressed ethical dilemmas in practice. In-depth thematic and content analysis of the data was undertaken. The relatively small, single site sample may not account for the affects of organisational culture on the results. Results: Four major themes emerged: ‘Best for the patient’, ‘Accountability’, ‘collaboration’ and ‘policy’. In addition professional relationships were identified as key to resolving ethical dilemmas. Moral distress was evident in the data as identified in the literature, and reflects the emotional labour nurses’ experience. Discussion: Support is required for nurses to acquire the skills to develop and maintain professional relationships for addressing ethical dilemmas in practice. Nurses require strategies to address the negative impact of moral distress. Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas. Recommendations: Research is required to explore this phenomenon in other geographical areas and professional settings. Nurses need to engage with political and organisational macro and micro decision making. Further research is required to establish how nurses can manage moral residue and minimise the negative impact of moral distress

Nurses’ contributions to the resolution of ethical dilemmas in practice

Background: Complex and expensive treatment options have increased the frequency and emphasis of ethical decision making in healthcare. In order to meet these challenges effectively we need to identify how nurses contribute the resolution of these dilemmas. Aims: To identify the values, beliefs and contextual influences that inform decision making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice. Design: An interpretive exploratory study was undertaken, eleven registered acute care nurses, working in a district general hospital in England were interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification. Participants and context: Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis. Ethical considerations: Ethical approval was obtained from local the National Research Ethics Committee Findings: Four major themes emerged: ‘Best for the patient’, ‘Accountability’, ‘collaboration and conflict’ and ‘concern for others’. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas. Discussion Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro and micro decision making. Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemma

Is It My Fault? Contemplative Reactions Among Nurses Toward the Existence of BlamingCulture in Relation to Their Documentation : A Malaysian Context

Introduction: Nursing documentation is the key to nursing care in hospitals. Nursing documentation contains evidences which demonstrate a significant association between the comprehensive level of nursing care and nurses’ professional practice. Therefore, nurses in Malaysia are trained to abide with the code of professional practice (1998) which required them to contrive a complete and comprehensive nursing documentation. Despite the importance of nursing documentation in the nursing professional practice, such study almost non-existent in Malaysia. Hence, there is a need to explore nurses understanding about existence of professionalism within their documentation, from a Malaysian context. Methods: The study utilized a qualitative approach which aimed to explore the perceptions among nurses in Malaysia on their documentation with relation to professionalism in nursing. Forty semi structured interviews were conducted in order to obtain an understanding of nurses’ views on their documentation and its influence on their ways of preparing and completing their documentation. Thematic analysis was used to identify categories and themes in nurses’ accounts of their documentation with relation to professionalism in nursing. Results: One of many profound findings from the study is the fear among nurses of “blaming culture” in that occurs their clinical setting. The nurses perceive “blaming culture” do not tolerate mistakes and they are more likely to be blamed for poor patient safety and insufficient quality of care. This is because nurses are directly involved in delivering care to patient or client in the hospital. “Blaming culture” however motivates nurses to ensure their documentation is complete, comprehensive and contemporaneous. Conclusion: Interestingly, the nurses perceive their documentation as an important evidence if there are possible future medical legal issues that they might have to involve with

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

'Care and compassion': why does it go wrong?

This editorial is in response to Care and Compassion, the latest report published by the Parliamentary and Health Service Ombudsman (2011). The report identifies and discusses ten separate investigations following complaints regarding the care of older people within the NHS. Each account provides a unique story of the experiences faced by older people and their families during a period of ill health. Ann Abraham, Health Service Ombudsman for England, highlights that prior to this, each of the individuals referred to in the report led full, worthwhile lives, valued by themselves, their families and friends. Each case paints a disturbing picture of the consequences when things go wrong in the management and delivery of health care for older people whilst in hospital, during discharge and following discharge into the community. Unfortunately nine of the ten patients within the report died during the events outlined. It is essential that health-care staff learn from such incidents to improve service and care provided to individuals

Using Visual Tools for Analysis and Learning

This pack is intended as a resource for lecturers and students to facilitate the further development of their learning and teaching strategies. Visual tools were initially introduced within a module of the Year 3 nursing curriculum within the University of Huddersfield by Dr Rob Burton. Throughout the period of 2007-2008 a small team of lecturers with a keen interest in this teaching and learning strategy engaged in exploring and reviewing the literature. They also attended a series of local workshops held by Oliver Caviglioli, a keen author in relation to visual tools. The use of visual tools as a learning and teaching strategy is now being encouraged within both primary and secondary education. Therefore future students should have some experience of using them. Visual tools have been used as both formative and summative elements of student nurse assessment and are being used creatively within the school. Throughout the duration of this project, aspects of the work have received a positive response at both national and international conferences including HERDSA July 2007, Adelaide, Australia; International Nursing Research Conference, Malaysia March 2008 and Nurse Education Tomorrow (NET) Conference, Cambridge September 2008. The pack contains information regarding the background, relevant theory and the development of visual tools. It has been designed to introduce you to the principles of using visual tools for analysis and adult learning. The main message is that the tools themselves form a systematic approach to be used in learning and teaching. It contains examples of various visual tools and a series of exercises to support you through the stages of the development of visual tools. It is hoped that this will enable you to develop visual tools within your own field of expertise. Within the pack there are some examples of visual tools, although these are not exhaustive. We hope that you enjoy the pack and that it inspires you to further explore the wide variety of visual tools and their potential value within adult education

Visual tools as a learning and teaching strategy within healthcare education

There are a wide range of visual tools that can be used within a structured approach to support learning and teaching. Visual tools include mind maps, concept maps and various other diagrams that can each be used in a variety of ways to aid, develop and represent learning. Caviglioli et al (2002) state that we all have schemas formed by our external and internal experiences. By representing schema externally they can be added to, adapted and changed, particular aspects can be scrutinised in detail and explored for further analysis. Visual tools can be used by students to develop maps which enables them to absorb and understand information. The utilisation of visual tools also enables students to identify and externalise their models of understanding. Through this process, problem-solving approaches to learning and teaching can be promoted. The visual tool is therefore used as a vehicle which enables students to develop conclusions after working through a problem. Buzan (1995) states that, traditionally, education has been built on the structural patterns of speech, which are in the main linear in nature. However he argues that the human brain does not simply think in a linear fashion. What is not accounted for is the multi-modal nature of the human 'holographic' brain. Vision is a symbolic process and as images are inputted into the brain any number of representations of it can be formed. Visual tools can be used in order to assist students to assimilate their findings/conclusions and provide visual explanations of these representations. Visuals tools may be used by students within educational institutions in a variety of ways to support them in both the planning and presentation aspects of their work. Within the practice based learning environment, students may use visual tools to develop their skills of problem-solving and decision making. The tools also enable students to develop their time management and organisational skills. All of which contribute to their overall professional development and growth as they work towards becoming an effective practitioner delivering high quality nursing care. In addition, nurse lecturers can effectively utilise visual tools to support the planning of lectures tutorials and practice learning opportunities. Once experienced in the use of mapping and presentation of data using visual tools, healthcare professionals can further use the tools to enable them to plan their personal and professional development associated with life long learning. These tools can be used for higher-level thinking and not just the merely descriptive. In using them, analytical thinking, where a subject is rigorously examined in a logical step-by-step manner (Rose and Nicholl, 1997), can be made easier, hence the suggestion for their use to provide portfolio evidence of information and reflections. This would fit the notion of Williamon and Valentine (2002) of hierarchical organisation as a cognitive principle that applies to the encoding and retrieval of both motoric and symbolic information. There is no Visual aspect that cannot be used within these and they can be adapted and developed in however the individual wishes to do so. The use of the tools relate to the representation of levels of sophistication of information, Burton and Bodenhamer (2000) suggest that humans make representations in the forms of nominal (sorted into categories), ordinal (compared or ranked against the qualities of other representations), interval (comparison with even more detail) and ratio data (highlighting interrelationships and meaning between representations). It is by recognising the tools used to represent types and levels of data the student and facilitator can utilise them in the presentation of data and demonstrate problem-solving An original project, funded through a teaching and learning grant, resulted in the development of a teaching package to support the use of visual tools within higher education. This work was undertaken within the School of Human and Health Sciences at The University of Huddersfield, the use of these tools is now integrated within the curriculum for pre-registration nurse education. Workshops for students and staff are facilitated by the project designers to support its dissemination across the school and university. Aim of presentation: The aim of the presentation is to discuss the use of visual tools as a learning and teaching strategy within healthcare education. Objectives: 1. Identify the use of how visual tools can be used within healthcare education as learning and teaching strategy. 2. Share ideas on how these visual tools are used within the curriculum at The University of Huddersfield. 3. Discuss how these can be used as an assessment strategy and the development of there use within higher education to demonstrate levels of understanding and problem-solvin

What the Nurse does Exploring the nurses contribution to the resolution of ethical dilemmas in secondary care - the pilot study

Introduction Nurses face ethical dilemmas as part of their professional practice and it is often these that cause the greatest concern for the patient, their family and the nurse (Storch 2004, DH,1999) . It is therefore important that we are able to understand what registered nurses contribute to addressing these dilemmas as they occur. Aim of the study The aim of this pilot study is to test the data collection methods for a study in order to examine what it is that Registered Nurses contribute to the resolution of ethical dilemmas as part of their nursing practice. Methods This is a qualitative study using audio recording of semi-structured interviews to collect narrative data from participants (Polit and Beck 2006). A two phased analysis was undertaken a thematic approach, followed by a narrative analysis to examine the cultural dimensions within the clinical setting (Burns and Grove 2001). Results Questions required minor amendments and three themes emerged from the data: Organisational priorities Nurse – phycian relationship ‘Best for the patient’ Discussion incl. Conclusion Participants identified and discussed conflicts that have arisen between organisational objectives, procedures or protocol and that which was thought to be ‘best for the patient’. Practical relevance This pilot study highlighted the importance of developing the appropriate interviewing skills required for data collection and appropriate wording of questions to illicit the required data from participants prior to undertaking major study Research implications Three key areas identified by registered nurses in relation to ethical dilemmas where further research would be beneficia