Caring, men and women, nurses and doctors, and health care ethics.
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Achievement↗
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Results for “Moral Development”
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Gilligan: a voice for nursing?
The current reform of nursing education is resulting in major changes in the curricula of colleges of nursing. For the first time, ethical and moral issues are being seen as an important theme underpinning the entire course. The moral theorist with whose work most nurse teachers are acquainted is Kohlberg. In this paper, it is suggested that his work, and the conventions of morality which he exemplifies, may not be the most appropriate from which to address the moral issues facing the nurse. The author suggests that the work of Carol Gilligan of Harvard university is of great significance, not only for nurses involved in the teaching of ethics, but for all nurses. Gilligan's emphasis on caring and relationships accords with the common experience of the nurse, and echoes the current revival of interest within nursing in examining, and valuing, the phenomenon of caring.
Education, Nursing↗
Modifying autonomy--a concept grounded in nurses' experiences of moral decision-making in psychiatric practice.
Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autonomy' and its dimensions, such as being aware of the patient's vulnerability, caring for and caring about the patient, were identified. The findings in this study make clear the need for further research into the experiential aspect of ethical decision-making in psychiatric practice.
Beneficence↗
Can there be an ethics of care?
There is a growing body of writing, for instance from the nursing profession, espousing an approach to ethics based on care. I suggest that this approach is hopelessly vague and that the vagueness is due to an inadequate analysis of the concept of care. An analysis of 'care' and related terms suggests that care is morally neutral. Caring is not good in itself, but only when it is for the right things and expressed in the right way. 'Caring' ethics assumes wrongly that caring is good, thus it can tell us neither what constitutes those right things, nor what constitutes the right way.
Emotions↗
Partial and impartial ethical reasoning in health care professionals.
OBJECTIVES: To determine the relationship between ethical reasoning and gender and occupation among a group of male and female nurses and doctors. DESIGN: Partialist and impartialist forms of ethical reasoning were defined and singled out as being central to the difference between what is known as the "care" moral orientation (Gilligan) and the "justice" orientation (Kohlberg). A structured questionnaire based on four hypothetical moral dilemmas involving combinations of (health care) professional, non-professional, life-threatening and non-life-threatening situations, was piloted and then mailed to a randomly selected sample of doctors and nurses. SETTING: 400 doctors from Victoria, and 200 doctors and 400 nurses from New South Wales. RESULTS: 178 doctors and 122 nurses returned completed questionnaires. 115 doctors were male, 61 female; 50 nurses were male and 72 were female. It was hypothesised that there would be an association between feminine subjects and partialist reasoning and masculine subjects and impartialist reasoning. It was also hypothesised that nurses would adopt a partialist approach to reasoning and doctors an impartialist approach. No relationship between any of these variables was observed.
Attitude of Health Personnel↗
Providers' gender and moral reasoning: a proposed agenda for research on providers and patients.
Women constitute 35% of providers in genetics, at the doctoral level. A survey of 682 geneticists in 19 nations showed that gender was the single most important determinant of ethical decision making. Women were less directive and more observant of patient autonomy than men. The future influx of women into medicine calls for research on provider gender and decisions. Research is also needed on women's and men's perceptions of abortion for genetic reasons, on extended families' views, on agreement between partners and on overall effectiveness of genetic counseling, including communication, elements of provider satisfaction, interpretation of risk and uncertainty after counseling.
Abortion, Eugenic↗
Psychosocial issues in reproductive genetic testing and pregnancy loss.
This paper considers the psychosocial experience of women undergoing reproductive genetic testing, with attention to the impact of pregnancy loss after testing. New directions for research are called for to provide more in-depth understanding of the meaning of these experiences for women and their male partners.
Abortion, Eugenic↗
The ethical commitments of academic faculty in psychiatric education.
OBJECTIVE: This article explores the commitment of faculty to ethics training in psychiatric education. Although psychiatry has insufficiently addressed the profession's need for ethics training in education, program directors acknowledge its critical importance, and its positive impact has been demonstrated. Additionally, residents often seek ethics training as part of their instruction. METHOD: The author suggests that academic faculty could respond to the profession's inadequate treatment of ethics training by helping trainees develop moral agency--the ability to recognize, assess, and respond to ethical dilemmas; decide what constitutes right or wrong care; and act accordingly. The author also describes how this objective could be met by promoting professionalism and offering didactic instruction that address substantive and process issues regarding psychiatric care. CONCLUSION: Specific recommendations are provided.
Attitude↗
My parent's dignified death is different from mine: moral problem solving about euthanasia.
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Adult↗
Children who lie: a review of the literature.
In this paper we review 18 years of literature on the causes and management of lying in children. Developmental, psychoanalytic, interactional and sociological frames of reference have been applied in different papers to understand this phenomenon of childhood and adolescence. In recent years, some experimental studies confirm developmental concepts, yet others suggest that children of the eighties are changing in their moral development. The scarcity of references on the management of lying as a symptom is noted.
Child↗
Teaching moral reasoning to student nurses.
Teaching moral reasoning to students is a challenge for all nursing educators. The National League for Nursing and American Nurses' Association emphasize the importance of ethical content within the curriculum. Review of the literature indicates that ethics has been part of the nursing curriculum since the early 1900s. However, the focus of nursing ethics has changed to more critical reflective thinking versus duties and etiquette. Educators have used a variety of methods for teaching ethics and integrating it into the curriculum. Yet nursing graduates still lack adequate skills to be morally accountable practitioners. This creates a dilemma for the educator to find ways to integrate more ethics content into an already crowded curriculum. The code of ethics of holistic nurses may serve as a basis to guide nurse educators in resolving some of the problems encountered in promoting moral education.
Codes of Ethics↗
The case of Baby M: nursing care in an ethical wilderness.
This is a reflective case study of an infant with Down Syndrome and a potentially fatal cardiac defect. It is a story of hope and loss, of silence and learning to speak, and of relinquishing space and standing ground. The purpose of this article is to explore the conflicting claims a neonatal intensive care (NICU) nurse faces in caring for critically ill infants. The questions of "Who speaks?" and "Who listens?" are addressed. The concepts of women's moral development and a nursing definition of voice are included. It is proposed that the conventional feminine voice and the embodied knowledge so integral to expert nursing actually draw strength away from the voice that needs to be permitted into the circle of decision makers when ethical issues are raised in the NICU.
Down Syndrome↗
Is moral education of nurses still possible?
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Adolescent↗
Moral sensitivity in psychiatric practice.
This study reports the results of a study of Swedish psychiatrists' responses to moral statements related to decision making in the psychiatric context. Use was made of the Moral Sensitivity Questionnaire, a modified instrument previously constructed from a theory of moral sensitivity. This Likert-type scale contains 30 items constructed from the following categories: interpersonal orientation, structuring moral meaning, benevolence, modifying autonomy, experiencing moral conflict, and trust in medical knowledge and principles of care. The purpose was to identify possible differences in responses rather than to evaluate right or wrong responses. The analysis is based on 754 completed questionnaires. The results of the study showed some significant differences in the item and category levels; for example, male psychiatrists experienced more conflicts than female psychiatrists and agreed to a greater extent that medical knowledge was most important in deciding what was best for the patient. The results also showed that more female than male psychiatrists thought that the relationship with the patient was most important in psychiatric practice.
Adult↗
A model for conceptualizing the moral dynamic in health care.
Ethics involves an organized, reasoned approach to gathering and processing data in order to arrive at decisions about what to do, what to value, and/or what virtues to cultivate. A model is proposed for conceptualizing this complex dynamic, which incorporates elements of both rule-and-principle ethics and the ethic of care. The model suggested here has two levels. The first level identifies the components that comprise philosophical reasoning; the second contextualizes and operationalizes the model in relation to the processor's philosophical stance on the nature of knowing. Three philosophical stances are identified and described: science-dominant, person-dominant, and science-person equilibrium. Physicians tend to process patients from first perspectives, nurses from second. Hence, health team collaboration in moral problem solving is critically important.
Bioethical Issues↗
Cultivating a moral sense of nursing through model emulation.
This paper reports part of a longitudinal research project, which sought to capture students' conceptualization of caring practice as they progressed to different levels of study in a nursing diploma programme in Hong Kong. Model emulation was found to be an effective means of focusing students' learning processes on the moral aspects of nursing practice. The theory of model emulation from a Chinese perspective and how it is applied to create a learning context to allow students to acquire a moral sense of nursing are discussed. The participating students are invited to be sincere enquirers in the pursuit of the good embedded in practice through introspective self-examination and dialogue. They are asked to describe and share their experience of positive and negative examples of nursing in written accounts. Van Kaam's phenomenological method was adopted to explicate the good and bad constituents of nursing from these examples, with the students assuming an active role in the explication process. The explication reveals that the students were able to articulate the good and bad practices in a variety of patient care situations.
Confucianism↗
Acting from the virtue of caring in nursing.
The author challenges the recently argued position of Helga Kuhse that caring is merely a preparatory stage to moral action and that impartial, principled thinking is required to make action moral, by suggesting a notion of caring as virtue. If caring is a virtue then acting from that virtue will be acting well. Acting from the virtue of caring involves eight features, which include not only that of being sensitive to, and concerned about, the patient, but also that of being aware of, and sensitive to, the relevant ethical principles. In this way, caring is seen as an overarching quality that gives action its moral character. The moral character of an action does not derive only from its having been performed in the light of principles.
Empathy↗
Nurturing a child's spirituality.
Nurturing a child's spirituality should be an integral part of holistic care. The concept of spirituality is linked to the child's cognitive, social, psycho-sexual and moral development. Knowledge of childhood spirituality can help to support children coping with traumatic life-events. The expression of beliefs and feelings that encompass spirituality can be facilitated through literature and music and through other strategies. Educators need to empower professionals to have the awareness, emotional resources and skills to ensure that they can be spiritually supportive
Adaptation, Psychological↗