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PubMed1990

Nursing ethics and Project 2000.

Project 2000 gives us an opportunity to reconsider the need for nursing ethics in initial nurse education in the United Kingdom. Three arguments are presented to justify its inclusion. The overall aim of an ethics course should be to help the student become an autonomous moral agent, capable of functioning in the complex and difficult nursing environment. Hence, to design such a course we need an analysis of the skills, knowledge and motivation required by such an agent. This will help us choose our objectives and course content. A tentative analysis is offered. Suggestions are made about the teaching of the course and the integration with other subject areas. Some practical, moral and philosophical objections to this approach are considered and replies are offered.

Clinical Competence↗
PubMed1992

Ethical reasoning in nurses' and physicians' stories about care episodes.

Twenty-three registered nurses and nine physicians reported 43 stories about ethically difficult care situations. Themes in nurses' and physicians' stories were described by means of narrative ethical theory. It turned out that nurses and physicians related different kinds of stories. They also seemed to use different kinds of ethical reasoning. This result was interpreted as mainly connected to the fact that the two professions have different tasks to accomplish and are trained in disciplines with different foci; nursing and medicine. The need to find a common frame story covering the two professional stories was stressed.

Adult↗
PubMed1996

Is the professional code still the cornerstone of clinical nursing practice?

Although codes of practice for those concerned with the health care of others have always been inherent in the structure of societies, they have been institutionalized within the nursing discipline since the end of the last century. Up until the early 1970s they promulgated subservience to the medical discipline. As a result of the processes of emancipation and professionalization, the philosophy of the nurse has come to contain concepts of autonomy, accountability and patient-advocacy, based on a personal and individualized care system. Research in recent years has shown that nurses are making morally sound and ethically acceptable choices based on their own decision-making abilities, whilst having little or no active knowledge of the existing professional codes. Based on the literature, the author discusses ethical codes in relation to their perception by nurses in the clinical situation. The influence of the code in the areas of moral decision making, administration and management, and education are likewise discussed and the conclusion is reached that codes remain the cornerstone of nursing practice.

Attitude of Health Personnel↗
PubMed1994

Professional behaviour of medical school graduates: an analysis.

Recent graduates (1989-1990) of a traditional school of Chinese medicine were assessed by observers using a 10-item scale for professional behaviour in the non-cognitive realm. Overall, 10.7% of the graduates had low ratings on this scale. Of those who scored in the top two quartiles on this scale, 71.4% reported that 'Professional ethics' was the key determinant of their professional behaviour, whereas legal concerns were the prime motivator for only 3.6% of the top scorers. It was also found that students' scores in the medical ethics course correlated with their professional behaviour score to a statistically significant degree.

Attitude of Health Personnel↗
PubMedDate not supplied

Children's distributive justice judgments: aversive racism in Euro-American children?

Euro-American 2nd- and 4th-grade children (Ms=7.67 and 9.82 years) heard stories about Black and White characters who produced artwork yielding a windfall reward. Children allocated rewards to characters, justified their allocations, and judged the fairness of patterns representing different justice principles. Older children allocated more money to Black than White productive characters and to White than Black needy characters, consistent with predictions from aversive racism theory. Rationales most often relied on equality principles; older children gave more equity-based justifications for Black than for White characters. Fairness ratings of patterns representing 4 justice principles revealed effects for age and character race. Implications for understanding the developmental course of moral judgments as they apply to racial differences are discussed.

Age Factors↗
PubMed1995

The stories of physicians, registered nurses and enrolled nurses about ethically difficult care episodes in surgical care.

Twenty physicians, 19 registered nurses (RN), and 20 enrolled nurses (EN) working in surgical care in Sweden narrated their experiences of being in ethically difficult care situations. All three professional groups disclosed a strong wish to help patients. The narrations of the physicians and the ENs indicated that they were very much involved in their patients, while most of the RNs' stories were narrated from a distanced onlooker's perspective and disclosed a lot of moral outrage, mainly directed towards physicians. The physicians were the only group that emphasized the importance of acting in accordance with science and proven experience. Like RNs they emphasized the importance and difficulty of telling the truth to the patients and their families and being open to one's own and others' harsh experiences. RNs and ENs emphasized the patient's right to a death with dignity and the difficulties connected with being with dying patients, and they also described feelings of powerlessness and neglect of patients related to a heavy work load. ENs narrated difficulties related to providing patients with individualized but fair care.

Adult↗
PubMed1996

Neonatal euthanasia: attributions of students and nurses.

An attributional analysis of neonatal euthanasia was undertaken in two studies to compare the responsibility attributions of nursing and non-nursing students (Study 1) and nurses (Study 2) toward a physician for a critically ill neonate's death. In both studies, vignettes about a newborn's death differed with respect to the physician's treatment of the critically ill newborn. In the student study, the physician was attributed the least responsibility for the newborn's death when cardiopulmonary resuscitation was attempted but failed, followed by the physician's issuance of either a "Do Not Resuscitate" order or an order to turn off the infant's respirator. Greatest responsibility was attributed to the physician when he ordered the infant's nutritional and hydration support to be terminated. In addition, the student's major (nursing vs. non-nursing) and the nursing student's educational cohort impacted the level of physician responsibility attributed. In contrast, the nurses' study found that the termination of nutritional and hydrational support was viewed as different from the physician's other three actions.

Adult↗
PubMed2006

Registered nurses' willingness to serve populations on the periphery of society.

PURPOSE: To (a) determine the relative combined contributions of age, highest level of education, gender, and nursing certification on registered nurses' values, and (b) to identify the relative combined contributions of age, highest level of education, gender, nursing certification, and values on registered nurses' willingness to serve underserved and disenfranchised populations. DESIGN: Survey. METHODS: Web-based anonymous survey containing the AACN Values QuestionnaireNurse, the Willingness to Serve the Underserved and Disenfranchised Scale, and a demographic questionnaire were used to assess the meaning that participants attach to seven values; the willingness of participants to care for members of diverse groups; and participant demographic information. Data analysis was accomplished using regression analyses with a convenience sample of 128. FINDINGS: Age and highest level of education showed significant combined contributions to the values scores; however, these variables, including values, were not significant in predicting nurses' willingness to serve underserved and disenfranchised populations. CONCLUSIONS: Demographic characteristics (age and level of education) showed limited influence on values, but no variables included in this study were significantly associated with registered nurses' willingness to serve populations on the periphery of society.

Adult↗
PubMedDate not supplied

Moral agency in nursing.

Moral agency involves risk. It is an action that is at odds with the traditional role of the nurse. However, as nurses assume more responsibility and accountability for client management and outcomes in an increasingly complex and uncertain environment, it is essential to approach ethical dilemmas in a manner consistent with the caring component of nursing. Case examples are utilized to illustrate the attributes necessary for nurses to fulfill their obligations in their nurse-client relationships.

Ethics, Nursing↗
PubMed1994

The teaching of medical ethics to medical students.

Teaching medical ethics to medical students in a pluralistic society is a challenging task. Teachers of ethics have obligations not just to teach the subject matter but to help create an academic environment in which well motivated students have reinforcement of their inherent good qualities. Emphasis should be placed on the ethical aspects of daily medical practice and not just on the dramatic dilemmas raised by modern technology. Interdisciplinary teaching should be encouraged and teaching should span the entire duration of medical studies. Attention should be paid particularly to ethical problems faced by the students themselves, preferably at the time when the problems are most on the students' minds. A high level of academic demands, including critical examination of students' progress is recommended. Finally, personal humility on the part of teachers can help set a good example for students to follow.

Bioethics↗
PubMed2006

The bioethics of enhancing human performance for spaceflight.

There are many ways of enhancing human performance. For military aviation in general, and for spaceflight in particular, the most important tools are selection, training, equipment, pharmacology, and surgery. In the future, genetic manipulation may be feasible. For each of these tools, the specific modalities available range from the ethically acceptable to the ethically unacceptable. Even when someone consents to a particular procedure to enhance performance, the action may be ethically unacceptable to society as a whole and the burden of risk for the individual may be too great. In addition, there are several characteristics that define the quality and the acceptability of the consent. Each method of enhancing performance will be examined in the context of the principles of medical ethics in a western society: autonomy, non-maleficence, beneficence, and justice. The aim is to draw the attention of aeromedical practitioners to the complexities of ethical dilemmas such as this particular one in order to help them to develop a morally justifiable code of practice that balances society's needs against individual ambitions and corporate goals.

Aerospace Medicine↗
PubMed1995

Teaching ethics in psychiatry: a one-day workshop for clinical students.

In this paper we describe the objectives of teaching medical ethics to undergraduates and the teaching methods used. We describe a workshop used in the University of Liverpool Department of Psychiatry, designed to enhance ethical sensitivity in psychiatry. The workshop reviews significant historical and current errors in the ethical practice of psychiatry and doctors' defence mechanisms against accepting responsibility for deficiencies in ethical practice. The workshop explores the student doctors' own group ethos in response to ethical dilemmas, and demonstrates how the individual contributes to and is responsible for the group ethos through participation and also through nonparticipation. The student feedback about the workshop is reviewed. The Toronto Ethical Sensitivity Instrument was used to assess whether or not the workshop altered sensitivity. Compared to a control group the attenders' sensitivity was significantly increased (on Student's t-test p equals or is less than 0.002).

Education, Medical, Undergraduate↗
PubMed1996

Ethical reasoning in mixed nurse-physician groups.

OBJECTIVES: To study the ethical reasoning of nurses and physicians, and to assess whether or not modified focus groups are a valuable tool for this purpose. DESIGN: Discussion of cases in modified focus groups, each consisting of three physicians and three nurses. The discussion was taped and analysed by content analysis. SETTING: Five departments of internal medicine at Danish hospitals. SAMPLE: Seven discussion groups. MAIN MEASUREMENTS: Ethical content of statements, style of statements, time used by each participant. RESULTS: Danish physicians and nurses do not differ in the kind of ethical reasoning they use, but physicians use more of the discussion time than nurses, they use a more assertive style of argumentation, and the solutions chosen are usually first put forward by physicians. CONCLUSION: The results and informal comparisons with similar data from long qualitative interviews indicate that groups of this kind are a useful tool for gathering data on ethical reasoning.

Aged↗
PubMed1999

Power and the teaching of medical ethics.

This paper argues that ethics education needs to become more reflective about its social and political ethic as it participates in the construction and transmission of medical ethics. It argues for a critical approach to medical ethics and explores the political context in medical schools and some of the peculiar problems in medical ethics education.

Codes of Ethics↗
PubMed2000

Evaluation of research ethics committees in Turkey.

In Turkey, there was no legal regulation of research on human beings until 1993. In that year "the amendment relating to drug researches" was issued. The main objectives of the regulation are to establish a central ethics committee and local ethics committees, and to provide administrative control. There are no compulsory clinical ethics lectures in the medical curriculum, so it is also proposed that research ethics committees (RECs) play a central educational role by helping physicians to be aware of moral problems and by contributing to the training of research teams.

Drug Evaluation↗