This paper explores the nature of trust in nurse–patient relationships from the perspective of the patient's trust in the nurse and what might be said to then render such a relationship trustworthy, from the patient's point of view. The paper commences with a general examination of the nature of trust, followed by consideration of the nature of professional–patient relationships in healthcare, with emphasis on nurse– patient relationships in particular. The nature of this relationship is used to (...) provide grounds for arguing, both morally and conceptually, that the nature of patients’ trust in those who nurse them is generally such that for the nurse to respond in a trustworthy way, she must care about her patients, not just for them. In arriving at this conclusion, the paper deliberately restricts its focus to nurse–patient encounters where patients are adults and a relationship, as opposed to a brief engagement between two people, can be said to have taken place. The context for this focus is public sector health care in the United Kingdom. In the text, gendered pronouns referring to doctors, nurses and patients are meant to be inclusive of both sexes. (shrink)

The aim of this study was to report the results of a literature review of empirical studies on trust within the nurse–patient relationship. A search of electronic databases yielded 34 articles published between 1980 and 2011. Twenty-two studies used a qualitative design, and 12 studies used quantitative research methods. The context of most quantitative studies was nurse caring behaviours, whereas most qualitative studies focused on trust in the nurse–patient relationship. Most of the quantitative studies used a descriptive design, (...) while qualitative methods included the phenomenological approach, grounded theory, ethnography and interpretive interactionism. Data collection was mainly by questionnaires or interviews. Evidence from this review suggests that the development of trust is a relational phenomenon, and a process, during which trust could be broken and re-established. Nurses’ professional competencies and interpersonal caring attributes were important in developing trust; however, various factors may hinder the trusting relationship. (shrink)

The nurse-patient relationship involves complex attitudes and behaviours with ethical and deontological implications. It has been linked to improvements in patient health outcomes, although there is still no consensus in the scientific literature as to the definition and characterisation of the concept. This article aim to define the concept of the nurse-patient relationship. A concept analysis was conducted using the Walker and Avant method to identify the attributes defining the nurse-patient relationship. An integrative review of the literature was conducted using (...) the PubMed, Web of Science, Scopus, and Cumulative Index to Nursing & Allied Health Literature databases. A review of the grey literature and other minor non-indexed publications on the topic was also conducted. A total of 36 articles were included in the review. A model case, a contrary case, a related case, and empirical references were produced to clarify the concept and identify its essential attributes. The concept is defined as a helping relationship involving interaction between different players. It is the basis of nursing care and is intended to meet the healthcare needs of the individual receiving this care. It is also viewed as an intervention in itself, requiring a specific training process just like any other nursing skill. The essential attributes of the relationship are empathy, presence, contact, authenticity, trust, and reciprocity. In conclusion, the nurse-patient relationship is a helping relationship established with the patient and/or their family based on interaction, communication, respect for ethical values, acceptance, and empathy in order to encourage introspection and behavioural change. Key components include communication, active listening, and respect. Bioethical values and confidentiality must also be present to ensure that the relationship is built on equality and intimacy. (shrink)

Introduction: Empathy is a complex human experience that involves the subjective intersection of different individuals. In the context of nursing care in the geriatric setting, the benefits of empathetic relationships are directly related to the quality of the practice of nursing. Objective: Analyze scientific production on the benefits of empathy in the nurse–patient relationship in the geriatric care setting. Methods: An integrative review of the literature was performed using the PubMed, Cochrane, CINAHL, Scopus, PsycINFO, and Web of Science (...) databases. The articles retrieved were organized, evaluated, and classified based on the level of scientific evidence. Results: Relationships of empathy between nurses and older people were analyzed in quasi-experimental studies using different assessment tools, the majority of which had moderate levels of validity and reliability. Studies with a qualitative approach discussed the meaning of empathy in terms of the quality of care offered, compassion, and vulnerability. Discussion: Levels of empathy increase when activities are developed with the aim of teaching, sensitization, and training for relational care between nursing staff and older people. The analysis of empathetic relationships is important to the evaluation of the quality of care provided to older people. Conclusion: Empathy in the nurse–patient relationship in the geriatric care setting is an important ethical aspect that contributes to the quality of the practice of nursing. The present findings indicate the need for more robust assessment tools with adequate psychometric properties and the descriptive analysis of empathy. (shrink)

The current international healthcare focus on ensuring the perspectives and needs of individual persons, families or communities are met has led to the core tenet of person‐centred care for all. The nurse–patient relationship is central to the provision of care, and enhancing this relationship to ensure trust and respect supports optimal care outcomes for those accessing healthcare services. Engaging authentically is one of the recognised key approaches in person‐centred practice, and this scoping review of the literature aims to gain (...) an understanding of the role this process plays in developing effective relationships between nurses and the people they care for. A systematic search of databases and grey literature was undertaken, and twenty‐one research papers met the inclusion criteria. A thematic analysis revealed four themes: ‘getting to know the patient as a person’, ‘the complexity of relationship building—it takes time’, ‘the nurse: characteristics and behaviours that support the nurse–patient relationship’ and ‘the patient voice’. Nurses and patients both benefit from effective relationships, feeling valued and experiencing greater satisfaction with care. Key elements of engaging authentically were revealed as a nurse–patient relational process through this literature review; however, further research is needed to gain a greater understanding of this concept. (shrink)

Recognition theory attempts to conceptualize interpersonal relationships and their normative political implications. British social philosopher Gillian Rose developed her own version of recognition rooted in the work of Georg Hegel. This article applies Rose's theory of recognition to care, arguing that its emphasis on lack of identity, the dynamic process of recognition and the existential risks involved accurately describes the relationship between nurse and patient. Rose's version is compared to both contemporary notions of the interpersonal in healthcare literature, other (...) forms of recognition theory and Emmanuel Levinas's vision of intersubjective relationships, a traditional philosophical basis for nursing care. In each case, I will argue that Rosean recognition is a fuller, more complex and ultimately more satisfying view of the relationships involved. (shrink)

The present paper focuses on the nurse–patient relationship in forensic psychiatric care. From research in the field six categories of nurse–patient interactions are identified: ‘building and sustaining relationships’, ‘supportive/encouraging interactions’, ‘social skills training’, ‘reality orientation’, ‘reflective interactions’ and ‘practical skills training’. The content of each category of interaction in the context of forensic psychiatric care is described. A conceptual model is presented together with an empirical, philosophical and theoretical foundation for the use of verbal and social interactions (...) in nurse–patient interactions in forensic psychiatric nursing care. The implications and possible uses of the model in the practical field of forensic psychiatric care are discussed. (shrink)

Although we theorize that nurses ‘make a difference’ to patient outcomes and speculate that this happens because nurses ‘care’, there is so far little evidence to support this nebulous claim. Efforts to promote care as the defining characteristic of nursing, and an ‘ethic of care’ as the ethical basis of nursing, have sparked debate within the discipline. This debate has resulted in a polarization that has effectively stalled productive discourse on the issues. Moreover, the focus on care has been at (...) the expense of understanding the true nature of the relationship between caring and the broader base of ethical knowledge that underpins nursing and that must underpin nursing if it is a viable practice profession. This paper used the framework of philosophical argument to explore the moral and ethical foundations of nursing from the perspective of personal and public morals, and responsive nurse–patient relationships as the reflection of ethical nursing knowledge. The foundation of ethical nursing knowledge is the personal moral sense that resides within the individual and that nurses hold in common with others. Personal moral knowledge is transformed into disciplinary ethical knowledge specific to nursing through disciplinary consensus. Responsive relationships are conceptualized in the nursing literature as founded on three essential elements: respect, trust, and mutuality. These three elements are grounded in ethical nursing knowledge; therefore responsive nurse–patient relationships reflect both personal moral knowledge and disciplinary ethical knowledge. By facilitating the articulation of ethical nursing knowledge in practice, responsive relationships connect theory, ethical knowledge, and clinical outcomes. (shrink)

This article examines one aspect of the criticism of inauthenticity that can be levelled against the trustworthiness of professional relationships in general and nurse-patient relationships in particular. The overall question is: are such relationships inherently trustworthy or untrustworthy, from the patient’s point of view? The author concludes that, in spite of legitimate grounds for concern, and while it remains true that nurse-patient relationships may be untrustworthy, they are not inherently so for reasons of inauthenticity relating to (...) emotional labour. The arguments used to defend this claim take their force from the idea that different criteria may be needed to assess the authenticity of nurse-patient relationships from those used to evaluate authenticity in ordinary social relationships. The utility of Hochschild’s idea of ‘deep’ acting, as offering a useful model for the management of emotions in nursing, is examined and rejected. (shrink)

Heideggerian philosophy is frequently chosen as a philosophical framing, and/or a hermeneutic analytical structure in qualitative nursing research. As Heideggerian philosophy is dense, there is merit in the development of scholarly resources that help to explain discrete Heideggerian concepts and to uncover their relevance to contemporary human experience. This paper uses a meta-synthesis methodology to pool and synthesise findings from 29 phenomenological research reports on Being-with in the nurse–patient relationship. We firstly considered and secured the most relevant Heideggerian elements (...) to nurse–patient Being-with. Under these deductive codes, we then inductively developed sub-themes that seemed to explain the multifaceted nature of Being-with, through a secondary analysis and synthesis of published data from 417 patient, carer and nurse participants. Dasein-with was enhanced when nurses had first-hand experience with a phenomenon. Nurses moved between the inauthentic they-mode, and the authentic self-mode. Through circumspection, technology and people were encountered environmentally feeding into nursing attention, assessment and communication. Nursing as a social arrangement was expressed through either leaping-in care or leaping-ahead care. There was a place for both inauthentic and authentic discourse that nurses wove through the ontic everydayness of nursing tasks. (shrink)

The Fundamentals of Care Framework is an evidence‐based, theory‐informed framework that conceptualises high‐quality fundamental care. The Framework places the nurse–patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse–patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality of (...) class='Hi'>nurse–patient relationship instruments by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty‐seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring ‘focus’, ‘anticipate’ and ‘evaluate’. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse–patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework. (shrink)

For most nurses world-wide, activities are centred around working directly with patients and so the nurse-patient relationship is of the greatest importance. Ethnocentrism on the part of the health care community has led to misdiagnosis, mistreatment and undertreatment of culturally diverse individuals world-wide. This author discusses a tool, Greipp's Model of Ethical Decision-Making, which can be used to assist nurses in analysing the effects of culture, beliefs and diversity upon the caregiver and care recipient within an ethical framework.

The nurse–patient relationship is of great significance for both nurses and patients. The purpose of this article is to gain an understanding of how the individual is constituted through a focus on the execution of the patient’s and nurse’s role in the joint relationship. The article represents a social-constructionist consideration using Kenneth Gergen’s concept of multi-being. Gergen’s notions of the self as a multi-being focuses on the individual’s relational character through former relationships and social interactions. Gergen’s concept is (...) applied onto nurses and patients as individuals to gain an understanding of the broader institutional and social context of each role and their interactions within the nurse–patient relationship. The article focuses on the nurse–patient relationship in general with regard to specific challenges in the home care setting. Various demands and experiences from a myriad of past relationships merge as potential actions for nurses and patients during the forming of a relationship. Nurses as multi-beings see themselves confronted with guidelines and legal conditions, their own as well as the patients’ expectations and the actual possible forming of a relationship in the light of daily nursing care. Patients as multi-beings experience an extended social environment that comprises the nurse–patient relationship while simultaneously having to cope with illness and increasing care dependency within their own homes. Discrepancies can be observed in the relationship with regard to the inherent human qualities, the demands of forming a relationship, and the actual relationship arising due to framework conditions. (shrink)

The journey through the history of nursing, and its philosophical and political influences of the moment, contextualizes the interest that arose about the nurse–patient relationship after World War II. The concept has always been defined as a relationship but, from a phenomenological approach based on a historical, philosophical, psychological and sociological cosmology, it is possible to re‐conceptualize it as ‘caring interaction’. Under the vision of aesthetics and sociopoetics, the object of nursing care is the most delicate, vulnerable and unrepeatable (...) raw material: the person, whose feelings and reciprocity, which must be considered. In addition, it involves the adoption of the socio‐critical paradigm, as it considers the importance of actively involving the person, not just patient anymore, or their family in the nursing cares, optimizing the reciprocity inherent to this interactivity. In short, our philosophical and epistemological approach to the concept of nurse–patient relationship proposes a new conceptualization of it as a caring interaction. (shrink)

Objectives: To assess French district nurses’ opinions towards euthanasia and to study factors associated with these opinions, with emphasis on attitudes towards terminal patients.Design and setting: An anonymous telephone survey carried out in 2005 among a national random sample of French district nurses.Participants: District nurses currently delivering home care who have at least 1 year of professional experience. Of 803 district nurses contacted, 602 agreed to participate .Main outcome measures: Opinion towards the legalisation of euthanasia , attitudes towards terminal patients (...) .Results: Overall, 65% of the 602 nurses favoured legalising euthanasia. Regarding associated factors, this proportion was higher among those who discuss end-of-life issues with terminal patients , who consider competent patients should always be told their prognosis and who value the role of advance directives and surrogates in end-of-life decision-making for incompetent patients . Women and older nurses were less likely to favour legalising euthanasia, as were those who believed in a god who masters their destiny.Conclusions: French nurses are more in favour of legalising euthanasia than French physicians; these two populations contrast greatly in the factors associated with this support. Further research is needed to investigate how and to what extent such attitudes may affect nursing practice and emotional well-being in the specific context of end-of-life home care. (shrink)

Metaphors are central in communication and sense-making processes in health-related contexts. Yet how the metaphors used by health-care-professionals to make sense of their patients and their relations to them are associated to the perceived valence of their clinical encounters is underexplored. Drawing-upon the ABC Model of Dehumanization, this study investigated how the humanizing or dehumanizing metaphors nurses’ use for making sense of their pain patients are associated with how they perceived their relationships with them. Fifty female nurses undertook individual (...) narrative-episodic interviews about easy/difficult cases in pain care. A content analysis classified the metaphors, identifying eight classes reflecting different types of patients (de)humanization. A multiple correspondence analysis extracted patterns of metaphors and their association with the perceived characteristics of the patient-nurse relationship. It showed how these patterns were not associated with patient sex or socioeconomic status (SES) but were related to the perceived valence of the clinical relationship. By uncovering how patient metaphors guide nurses’ sense-making and potentially modulate interactions in clinical encounters, these findings may contribute to improve quality of pain care. (shrink)

Background: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts. Aim: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies. Research design: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses. Participants: The 69 participants attended a 1-year (...) educational programme for ambulance nurses at a Swedish university. Ethical consideration: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study. Findings: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care. Discussion: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation. Conclusion: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability. (shrink)

Background The ambulance service provides emergency care to meet the patient’s medical and nursing needs. Based on professional nursing values, this should be done within a caring relationship with a holistic approach as the opposite would risk suffering related to disengagement from the patient’s emotional and existential needs. However, knowledge is sparse on how ambulance personnel can meet caring needs and avoid suffering, particularly in conjunction with urgent and emergency situations. Aim The aim of the study was to explore ambulance (...) nurses’ experiences of relationships with patients in urgent and emergency situations. Methods Data collection was performed using individual open-ended interviews with six ambulance nurses. The data were analyzed using a thematic analysis. Results Relationships with patients during urgent and emergency assignments emerged as three themes: “ Ambiguous silence,” “ Professional competence” and “ Challenging inadequacy” comprising eight sub-themes in total. The result shows that the ambulance nurses found it difficult to prioritize between medical care and establishing a caring relationship with the patient. However, sometimes a wordless relationship was perceived sufficient and considered a first step towards a verbal relationship. Conclusions Ambulance nurses experience that a caring relationship cannot and does not need to be prioritized in the acute stage. This uncovers a dichotomy approach to medical care versus caring relationships that exclude a holistic approach. Thus, patients’ emotional, existential and physical needs are not considered as equally important. Clinical relevance: It is important to stimulate reflection on core ethical nursing values, in training and simulation exercises among clinically active ambulance nurses. (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict (...) were higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

The aim of this study was to deepen nurses’ understanding of the importance of carefully managing the first nurse-patient encounter in a psychiatric setting according to each patient’s suffering and future hopes. The study was carried out using an action research approach. The action planned was the implementation of a conceptual model reflecting Eriksson’s caring theory. Data were collected by interviews with nurses and observational notes kept in a research diary. The data analysis followed the procedure of qualitative content analysis. (...) A generalization of the entire learning process shows the first nurse-patient encounter to be a moral commitment in nursing. A theoretical framework of nursing assessment conveying knowledge about the patient as unique and being a whole person can support the nurse in encouraging the patient to enter into a relationship. This insight stimulated the nurses in this study to reflect on the moral responsibility of continuing the relationship and initiating an ongoing nursing process. Awareness of this responsibility made them reflect more on the possibility of nurses taking autonomous actions in order not to abandon the patient and to avoid feeling guilty. (shrink)

The aim of this study was to deepen nurses’ understanding of the importance of carefully managing the first nurse-patient encounter in a psychiatric setting according to each patient’s suffering and future hopes. The study was carried out using an action research approach. The action planned was the implementation of a conceptual model reflecting Eriksson’s caring theory. Data were collected by interviews with nurses and observational notes kept in a research diary. The data analysis followed the procedure of qualitative content analysis. (...) A generalization of the entire learning process shows the first nurse-patient encounter to be a moral commitment in nursing. A theoretical framework of nursing assessment conveying knowledge about the patient as unique and being a whole person can support the nurse in encouraging the patient to enter into a relationship. This insight stimulated the nurses in this study to reflect on the moral responsibility of continuing the relationship and initiating an ongoing nursing process. Awareness of this responsibility made them reflect more on the possibility of nurses taking autonomous actions in order not to abandon the patient and to avoid feeling guilty. (shrink)

In this paper I examine the meaning of physical touch as it occurs in the nurse–patient interaction. There are two aspects of the nurse–patient relationship that are found in most nurse–patient interactions which together have profound implications for nurses as practitioners and as individual human persons. The first is the clinical intimacy of the nurse–patient relationship where nurses touch, rub, smooth, clean, dress and otherwise physically interact with patients. The other is the existential crisis, the possibility (...) of loss, suffering and death that lurks at the horizon of most, if not all, healthcare encounters. Edmund Husserl, Merleau‐Ponty and more recently Robert Sokolowski argue that tactile sensations and resultant perceptions are fundamental to all sensory perception. Further, they argue that tactile sensation is fundamental for the ongoing constitution of ‘my’ self as a person and for the development and exercise of human intersubjectivity. If tactile interaction is crucial to the development of our very selves as persons and a significant aspect of our interaction with patients includes direct or observed tactile sensations and if further these sensations occur around the context of existential crises for our patients, then nurse's very selves as persons are being challenged by these interactions. Here, then I examine the philosophical argument for the role of tactile sensations in our human development and briefly look at contemporary neurophysiologic research that supports this philosophical account. I then suggest ways such physical intimacy can lead to a strengthening or weakening of the person of the nurse and the nursing interaction and end with some thoughts about ways to support nurses in these activities. (shrink)

Effective public health nursing relies on the development of responsive and collaborative relationships with families. While nurse–family relationships are endorsed by home visitation programs, training nurses to follow visit‐to‐visit protocols may unintentionally undermine these relationships and may also obscure nurses’ clinical understanding and situated knowledge. With these issues in mind, we designed a home‐visiting intervention, titled Listening with Care, to cultivate nurses’ relationships with teen mothers and nurses’ clinical judgment and reasoning. Rather than using protocols, the (...) training for the intervention introduced nurses to narrative methods and therapeutic tools. This mixed‐method pilot study included a quasi‐experimental design to examine the effect of the intervention on teen mothers’ depressive symptoms, self‐silencing, repeat pregnancy, and educational progress compared to teens who received usual care. Qualitative data were collected from the nurses to evaluate the feasibility and acceptability of the intervention and therapeutic tools. The nurses endorsed the therapeutic tools and expected to continue using them in their practice. Despite the lack of statistically significant differences in outcomes between groups, findings suggest that further study of the intervention is warranted. Future studies may have implications for strengthening hidden aspects of nursing that make a difference in the lives of teen mothers. (shrink)

Metaphors of medicine are common, such as war, which is evident in much of our language about health‐care where patients and healthcare professionals fight disease, or the game, which is one way to frame the nurse–doctor professional relationship. This study analyses six pilot episodes of American (Grey's Anatomy, Hawthorne, Mercy, Nurse Jackie) and Australian (All Saints, RAN) medical television programmes premiering between 1998 and 2009 to assess one way that our contemporary culture understands and constructs professional relationships between nurses (...) and doctors. Analysis shows that these popular television programmes frequently depict conflict, with games, civil war and mutiny between nurses and doctors over patient safety rather than professionals working collaboratively in teams to deliver health‐care. Although the benefit of this televised conflict is the implication that nurses are knowledgeable, skilled professionals, the negative connotations include a dysfunctional and dangerous healthcare system, and also ongoing power struggles. Given that popular culture can sometimes influence the public's understanding of real‐life nursing practice, it is important to explore what these metaphors of conflict are communicating about the nurse–doctor relationship. (shrink)

Background Scientific advances have resulted in more complex medical systems, which in turn have led to an increase in the number of patient safety incidents. In this environment, the importance of honest disclosure of PSIs is rising, which highlight the need to settle a reliable system. This study aimed to investigate the effects of patient safety culture and ethical awareness on open disclosure of PSIs. Methods Data were collected from 389 nurses using self-reported perceptions of open disclosure of PSIs, perceptions (...) of patient safety culture, and ethical awareness. Results Perception of open disclosure of PSIs was significantly correlated with ethical awareness and perception of patient safety culture. Ethical awareness had the greatest impact on perception of PSIs, and two components of the perception of patient safety culture, namely overall knowledge about patient safety and staffing, were found to have significant effects. Conclusions To enhance nurses’ perception of open disclosure of PSIs, educational curriculum and programs that teach and practice fundamental ethical values are needed. Furthermore, it also calls for effort on the part of healthcare institutions and the government, as well as people’s trust, to implement a legal safety net and foster patient safety culture to promote honest disclosure of PSIs to patients. (shrink)

This article uncovers the current discursive practices concerning socially vulnerable people in Danish society. A discourse analytical approach inspired by Michel Foucault, along with contributions from Erving Goffmann's work ‘Stigma’, is utilized throughout the analysis. First, the dominant discursive formations are described across the data material, consisting of sociopolitical and health policy documents. Second, we uncover how problematizations and mechanisms of power along with the emergence of the competition state push socially vulnerable people out into the periphery of society. Finally, (...) we discuss responsibility regarding social vulnerability and the structural injustice that follows. Our aim is to facilitate critical awareness of how socially vulnerable people are constructed and contribute to destabilizing accepted meanings and perceptions of social vulnerability. This study shows that being categorized as socially vulnerable is associated with poor health behavior and perceived as being in a dependent relationship with superior systems. The analysis points to a focus on strengthening and developing the work capacity of socially vulnerable people. Thus, the objective of the analyzed documents revolves around securing socially vulnerable people's contribution to society's economy. This article contributes with a perspective on how society, and therefore also healthcare professionals, perceive and interact with socially vulnerable people. (shrink)

BackgroundCultural competence is considered as one of the main skills of nurses enabling them to provide nursing care for those with different cultures. One of the cases related to nurses’ cultural competence is observance of ethical codes, but it has not been investigated sufficiently in studies.AimThis study has been conducted to determine the relationship between nurses’ cultural competence and observance of ethical codes in practice.Research designThis descriptive-correlational study was conducted in 2020. Sampling was done at several stages. The data were (...) collected using questionnaires of demographic information, cultural competence, and observance of ethical codes as self-report. The questionnaires were provided to the subjects by the corresponding researcher and the data were analyzed using Pearson correlation test.Participants and research contextThis study was done with participation of 267 nurses working in four training hospitals located in northwestern Iran and 16 head nurses of selected wards.Ethical considerationsThe study was approved by Human Ethics Committee of Hamadan University of Medical Sciences. Participation was voluntary. Consent was obtained and confidentiality kept.FindingsThe results of Pearson correlation coefficient test showed a positive and statistically significant relationship between cultural competence and observance of ethical codes (r = 0.524, p = 0.001). In addition, cultural competence and observance of ethical codes by most nurses were at a moderate level.ConclusionsThe results of the present study showed a significant relationship between nurses’ cultural competence and observance of ethical codes. Therefore, it can be concluded that by strengthening the level of nurses, the level of observing ethical codes by them can be increased. Cultural competency and observance of ethical codes are important components of nursing care, and their development can improve nursing care delivery to clients through academic training, hidden curriculum and in-service education. (shrink)

How patients and nurses experience the acute care psychiatric environment The concept of the therapeutic milieu was developed when patients’ hospitalizations were long, medications were few, and one‐to‐one nurse–patient interactions were the norm. However, it is not clear how the notion of ‘therapeutic milieu’ is experienced in American acute psychiatric environments today. This phenomenological study explored the experience of patients and nurses in an acute care psychiatric unit in the USA, by asking them, ‘What stands out to you about (...) this psychiatric hospital environment?’ Three figural themes emerged, contextualized by time, which was a source of stress to both groups: for patients there was boredom, and for nurses, pressure and chaos. Although they shared some themes, nurses and patients experienced them differently. For instance, nurses felt caged‐in by the Plexiglas‐enclosed nursing station, and patients felt caged‐in by the locked doors of the unit. The findings from this US study do not support the existence of the therapeutic milieu as described in the literature. Furthermore, although the nurse–patient relationship was yearned for by nurses, it was nearly absent from patients’ descriptions. The caring experienced by patients was mainly derived from interactions with other patients. (shrink)

The purpose of this article is to examine whether patient/client autonomy is always compatible with the nurse’s role of advocacy. The author looks separately at the concepts of autonomy and advocacy, and considers them in relation to the reality of clinical practice from professional, ethical and legal perspectives. Considerable ambiguity is found regarding the legitimacy of claims of a unique function for nurses to act as patient advocates. To act as an advocate may put nurses at personal and professional risk. (...) It may also be deemed arrogant and insulting to other health care professionals. Patient autonomy can be seen as a subcategory of the right of every individual to self-determination, and as such is protected by law. However, it is questionable whether the traditionally paternalistic approach to health care provision truly respects the autonomous rights of each patient. The author considers examples and cases from the literature that resulted in professional and/or personal difficulties for the nurses involved, and also reflects on an incident from her own practice where a positive outcome was achieved that demonstrated compatibility between the concepts under consideration. (shrink)

The idea behind this article is to discuss the importance and to develop the concept of reciprocity in asymmetric professional relationships. As an empirical starting point for an examination of the possible forms of reciprocity between patients and nurses in psychiatry, we chose two qualitative in-depth interviews with two different patients. The manners in which these two patients relate to medical personnel—one is dependent, the other is independent—show that this presents challenges to nurses. The theoretical context is provided by (...) the notion of mature care as it has been developed by feminist-oriented ethics of care, in contrast to the notion of altruistic care. In relation to the concept of mature care, we discuss how nursing can be perceived in demanding relationships with patients in psychiatry. Reciprocity implies that, in principle, the interests of the nurses also matter in a nurse-patient relationship. We show that reciprocity—in practice—is complicated and challenging in a number of different ways. Mature care—with its systematic inclusion of relationships and reciprocity—provides an alternative understanding of what takes place between patients and nurses compared with an altruistic notion of care. As such, mature care can be regarded as an useful paradigm for nurse-patient relationships in psychiatry. (shrink)

One of the largest, oldest, and most interesting challenges in health care is the balancing act in which clinicians have generally uncontroversial duties both to individual patients and to communities. Physicians and nurses must — so we teach them — put patients first, and at the same time recognize that individuals are members of communities. Individuals affect the health of communities, and communities affect the health of individuals. Thus, the moral and professional duties that result are sometimes in conflict.Moreover, the (...) traditional, prosaic clinical encounter is evolving in an environment increasingly shaped by electronic health records, personal health records, pharmacogenomics and vast networks of data collection and storage for public health surveillance, human subjects research, health services evaluation, and comparative effectiveness research. Health information technology is changing everything. It would be perverse otherwise: imagine large amounts of data and information either ignored, missed, or collected and then ignored. (shrink)

Traditional moral theories of rights and principles have dominated medical ethics discussions for decades. Appeals to utilitarian consequences, as well as the principles of respect for autonomy, beneficence, and justice, have provided the standard vocabulary and filled the literature of the field.Recently on the bioethics scene, however, there has been some discussion of virtue, and, particularly within the nursing ethics literature, appeals are being made to the feminist ethics of care. This intimation of a shift in the wind may have (...) to do with postmodern doubt, or it may be attributable to the claim that virtue theory and the ethics of care are more appropriate to private interaction; theories of rights and justice are best applied to the political domain of public policy. (shrink)

The patient’s home is a common setting for palliative care. This means that we need to understand current palliative care philosophy and how its goals can be realized in home‐care nursing encounters (HCNEs) between the nurse, patient and patient’s relatives. The existing research on this topic describes both a negative and a positive perspective. There has, however, been a reliance on interview and descriptive methods in this context. The aim of this study was to explore planned HCNEs in palliative care. (...) The design was a multiple case study based on observations. The analysis includes a descriptive and an explanation building phase. The results show that planned palliative HCNEs can be described as a process of co‐creating possibilities for the patient to reach vital goals through shared knowledge in a warm and caring atmosphere, based on good caring relations. However, in some HCNEs, co‐creation did not occur: Wishes and needs were discouraged or made impossible and vital goals were not reached for the patients or their relatives. Further research is needed to understand why. The co‐creative process presented in this article can be seen as a concretization of the palliative care ideal of working with a person‐centered approach. (shrink)

This article presents evidence regarding aspects of the gendered nature of care women with gynaecological cancer receive from their (usually) male surgeons and oncologists in Australia. We argue that despite women’s general preference for female gynaecologists, those with a gynaecological cancer develop a strong therapeutic relationship with their male medical specialist, not extended to their (usually) female nurses and other allied health professionals. Given the highly sensitive and sexualized nature of gynaecological cancer, this requires explanation. These findings can be partly (...) explained by examining the division of labour between nurses and doctors, specifically issues of control over this process and the development of specializations. The findings also bring into stark relief the way in which power and status differences can be used by medicine to create a positive therapeutic relationship with patients while simultaneously de-eroticizing the intimate procedures necessary in assisting women throughout their cancer treatment. Importantly, this relationship also has relevance for policy makers, particularly those concerned with the highly gendered division of labour of the medical specialty workforce in Australia. (shrink)

Physician assistants (PAs), nurse practitioners (NPs), and medical residents constitute an increasingly significant part of the American health care workforce, yet patient assent to be seen by nonphysicians is only presumed and seldom sought. In order to assess the willingness of patients to receive medical care provided by nonphysicians, we administered provider preference surveys to a random sample of patients attending three emergency departments (EDs). Concurrently, a survey was sent to a random selection of ED residents and PAs. All respondents (...) were to assume the role of patient when presented with hypothetical clinical scenarios and standardized provider definitions. Despite presumptions to the contrary, ED patients are generally unwilling to be seen by PAs, NPs, and residents. While seldom asked in practice, 79.5% of patients fully expect to see a physician regardless of acuity or potential for cost savings by seeing another provider. Patients are more willing to see residents than nonphysicians. (shrink)

Background:To provide care with high quality, nurses face a number of moral issues requiring them to have moral abilities in professional performance. Moral sensitivity is the first step in moral performance. However, its relation to the quality of care patients receive is controversial.Research objective:This study aims to determine the relationship between the moral sensitivity of nurses and the quality of care received by patients in the medical wards.Research design:A descriptive correlational study using validated tools, including Moral Sensitivity Questionnaire and the (...) Quality Patient Quality Scale.Participants and research context:In total, 198 nurses and 198 patients in 17 medical wards of hospitals affiliated with Tabriz University of Medical Sciences, Iran.Ethical considerations:The study was reviewed and approved by the Ethics Committee of Tabriz University of Medical Sciences.Findings:The mean values of nurses’ moral sensitivity and nurses’ quality care were 136.47 ± 13.30 and 196.36 ± 44.10, respectively. There was no significant relationship between the patient care quality and nurses’ moral sensitivity ( r = −.14, p =.5). However, there was a significant inverse relationship between the dimension of “Experiencing moral conflicts” and the overall score of quality care ( r = −.50, p =.04), the dimensions of “psychosocial ( r = −.50, p =.04)” and “physical ( r = −.50, p =.03).”Conclusion:Considering the significant inverse relationship between the score of patient quality care and the dimension of moral conflict experience, it seems when nurses make moral decisions, they experience a conflict between personal and professional values in their careers and thus experience moral tension. If this tension is not resolved properly, it can provide a way for them to distance themselves from patients, thereby making nurses indifferent to moral care. (shrink)

This article discusses findings from a mixed method literature review that investigated cancer patients’ perceptions of what constitutes a good nurse. To find pertinent articles, we conducted a systematic key word search of five journal databases (1998—2008). The application of carefully constructed inclusion criteria and critical appraisal identified 12 relevant articles. According to the patients, good nurses were shown to be characterized by specific, but inter-related, attitudes, skills and knowledge; they engage in person-to-person relationships, respect the uniqueness of patients, (...) and provide support. Professional and trained skills as well as broad and specific nursing and non-nursing knowledge are important. The analysis revealed that these characteristics nurtured patient well-being, which manifests as optimism, trust, hope, support, confirmation, safety and comfort. Cancer patients’ perceptions of what constitutes a good nurse represent an important source of knowledge that will enable the development of more comprehensive and practice-based views on good nursing care for such patients. These perceptions help us to understand how nurses effectively make a difference in cancer patient care. (shrink)

Ethics in nursing: continuity and change -- Cultural issues, methods and approaches to nursing ethics -- Nursing ethics: what do we mean by 'ethics'? -- Becoming a nurse and member of the profession -- Power and responsibility in nursing practice and management -- Professional responsibility and accountability in nursing -- Classical areas of controversy in nursing and biomedical ethics -- Direct responsibility in nurse/patient relationships -- Conflicting demands in nursing groups of patients -- Ethics in healthcare management: research, evaluation (...) and performance management -- The political ethics of healthcare: health policies and resource allocation -- Corporate ethics in healthcare: strategic planning and ethical policy development -- Making moral decisions and being able to justify our actions -- The relevance of moral theory: justifying our ethical policies. (shrink)

The general expectation that patients should be willing to trust nurses is rarely explored or challenged despite claims of diminishing public trust in social and professional institutions. Everyday meanings of trust take account of circumstance and suggest that our understanding of what it means to trust is contextually bound. However, in the context of health care, to trust implies a particular understanding which becomes apparent when abuses of this trust are reported and acknowledged as scandals. The predominant assumption in the (...) literature that trust is something that occurs between equally competent adults cannot explain trust in nursing precisely because of the unequal power relationships between patients on the one hand and healthcare professionals on the other. Moreover, the tendency to conflate terms such as trust, reliance, confidence and so on suggests that confusion permeates discussions of trust in nursing. In this paper, I argue in support of Annette Baier’s requirement of good will (or lack of ill will) as the essential feature of trust, and outline how this account (i) enables us to make the necessary distinctions between trust on the one hand and ‘trust pretenders’ on the other; and (ii) lays the foundations for understanding trust in relationships, such as those between patients and nurses, where power differentials exist. (shrink)

Nurses are increasingly faced with situations in practice regarding the prolongation of life and withdrawal of treatment. They play a central role in the care of dying people, yet they may find themselves disempowered by medical paternalism or ill-equipped in the decision-making process in end-of-life situations. This article is concerned with the ethical relationships between patient autonomy and medical paternalism in end-of-life care for an advanced cancer patient. The nurse’s role as the patient’s advocate is explored, as are the (...) differences between nursing and medicine when confronted with the notion of patient autonomy. The impetus for this discussion stems from a clinical encounter described in the following scenario. (shrink)