The purpose of this study was to test a causal model of ethical conflict in practice and autonomy in a sample of 254 nurse practitioners working in the primary care areas of family health, pediatrics, adult health and obstetrics/gynecology in the state of Maryland. A test of the model was conducted using a path analytic approach with LISREL 8.30 hypothesizing individual, organizational and societal/market factors influencing ethical conflict in practice and autonomy. Maximum likelihood estimation was used to estimate the parameters (...) most likely to have generated the data. Forty-five percent of the total variance in ethical conflict was explained by the variables of ethical environment and ethical concern. Ethical concern, idealistic philosophy, ethics education in continuing education, percentage of client population enrolled in managed care, and market penetration explained 15% of the total variance in autonomy. The findings of this study indicate that the causal model of ethical conflict in practice and autonomy is consistent with the data and contributed to a fuller understanding of clinical decision making associated with practicing in a managed care environment. The final model supported a conceptual framework that is inclusive of three domains: individual, organizational and societal/market variables. (shrink)

We reflect upon the meaning of freedom and autonomy in nursing behaviour, attempting to outline the contemporary situation of nursing in Italy, where the profession is achieving important results after a long period of submission and subordination. The way to real emancipation is not easy, but a statement of law on the one hand - abolishing constraints such as the Mansionario - and professional self-regulation on the other - the recent new Deontological Code - represent a real conquest in that (...) direction. However, no statement of law or deontology can be sufficient without deeper reflection by the profession on itself and its tasks, potentiality, social importance and self-esteem. (shrink)

Truth-telling in healthcare practice can be regarded as a universal communicative virtue; however, there are different views on what consequence it has for giving or diminishing hope. The aim of this article is to explore the relationship between the concepts of truth-telling and hope from a relational ethics approach in the context of healthcare practice. Healthcare staff protect themselves and others to preserve hope in the care of seriously sick patients and in end-of-life care. This is done by balancing truth-telling (...) guided by different conditions such as the cultural norms of patients, family and staff. Our main conclusion is that the balancing of truth-telling needs to be decided in a mutual understanding in the caring relationship, but hope must always be inspired. Instead of focusing on autonomy as the only guiding principle, we would like to propose that relational ethics can serve as a meaningful perspective in balancing truth-telling. (shrink)

Ethical issues in international nursing research are identified and the perspectives of the International Centre for Nursing Ethics are offered in an effort to develop an international consensus of ethical behaviour in research. First, theoretical issues are reviewed, then initial conditions for ethical conduct are defined, and protocol design and procedure considerations are examined. A concerted effort is made to identify and avoid a western bias. Broad guiding principles for designing and reviewing research are offered: (1) respect for persons; (2) (...) beneficence; (3) justice; (4) respect for community; and (5) contextual caring. A collaborative model of the researcher-participant relationship is suggested and discussed. (shrink)

The rapid advances and scope of the Human Genome Project bring into sharp focus the relevance of genetics and ethics for nursing and midwifery practice in the new millennium. This article offers a UK perspective on how education plays a crucial part in preparing practitioners to integrate clinical advances effectively and ethically, yet may be failing in this role. Provision for teaching genetics in the UK has been found to be largely inadequate and the ethical implications of this are reviewed. (...) The context of genetics teaching is a further issue. Genetics is classified in the bioscience component of training courses in nearly 70% of UK nursing colleges; this may be of significance in its perceived relevance to practice. Finally, the ethical issues around the teaching of genetics will be discussed. Educators who are involved in delivering the genetics component of the curriculum are under an obligation to consider how learning is best achieved and how the delivery itself should be ‘ethical’. (shrink)

In this article it is argued that there are barriers to effective and non-discriminatory practice when mentoring overseas nurses within the National Health Service (NHS) and the care home sector. These include a lack of awareness about how cultural differences affect mentoring and learning for overseas nurses during their period of supervised practice prior to registration with the UK Nursing and Midwifery Council. These barriers may demonstrate a lack of effective teaching of ethical practice in the context of cultural diversity (...) in health care. This argument is supported by empirical data from a national study. Interviews were undertaken with 93 overseas nurses and 24 national and 13 local managers and mentors from six research sites involving UK health care employers in the NHS and independent sectors in different regions of the UK. The data collected showed that overseas nurses are discriminated against in their learning by poor mentoring practices; equally, from these data, it appears that mentors are ill-equipped by existing mentor preparation programmes to mentor overseas-trained nurses from culturally diverse backgrounds. Recommendations are made for improving mentoring programmes to address mentors’ ability to facilitate learning in a culturally diverse workplace and thereby improve overseas nurses’ experiences of their supervised practice. (shrink)