Humanism in forensic psychiatry: the use of the tidal nursing model The humanist school of thought, which finds resonance in many conceptual models and theories designed to guide nursing practice, needs to be understood in the context of the total institution, where the individual is subjected to a mortification of the self, and denied autonomy. This article will engage in a critical reflection on how humanism has influenced nursing theorists and the subsequent production of conceptual (...) class='Hi'>models and theories, especially as they relate to the field of forensic psychiatric nursing. Although humanism provides optimism for nurse–patient relations, this article explores the incapability of such a philosophy to acknowledge the power relationships between individuals and its inability to explain the day‐to‐day realities experienced in forensic nursing, where the possibility of interpersonal violence reshapes nursing care. The tidal model will be discussed in detail as an example of a recently developed humanistic nursing model. Viewed from this perspective, it is clear that humanistic philosophy and its subsequent models of care are in discordance with the highly specialized field of forensic nursing. (shrink)

In the yeasts Saccharomyces cerevisiae and Schizosaccharomyces pombe, the initiation of DNA replication is controlled at a point called START. At this point, the cellular environment is assessed; only if conditions are appropriate do cells traverse START, thus becoming committed to initiate DNA replication and complete the remainder of the cell cycle. The cdc2+ / CDC28+ gene, encoding the protein kinase p34, is a key element in this complex control. The identification of structural and functional homologues of p34 suggests that (...) it has a role in the control of DNA replication in all eukaryotes. The WHI1+, CLN1+ and CLN2+ gene products, identified in S. cerevisiae, are positive regulators that function at START and may interact with p34. Determining how passing the START control point leads to the initiation of DNA replication is a major outstanding challenge in cell cycle studies. (shrink)

Specially selected articles from the Journal of Advanced Nursing have been updated where appropriate by the original author. Models, Theories and Concepts brings together international authorities in their specialist fields to consider the gaps occurring between theory and practice, as well as the evaluation of a selection of models and emerging theories.

Theories and models are not equivalent. I argue that an orientation towards models as a primary carrier of nursing knowledge overcomes many ongoing challenges in philosophy of nursing science, including the theory–practice divide and the paradoxical pursuit of predictive theories in a discipline that is defined by process and a commitment to the non‐reducibility of the health/care experience. Scientific models describe and explain the dynamics of specific phenomenon. This is distinct from theory, which is traditionally (...) defined as propositions that explain and/or predict the world. The philosophical case has been made against theoretical universalism, showing that a theory can be true in its domain, but that no domain is universal. Subsequently, philosophers focused on scientific models argued that they do the work of defining the boundary conditions—the domain(s)—of a theory. Further analysis has shown the ways models can be constructed and function independent of theory, meaning models can comprise distinct, autonomous “carriers of scientific knowledge.” Models are viewed as representations of the active dynamics, or mechanisms, of a phenomenon. Mechanisms are entities and activities organized such that they are productive of regular changes. Importantly, mechanisms are by definition not static: change may alter the mechanism and thereby alter or create entirely new phenomena. Orienting away from theory, and towards models, focuses scholarly activity on dynamics and change. This makes models arguably critical to nursing science, enabling the production of actionable knowledge about the dynamics of process and change in health/care. I briefly explore the implications for nursing—and health/care—knowledge and practice. (shrink)

Role modelling communicates a standard of behavior to another person. Silent role modelling occurs when this standard can be communicated without articulating reasons for the action; articulate role modelling occurs when it is necessary to articulate reasons in order to effectively role model the standard of behavior, and to avoid misinterpretation. Nurses are role models in virtue of the respect and admiration given to the nursing profession. As such, nurses have role model obligations. This paper examines nurses' role (...) model obligations for healthy behaviors and pandemic precautions. Research often identifies nurses as role models for healthy behavior, despite the fact that nurses are typically no healthier than the general population. This paper argues that nurses do not have a duty to role model healthy behaviors. The ability to adopt healthy behaviors is affected by numerous personal and individual factors. For a nurse to share their struggles to adopt healthy behaviors as articulate ‘imperfect’ role models violates their right to privacy. By contrast, nurses do have a moral duty to role model pandemic precautions during the COVID-19 pandemic, such as correctly wearing appropriate masks, maintaining social distancing, avoiding gatherings of multiple households when pandemic precautions are not being taken, and staying up to date on vaccination. Nurses’ duty to role model pandemic precautions does not involve sharing any personal information. Nurses have a duty to be silent role models when the risk of misinterpretation is low, and a duty to be articulate role models, who explicitly communicate reasons for the role modelled behavior, when necessary to ensure they are not misinterpreted. When articulate role modelling goes beyond the minimal role modelling duty, and imposes a comparative cost to the nurse, articulate role modelling is not obligatory, but supererogatory. (shrink)

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? Which strategies do nurses use to provide compassionate care? What is the specific model of compassionate care for the nursing context? A grounded (...) theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: contextual factors affecting compassionate care, the compassionate care actions, and the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses’ ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses’ ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model provides a model to guide nursing care and research. (shrink)

To deal with the upcoming challenges and complexity of the nursing profession, it is deemed important to reflect on our current organization of care. However, before starting to rethink the organization of nursing care, an overview of important elements concerning nursing care organization, more specifically nursing models, is necessary. The aim of this study was to conduct a mapping review, accompanied by an evidence map to map the existing literature, to map the field of knowledge (...) on a meta‐level and to identify current research gaps concerning nursing models in a hospital setting. Next to nursing models, two other organizational correlates seem to be of importance when looking at the organization of nursing care: nurse staffing and skill mix. Although it seems that in recent research, the theoretical focus on the organization of nursing care has been left behind, the increasingly complex healthcare environment might gain from the use of nursing theory, or in this case, care delivery models. As almost no fundamental studies have been done toward the combination of care delivery models, nurse staffing, and skill mix, those elements should be taken into account to fully capture the organization of nursing care in future research. (shrink)

Using a conceptual framework and method combining ethical enquiry and phenomenology, we asked 73 senior baccalaureate nursing students to answer two questions: (1) What is nursing students’ experience of an ethical problem involving nursing practice? and (2) What is nursing students’ experience of using an ethical decision-making model? Each student described one ethical problem, from which emerged five content categories, the largest being that involving health professionals (44%). The basic nature of the ethical problems consisted of (...) the nursing students’ experience of conflict, resolution and rationale; 85% of the students stated that using an ethical decision-making model was helpful. Although additional research is needed, these findings have important implications for nursing ethics education and practice. (shrink)

Modelling nursing activities: electronic patient records and their discontents A fully integrated and operating EPR in a clinical setting is hard to find: most applications can be found in outpatient or general practice settings or in isolated hospital wards. In clinical work practice problems with the electronic patient record (EPR) are frequent. These problems are at least partially due to the models of health care work embedded in EPRs. In this paper we will argue that these problems are (...) at least partially due to the models of health care work embedded in current EPRs. We suggest that these models often contain projections of nurses’ and doctors’ work as it should be performed on the ward, rather than depicting how work is actually performed. We draw upon sociological insights to elucidate the fluid and pragmatic nature of healthcare work and give recommendations for the development of an empirically based EPR, which can support the work of nurses and other health care providers. We argue that these issues are of great importance to the nursing profession, since the EPR will help define the worksettings of the future. Since it is a tool that will impact the development of the nursing profession, nurses have and should have a stake in its development. (shrink)

Opinion leaders are informal leaders who have the ability to influence others' decisions about adopting new products, practices or ideas. In the healthcare setting, the importance of translating new research evidence into practice has led to interest in understanding how opinion leaders could be used to speed this process. Despite continued interest, gaps in understanding opinion leadership remain. Agent‐based models are computer models that have proven to be useful for representing dynamic and contextual phenomena such as opinion leadership. (...) The purpose of this paper is to describe the work conducted in preparation for the development of an agent‐based model of nursing opinion leadership. The aim of this phase of the model development project was to clarify basic assumptions about opinions, the individual attributes of opinion leaders and characteristics of the context in which they are effective. The process used to clarify these assumptions was the construction of a preliminary nursing opinion leader model, derived from philosophical theories about belief formation. (shrink)

Three studies using the Dreyfus model of skill acquisition were conducted over a period of 21 years. Nurses with a range of experience and reported skill-fulness were interviewed. Each study used nurses’ narrative accounts of actual clinical situations. A subsample of participants were observed and interviewed at work. These studies extend the understanding of the Dreyfus model to complex, underdetermined, and fast-paced practices. The skill of involvement and the development of moral agency are linked with the development of expertise, and (...) change as the practitioner becomes more skillful. Nurses who had some difficulty with understanding the ends of practice and difficulty with their skills of interpersonal and problem engagement did not progress to the level of expertise. Taken together, these studies demonstrate the usefulness of the Dreyfus model for understanding the learning needs and styles of learning at different levels of skill acquisition. (shrink)

With questions raised as to whether or not nursing knowledge should be developed from extant conceptual/theoretical models or from practice-based environments, this paper utilizes Kuhn's disciplinary matrix and Laudan's model of consensus formation to explore the changing nature of the discipline's structural matrix. Kuhn's notion that a discipline's structural matrix includes symbolic generalizations, models and exemplars, and Laudan's view that a maturing discipline embraces factual, methodological, and axiological (goals and aims) knowledge, and that context and discourse are (...) also involved in advancing a discipline is described as a means for reconciling the source of nursing knowledge. This paper posits that shared axiological goals connect both theorists and practitioners, and resolve potential conflicts as to viable sources of nursing knowledge. Through shared goals that include humanization, meaning, quality of life, caring, consciousness, transcendence, and presence, which bridge both theoretical and practice approaches, nursing's charge to contribute to the good of society is fulfilled. (shrink)

My purpose in this short response to Clinton's interesting article On Bender's orientation to models: Towards a philosophical debate on covering laws, theory, emergence and mechanisms in nursing science, which is published in this issue, is not to provide any counterargument to Clinton's interpretation of my own argument; readers are welcome to interrogate both articles at their leisure and make their own conclusions. What I will do instead is provide a brief critical assessment of my own (il)logic re (...) bringing in the notion of mechanism as conceived by Machamer, Darden and Craver into an argument for models versus theories as a carrier of nursing knowledge. (shrink)

Nursing scholars continuously refine nursing knowledge and the philosophical foundations of nursing practice. They advance nursing knowledge by creating new knowledge and weighing the relevance of developments in cognate sciences. Nurse philosophers go further by providing epistemological and ontological arguments for explanations of nursing phenomena. In this article, I engage with Bender's arguments about why mechanisms should have more primacy as carriers of nursing knowledge. Despite the careful scholarship involved, Bender's arguments need to be (...) more convincing. Accordingly, this article encourages debate about Bender's arguments for reorientating nursing science to mechanisms. I begin by suggesting that the claim that the theory‐practice divide can be overcome by reorientating to mechanisms is acceptable only if we accept Bender's depiction of the challenge. Then I question the ontology Bender relies on to justify reorientating nursing science. After that, I argue that mechanisms in models that parallel analytical sociology undermine the kind of nursing science Bender advocates. I illustrate my arguments with a social mechanism thought experiment. Then I explain why Bender's arguments cannot escape the received view of science or inform emancipatory nursing action without theory. Finally, I mention some caveats and implications for nursing science. (shrink)

Racism in nursing is multifaceted, ranging from internalized racism and interpersonal racism to institutional and systemic (or structural) elements that perpetuate inequities in the nursing profession. Employing the socio‐ecological model, this study dissects the underlying challenges across various levels and proposes targeted mitigation strategies to foster an inclusive and equitable environment for nursing education. It advances clear, context‐specific mitigation strategies to cultivate inclusivity and equity within nursing education. Effectively addressing racism within this context necessitates a tailored, (...) multistakeholder approach, impacting nursing students, faculty, administration, professional organizations, and licensing and accrediting bodies. This all‐encompassing strategy recognizes that the interplay of interpersonal dynamics, community culture, institutional policies, and broader societal structures intricately shapes individual experiences. Nurses, nurse leaders, educators, organizations, and policymakers can work together to create a more equitable and inclusive nursing profession by targeting each of these levels. This transformational process can yield positive outcomes across various environments where nurses learn, work, and serve people and enable the demographic composition of nurses to better match the populations served. (shrink)

The purpose of this article is to describe the development of a model of moral distress in military nursing. The model evolved through an analysis of the moral distress and military nursing literature, and the analysis of interview data obtained from US Army Nurse Corps officers (n = 13). Stories of moral distress (n = 10) given by the interview participants identified the process of the moral distress experience among military nurses and the dimensions of the military (...) class='Hi'>nursing moral distress phenomenon. Models of both the process of military nursing moral distress and the phenomenon itself are proposed. Recommendations are made for the use of the military nursing moral distress models in future research studies and in interventions to ameliorate the experience of moral distress in crisis military deployments. (shrink)

ZusammenfassungDerzeit gibt es in Österreich kein in allen Bundesländern einheitlich etabliertes Betreuungsmodell eines „Heimarztes“ für Pflegeheime. Im Bundesland Wien werden seit mehr als 100 Jahren chronisch Kranke und hochgradig pflegebedürftige Menschen in den städtischen Pflegeeinrichtungen und in einigen Institutionen geistlicher Träger rund um die Uhr von angestellten geriatrisch versierten ÄrztInnen betreut. Die Rechtsform dieser Häuser entspricht prinzipiell der einer „Pflegeanstalt für Chronisch Kranke“ nach dem Österreichischen Krankenanstaltengesetz. Aber auch andere Träger in Wien und Niederösterreich beschäftigen angestellte ÄrztInnen an Bettenstationen von (...) Pflege- und Wohnheimen. Der Bedarf nach einer kontinuierlichen, fachlich spezialisierten ärztlichen Betreuung ergibt sich vor allem aus der Notwendigkeit der Therapie psychiatrischer Erkrankungen im hohen Alter mit Psychopharmaka, der komplexen Multimorbidität und Polypharmazie, sowie aus dem Bedarf nach rehabilitativen Maßnahmen bzw. palliativer Begleitung am Lebensende. Mit dieser Aufgabenstellung sind geriatrisch nicht adäquat ausgebildete bzw. nicht in den Pflegeheimen integrierte ÄrztInnen häufig überfordert. Die Konsequenzen davon sind häufige Spitalseinweisungen bzw. suboptimale ärztliche Betreuung. Als notwendige Maßnahmen zur Qualitätssicherung in geriatrischen Pflegeeinrichtungen ist daher bundesweit die Implementierung von qualifizierten HeimärztInnen nach niederländischem Vorbild zu fordern. (shrink)

Nursing practice occurs in the context of conversations with healthcare users, other healthcare professionals, and healthcare institutions. This discussion paper draws on symbolic interactionism and Fairclough's method of critical discourse analysis to examine language that nurses use to describe the people in their care and their practice. We discuss how nurses’ use of language constructs meaning about healthcare users and their own work. Through language, nurses are articulating what they believe about healthcare users and nursing practice. We argue (...) that the language nurses use can contribute to viewing their practice as tasks on bodies that must be accomplished efficiently and objectively within the biomedical model, rather than relational and person‐centered. Moreover, the language nurses use can perpetuate a sense of powerlessness within healthcare systems yet paradoxically they are in a position of power over healthcare users. Nurses’ compliance with the efficiency and biomedical model results in a lack of emphasis on the full breadth of nursing work, which could be enacted in relational rather than power‐laden practices. We conclude by positing that careful use of language among nurses in all settings is essential, if we are to begin to articulate what nursing is to ourselves and to others. (shrink)

Corporate and commercial values are inducing some healthcare organizations to prescribe a customer service model that reframes the provision of nursing care. In this paper it is argued that such a model is incommensurable with nursing conceived as a moral practice and ultimately places nurses at risk. Based upon understanding from ongoing research on compassion fatigue, it is proposed that compassion fatigue as currently experienced by nurses may not arise predominantly from too great a demand for compassion, but (...) rather from barriers to enacting compassionate care. These barriers are often systemic. The paradigm shift in which healthcare environments are viewed as marketplaces rather than moral communities has the potential to radically affect the evolution of nursing as a discipline. (shrink)

Refining the model for an emergency department‐based mental health nurse practitioner outpatient service The mental health nurse practitioner (MHNP) role based in the emergency department (ED) has emerged in response to an increase in mental health‐related presentations and subsequent concerns over waiting times, co‐ordination of care and therapeutic intervention. The MHNP role also provides scope for the delivery of specialised primary care. Nursing authors are reporting on nurse‐led outpatient clinics as a method of healthcare delivery that allows for enhanced (...) access to health‐care, particularly following hospital discharge. However, due to a lack of in‐depth substantiation, this mode of service delivery requires more thorough investigation. This study describes the refinement phase undertaken before the implementation and pilot evaluation of a formalised and structured MHNP outpatient service in the ED of a large inner‐city hospital in Sydney, Australia. An expert advisory panel (EAP) consisting of key local informants was convened to provide feedback on and refinement to the proposed model. This related to issues such as target population, structure and process considerations, outcome measures and interface within the overall health service. Findings from the EAP meeting are presented and discussed. The importance of linking methods with the appropriate methodology in evaluating a healthcare program is highlighted. (shrink)

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)

The purpose of this study was to develop and empirically test a model for predicting the key factors affecting nurses’ behavioral intention to use mobile learning. We explored behavioral intention from users’ perspectives by applying an extended unified theory of acceptance and use of technology model with the addition of information quality, system quality, technostress, and satisfaction. We conducted a survey of the district and regional hospitals in central Taiwan. Data were derived from 434 respondents. Structural equation modeling was applied (...) to analyze the causal effects of 15 hypothesized predictive factors. We determined that satisfaction, social influence, performance expectancy, facilitating conditions, and effort expectancy positively impacted nurses’ behavioral intention to use m-learning. In addition, technostress was a negative antecedent of effort expectancy. Information quality and system quality had significantly positive effects on satisfaction, performance expectancy, and effort expectancy. This study provides hospital managers with a reference when assessing future developments and informs approaches to promote m-learning. (shrink)

Background Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students’ caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy. Research objective This study aimed to examine the mediating effect of moral (...) sensitivity and the moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours. Research design A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro. Participants and research context This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China. Ethical considerations This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students. Results The clinical internship environment ( B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity ( B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students’ caring behaviours via moral sensitivity ( B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours ( B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity ( B = 0.006, 95% CI = [0.003, 0.010]). Conclusion Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students. (shrink)

Quality of nursing cannot be assessed in terms of performance referenced criteria, but only in terms of the personal qualities displayed in the performance. The key to improvement in practice may be the improvement of emotional and motivational tendencies. In essence, professional development implies personal development. Harré makes a distinction between ‘powers to do’ and ‘powers to be’ (a state of being). The former are the capacities that individuals acquire to perform their tasks and roles. Professional development therefore involves, (...) first, the acquisition of the capacities necessary for the successful completion of a set of professional tasks (the powers to do). Secondly, it involves the acquisition of the appropriate emotions and motivations, and the theories about human nature and the conduct that underpins them (the powers to be). Therefore, these capacities cannot be derived from an analysis of tasks, since what are defined as tasks in the first place are determined by the exercise of such powers. The acquisition of attitudes constitutes a source of competent practice. Harré’s model of ‘personal identity’ provides a conceptual framework for thinking about the process of the acquisition of nursing competence and its relationship to differing views of nursing. Considerations relating to different priorities within Harré’s model make it possible to raise questions about the objectives of competence at different stages. (shrink)

The purpose of this discussion paper is to explore how nurses can be strategically poised to advocate for needed policy change in support of greater income equality and other social determinants of health. We adapted Bronfenbrenner's social‐ecological model to highlight how four broad pervasive subsystems shape the opportunities that nurses have to engage in advocacy at the policy level. These subsystems include organizations (the microsystem), professional bodies (the mesosystem), public policies (the exosystem), and societal values (the macrosystem). On the basis (...) of this adapted model, we recommend changes among modifiable elements of the microsystem and mesosystem that can help position nurses (ecologically and collectively) to advocate for public policy change and use examples from a Canadian context to illustrate these points. We believe that the ideas arising from this model can be widely used where policy action on the social determinants of health is needed to inform, guide, and frame change efforts and advocacy work. (shrink)

Nursing knowledge stems from a dynamic interplay between population‐based scientific knowledge (the general) and specific clinical cases (the particular). We compared the ‘cascade model of knowledge translation’, also known as ‘classical biomedical model’ in clinical practice (in which knowledge gained at population level may be applied directly to a specific clinical context), with an emergentist model of knowledge translation. The structure and dynamics of nursing knowledge are outlined, adopting the distinction between epistemic and non‐epistemic values. Then, a (moderately) (...) emergentist approach to nursing knowledge is proposed, based on the assumption of a two‐way flow from the general to the particular and vice versa. The case of the ‘placebo effect’ is analysed as an example of emergentist knowledge. The placebo effect is usually considered difficult to be explained within the classical biomedical model, and we underscore its importance in shaping nursing knowledge. In fact, nurses are primarily responsible for administering placebo in the clinical setting and have an essential role in promoting the placebo effect and reducing the nocebo effect. The beliefs responsible for the placebo effect are as follows: (1) interactive, because they depend on the relationship between patients and health care professionals; (2) situated, because they occur in a given clinical context related to certain rituals; and (3) grounded on higher order beliefs concerning what an individual thinks about the beliefs of others. It is essential to know the clinical context and to understand other people's beliefs to make sense of the placebo effect. The placebo effect only works when the (higher order) beliefs of doctors, nurses and patients interact in a given setting. Finally, we argue for a close relationship between placebo effect and nursing knowledge. (shrink)

Despite similar health problems, older persons show different care seeking behaviours for a variety of reasons. The aim of this study was to identify motives underlying the attitudes of older persons to seek nursing care and to develop a theoretical rationale which allows viewing their mutual interaction. Theory development according to Walker and Avant was used as a method to derive a model from the reviewed literature. Six categories were identified that may influence seeking of nursing care: perceived (...) threat, disposition, external options & barriers, current coping abilities, influence of significant others, and outcome value. Findings do not allow determination of factors that may predict care seeking attitude but provide a loosely structured conceptual model for culture specific investigations. Qualitative studies guided by the model should be conducted in order to develop testable theories of care seeking for different cultures and settings. (shrink)

The public image of nursing is important because it can facilitate or create barriers to achieving an adequate supply of nursing human resources. This study sought to gain a better understanding of nursing’s professional image within the Republic of Georgia. The Nursing Human Resources Systems model was used to guide the study’s exploratory, qualitative approach. Data collection occurred over a 2‐week period in the Republic of Georgia, and thirty‐three participants formed the final study sample. Participants included (...) healthcare professionals, key informants from nonprofit and research institutions, and patients. Data analysis occurred using directed content analysis techniques, and three themes emerged: (a) gender dimension; (b) the nursing service recipient experience; and (c) historical legacies. Themes revealed the complexities of nursing’s image in the country. Findings from this study serve as baseline data for understanding nursing’s image in the Republic of Georgia which could assist with improving pre‐entry nursing production issues. (shrink)

Background:Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic.Objective:To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency.Research design:A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for Covid-19 patients in (...) the acute care units within large academic medical systems in Maryland and New York City during April to June 2020.Ethical considerations:We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore.Results:We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies.Discussion/Conclusion:Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding (...) end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)

In this article, we report the outcome of a sociological inquiry into nursing knowledge of death and dying, specifically ‘the good death’. A genealogical approach informed by actor‐network theory and appreciative inquiry were used to compose a broad socio‐material account of how nurses concern themselves with the care of the dying and end‐of‐life care. Our enquiry revealed similarly to other studies, that there was no shared or overarching model of care. Key themes derived from nurses' translations of ‘the good (...) death’ were re‐presented pictorially as six pillars and two processes to comprise a new diagram of The Personalised Ideal Death. (shrink)

Los avances científico-tecnológicos han abierto una brecha en cuanto a los tratamientos médicos y los valores morales que deben sustentar la atención de salud. El profesional de enfermería no está exento de estos peligros, por lo que se ha generado un nuevo modelo ético que se integre al proceso de atención de enfermería. Con el objetivo de determinar los conocimientos y opiniones de estos profesionales, del área de cirugía de mínimo acceso, acerca de la aplicación del modelo en el contexto (...) de estos servicios, se diseñó una investigación de tipo observacional descriptiva con empleo de metodología cualitativa. Como técnica de exploración se usó la entrevista en profundidad, así como un panel de expertos para la construcción de la guía de entrevista. Se entrevistó a 34 enfermeras que laboraban en el Centro Nacional de Cirugía de Mínimo Acceso durante el período del estudio. Se concluye que la práctica de la cirugía de mínimo acceso es propicia para que médicos y enfermeras hagan una mayor observancia del derecho de autonomía de los pacientes. Se reconoce la capacidad de este personal para tomar decisiones independientes de los médicos en cuanto a las acciones de cuidado, lo que implica una mayor responsabilidad. Scientific and technological advances have opened a gap between medical treatments and the moral values that should support health care. The nurse is not exempt from these dangers. As such, a new ethical model that integrates to the process of nursing care has emerged. In order to determine the knowledge and opinions of the professionals who work in minimal access surgery services on the implementation of this model, a descriptive, observational study was designed utilizing qualitative methodology. In-depth interviewing was used as the primary testing technique. A panel of experts from the National Center of Minimal Access Surgery was consulted to develop the interview guide. Thirty-four nurses from the National Center for Minimal Access Surgery were interviewed over the course of the study period. Results suggest that the setting of minimal access surgery is conducive to medical professionals making greater observance of the right to patient autonomy. The ability of this staff to make independent decisions regarding medical care action is recognized, which implies greater responsibility. (shrink)

This study explored tacit knowledge based on an expert nurse's practice who cares for stroke patients by using the hermeneutic phenomenological approach. The participant (‘Ms. A’) was a nursing researcher and college faculty member involved in the education of advanced practice nurses; her specialty was stroke rehabilitation nursing. She was asked to describe the meaning and value she gained from her memorable nursing experiences. Four interviews—approximately 1 h each—were conducted, and the associated data were interpreted together with (...) the participant based on the method of interpretive circulation. Notably, the analysis was ended when a fusion of horizons was recognized. The participant recalled her nursing experiences based on six model cases. During the analysis, the following five elements were extracted: [belief in the ability of vulnerable people to survive]; [being together]; [respect for human dignity]; [preparedness to respond to and bear suffering together]; and [theoretical knowledge base approaches true understanding of patient experience]. Further, the nursing model—the Roy Adaptation Model—utilized by Ms. A in the process of recognizing humans as whole beings was deeply interpreted and implemented as a guideline for her implicit advanced practice. Moreover, her deep understanding and utilization of theoretical knowledge base also built the foundation for her implicit advanced practice. In conclusion, Ms. A's tacit knowledge and the elements support the process of tacit knowledge acquisition. Her narratives, hermeneutic attitude as an interpreter, and learning attitude throughout interaction with others will strongly help her knowledge development. We intend to continue the study with multiple participants and explore the structure of tacit knowledge possessed by advanced practitioners. Future endeavours will include the development of a tacit knowledge learning strategy. (shrink)

Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified (...) and triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen. (shrink)

Background Previous research mainly focuses on how to support nursing students in caring for the patient and on educators’ views of students’ development as professional caring nurses. Against this background, it is important to further investigate nursing students’ perspectives on what it means to become a professional caring nurse. Research aim This qualitative systematic review study aims to identify and synthesize nursing students’ perceptions on the meaning of becoming a caring nurse. Research design and data sources Systematic (...) data searches were conducted by using the electronic databases MEDLINE (Ovid), CINAHL (EBSCO), Academic Search Premiere (EBSCO), and Philosopher`s Index. In total, 13 studies met the inclusion and quality criteria. The articles were analyzed by a systematic review and a thematic synthesis according to Thomas and Harden. Ethical consideration The study followed good ethical practice guidelines outlined in the Northern Nurses’ Federation. Findings The analysis resulted in eight descriptive themes and finally in three analytical themes: Becoming is to get in touch with one’s inner ethic or ethos, Becoming is a movement between courage, understanding, and being touched, and Becoming is strengthened through caring role models and a learning culture. Conclusions Becoming a professional caring nurse is seen as an ongoing movement toward a deeper understanding of oneself and one’s being and bearing. This movement is enabled when nursing students have a sense of self-awareness, courage to stand in their vulnerability, and reflect on their responsibility, caring attitude, and inner values and ethics. The force of becoming is that the attention is directed beyond self to care for and feel empathy for others in a caring manner. Becoming is released through a caring relationship, external confirmation, and good role models. A lack of external support in the movement can potentially prevent the students from becoming a professional caring nurse. (shrink)

The study reviewed 20 currently-available structured ethical decision-making models and developed an integrated model consisting of six steps with useful questions and tools that help better performance each step: (1) the identification of an ethical problem; (2) the collection of additional information to identify the problem and develop solutions; (3) the development of alternatives for analysis and comparison; (4) the selection of the best alternatives and justification; (5) the development of diverse, practical ways to implement ethical decisions and actions; (...) and (6) the evaluation of effects and development of strategies to prevent a similar occurrence. From a pilot-test of the model, nursing students reported positive experiences, including being satisfied with having access to a comprehensive review process of the ethical aspects of decision making and becoming more confident in their decisions. There is a need for the model to be further tested and refined in both the educational and practical environments. (shrink)

In Spain, the introduction of the new Diploma in Nursing in 1977 saw the role of nurses shifting from that of medical assistants with technical skills to being independent members of the healthcare team with specific responsibility for providing professional nursing care. Here, we analyse the evolution of the nursing profession in Spain following the transfer of nurse education to universities, doing so through interviews with the first generation of academic tutors. This was a qualitative study using (...) the method of analytic induction and based on the principles of grounded theory. Participants were selected by means of theoretical sampling and then underwent in‐depth interviews. Steps were taken to ensure the credibility, transferability, dependability and confirmability of data. The main conclusion of the analysis is that there is a gap between a theoretical framework borrowed from the Anglo‐American context and a nursing practice that, in Spain, has traditionally prioritised the application of technical procedures, a role akin to that of a medical assistant. It is argued that a key factor underlying the way in which nursing in Spain has evolved in recent decades is the lack of conceptual clarity regarding what the role of the professional nurse might actually entail in practice. (shrink)

Nurses working in a newborn intensive care unit report that treatment decision disagreements for infants in their care may lead to ethical dilemmas involving all health-care providers. Applying Rest’s Four-Component Model of Moral Action as the theoretical framework, this study examined the responses of 224 newborn intensive care unit nurses to the Nurses Ethical Involvement Survey. The three most frequent actions selected were as follows: talking with other nurses, talking with doctors, and requesting a team meeting. The multiple regression analysis (...) indicates that newborn intensive care unit nurses with greater concern for the ethical aspects of clinical practice (p =.001) and an increased perception of their ability to influence ethical decision making (p =.018) were more likely to display Nurse Activism. Future research is necessary to identify other factors leading to and inhibiting Nurse Activism as these findings explained just 8.5% of the variance. (shrink)

Background:Forgiveness has the potential to resolve painful feelings arising from nurse–patient conflicts. It would be useful to evaluate direct and indirect important factors which are related to forgiveness in order to design interventions that try to facilitate forgiveness.Aim/objective:The purpose of this study was to evaluate the intermediating role of empathy in the cultural competence–forgiveness association among nurses using structural equation modeling.Research design:The research applied a cross-sectional correlational design.Participants and research context:The study included 380 nurses eight hospitals in southern Iran.Ethical considerations:The (...) Ethics and Research Committee of Birjand University of Medical Sciences approved the study protocol. The voluntary nature of participation was explained consent was obtained from participants, and anonymity was guaranteed.Findings:Most of the participants were married and female and fell in the 20- to 30-year-old category. Most of them (89.5%) had a working experience of 1–10 years. The proposed model showed that nurses’ empathy intermediated the association between nurses’ cultural competence and forgiveness which has fitted the data acceptably (root mean square error approximation = 0.070; comparative fit index = 0.993; goodness-of-fit index = 0.983; and χ2/df = 2.85).Conclusion:Empathy skills and cultural competence training were essential for interventions aimed at increasing the tendency to forgive patients. In such interventions, planners should aim at increasing nurses’ cultural competence in order to enhance their empathy toward patients, which can, in turn, lead to a greater wish to forgive patients. (shrink)

This article describes a case study in which community consultation was used to assist in the preparation of a research project on viewing self in the mirror after mastectomy. Breast cancer survivors, nurses, and other health care professionals were consulted using a variety of interactive modalities. Over a period of three months, pre-research planning information was obtained from participants. A descriptive qualitative design was used to analyze the data. The ethical goals of community consultation provided the framework for dialogue and (...) the synthesis of information. During this project, the potential benefits of the proposed research study were explored. Possible risks to future participants were discussed, and recommendations for participant protection suggested. Community members provided insight into the legitimacy of the study. Community consultation is a tool that researchers may consider when designing studies. (shrink)

The aim of a previous study was to describe nursing in Slovenia generally, and to identify the most appropriate nursing model for that country. One specific finding was the issue of partner-like relationships; this article deals with that issue only. An interpretive paradigm and qualitative research design were used with a modified grounded theory approach. Interviews were carried out with selected nursing leaders ( n = 24) and other professionals (n = 6) in order to draw on (...) their knowledge and experience to describe the reality of nursing phenomena. The results of this research suggest that participants wish to use a theory that emphasizes clients and treats them as equal partners in nursing, promotes health, and rests on interpersonal relationships. The participants described the missing or obscure parts in nursing and their own beliefs and values about human beings and nursing. Descriptions of and the need for partner-like relationships, and the specific elements of such relationships, were of main concern. The participants argued that nurses need high quality and continuing education to ensure competent nursing practice. The indication is that Slovenia should move to graduate and undergraduate nurse education to foster expert reflective practice in order to abolish routinized care carried out in a hierarchical system. (shrink)

This historical study aims to explain how the transition from student nurse service to fully qualified “graduate nurse” service in the United States in the 20th century affected assumptions about fundamental patient care in hospital wards and provide historical context for current apprenticeship programs. Through analysis of documents from 1920 when student nurse service, a nurse apprentice model, was the norm to 1960 when the nurse apprentice model was waning in favor of registered nurse service, this study found that the (...) replacement of student nurses with registered nurses led to weakened standardization of fundamental bedside care and the introduction of large numbers of unlicensed nursing assistants. While student nurses could perform all the functions of fully qualified graduate nurses, nursing assistants could not, resulting in a separation of fundamental nursing care from the professional nurse role and changes in assumptions and attitudes toward fundamental care. These changes had a negative effect on fundamental nursing care. New apprenticeship programs provide opportunities for improvement. (shrink)

Background:Stigma is considered a major barrier to accessing healthcare services by female sex workers. Current knowledge of nurses’ attitudes appears to imply a stigma toward female sex workers. But in-depth understanding of their perceptions is scarce. Furthermore, factors that inform a conceptual understanding of how this occurs are lacking.Objectives:The study aimed to explore nurses’ attitudes toward female sex workers and factors affecting caring for female sex workers.Research design:This was a qualitative study. A content analysis approach was adopted in analyzing the (...) data.Participants and research context:Thirty-three practicing nurses participated in seven semi-structured focus group interviews and three key informants participated in three individual interviews in Hong Kong.Ethical considerations:This study was approved by the Ethics Committee of one university in Hong Kong.Findings:The findings revealed three themes: (1) accept, stigmatize, or against sex work; (2) reluctance, hesitation, or willingness to care for female sex workers; and (3) factors affecting the care of female sex workers.Discussion and conclusion:This study found that nurses held different attitudes toward female sex workers, and they experienced feelings of reluctance, hesitation, or willingness to care for female sex workers. Multi-level factors could affect their level of comfort of caring for female sex workers. Intervention should be developed to encourage health professionals to examine their personal views toward female sex workers introspectively, how their attitude may have affected the provision of quality services, and to enhance the provision of sensitive non-discriminative services to female sex workers. (shrink)