We recognize a paradox of power and promise in the context of legislative and organizational changes in nurse regulation which poses constraints on nursing's capacity to bring voice and influence to pressing matters of healthcare and public policy. The profession is at an important crossroads wherein leaders must be well informed in political, economic and legislative trends to harness the profession's power while also navigating forces that may put at risk its central mission to serve society. We present a critical (...) policy analysis of the impact of recent regulatory trends on what the International Council of Nurses considers nursing's three ‘pillars’ – the profession of nursing, socioeconomic welfare of nurses and nurse regulation. Themes surfacing from this analysis include regulatory discontinuity, a tightening of regulatory control, and an increasingly managerial governance culture. These themes illuminate insights and strategies required to renew and revitalize the social mandate of our profession amidst a climate of urgency in the questioning of nurse scholars with respect to the future of the profession. At this historic juncture, nurses must clearly understand the implications of legislative and organizational regulatory changes to ensure the profession contributes to full capacity in achieving health and health equity globally. (shrink)

Moral distress is a phenomenon that has been receiving increasing attention in nursing and other health care disciplines. Moral distress is a concept that entered the nursing literature – and subsequently the health care ethics lexicon – in 1984 as a result of the work done by American philosopher and bioethicist Andrew Jameton. Over the past decade, research into moral distress has extended beyond the profession of nursing as other health care disciplines have come to question the impact of moral (...) constraint on individual practitioners, professional practice, and patient outcomes. Along with increased interest in the phenomenon of moral distress have come increasing critiques – critiques that in their essence point to a serious lack of conceptual clarity in the definition, study, and application of the concept. Foundational to gaining conceptual clarity in moral distress in order to develop strategies to prevent and ameliorate the experience is a careful revisiting of the epistemological assumptions underpinning our knowledge and use of the concept of moral distress. It is our contention that the conceptual challenges reveal flaws in the original understanding of moral distress that are based on an epistemological stance that holds a linear conception of cause and effect coupled with a simplistic perspective of ‘constraint’ and ‘agency’. We need a more nuanced approach to our study of moral distress such that our ontological and epistemological stances help us to better appreciate the complexity of moral agents acting in organizational contexts. We believe that critical realism offers such a nuanced approach. (shrink)

Introduction Good quality of care is dependent on nurses’ strong clinical skills and moral competencies, as well. While most nurses work with high moral standards, the moral performance of some nurses in some organizations shows a deterioration in their moral sensitivity and actions. The study reported in this paper aimed to explore the experiences of nurses regarding negative changes in their moral practice. Materials and methods This was a qualitative study utilizing an inductive thematic analysis approach, which was conducted from (...) February 2017 to September 2019. Twenty-five nurses participated in semi-structured interviews. Results The main theme that emerged from our analysis was one of moral neutralization in the context of an unethical moral climate. We found five sub-themes, including: feeling discouraged; normalization; giving up; becoming a justifier; and moral indifference. Conclusions Unethical moral climates in health organizations can result in deterioration of morality in nurses which can harm both patients and health systems. Some unethical behaviors in nurses can be explained by this process. (shrink)

The increasing demographic changes of populations in many countries require an approach for managing the complexity of sociocultural differences. Such an approach could help healthcare organizations to address healthcare disparities and inequities, and promote cultural safety for healthcare providers and patients alike. Almutairi's critical cultural competence (CCC) is a comprehensive approach that holds great promise for managing difficulties arising from sociocultural and linguistic issues during cross‐cultural interactions. CCC has addressed the limitations of many other cultural competence approaches that have been (...) discussed in the literature. Therefore, the purpose of this study is to define the construct of CCC and the theoretical components of the CCC. (shrink)

The ethical theories employed in health care today assume, in the main, a modern Western philosophical framework. Yet the diversity of cultural and religious assumptions regarding human nature, health and illness, life and death, and the status of the individual suggest that a cross-cultural study of health care ethics is needed. A Cross-Cultural Dialogue on Health Care Ethics provides this study. It shows that ethical questions can be resolved by examining the ethical principles present in each culture, critically assessing each (...) value, and identifying common values found within all traditions, It encourages the development of global awareness and sensitivity to and respect for the diversity of peoples and their values and will advance understanding as well as help to foster a greater balance and a fuller truth in consideration of the human condition and what makes for health and wholeness. (shrink)

Concepts and Cases in Nursing Ethics is a case-based exploration of the core principles of health care ethics applied to nursing. The book is a collaboration between philosopher-ethicist Michael Yeo and nurse-ethicist and educators Anne Moorhouse, Pamela Khan, and Patricia Rodney. It thus combines philosophical and ethical analysis with extensive knowledge and experience in nursing and health care. The book is organized around six main concepts in health care ethics: beneficence, autonomy, truthfulness, confidentiality, justice, and integrity. A chapter is devoted (...) to the elucidation of each of these concepts. In each chapter, historical background and conceptual analysis are supplemented by case studies that exemplify issues and show how the concept applies in health care and nursing practice. In this new edition, the conceptual analysis throughout has been updated and reworked in view of changes in the health care system. In addition, there is a new chapter specifically devoted to recent developments affecting nursing and other health professions. Previous case studies have been modified and new ones added to address current and emerging issues. Although the text focuses mainly on the social and political situation of nursing, the analysis has relevance also for medicine and the allied health professions, and indeed for anyone working in the health system. (shrink)

_Concepts and Cases in Nursing Ethics_ is a case-based exploration of the core principles of health care ethics applied to nursing. The book is a collaboration between philosopher-ethicist Michael Yeo and nurse-ethicist and educators Anne Moorhouse, Pamela Khan, and Patricia Rodney. It thus combines philosophical and ethical analysis with extensive knowledge and experience in nursing and health care. The book is organized around six main concepts in health care ethics: beneficence, autonomy, truthfulness, confidentiality, justice, and integrity. A chapter is devoted (...) to the elucidation of each of these concepts. In each chapter, historical background and conceptual analysis are supplemented by case studies that exemplify issues and show how the concept applies in health care and nursing practice. In this new edition, the conceptual analysis throughout has been updated and reworked in view of changes in the health care system. In addition, there is a new chapter specifically devoted to recent developments affecting nursing and other health professions. Previous case studies have been modified and new ones added to address current and emerging issues. Although the text focuses mainly on the social and political situation of nursing, the analysis has relevance also for medicine and the allied health professions, and indeed for anyone working in the health system. (shrink)

_A portion of the revenue from this book’s sales will be donated to Doctors Without Borders to assist the humanitarian work of nurses, doctors, and other health care providers in the fight against COVID-19 and beyond._ _Concepts and Cases in Nursing Ethics_ is an introduction to contemporary ethical issues in health care, designed especially for Canadian audiences. The book is organized around six key concepts: beneficence, autonomy, truth-telling, confidentiality, justice, and integrity. Each of these concepts is explained and discussed with (...) reference to professional and legal norms. The discussion is then supplemented by case studies that exemplify the relevant concepts and show how each applies in health care and nursing practice. This new fourth edition includes an added chapter on end-of-life issues, and it is revised throughout to reflect the latest developments on topics such as global health ethics, cultural competence, social media, and palliative sedation, as well as ethical issues relating to COVID-19. (shrink)