The aim of the study was to report the results of a systematically conducted literature review of empirical studies about healthcare organizations’ ethics and management or leadership issues. Electronic databases MEDLINE and CINAHL yielded 909 citations. After a two stage application of the inclusion and exclusion criteria 56 full-text articles were included in the review. No large research programs were identified. Most of the studies were in acute hospital settings from the 1990s onwards. The studies focused on ethical challenges, dilemmas (...) in practice, employee moral distress and ethical climates or environments. Study samples typically consisted of healthcare practitioners, operational, executive and strategic managers. Data collection was mainly by questionnaires or interviews and most of the studies were descriptive, correlational and cross-sectional. There is need to develop conceptual clarity and a theoretical framework around the subject of organizational ethics and the breadth of the contexts and scope of the research needs to be increased. (shrink)

The aim of this review was to analyse the empirical studies that focus on ethics in nursing care for older people, scoping the need and areas for further study. A search of the MEDLINE and CINAHL databases (earliest to August 2009) was conducted using the the keywords: ethic* and nursing or care or caring and elderly or aged or older. After a four-stage process, 71 empirical articles were included in the review, with informants ranging from elderly people to relatives, caregivers, (...) managers and students in care settings. The review focusses on the concepts, contexts, methods and validity of these studies. Based on the analysis, the reviewed research seems to be fragmented and multifaceted, focussing on selected issues such as autonomy, self-determination and informed consent. No large research programs or research traditions were found so it was not possible to draw any conclusions about suitable methods, study designs or instruments of measurement for use in this research area. (shrink)

The authors ofImages of mindhave been highly successful in unravelling the neural basis of complex brain functions. Their emphasis on top-down processingin experimental neuroscience is especially important and, it is hoped, influential. Tracking brain activation accurately botli in space and in time would benefit from studiesofindividual subjects without relying on grand average data.

This article analyzes three video-recorded asylum interviews, their written records and the corresponding decisions by the Finnish Immigration Service. The goal is to identify the causes and consequences of vulnerability in instances that are particularly important when assessing whether the asylum seeker has a well-grounded fear of persecution. A combination of linguistic, psychological and epistemic perspectives on vulnerability shows that these three dimensions are closely intertwined in asylum interviews. Linguistic vulnerability is linked for the most part to interpreting, whereas psychological (...) vulnerability stems from the difficulty in recounting traumatic experiences. Both linguistic and psychological vulnerabilities are central forces that also lead to epistemic vulnerability. Epistemic vulnerability, we claim, gives rise to certain practices within the asylum procedure, which again represents the materialization of the discourses of reporting, truth and credibility. (shrink)

Background Moral courage means courage to act according to individual’s own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower. Objective To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care. Research design Was a descriptive-correlational study using a questionnaire, containing Nurses Moral Courage Scale©, a video vignette of (...) the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives. Participants and research context Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses’ Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette. Ethical considerations Good scientific inquiry guidelines were followed. Permission to use the Nurses’ Moral Courage Scale© was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses’ Association. Findings The mean value of potential whistle-blowers’ moral courage on a Visual Analogue Scale (0–10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers’ moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables. Discussion and conclusion In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing. (shrink)

We raise the possibility that the roles words typically play in sentence context, rather than their motor or visual associations, determine the organization of language in the brain. We also discuss time-sensitive functional imaging approaches that allow experimentation both on isolated words and connected language.

Although we can observe noticeable progress in gender diversity on corporate boards, these boards remain far from gender balanced. Our paper builds on social identity theory to examine the impact of corporate elites—men and women who sit on multiple corporate boards—on board diversity. We extend the main argument of social identity theory concerning favouritism based on homophily by suggesting that boards with men with multiple appointments are unwilling to include female board members to protect the monopoly value generated by their (...) elite status. The empirical analysis, based on DAX 30 firms in the period of 2010–2015, shows that the presence of multi-board men is negatively associated with women’s participation, while the presence of multi-board women and other women on management boards is positively related to gender diversity on boards. Furthermore, robustness tests support and confirm our conclusion that multi-board men have a significant association with board diversity, even with small size. Additionally, we find a significant effect arising from pressure related to the introduction of gender quotas in Germany, effective in 2016, indicating the effectiveness of gender quota policies for board gender diversity. (shrink)

The crisis resilience of vital social systems is currently the target of constant development efforts in Finland, as their drifting into crisis would weaken societies’ functional abilities, safety, and security. This is also the case regarding the Finnish health care system. In an attempt to move beyond existing frameworks of crisis imagination, this article takes an unconventional stance by elucidating endogenous crisis dynamics present in the Finnish health care system. Delphi process was conducted for top experts in Finnish health care (...) and crisis management. With a dissensus-seeking orientation, our aim was to fertilize disagreements among panelists to reveal key vulnerabilities in the health system. Despite our efforts to evoke dissensus, the panelists ended up generating a consensus that aims to protect the underlying assumptions of the health system’s knowledge structure. Through inductive analysis of expert discourses, the data was analyzed through our research question “what constitutes a crisis-proof health system and a crisis-prone health system”. What is framed as a strength of the system by our panelists, namely the ability to maintain legitimacy, improve efficiency, and guarantee continuity, can still have questionable implications that are left ungrasped. A system’s theory approach illustrates how such effects can develop and escalate beyond the reach of social interventions, and thus be predisposed to cause objectionable yet concealed social crises. The discussion illustrates how these endogenous crisis dynamics could be seen to materialize in real-life cases. (shrink)

This study identified and described ethical problems encountered by physiotherapists in their practice and physiotherapists’ moral sensitivity in ethical situations. A questionnaire-based survey was constructed to identify ethical problems, and the Moral Sensitivity Questionnaire Revised version was used to measure moral sensitivity. Physiotherapists (n = 116) working in public health services responded to the questionnaire. Based on the results, most of the physiotherapists encounter ethical problems weekly. They concern mainly financial considerations, equality and justice, professionalism, unethical conduct of physiotherapists or (...) other professions and patients’ self-determination. The dimension of moral strength was emphasised in physiotherapists’ self-evaluations of their moral sensitivity. As a conclusion, ethical problems do occur not only at individual level but also at organisational and society level. Physiotherapists seem to have moral strength for speaking on behalf of the patient. Scarce resources make them feel insufficient but much could still be done to provide quality care in co-operation with other health-care professionals. (shrink)

Conducting nursing research in long-term care facilities and with samples of older people requires careful attention to research ethics and the ethical conduct of the study. This review analysed the research ethics of the empirical studies that focus on older people in long-term care settings as research participants. Articles (n = 66) focussing on older people in long-term care settings as research informants were retrieved from an electronic search of MEDLINE (1990 to February 2012) using the MESH terms ‘Nursing’ AND (...) ‘Long-term care’ (578 citations) and ‘Institutionalization’ and ‘Nursing’ (89 citations). Ethical approval procedure was reported in more than half of the studies (58%) and informed consent in two-thirds of the studies (70%). Ethical issues in data collection were described in most of the articles, but only a few reported ethics in problem statement, reporting or presenting implications. There is a need to focus on reporting research ethics and procedures in empirical research on vulnerable people. (shrink)

These days a good dose of Hope is good for all of us. Anyone will enjoy this spiritual and inspirational journey filled with reflections and pictures instilling hope and reminding us how challenges can be turned into opportunities. This book is encouraging to anyone who is struggling. It's a companion that can help us learn more about ourselves and life. This book is born out of a "dark night of the soul". The author has survived two cancers and is sharing (...) writings from this difficult time as well as the joy and gratitude of being alive. Some of the writings are powerful heart touching poems. Some are more philosophical, conversational investigations on different topics. Some are sparks of Light. The beautiful inspiring pictures will add to the deep messages. One can read this book in the order of the pages or just open the book anywhere, trusting that the most supportive message for that particular day will present itself. It includes practices that are helpful in turning the pain of the challenges into personal growth. Since it's a small and simple book any layperson who is sick, grieving or struggling with any life challenges can find hope from it. The book can be in on the coffee table of any family or individual's night table. It is also relevant for professionals who can recommend it to their clients as well as to have in their waiting rooms. Also, hospice and hospitals can have this book available for their clients. The main purpose of this book is to instill hope and bring light to people's lives. It is also an invitation to look at things with a wider perspective and to see that we can learn from the challenges in life. This book can be a supportive companion for challenging times and will enlighten anyone's day. (shrink)

Managers tasked with organizational change often face irreconcilable demands on how to enact justice—situations we call _justice conundrums_. Drawing on interviews held with managers before and after a planned large-scale change, we identify specific conundrums and illustrate how managers grapple with these through three prototypical paths. Among our participants, the paths increasingly diverged over time, culminating in distinct career decisions. Based on our findings, we develop an integrative process model that illustrates how managers grapple with justice conundrums. Our contributions are (...) threefold. First, we elucidate three types of justice conundrums that managers may encounter when enacting justice in the context of planned organizational change (the justice intention-action gap, competing justice expectations, and the justice of care vs. managerial-strategic justice) and show how managers handle them differently. Second, drawing on the motivated cognition and moral disengagement literature, we illustrate how cognitive mechanisms coalesce to allow managers to soothe their moral (self-) concerns when grappling with these conundrums. Third, we show how motivated justice intentions ensuing from specific justice motives, moral emotions, and circles of moral regard predict the types of justice conundrums managers face and the paths they take to grapple with them. (shrink)

Background Professional care workers face ethical issues in long-term care settings (LTCS) for older adults. They need to be independent and responsible, despite limited resources, a shortage of skilled professionals, global and societal changes, and the negative reputation of LTCS work. Research aim Our aim was to describe the care workers’ lived experiences of ethical issues. The findings can be used to gain new perspectives and to guide decision-making to improve the quality of care, occupational well-being and nursing education. Research (...) design Focus group interviews were analyzed using a hermeneutic-phenomenological method. The analysis comprised three steps: naïve reading, structural analysis, and comprehensive understanding. Participants and research context We randomly sampled LTCS service providers in Finland and 53 care workers with different educational backgrounds from seven organizations participated in focus group interviews in 2021. Ethical considerations This was a sensitive study, which was connected to the participants’ individual views of the world, professional ethics and social and health care legislation. The participants' provided informed consent and their anonymity was guaranteed. Findings Care workers spoke about their lived experiences of ethical issues in an emotional way, using practical examples. They talked about how they were experts at caring and advocating for residents, balanced the responsibilities of their different roles, and defended their work to the wider society. The care workers said that ethical aspects of their work were too difficult to solve on their own. There were elements of their working environment and practices that caused unnecessary strain and they needed the commitment of managers, organizations, and society to solve ethical issues in LTCS. Conclusions Ethical issues were related to the well-being of both residents and care workers and reflected both internal and external pressures. Some issues could not be resolved by individuals and needed input from managers, organizations, and society. (shrink)

In the course of their child?s school years, a group of parents were asked to assess their child?s mathematical competence and indicate whether they endorsed the gender stereotype pertaining to it. Once the child had entered upper primary school, the consistent stereotypic parents tended to rate their boys? mathematical competence higher than the parents of girls did. Additionally, the parents whose attitude turned into an anti?stereotypical one perceived their girls? mathematical competencies as higher than those of the boys, which was (...) related to their perception that the boys? competencies were getting worse while the girls? competencies were getting better. (shrink)

Humans all around the world are drawn to creating and consuming art due to its capability to evoke emotions, but the mechanisms underlying art-evoked feelings remain poorly characterised. Here we show how embodiement contributes to emotions evoked by a large database of visual art pieces (n = 336). In four experiments, we mapped the subjective feeling space of art-evoked emotions (n = 244), quantified “bodily fingerprints” of these emotions (n = 615), and recorded the subjects’ interest annotations (n = 306) (...) and eye movements (n = 21) while viewing the art. We show that art evokes a wide spectrum of feelings, and that the bodily fingerprints triggered by art are central to these feelings, especially in artworks where human figures are salient. Altogether these results support the model that bodily sensations are central to the aesthetic experience. (shrink)

Although the literature on organizational justice enactment is becoming richer, our understanding of the role of the deontic justice motive remains limited. In this article, we review and discuss theoretical approaches to and evidence of the deontic justice motive and deontic justice enactment. While the prevalent understanding of deontic justice enactment focuses on compliance, we argue that this conceptualization is insufficient to explain behaviors that go beyond the call of duty. We thus consider two further forms of deontic behavior: humanistic (...) and supererogatory behavior. Drawing on the concepts of situation strength and person strength, we further argue that the reduced variance in behavior across morally challenging situations makes deontic justice enactment visible. We thus observe deontic justice enactment when an actor’s deontic justice motive collides with strong situational cues or constraints that guide the actor to behave differently. We formulate propositions and develop a theoretical model that links the deontic justice motive to moral maturation and deontic justice enactment. (shrink)

Moral distress (MD) has received considerable attention in the nursing literature over the past few decades. It has been found that high levels of MD can negatively impact nurses, patients, and their family and reduce the quality of patient care. This study aimed to investigate the potentially effective interventions to alleviate MD in critical care nurses. In this systematic review, a broad search of the literature was conducted in the international databases including PubMed/MEDLINE, Web of Science, and Scopus, as well (...) as Google Scholar search engine using keywords such as moral distress, intensive care unit, ICU, nurses, and critical care nurses from 1984, when the concept of MD was first introduced in the nursing literature, up to 29 October 2020. Studies focusing on the interventions for managing MD in critical care nurse were evaluated. The quality of eligible papers was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A total of 8 studies fulfilled the eligibility criteria. Three studies had RCT design and five studies had quasi-experimental design. All studies were conducted in the United States or Iran. Educational workshop, moral empowerment program, social work intervention, nursing ethics huddles, and multifaceted resiliency bundle intervention were effective interventions for managing of MD among critical care nurses. There is limited but promising research evidence evaluating the efficacy of educational interventions for managing of MD among critical care nurses. Although some positive results have been reported, there is limited generalizable evidence due to the variability of interventions. These findings highlight the need for further studies to validate the efficacy of these interventions or develop more potent and efficient interventions for reducing MD in critical care nurses. (shrink)

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare (...) context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

Background:In the past two decades, interest in the concept of ethical climate and in its research has increased in healthcare. Ethical climate is viewed as a type of organizational work climate, and defined as the shared perception of ethically correct behavior, and how ethical issues should be handled in the organization. Ethical climate as an important element of nursing environment has been the focus of several studies. However, scoping reviews of ethical climate research in nursing have not been conducted to (...) guide further research in this area.Objective:The purpose of this scoping review is to describe and analyze studies focusing on ethical climate in nursing environment to elicit an overall picture of the research in this field.Methods:A scoping review methodology guided by Arksey and O’Malley and Levac et al. was used. Studies were identified by conducting electronic searches on PubMed/MEDLINE, CINAHL, Web of Science Core Collection, PsycINFO, and Scopus and Philosophers’ Index databases. Of 1051 citations, 56 articles matched the inclusion criteria.Ethical considerations:This study was conducted according to good scientific guidelines.Findings:Ethical climate is a topical research area which has been explored with different methods and outcomes, in different environments, and has mainly been perceived positively. The focus of the studies was on finding associations between ethical climate and work-related factors such as job satisfaction, moral distress, and turnover intentions. Methodologically, research was rather homogeneous using quantitative, descriptive, and correlative research designs.Conclusion:Novel perspectives and more diverse methodological approaches paying attentions to issues affecting generalizability of the findings could expand our knowledge in this area. (shrink)

The aim of this study was to identify the ethical problems that nurse managers encounter in their work and the role of codes of ethics in the solutions to these difficulties. The data were collected using a structured questionnaire and analysed statistically. The target sample included all nurse managers in 21 specialized health care or primary health care organizations in two hospital districts in Finland (N = 501; response rate 41%). The most common ethical problems concerned resource allocation as well (...) as providing and developing high quality care. This was the case in different managerial positions as well as in types of organization. Professional codes of ethics were used more often for problems related to patients’ care compared with issues of resource allocation. Nurse managers at middle or strategic management levels used codes of ethics more often than those in charge of a ward. More research is required to investigate ethical decision making in nursing management, especially with regard to problem solving. In addition, new guidelines and continuing education in ethics are important for management personnel. (shrink)

Background:The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients’ rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions.Objectives:To examine ethics interventions conducted on healthcare professionals and healthcare students to (...) achieve ethics-related outcomes.Research design:A systematic review.Methods:Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher’s Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis.Ethical consideration:This systematic review was conducted following good scientific practice in every phase.Findings:It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics.Conclusion:Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals. (shrink)

Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses’ and nursing students’ moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses’ and nursing students’ moral competence, a (...) literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare. (shrink)

This study examines how institutional logics interplay in a cross-sector social partnership that manages refugee integration in a rural district in Germany. In an inductive 15-month case study that drew on interviews and observations, we observe the dynamic materialization of institutional logics in day-to-day practices and an increasing contradiction and even rivalry between community- and market-based institutional logics over time. As a result, we delineate a model explaining the interplay of institutional logics along two dimensions: the dominance of one salient (...) logic and whether conflicts arise among logics. Our analysis also addresses the unifying properties of community as an institutional logic, especially in the context of urgency conditions. In addition, we show the influence of exogenous events and their media coverage on the interplay and conflicts of institutional logics. By unfolding the complexity of refugee integration—one of the global grand challenges of the present—we deepen the current understanding of the specific challenges addressed by cross-sector social partnerships. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

BackgroundPatients have the right to equal, respectful treatment. Nowadays, one third of patient complaints concern health care staff’s behavior towards patients. Ethically safe care requires ethical competence, which has been addressed as a core competence in physiotherapy. It has been defined in terms of character strength, ethical awareness, moral judgment skills in decision-making, and willingness to do good. The purpose of this study was to analyze the ethical competence of practicing physiotherapists.MethodA self-evaluation instrument (Physiotherapist’s Ethical Competence Evaluation Tool) based on (...) an analysis of a concept “ethical competence” was constructed in 2016 and physiotherapists (n = 839), working in public health services or private practice responded to the questionnaire.ResultsBased on the results, most of the physiotherapists evaluated themselves highly ethically competent in all areas of ethical competence, subscales being Strength, Awareness, Skills and Will. Willingness to do good was evaluated as highest, while character strength, including the strength to support ethical processes and speak on behalf of the patient, was evaluated the lowest. Physiotherapists most commonly consult a colleague when encountering an ethical problem. Other methods for problem solving are not very familiar, neither are the international or national ethical codes of conduct.ConclusionsThis was the first attempt to assess all aspects of ethical competence empirically in a clinical environment in physiotherapy, using a novel self-evaluation instrument. Even if physiotherapists evaluate themselves as competent in ethics, further exploration is needed for ethical awareness. Also the patients’ viewpoints about ethically competent care should be considered, to better ensure ethical safety of the patient. (shrink)

The focus of this article is perceptions of elderly patients and nurses regarding patients’ autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which patients (...) received information from nursing staff or were offered opportunities to make decisions.This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

ObjectivesNovel information about the relationships between farmers’ job demands, lack of resource, burnout, and ill health is reported based on testing the so-called “health impairment process” of the Job Demands─Resources Model on a representative sample of Finnish dairy farmers. The aim was to find out whether two different job demand factors; workload, societal demands and lack of resource; loneliness, were related to the indicators of ill health via burnout.MethodsThe data is based on a postal survey of 400 Finnish dairy farms. (...) Altogether 265 questionnaires were received from 188 farms and included in the analysis. The response rate was 47 per cent among sample farms. Structural equation modelling was used to analyze the relationships between the variables. Explanatory factor analysis was used to group the job demand and lack of resource variables.ResultsWe identified two job demand factors, which we labelled workload and societal demands and one lacking job resource, loneliness. Our theoretical model was supported in that two of the factors, namely workload and loneliness, were related to ill health indirectly via burnout. In addition, workload was directly connected with ill health. Societal job demands were not significantly related to burnout, or to ill health.ConclusionOur results suggest that farmers could benefit from means to reduce workload, especially the physical load. This topic needs further research as the restructuring process has increased farm enterprise sizes. There is a need to develop tools and projects to alleviate loneliness among farmers. Lack of social support, high workload, ill health, and burnout among farmers may have serious direct and indirect negative consequences for the sustainability of farming. (shrink)

Background: I suggest this individualized care is a fundamental principle closely linked to nursing ethics and has important benefits for the patients, however, nurses do not always take into consideration the principles of individualized care. Moreover, there is no validated instrument to assess patients’ views of individualized care in Spanish-speaking countries. Objectives: To assess the validity and reliability of the Spanish version of the Individualized Care Scale-patient. Design: A cross-sectional study design was conducted. A questionnaire survey, including the Individualized Care (...) Scale-patient, was used for data collection. Psychometric properties of reliability and validity were assessed. Fit indices of the overall model were computed. Participants and research context: Survey data were collected from a sample of 118 inpatients at a public hospital in Spain. Ethical considerations: Informed consent from participants and ethical approval was obtained from a regional Clinical Research Ethics Committee. Findings: Ordinal Cronbach’s alphas were 0.966 for Individualized Care Scale-patient subscale A and 0.969 for Individualized Care Scale-patient subscale B. The polychoric correlation between each item and the subscale ranged between 0.653–0.874 and 0.604–0.916, respectively. The exploratory factor analysis revealed a three-factor solution. Personal life situation explained relatively large amounts of the variance. Goodness of fit index showed a good fit for the model. Discussion: This study confirms three factors underlining the individualized care concept, but some differences were found in the load of the factors, such as the relevance of “personal life situation” subscale, that need further research. Conclusion: The Spanish version of the Individualized Care Scale-patient is reliable, valid, user-friendly, and suitable to be used in Spanish-speaking countries showing satisfactory properties. This instrument may help managers better understand and develop areas in which patients perceive lower individualized care received and the factors influencing it. Such key information will help ensure the right of the patient to be respected as an individual. (shrink)