Increasing evidence demonstrates that the Aboriginal population experience greater health disparities and receive a lower quality of health care services. The Canadian Nurses Association (CNA) code of ethics states that nurses are required to incorporate culture into all domains of their nursing practice and ethical care. The aim of this article is to examine the concepts of cultural competency and cultural safety by way of relational ethics. To address these disparities in health care, cultural competency training programs (...) are being widely advised. Recent research into cultural safety has not only recognized the importance of culture in nursing practice and organizational structures, but also extended the concepts to the culture of the client. In recognizing this diversity, nurses must pay close attention to their relationships with their clients. It is argued that the answers lie in relational ethics, which honors indigenous people’s connection to self, others, the environment, and the universe. (shrink)

Nurses play a key role in the provision of services in relation to sexuality in both primary and sexual and reproductive health‐care. Given the intersection of sexualities with a range of social injustices, this study reviews research on nursing practice concerning sexuality from an emancipatory/social justice perspective. A systematic review of English articles published in nursing journals appearing on the Web of Science database from 2009 to 2014 was conducted. Thirty‐eight articles met the inclusion criteria. Analysis consisted (...) of a descriptive phase (types and location of studies, aspects of sexualities focused on, target health users and aspects of nursing practice focused on) and a critical/emancipatory phase. In terms of practice, our analysis revealed that: barriers exist to the integration of issues relating to sexuality in nursing practice; the social location of nurses and their personal feelings regarding sexuality influence their practice; content that addresses gendered norms and media that assist in communication underpin some emancipatory practices. Few studies locate analyses of nursing practice within gendered, cultural and social norms; consider advocacy as part of the practice of nurses; or analyse the promotion of health user participation in health services and structures. The implications for emancipatory practice are drawn out. (shrink)

Increasing evidence demonstrates that the Aboriginal population experience greater health disparities and receive a lower quality of health care services. The Canadian Nurses Association (CNA) code of ethics states that nurses are required to incorporate culture into all domains of their nursing practice and ethical care. The aim of this article is to examine the concepts of cultural competency and cultural safety by way of relational ethics. To address these disparities in health care, cultural competency training programs (...) are being widely advised. Recent research into cultural safety has not only recognized the importance of culture in nursing practice and organizational structures, but also extended the concepts to the culture of the client. In recognizing this diversity, nurses must pay close attention to their relationships with their clients. It is argued that the answers lie in relational ethics, which honors indigenous people’s connection to self, others, the environment, and the universe. (shrink)

Undisputedly, the United States’ health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty‐five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create ethical questions about the (...) balance of benefits and burdens associated with these advances. Every day on every shift, nurses at the bedside feel an intense array of ethical issues. At the same time, administrators, policy‐makers, and regulators struggle to balance commitments to patients, families, staff members, and governing boards. Ethical responsibilities and the fiduciary, regulatory, and community service goals of health care institutions are not mutually exclusive; they must go hand in hand. If they do not, our health care system will continue to lose valued professionals to moral distress, risk breaking the public's trust, and potentially undermine patient care. At this critical juncture in health care, we must look to new models, tools, and skills to confront contemporary ethical issues that impact clinical practice. The antidote to the current reality is to create a new health care paradigm grounded in compassion and sustained by a culture of ethical practice. (shrink)

Nursing knowledge development and application are influenced by numerous factors within the context of science and practice. The prevailing culture of science along with an evolving context of increasingly technological environments and rationalization within health care impacts both the generation of nursing knowledge and the practice of nursing. The effects of the culture of science and the context of nursing practice may negatively impact the structure and application of nursing knowledge, (...) how nurses practice, and how nurses understand the patients and families for whom they care. Specifically, the nature of critical care and its highly technical environment make critical care nursing especially vulnerable to these potentially negative influences. The influences of the culture of science and the increasingly technical practice context may result in an overreliance on the natural sciences to guide critical care nursing actions and an associated marginalization of the caring relationship in critical care nursing practice. Within this environment, nursing philosophy may not be foundational to nursing actions; rather, the dominant culture of science and the rationalization of health care may be informing nursing practice. As such, the ideology and goals of nursing may not be central to the practice of critical care nursing. The purpose of this paper is to explore the influence of the culture of science on the development of nursing knowledge and theory. Further, we aim to describe the value of using conceptual frameworks, such as Roy's Adaptation Model, as a nursing philosophy to influence the development of person‐centred nursing knowledge and theory to inform critical care nursing practice as it related to the care of patients and families. In doing so, nursing philosophy is situated as foundational for nursing actions. (shrink)

Philosophy has a complicated relationship with nursing practice. Selected concepts from Hans‐Georg Gadamer's Truth and Method specifically prejudice, conversation, and language are articulated. An exemplar involving nursing practice at an outpatient clinic for women seeking pre‐ and postbreast cancer care is offered to explicate these concepts. We considered the fit of Gadamer's philosophy, particularly the concept of conversation, within a public health nursing practice context in home and community settings of the client/family and offered (...) tentative conclusions. To extend the discussion of the relationship between philosophy and nursing practice, we posed questions developed to provide deeper insight into this complicated relationship. (shrink)

This article presents the derivation of moral competence in nursing practice by identifying its attributes founded on Thai culture. In this process moral competence is formed and based on the Thai nursing value system, including personal, social and professional values. It is then defined and its three dimensions (moral perception, judgment and behavior) are also identified. Additionally, eight attributes as indicators of moral competence are identified and selected from three basic values. The eight attributes are loving (...) kindness, compassion, sympathetic joy, equanimity, responsibility, discipline, honesty, and respect for human values, dignity and rights. All attributes are discussed by addressing the three moral dimensions in order to present how to deal with ethical issues in nursing practice. As a summary, a model of moral competence is presented to demonstrate moral competence in nursing practice in Thailand. (shrink)

Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values that (...) configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients’ drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses’ profession in the palliative field and help them implement palliative care philosophy in practice. (shrink)

Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values that (...) configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients’ drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses’ profession in the palliative field and help them implement palliative care philosophy in practice. (shrink)

This article presents the works of great Polish philosopher, Mieczysław Albert Krąpiec, whose creative output can be applied to professional nursing practice. Krąpiec's philosophical heritage is extensive and encompasses many philosophical fields: metaphysics, philosophical anthropology, philosophy of law, philosophy of culture, philosophy of politics and philosophy of language. Krąpiec created an original philosophical synthesis characterized by a realistic approach. In this paper, I present only one of several original philosophical concepts developed by Krąpiec: the theory of the (...) person based on seven essential characteristics, that is the ability for cognition, love, freedom, religion, legal subjectivity, completeness and dignity. I attempt to show how these personal characteristics correspond to various patient needs. I argue that the qualitative deficit of any personal characteristics indicated by Krąpiec corresponds to a patient's real need that must be satisfied. I also stress that the skilful diagnosing of all—not only selected—qualitative deficits of characteristics can be defined as holistic care in the nursing profession. (shrink)

The everyday expressions of nursing practices are driven by their entanglement in complex flows of social, cultural, political and economic interests. Early expressions of trained nursing practice in the United States and Europe reflect claims of moral, spiritual and clinical exceptionalism. They were both imposed upon—and internalized by—nursing pioneers. These claims were associated with an endogenous narrative of discipline and its physical manifestation in early nursing schools and hospitals, which functioned as “total institutions.” By contrast, (...) the external forces—diffuse yet pervasive—impacting upon contemporary nursing more closely align with the power dynamics explored in Gilles Deleuze's concept of the Society of Control. The example of sensor technology and telemetric monitoring of nurses’ locations in the clinical setting exemplifies the intense presence of surveillance, performance metrics and the “rationalization” of nursing practice. It falls upon nurses to recognize, accept or challenge these dynamics in order to shape the future of nursing practice into a discipline which embodies our values and priorities. (shrink)

Despite achieving broad acceptance of the moral case for treating animals fairly, the animal rights movement has reached an impasse concerning legal rights for animals. Zoopolis proposes a new approach to addressing this failure: integrating animal interests into human society via political institutions and practices. Zoopolis’s central theory that humans owe animals citizenship rights in a shared human-animal society, but that acceptance of responsibilities by animals also is required, has merit for the advancement of animal rights discourse. But its anthropocentric (...) approach, which itself exerts power over animals, necessitating suppression and policing of animals’ natural behavior, is problematic. (shrink)

The metaphor of host and guest has value for exploring the practice and role identity of nurses on inpatient mental health units. Two complementary texts, one from the ancient Zen record of Lin‐chi, and the other from the contemporary hermeneutic philosopher Richard Kearney, are used to elaborate meanings of host and guest that can be applied to the situation of mental health nurses. In a doctoral study with a hermeneutic design, I addressed the topic of nurse–patient relationship using an (...) interpretive framework that included sources from Buddhist thought. The positions of host and guest emerged from interviews with nurses as one interpretive theme to open up new understanding of the topic. The two texts, originally distant in era and culture, both employ the host and guest metaphor. They are applied to extracts from interviews to open up discussions of hierarchy, status, patients' perspectives, otherness and resistances as features of nurses' complex experience. These provide insights into understanding practice and suggest implications for how institutional environments shape practice. An intercultural reading of texts can provide a source of new understanding of nurse–patient relationships. (shrink)

A relatively small but intellectually robust strand in the Christian religion is the Reformed tradition. Especially, its Calvinist sensibilities inform this Protestant stance towards human culture in general and vocations in particular. Correspondingly, there are some small but robust contributions to academic discourse in nursing ethics. So far there has been no attempt to bring those together as a distinct approach. This article suggests such a Reformed Christian, especially Calvinist, account of nursing ethics. Central to the Reformed (...) perspective is the notion that God is sovereign over all of creation and culture and hence that there can be no religiously or morally neutral area in human life. Consequently, nursing is not seen as professional to the extent it is based on research evidence or theoretical models, but to the extent it serves the ultimate purpose of the practice of care. In the Reformed view, this purpose is fostering the well-being of human beings in need as intrinsically valuable. Nurses are professionals who accept this responsibility, that is, the whole of expectations holding for personal qualities, conduct and outcomes, required to serve the purpose of care. As this is a moral purpose, succeeding or failing to live up to these expectations is the source of moral issues in nursing. (shrink)

Marginalization has been used as a guiding concept for nursing research, theory and practice. Its properties have been identified and updated in 1994 and 1999, respectively. This article re-examines marginalization, considering it to be a concept that changes with pivotal historical events. The events of September 11, 2001, and the war between the US/UK and Iraq are such pivotal events. The notion of the linguistic habitus and symbolic violence as outlined by Bourdieu provide new insights about the dynamics (...) of marginalization. Specifically noted is the marginalization of persons and cultures based on their designation by the current US administration, and as interpreted through mainstream media, as actual or potential ‘terrorists’. A parallel situation in nursing is discussed, beginning with nursing's own marginality, related to the dynamics of symbolic violence. Nursing is argued to be vulnerable to having essential words and practices co-opted by dominant institutions and altered in meaning, that is, made incongruent with the discipline's emphasis on core values of confidentiality, equity and care. In response to marginalization and exteriorization those affected can use voice and testimony to ‘recreate the centre’. Suggestions for protecting our practices and philosophy are included. (shrink)

Nursing has evolved, yet media representation has arguably failed to keep up. This work explores why representation has been slow in accurately depicting nurses' responsibilities, impacts on public perceptions and professional identity. A critical realist review was employed as this method enables in-depth exploration into why something exists. A multidisciplinary approach was adopted, drawing from feminist, psychological and sociological theories to provide insightful understanding and recommendations. One main feminist lens has been implemented, using Laura Mulvey’s ‘Male-Gaze’ framework for content (...) analysis of three nurse-related advertisements to explore how the profession's female status influences representation, public perception and how this might impact nursing. Nurse representation has important real-world consequences. It is essential to improve unnecessary negative portrayals and contest ingrained stereotypes as there are costs to public opinion and nursing's self-identity. Nursing's female status has an impact within a male-dominated media industry, with a leisurely approach adopted toward changing representation. Media images become societally ingrained, this reiterates the significance of accurate/positive depictions. Social media is an instant method of communication with the public to combat stereotypes and maintain engagement to provide better understanding of what nurses do. (shrink)

BackgroundProfessional ethics refers to the use of logical and consistent communication, knowledge, clinical skills, emotions and values in nursing practice. This study aimed to explore and describe factors that affect professional ethics in nursing practice in Iran.MethodsThis qualitative study was conducted using conventional content analysis approach. Thirty nurses with at least 5 years of experience participated in the study; they were selected using purposive sampling. Data were collected through semi-structured interviews and analyzed using thematic analysis.ResultsAfter encoding (...) and classifying the data, five major categories were identified: individual character and responsibility, communication challenges, organizational preconditions, support systems, educational and cultural development.ConclusionsAwareness of professional ethics and its contributing factors could help nurses and healthcare professionals provide better services for patients. At the same time, such understanding would be valuable for educational administrators for effective planning and management. (shrink)

This article calls nursing to engage in the study of religions and identifies six considerations that arise in religious studies and the ways in which religious faith is expressed. It argues that whole-person care cannot be realized, neither can there be a complete understanding of bioethics theory and decision making, without a rigorous understanding of religious-ethical systems. Because religious traditions differ in their cosmology, ontology, epistemology, aesthetic, and ethical methods, and because religious subtraditions interact with specific cultures, each religion (...) and subtradition has something distinctive to offer to ethical discourse. A brief example is drawn from Native American religions, specifically their view of `speech' and `words'. Although the example is particular to an American context, it is intended to demonstrate a more general principle that an understanding of religion per se can yield new insights for bioethics. (shrink)

As an important professional value, dignity has always been an ethical concern in nursing education and practice. However, the dignity of nursing students in clinical environments has remained a little-discussed topic. This study aims to explore and describe nursing students’ dignity in clinical learning environments. This study is a qualitative descriptive work in which data were collected via semi-structured, in-depth, individual interviews and subsequently analyzed according to conventional content analysis. Based on the inclusion criteria of the (...) study, nursing students were selected from different departments of university hospitals in the south of Iran from October 2019 to December 2020. Sampling continued to the point of data saturation. This study has been approved by the institutional review board of the university. Two themes emerged from the data collected in the interviews: trust-based relationships and formation of professional identity. The findings of the study show that nursing students need to be supported by their instructors and perceive that the personnel and patients believe in their ability. In an effectively supportive, trust-based atmosphere, these factors can contribute to maintaining nursing students dignity. Also, showing respect for their personal identity, projecting a positive image of nursing, and giving them authority to perform executive and clinical tasks in hospital departments play a major role in the formation of nursing students’ professional identity and development of their dignity. Accordingly, it is recommended that in cultural contexts and clinical learning environments, more attention should be given to nursing students’ dignity. (shrink)

Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients’ well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA’s cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, public, (...) west-coast clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that (...) foster a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)

The culture of ‘culture’ in National Health Service policy implementationThe widespread reference to ‘culture’ in UK NHS policy and organisational literature suggests that culture has, in itself, become a cultural phenomenon. This article draws on anthropological thought to explore this trend, and finds it stems from the way that the term ‘culture’ has become analytically empty. Lack of rigour in the way that culture is conceptualised allows it to be used both to suggest an (...) evolved consensus among the workforce, and to validate the imposition of values and beliefs by management. Such manipulation of ‘culture’ is evident in recent NHS policy demanding cultural change to ensure a flexible, empowered and self‐regulating workforce — the type of workforce not only valued by health services, but pivotal to a post‐Fordist economy. The findings from an ethnographic study are drawn upon to consider the relationship between nurses’ cultural practices, corporate culture shaped by NHS policy, and the requirements of the economic domain. It is suggested that a commitment to post‐Fordist priorities of flexibility, empowerment and self‐regulation is not necessarily matched by any shift in the traditional location of power. The article concludes that greater analytical rigour is necessary to challenge the way in which ‘culture’ is manipulated by policy makers. (shrink)

Background:Complex and expensive treatment options have increased the frequency and emphasis of ethical decision-making in healthcare. In order to meet these challenges effectively, we need to identify how nurses contribute the resolution of these dilemmas.Aims:To identify the values, beliefs and contextual influences that inform decision-making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice.Design:An interpretive exploratory study was undertaken, 11 registered acute care nurses working in a district general hospital in England were (...) interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification.Participants and context:Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis.Ethical considerations:Ethical approval was obtained from the local National Research Ethics Committee.Findings:Four major themes emerged: ‘best for the patient’, ‘accountability’, ‘collaboration and conflict’ and ‘concern for others’. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single-site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas.Discussion:Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision-making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro- and micro-decision-making.Conclusion:Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas. (shrink)

The concept of ‘place’, and general references to ‘geographies of …’ are making gradual incursions into nursing literature. Although the idea of place in nursing is not new, this recent spatial turn seems to be influenced by the increasing profile of the discipline of health geography, and the broadening of its scope to incorporate smaller and more intimate spatial scales. A wider emphasis within the social sciences on place from a social and cultural perspective, and a wider turn (...) to ‘place’ across disciplines are probably equally important factors. This trend is raising some interesting questions for nurses, but at the same time contributes some confusion with regard to imputed meanings of ‘place’. While it is clear that most nurse clinicians and researchers certainly understand that place of care matters to their practices and patients, many diverse uses of ‘place’ are found within nursing literature, and contemporary understandings of the term ‘place’ within nursing are not immediately clear. It is in this context that this article plans to advance the discussion of place. More specifically, the aims of this paper are threefold: to critique ‘place’ as it appears in nursing literature, to explore the use of ‘place’ within health geography, whence notions of place and ‘geographies of’ have originated and, finally, to compare and contrast the use of ‘place’ in both disciplines. This critique intends to address a deficit in the literature, in this era of growing spatialization in nursing research. The specific questions of interest here are: ‘what is “place” in nursing?’ and ‘how do concepts of place in nursing compare to concepts of place in health geography?’. (shrink)

BackgroundDiscrimination in health care is an international challenge and a serious obstacle to justice and equality in health.Research objectiveThe purpose of this study was to design a grounded theory of discrimination in health care based on the experiences and perceptions of Iranian healthcare providers and patients.Research designThis qualitative study was conducted using by the grounded theory method.Participants and research contextData were collected through semi-structured interviews with 18 healthcare providers including 11 nurses, two physicians, two nurse’s assistants, and three patients in (...) two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling and analyzed simultaneously using the Corbin and Strauss (2015) approach.Ethical considerationsThe study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1398.023). Also, after explaining the objectives of the study, all the participants completed and signed the written consent form.FindingsThe “culture of discrimination” was the study’s core category, reflecting the nature of discrimination in health care. The theory of “culture of discrimination in health care” is the result of five main categories: “individual social stimuli,” “culture of discrimination,” “unintentional discrimination,” “conflict with discrimination,” and “dissatisfaction with discriminatory behavior.” These categories cover the underlying factors, strategies, and outcomes of the discrimination process in health care.DiscussionThe results of the study showed that nurses and other health care providers experience unintentional discrimination. Unintentional discrimination refers to discriminatory behaviors and practices of health care providers.ConclusionThe theory of culture of discrimination in health care can be used as a practical guide to describe and understand the role of health care providers, especially nurses. Further studies with a quantitative approach to applying this theory in medical settings are recommended. (shrink)

RACINE L and PERRON A. Nursing Inquiry 2012; 19: 190–201 Unmasking the predicament of cultural voyeurism: a postcolonial analysis of international nursing placementsThe growing interest in international nursing placements cannot be left unnoticed. After 11 years into this twenty‐first century, violations of human rights and freedom of speech, environmental disasters, and armed conflicts still create dire living conditions for men and women around the world. Nurses have an ethical duty to address issues of social justice and global (...) health as a means to fulfil nursing’s social mandate. However, international placements raise some concerns. Drawing on the works of postcolonial theorists in nursing and social sciences, we examine the risk of replicating colonialist practices and discourses of health in international clinical placements. Referring to Bakhtin’s notions of dialogism and unfinalizability, we envision a culturally safe nursing practice arising from dialogical encounters between the Self as an Other and with the Other as an Other. We suggest that exploring the intricacies of cultural and race relations in everyday nursing practice are the premises upon which nurses can understand the broader historic, racial, gendered, political and economic contexts of global health issues. Finally, we make suggestions for developing culturally safe learning opportunities at the international level without minimizing the impact of dialogical cultural encounters occurring at the local and community levels. (shrink)

Background:The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought.Objectives:This study explored nurses’ care practices at the end of life, (...) with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity.Research Design and context:Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated.Ethical Considerations:Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals.Findings:A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting.Discussion:Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members.Conclusion:Despite the avoidance of death talk and nurses’ lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values. (shrink)

Transformative ‘cultural shifts’ in nursing: participatory action research and the lsquo;project of possibility’For some time scholars have called for changes in nursing in order to address the subjugated position of nurses within health care. This paper argues that through an engagement with participatory action research, nurses open up a possibility to bring about transformative shifts in nursing culture. The motivation for nurses to engage with this research process arises out of an acknowledgement that they can no (...) longer live with the sense of pain and crisis endemic in much of their nursing practice, and a desire to take action to bring about transformative change within their local ward cultures. However, their participation in critical reflective and collaborative processes that underpin action research exposes an array of minor scattered nursing practices which frustrate possibilities for transformative change. Drawing on empirical accounts from research conducted by the author, the paper argues that once made explicit, these minor practices and the regimes of truth that nurture and sustain them, can be reconstructed and the possibility of transformative cultural shifts in nursing will then emerge. (shrink)

Drawing on previous empirical research, we provide an exemplary narrative to illustrate how patients have experienced hospital care organized according to evidence‐based fast‐track programmes. The aim of this paper was to analyse and discuss if and how it is possible to include patients’ individual perspectives in an evidence‐based practice as seen from the point of view of nursing theory. The paper highlights two conflicting courses of development. One is a course of standardization founded on evidence‐based recommendations, which specify (...) a set of rules that the patient must follow rigorously. The other is a course of democratization based on patients’ involvement in care. Referring to the analysis of the narrative, we argue that, in the current implementation of evidence‐based practice, the proposed involvement of patients resembles empty rhetoric. We argue that the principles and values from evidence‐based medicine are being lost in the transformation into the current evidence‐based hospital culture which potentially leads to a McDonaldization of nursing practice reflected as ‘one best way’. We argue for reviving ethics of care perspectives in today's evidence practice as the fundamental values of nursing may potentially bridge conflicts between evidence‐based practice and the ideals of patient participation thus preventing a practice of ‘McNursing’. (shrink)

Interprofessional collaboration involves some kind of knowledge sharing, which is essential and will be important in the future in regard to the opportunities and challenges in practices for delivering safe and effective health care. Nursing assistants are seldom mentioned as a group of health care workers that contribute to interprofessional collaboration in health care practice. The aim of this ethnographic study was to explore how the nursing assistants’ knowledge can be shared in a team on a spinal (...) cord injury rehabilitation ward. Using a sociomaterial perspective on practice, we captured different aspects of interprofessional collaboration in health care. The findings reveal how knowledge was shared between professionals, depending on different kinds of practice architecture. These specific cultural–discursive, material–economic, and social–political arrangements enabled possibilities through which nursing assistants’ knowledge informed other practices, and others’ knowledge informed the practice of nursing assistants. By studying what health care professionals actually do and say in practice, we found that the nursing assistants could make a valuable contribution of knowledge to the team. (shrink)

This article examines field studies of nursing work published in the English language between 1993 and 2003 as the first step towards an empirically based reformulation of the nursing mandate. A decade of ethnographic research reveals that, contrary to contemporary theories which promote an image of nursing work centred on individualised unmediated caring relationships, in real‐life practice the core nursing contribution is that of the healthcare mediator. Eight bundles of activity that comprise this intermediary role (...) are described utilising evidence from the literature. The mismatch between nursing's culture and ideals and the structure and constraints of the work setting is a chronic source of practitioner dissatisfaction. It is argued that the profession has little to gain by pursuing an agenda of holistic patient care centred on emotional intimacy and that an alternative occupational mandate focused on the healthcare mediator function might make for more humane health services and a more viable professional future. (shrink)

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

Although spiritual practices such as prayer are engaged by many to support well‐being and coping, little research has addressed nurses and prayer, whether for themselves or facilitating patients' use of prayer. We conducted a qualitative study to explore how prayer (as a proxy for spirituality and religion) is manifest—whether embraced, tolerated, or resisted—in healthcare, and how institutional and social contexts shape how prayer is understood and enacted. This paper analyzes interviews with 21 nurses in Vancouver and London as a subset (...) of the larger study. Findings show that nurses' kindness can buffer the loneliness and exclusion of ill health and in this way support the “spirit” of those in their care. Spiritual support for patients rarely incorporated prayer, in part because of ambiguities about permission and professional boundaries. Nurses' engagement with prayer and spiritual support could become a politicized site of religious accommodation, where imposition, religious illiteracy, and racism could derail person‐centered care and consequently enact social exclusion. Spiritual support (including prayer) sustained nurses themselves. We propose that nursing's equity‐oriented knowledge encompass spirituality and religion as sites of exclusion and inclusion. Nurses must be supported to move past religious illiteracy to provide culturally and spiritually sensitive care with clarity about professional boundaries and collaborative models of spiritual care. (shrink)

Background:The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery.Aim:To present (a) the arguments for and against conscientious (...) objection in nursing practice, (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice.Design:Discussion paper.Ethical considerations:Ethical guidelines has been followed at each stage of this study.Findings:Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient’s rights.Discussion and conclusion:Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice. (shrink)

Background:Moral courage is defined as courage to act according to one’s own ethical values and principles even at the risk of negative consequences for the individual. In a complex nursing practice, ethical considerations are integral. Moral courage is needed throughout nurses’ career.Aim:To analyse graduating nursing students’ moral courage and the factors associated with it in six European countries.Research design:A cross-sectional design, using a structured questionnaire, as part of a larger international ProCompNurse study. In the questionnaire, moral courage (...) was assessed with a single question (visual analogue scale 0–100), the questionnaire also covered several background variables.Participants and research context:The sample comprised graduating nursing students (n = 1796) from all participating countries. To get a comprehensive view about graduating nursing students’ moral courage, the views of nurse managers (n = 538) and patients (n = 1327) from the same units in which the graduating nursing students practised were also explored, with parallel questionnaires.Ethical considerations:Ethical approvals and research permissions were obtained according to national standards in every country and all participants gave their informed consent.Results:The mean of graduating nursing students’ self-assessed moral courage was 77.8 (standard deviation 17.0; on a 0–100 scale), with statistically significant differences between countries. Higher moral courage was associated with many factors, especially the level of professional competence. The managers assessed the graduating nursing students’ moral courage lower (66.5; standard deviation 18.4) and the patients slightly higher (80.6; standard deviation 19.4) than the graduating nursing students themselves.Discussion and conclusions:In all countries, the graduating nursing students’ moral courage was assessed as rather high, with differences between countries and populations. These differences and associations between moral courage and ethics education require further research. (shrink)

This paper looks at the cultural transformation of nursing. It argues that introducing computers in a female occupation is not simply a case of imposing ‘male’ technology on ‘female’ care-oriented practices and values. In order to understand current changes of nursing practice, three points of view have to be simultaneously kept in focus: 1) the differences between women's interests and ambitions; 2) the readings of a technology that have already been established through previous examples of design and (...) use (in hospitals up to date primarily for the purpose of establishing discipline and management control); and 3) the social practices that dominate a field of work (in the case of health work the already technology-driven cure aspect). (shrink)

Globalization is a part of modern life. Sharing a common set of professional nursing values is critical in this global environment. The purpose of this research was to examine the professional values of nursing students from two distinct cultural perspectives. Nurse educators in Taiwan partnered with nurse educators in the United States to compare professional values of their respective graduating nursing students. The American Nurses Association Code of Ethics served as the philosophical framework for this examination. The (...) convenience sample comprised 94 Taiwanese students and 168 US students. Both groups reported high scores on an overall measure of values. They did differ substantially on the relative importance of individual items related to advocacy, competence, education, self-evaluation, professional advancement, and professional associations. Global implications for the collaborative practice of nurses from different cultures working together can be improved by first recognizing and then attending to these differences in value priorities. (shrink)

Courting competency: nursing and the politics of performance in practiceNurses have long anguished over how best to assess performance in clinical practice. The ‘competency’ movement appears to have provided a solution to this problem. In this paper I undertake a ‘radical hermeneutic’ interrogation of the cultural text of clinical practice doubled with a poststructuralist interpretation of the literal text of the Australian competency project. Through this work I attempt to expose some of the deeply embedded assumptions that (...) underwrite the competency movement and amplify the problems posed by an uncritical appropriation of competency based training and assessment in nursing education. (shrink)

Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma‐ and violence‐informed care have been proposed as models of care to improve healthcare access, yet practitioners lack guidance on how to implement these models. In this paper, we build upon an existing framework of equity‐oriented care for (...) primary healthcare settings by proposing strategies to guide nurses in operationalizing cultural safety and trauma‐ and violence‐informed care into nursing practice at the individual level. This component is one strategy to redress inequitable access to care among Indigenous Peoples in Canada. We conceptualize barriers to accessing healthcare as intrapersonal, interpersonal, and structural. We then define three domains for nursing action: practicing reflexivity, prioritizing relationships, and considering the context. We have applied this expanded framework within the context of Indigenous Peoples in Canada as a way of illustrating specific concepts and focusing our argument; however, this framework is relevant to other groups experiencing marginalizing conditions and inequitable access to healthcare, and thus is applicable to many areas of nursing practice. (shrink)

The concept of cultural safety offers a unique approach to nursing practice, based on recognition of the power differentials inherent in any interaction. It is from within the context of nursing in Aoteaoroa/New Zealand (A/NZ) that the concept developed and was subsequently integrated into nursing education. Cultural safety is based within a framework of biculturalism, and is congruent with the tenets of the nation's founding document, the Treaty of Waitangi. Clarification of the concept is offered, together (...) with a review of the historical shift in nursing attitudes that has led to the emergence of ‘cultural safety’ as a viable and valued component of nursing practice.The argument is made that cultural safety has allowed for a more reflective, critical understanding of the actions of nursing to develop. This includes recognition that nurses’ attitudes and values have inevitably been influenced by social and political forces, and as such are in part reflective of those within the wider community. Comparison between the support given by nurses in the early 1900s to the theory of eugenics and the current acceptance of cultural safety is used to highlight this point. An examination of the literature identifies that ideological and conceptual changes have occurred in the approach of A/NZ nurses to issues with cultural implications for practice. A review of background factors relating to Maori health status and the Treaty of Waitangi is presented as a necessary context to the overall discussion.The discussion concludes with an acknowledgement that while the rhetoric of cultural safety is now part of nursing culture in New Zealand, there is no firm evidence to evaluate its impact in practice. Issues identified as impacting on the ability to assess/research a concept, such as cultural safety, are discussed. For cultural safety to become recognised as a credible (and indispensable) tool, it is necessary to further examine the ‘end-point’ or ‘outcomes’ of the process. (shrink)

The aims of this study were to present themes in nursing motifs as depicted in tattoos and to describe how it reflects upon nursing in popular culture as well as within professional nursing culture. An archival and cross‐sectional observational study was conducted online to search for images of nursing tattoos that were freely available, by utilizing the netnographic methodology. The 400 images were analyzed in a process that consisted of four analytical steps focusing on (...) metaphors and meanings in the tattoos. The findings present four themes: angels of mercy and domination; hegemonic nursing technology; embodying the corps; and nurses within the belly of the monster. The tattoos serve as a mirror of popular culture and the professional culture of nurses and nursing practice within the context of body art. Body art policy statements have been included in nursing personnel dress code policies. Usually these policies prohibit tattoos that are sexist, symbolize sex or could contribute and reproduce racial oppression. The results show that the tattoos can be interpreted according to several layers of meanings in relation to such policies. We therefore stress that this is an area highly relevant for further analyses in nursing research. (shrink)

Nursing research in China is at an early stage of development and little is known about the practices of Chinese nurse researchers. This interview study carried out at a university in central China explores the informed consent practices of Chinese nurse researchers and the cultural considerations of using a western technique. Nine semistructured interviews were conducted in English with assistance and simultaneous translation from a Chinese nurse with research experience. The interviews were analyzed by one western and two Chinese (...) researchers and major themes were identified. All participants endorsed informed consent as ethically required. Differences were noted between some of the informed consent practices typically recommended in the USA and those identified in this study, such as: recruitment using local and government officials, recruiting directly from medical records without special permission, family consultation in consent and consent control, and not revealing randomization to intervention groups receiving different treatments. (shrink)

In this article we focus on female genital mutilation. We analyse this problem as one of the most important issues of multiculturalism, which is also coming to the attention of the public in Italy as a consequence of the growing number of immigrants from African countries. The fundamental problem is about the acceptability of this practice: can female genital mutilation be permitted and, if so, on what basis? We will try to cope with this as a genuine conflict between (...) culture-relative values and universal values, such as human rights. Some attention will be drawn to Italian law. Finally, the impact on nurses of requests for genital mutilation will be described. (shrink)