Background:Horizontal violence, defined in the literature as ‘interpersonal conflict between two nurses at the same hierarchical levels in organizations’, often associated with bullying, affects the well-being of nurses, care recipients and the professional image of nursing and the organization due to increased turnover. One in every three newly graduated nurses is a victim of horizontal violence, although they do not always know how to define it.Aim:To investigate the direct and indirect experiences of horizontal violence in (...) newly graduated nurses as well as to shed light on the phenomenon, on its awareness and recognition.Methods:A qualitative phenomenological study was conducted between September and October 2018 with newly graduated nurses, with a work experience ranging between 6 months and 3 years. The interviews were conducted face-to-face, consisting of a first open general question, followed by semi-structured questions.Ethical considerations:The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Institution Review Board.Results:From the analysis of the interviews of the 21 participants, four main themes were identified: the ‘enemies’, that is those who exercised violence, the ‘weapons’ used by them to exercise violence, the ‘effects’ and the types of ‘armor’ identified to protect themselves.Discussion:Horizontal violence is rarely recognized by newly graduated nurses, even though our sample had directly or indirectly experienced horizontal violence. Tackling the phenomenon starting from the undergraduate degree courses, focusing on effective support and more protection by the organization leaders were the silent requests that emerged from this study.Conclusion:Preventing horizontal violence is important for nurses’ professional and private well-being, for professional conduct and for the quality of care provided to patients. (shrink)

This longitudinal study used the Gordon Personality Inventory to measure nursing students’ self-image, self-values and interpersonal values. It was performed with students from three colleges of health in the south of Sweden: Jönköping, Växjö and Kristianstad. The null hypothesis of the study was that the new academic three-year programme did not have the power to change significantly the students’ self-image and professional values. The hypothesis was tested by paired sample Student’s t-test. The result was that, at Jönköping, self-image changed and (...) increased significantly in the dimensions of ‘cautiousness’ and ‘personal relations’, and decreased in ‘sociability’, and increased in the self-value ‘order’. At Växjö the self-image dimensions of ‘original thinking’ and ‘personal relations’ increased, and, at Kristianstad, the students increased their self-image scores in ‘responsibility’. (shrink)

This longitudinal study (1994-1996) used the Gordon Personality Inventory to measure nursing students’ self-image (Gordon A), self-values (Gordon B) and interpersonal values (Gordon C). It was performed with students from three colleges of health in the south of Sweden: Jönköping (n = 54), Växjö (n = 24) and Kristianstad (n = 38). The null hypothesis of the study was that the new academic three-year programme did not have the power to change significantly the students’ self-image and professional values. The hypothesis (...) was tested by paired sample Student’s t-test. The result was that, at Jönköping, self-image changed and increased significantly in the dimensions of ‘cautiousness’ and ‘personal relations’, and decreased in ‘sociability’, and increased in the self-value ‘order’. At Växjö the self-image dimensions of ‘original thinking’ and ‘personal relations’ increased, and, at Kristianstad, the students increased their self-image scores in ‘responsibility’. (shrink)

Communication is an integral part of nursing practice—with patients and their relatives, other nurses and members of the healthcare team, and ancillary staff. Through interaction with the ‘other’, language and silence creates and recreates social realities. Acceptance, rejection or modification of social realities depends on what is expressed and by whom. Narratives that are offered can tell of some experiences and not others. Some nurses choose to be silent while others are silenced. In nursing situations recognising and allowing (...) silence to speak is a challenging but uniquely personal experience that embraces reflection in and on experiences, practice and self as a person and a professional. If enabled and truly heard, silence can speak more loudly than the hubbub of daily practice, allowing us to collectively question and challenge inherent assumptions and biases as professionals, and as a profession. Through a microcosm of Newly Graduated Nurses' lived experiences of nursing situations and expressions of silence individuals' discomfort and private efforts to ascribe meaning to experiences are reflected on. Returning to silence is to return to a constant process of professional transformation that can enable ways of knowing and being that can reform our profession from within and enable us to cast off shackles that bind us to a shameful cultural underbelly. (shrink)

The incidence of moral distress, compromised moral integrity, and leaving nursing is highest among nurses new to the profession. Understanding perceptions of moral integrity may assist in developing strategies to reduce distress and promote workforce retention. The purpose of this study was to determine how newly graduated baccalaureate prepared nurses perceive moral integrity and how prepared they feel to manage challenges to it. The design was qualitative descriptive using a confidential short answer online survey. Data were (...) analyzed using conventional content analysis. Moral integrity was perceived as acting like, becoming, and being a certain kind of person who was honest, trustworthy, consistently doing and standing up for what is right, despite the consequences but also expected to set aside their values and beliefs and do what others ask, even if this would mean acting contrary to their conscience. The contradiction within this perception needs explanation. (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)

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile's (Practice‐based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which (...) are learnt “on the job.” We suggest that learning “on‐the‐job” is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the “invisible learning” which occurs as newly qualified nurses learn to delegate and supervise. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A New Graduate Nurse’s StoryJill MountI was taking pre–med courses on the west coast when my mother was diagnosed with acute leukemia. I immediately finished out my classes, packed up my bags and cat and moved back to the town on the east coast where my parents lived. While my mother was fighting the leukemia, I spent many hours in her hospital room and I learned more about the (...) roles of doctors and nurses. Unlike what I had seen on television, where the doctors were always nearby and available to their patients, my mother’s doctors were seldom present. It was the nurses who spent the most time with my mother in the hospital. I wanted to care and be present for my patients like her nurses. So I decided to become a nurse. I didn’t realize that not all cancer units were like my mother’s where the nurses had time to really care for their patients.My mother’s attending doctor would visit her bedside once a day. The doctor would generally stand a few feet away from the foot of my mother’s bed and describe my mother’s latest blood counts. The doctor always seemed to keep her distance at the foot of the bed. As my mother’s series of chemotherapy treatments failed to put her in remission, the doctor would describe the next chemotherapy protocol that my mother would endure. My mother wanted desperately to live and she would keep copies of the blood counts her doctor provided her and would insist on trying the next round of chemotherapy, despite the list of grim side effects each seemed to come with. The doctor generally stayed an average of five minutes during these visits.My mother’s nurses, however, were a constant presence. I had not realized at the time that people are hospitalized primarily for nursing care. My mother was assigned several great nurses, who not only took her vital signs and administered her medications, but who seemed to care about her as a person as well. The nurses seemed to understand how difficult it was for my mother, a very independent person, not to have control over her health. To help her regain control, they provided her with guided visualizations. This was during the mid–eighties so they had her visualize her immune system as Pac–man eating all the cancer cells. My mother liked this because when she did the Pac– man visualizations, she felt she had some control directing her immune system to fight the disease.The nurses also provided my mother with emotional support. We were not a very physically affectionate family and the nurses encouraged us to give my mother hugs when she was not at risk for infections. They also gave her lots of back rubs. One of the nurses gave my mother a relaxation audiotape, which she listened to for hours, others provided her with poetry books. I believe it was partly the nurses’ physical and emotional care that enabled my mother to live as long and to fight the cancer for as long as she did. During the course of my mother’s illness, she received five rounds of chemotherapy over a period of ten months. Unfortunately her efforts to combat the cancer were unsuccessful and she died of complications of the disease and from the cumulative toxic side effects of the chemotherapy.After observing all the ways the nurses cared for my mother, I decided this was what I wanted to do and I decided to go to nursing school instead of medical school. I was able to apply my pre–med prerequisite courses to an accelerated nursing program [End Page E16] and I graduated with my bachelors in nursing after 18 months of nursing school.My nursing program emphasized the importance of viewing the patient as a whole person and not merely viewing them in terms of a particular disease or condition. Nursing school also reinforced how important nurse caring was for patients. I remember one of our exam questions focused on caring. The question was about a nurse walking into a patient’s room and finding the patient... (shrink)

Our analysis in this paper unfolds on two levels: a critique of the ‘realities’ of graduate nursing education and an argument to sustain its ‘ideals’. We open for discussion an aspect of graduate nursing education dominated by instrumental reason, namely the research industry, using an internal critique approach developed by Max Horkheimer and Theodor Adorno of the Early Frankfurt School. As we explain, internal critique arises out of, and relies on, the mismatch between goals, or ‘ideals’, and existing realities. Thinking (...) about ‘ideals’ of the academy, we draw on Hans-Georg Gadamer's view of the university as a place to think freely, creatively, and critically. The contemporary realities of the university, on the other hand, that emphasize the market values of the research industry forcefully shape nursing academic scholarship in a particular direction. In our attempt to recognize and disrupt the forces of the research industry with its instrumental reason, we consider Judith Butler's writings on how norms operate in society. We show that our growing involvement in the research industry makes it very difficult to disentangle ourselves from that situation. The values of the research industry actually suppress the very ideals of education and scholarship that we would like to uphold. As a contra-force, the internal critique of the ‘existing realities’ in the graduate nursing education unmasks the tyranny of the research industry and makes visible the importance of sustaining the higher goals and ideals in nursing scholarship. (shrink)

Drawing on a comprehensive, pan-national analysis of the corporatization of Canadian universities, as well as the notions of ‘parrhesiastic’ mentorship and practice, the authors examine the effects of the corporatized university, its implications for graduate nursing education and nursing's relative silence on the subject. With the preponderance of business interests, the increasing dependence of universities on industry funding, cults of efficiency, research intensivity, and the pursuit of profit so prevalent in today's corporatized university, we argue that philosophical presuppositions so crucial (...) to critical teaching, research, and reflection on nursing as a discipline are troublingly losing ground. We lament the erosion and fragmentation of philosophy, politics, and ethics as foundations for graduate education, which are increasingly perceived as less valuable, problematic, and in some cases, even burdensome. The effect of corporatization is the suppression of the critical engagement required of faculty in the everyday workings of institutions. We argue that, when the ideals of intellectual freedom, academic responsibility, duty, and obligation, as supported by philosophical thought, are smothered by the normalizing power of corporatized research agendas, philosophical approaches to inquiry and knowledge development become marginalized as scholars find themselves floundering in the face of a seeming ‘philosophy lost’. (shrink)

Canadian Schools of Nursing rest upon white, colonial legacies that have shaped and defined what is valued as nursing knowledge and pedagogy. The diversity that exists in clinical nursing and is emerging within the graduate student population is not currently reflected within nursing faculty and academic leadership. Black, Indigenous, and People of Color (BIPOC) nurse leaders, historically and presently, are repeatedly left unacknowledged as knowers and keepers of nursing knowledge. This lack of diversity persists across nursing knowledge generation, research, and (...) healthcare practices that ultimately aim to serve the increasingly diverse Canadian population. This narrative inquiry study examined the experiences of eight BIPOC graduate nursing students as they navigated white academic nursing spaces. The findings are presented to reflect their experiences of entrenched in whiteness, erasure of identity, and navigating belonging. These study findings highlight the importance of surfacing academic nursing history shaped by colonialism and racism, the need to diversify nursing faculty and the graduate nursing student population, and implementing nursing curricular and syllabi audits to ensure that they reflect the multitude of ways of knowing to expand dominant Eurocentric and Western knowledge in nursing education. (shrink)

Background Altruism is the core of nursing professionalism. Graduate nursing education in China started late and is still developing, exploring the current state of altruistic behavior and the perceived experience of altruism among graduate nursing students may have important implications for nursing education. Objective Explore the current state of altruistic behavior and the perceived experience of altruism among graduate nursing students in China. Research design This is a descriptive phenomenological qualitative research study, semi-structured in-depth interviews were conducted. Seventeen graduate nursing (...) students from three schools were selected to participate in the study. Colaizzi’s analysis method was performed with NVivo software to develop common themes from the data. Ethical considerations The research proposal was approved by the Research Ethic Committee of Yangzhou University, China. Results Four themes emerged from the analysis of the interviews of the 17 participants: “Definition of altruism,” “Altruism in the nursing profession,” “Altruism applied in practice,” and “Factors influencing altruistic behavior.” Conclusions Although participants indicated that the concept of “altruism” was relatively new to them, altruistic behavior is common in both their work and life. Many factors influence the altruistic behavior of graduate nursing students, including the environment, personal factors, education, recipient factors, occupational factors, and gains and losses. Families, schools, and hospitals should create favorable environments to foster altruistic tendencies in students. (shrink)

Social contracts are the mechanisms by which society legitimizes professions and grants them authority and autonomy to carry out their functions. The nursing profession is currently renegotiating its contract with society in a manner which clearly reflects a change from physician dominance, and emphasis on illness care to increased independent and autonomous functioning within a newly developing framework of nursing science which emphasizes health care. In return for their services, nurses are also negotiating for those benefits which historically (...) they have not received. These include legitimization of their newly acquired autonomous role functions, and adequate reimbursement mechanisms and structures. When the contemporary role of the nurse is fully legitimzed, the impact on contemporary society and health care is likely to be enormous. (shrink)

This article reports on research that examines newly qualified UK nurses’ experiences of implementing their ideals and values in contemporary nursing practice. Findings are presented from questionnaire and interview data from a longitudinal interpretive study of nurses’ trajectories over time. On qualification nurses emerged with a coherent and strong set of espoused ideals around delivering high quality, patient‐centred, holistic and evidence‐based care. These were consistent with the current UK nursing mandate and had been transmitted and reinforced (...) throughout their ‘prequalification’ programmes. The existence of professional and organisational constraints influenced their ability to implement these ideals and values once in practice. Data analysis revealed that within 2 years in practice the newly qualified nurses could be categorised as sustained idealists, compromised idealists, or crushed idealists. The majority experienced frustration and some level of ‘burnout’ as a consequence of their ideals and values being thwarted. This led to disillusionment, ‘job‐hopping’ and, in some cases, a decision to leave the profession. These data are explored and discussed to inform the question of whether the current nursing mandate is sustainable. (shrink)

This study describes the level of moral sensitivity among nursing students enrolled in a traditional baccalaureate nursing program and a master’s nursing program. Survey responses to the Modified Moral Sensitivity Questionnaire for Student Nurses from 250 junior, senior, and graduate students from one nursing school were analyzed. It was not possible to draw conclusions based on the tool. Moral category analysis showed students ranked the category structuring moral meaning highest and interpersonal orientation second. The moral issue ranking highest was (...) honesty, respect for the patient second, and third was responsibility to know the patient’s situation. Seniors agreed more often about the need to focus on patient safety. As students progress through the baccalaureate program and into the graduate program, their perspectives increasingly recognize the contextuality of moral issues. The results show a need to further develop a tool to measure moral sensitivity, using student understanding and perceptions of moral issues. (shrink)

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

Istarted my nursing career as a pediatric nurse working with children and their families at the Children's Hospital National Medical Center in Washington, DC. My first position was a staff nurse on a busy surgical floor called 4 Blue. To some degree, and as I reflect on that time, one is never truly prepared as a newly minted nurse or physician for the realities of becoming a clinician. So it was for me. I initially worked a rotational schedule of (...) two weeks of days and two weeks of nights where textbook pediatric cases became everyday experiences. Caring for the most complex of childhood illnesses included patients with osteosarcoma, Wilms tumor, neuroblastoma, short gut syndrome, biliary... (shrink)

This paper describes the first phase of an ongoing education and research project guided by three main intentions: (1) to create opportunities for phronesis in the classroom; (2) to develop new understandings about phronesis as it relates to nursing care generally and to caring for specific groups, like formerly incarcerated adults; and (3) to provide an opportunity for formerly incarcerated adults and graduate nursing students to participate in a dialectical conversation about ethical knowing. Gadamer's writings on practical philosophy, phronesis, and (...) the Socratic dialectic provide the philosophical foundation and framework for the project. The first phase in the project was a 4‐h class within a graduate‐level health promotion course during which 30 nursing students and three formerly incarcerated panelists engaged in a dialectic conversation about what it means to care for formerly incarcerated adults in a meaningful way. After the class, two focus groups were conducted, one with the students and one with the formerly incarcerated panelists. Findings articulated participants' prejudices and assumptions prior to the class, expanded sense of phronesis, and ability to consider nursing practice within a larger ethical framework. Panelists and students left the class with a deeper understanding of one another and expressed an openness towards continued dialectic conversations together. Use of the Socratic dialectic within nursing curricula reflects a current and critical trend in nursing education to bring non‐epistemologic forms of knowledge into the classroom. (shrink)

Nurse clinician‐scientists are increasingly expected to show leadership aimed at transforming healthcare. However, research on nurse clinician‐scientists' leadership (integrating researcher and practitioner roles) is scarce and hardly embedded in sociohistorical contexts. This study introduces leadership moments, that is, concrete events in practices that are perceived as acts of empowerment, in order to understand leadership in the daily work of newly appointed nurse clinician‐scientists. Following the learning history method we gathered data using multiple (qualitative) methods to get close to their (...) daily practices. A document analysis provided us with insight into the history of nursing science to illustrate how leadership moments in the everyday work of nurse clinician‐scientists in the “here and now” can be related to the particular histories from which they emerged. A qualitative analysis led to three acts of empowerment: (1) becoming visible, (2) building networks, and (3) getting wired in. These acts are illustrated with three series of events in which nurse clinician‐scientists' leadership becomes visible. This study contributes to a more socially embedded understanding of nursing leadership, enables us to get a grip on crucial leadership moments, and provides academic and practical starting points for strengthening nurse clinician‐scientists' leadership practices. Transformations in healthcare call for transformed notions of leadership. (shrink)

Palliative care and euthanasia have become the subject of ethical and political debate in Poland. However, the voice of nurses is rarely heard. The aim of this study is to explore the perception of palliative care and euthanasia among recent university bachelor degree graduates and experienced nurses in Poland. Specific objectives include: self-assessment of the understanding of these terms, recognition of clinical cases, potential acceptability of euthanasia, and an evaluation of attitudes towards palliative care and euthanasia. This is (...) an exploratory study. A convenience sample of 206 recent graduates and 252 experienced nurse practitioners were interviewed. A structured questionnaire was used for collecting and interpreting data. Subjective perception of the terms `palliative care' and `euthanasia' was high and consistent with the recognition of clinical cases. The majority of the nurses excluded euthanasia from palliative care. They recognized personal philosophy of life as the most influential factor affecting attitudes towards euthanasia. The importance of the law was valued more highly by the experienced nurses. (shrink)

Background Ethics communication has been described as a pedagogical form, promoting development of ethical competence among nursing students. The ‘one to five method’ was developed by this research group as a tool for facilitating ethical communication in groups among healthcare professionals but has not yet been evaluated. Aim To explore post-graduate nursing students’ experiences of practicing ethical communication in groups Research design The study design is qualitative. Participants and research context The study comprised 12 nursing students on a post-graduate course (...) for Registered Nurses focusing on palliative care. After education the students engaged as participants and facilitators in ethics communication in groups, with support from the ‘one to five method’. Data were derived from the students written reflections and subjected to thematic analysis. Ethical considerations The study was performed in accordance with the ethical standards in the 2013 Helsinki Declaration and approved by the Ethics Committee of the Medical Faculty at Umeå University Results An overall theme was identified, ‘being supported to achieve a democratic dialogue concerning ethical problems’ and five themes, related to each step of the ‘one to five method’. The themes concerned: putting the experience of an ethical dilemma into words; being confirmed by shared emotions; defining the value conflict using ethical principles; expressing virtues of empathy and raised awareness; jointly finding various action approaches. Discussion Regular ethics communication in groups encourages nursing students to actively seek understanding and clarification of ethically difficult situations. Conclusions The results indicate that ethics communication in groups could be a way of developing virtues during education. Interventions using the ‘one to five method’ need to be further studied among student groups from other healthcare contexts. (shrink)

ObjectivesTo examine implicit and explicit attitudes toward gay men and lesbian women among heterosexual undergraduate and graduate psychology and nursing students.MethodsImplicit attitudes were measured via the Implicit Association Test and explicit attitudes via the Attitudes Toward Lesbian Women and Gay questionnaire.Main resultsAll groups held negative implicit attitudes toward gay men and lesbian women. Among undergraduates, nursing students reported holding more negative explicit attitudes toward gay men and lesbian women than psychology students.ConclusionThe curricula in both nursing and psychology studies need to (...) address the medical and paramedical needs and issues of sexual minorities. (shrink)

What is Reflection? -- Human Factors -- Models of Reflection -- Reflection and NMC Revalidation -- Writing Reflectively -- Improving Care Through Reflection -- Critical Reflection -- Reflective Assignments -- Case Study 1 - Reflection in Practice - Newly Qualified Nurse (using Through the looking glass model of reflection) -- Case Study 2 - Reflection in Practice - Nursing Associate (using ERA Model of reflection) -- Case Study 3 - Reflection in Practice - Mental Health Nurse (using Rolf et (...) al Model of reflective practice) -- Case Study 4 - Reflection in practice - Qualified Nurse (using the REFLECT Model of reflection) -- Case Study 5 - Reflection in Practice - Learning Disability Nurse (using the Gibbs Model of Reflection) -- Case Study 6 - Reflection in Practice - Midwife (using the NMC Reflective accounts model) -- Reflection in Practice - Reflective Journal extract. (shrink)

Graduate nursing students should have a strong ethical theoretical foundation to identify and explore scientific and technological ethical issues impacting nursing care, to assume leadership positions in practice and education, and to conduct research contributing to nursing’s knowledge base. This paper reports the implementation and evaluation of a new ethics course at Turkish doctoral nursing programs. The first section describes course design and implementation. The second section evaluates the course and discusses results. Students’ evaluations indicated that the concept of caring (...) in key ethical theories, particularly care ethics, was vital to course content. The most preferred teaching method was case analysis. Students suggested increase in course length and credits, content inclusion of feminist ethics, and real-world knowledge application by other teaching strategies such as clinical practice visits and hospital ethics committee member participation. (shrink)

This paper challenges nurses to join together as a collective in order to facilitate ongoing analysis of the issues that arise for nurses and patients when nursing care is harnessed for health care efficiencies. It is a call for nurses to respond with a collective strategy through which we can ‘talk back’ and ‘act back’ to the powerful rationality of current thinking and practices. The paper uses examples from an institutional ethnographic (IE) research project to demonstrate how (...) dominant approaches to understanding nursing position nurses to overlook how we activate practices of reform that reorganize how we nurse. The paper then describes two classroom strategies taken from my work with students in undergraduate and graduate programs. The teaching strategies I describe rely on the theoretical framework that underpin the development of an IE analysis. Taken into the classroom (or into other venues of nursing activism) the tools of IE can be adapted to inform a pedagogical approach that supports nurses to develop an alternate analysis to what is happening in our work. (shrink)

Public, private, non-profit and for-profit nursing education enterprises in the U.S. are competing with one another in a newly complex and volatile educational landscape, placing academic leaders into situations fraught with moral, ethical and legal compromise with few precedents for guidance. This case study provides a richly contextualized narrative exploration of ethical and legal challenges to one leader’s moral courage, a fictionalized exploration drawn from multiple sources over time, to form a composite that is nonetheless firmly rooted in the (...) complexity and competitiveness characteristic of nursing education today. Our purpose is three-fold: 1) to direct the reader to moral and ethical questions that require thoughtful discourse and analysis among current and future academic nursing leaders; 2) to raise the issue of the need for regulations and oversight that reflect the changing realities of today’s increasingly complex and competitive educational arena; and 3) to encourage nursing education leaders to share additional cases that resonate for them, and in so doing, to expand the wellspring of ideas from which we can all draw in becoming more effective and morally courageous leaders. (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)

Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the (...) institutional review board (#191046). Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed. (shrink)

Background:Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described.Research aim:To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in (...) the neonatal intensive care unit.Research design:This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues.Participants and research context:All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software.Ethical considerations:The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189).Findings:Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners.Discussion:Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care.Conclusion:In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions. (shrink)

Although thousands of articles and books appear annually in the field of nursing ethics, the sheer volume of scholarly publications points to the need to provide assessment and focus, and that is what this book offers. Nursing and Healthcare Ethics documents the work of nurse scholars in ethics, and goes well beyond a mere documentation of what has transpired and a list of what can be done in the future. It creatively looks back to assess previous accomplishments and forward to (...) find new directions and strengthen future scholarly contributions in nursing ethics. Critical thinking activities, organized by the book s themes (such as vulnerability, care and caring, diversity and disparity, and pain and suffering) are examples of applying these scholarly insights into practice. This book is intended not only for undergraduate and graduate students in academic settings, but also for those in professional development programs. (shrink)

The total value set of a working individual consists of three components: personal, professional and organizational values. In the light of the changing health care environment, the individual nurse manager’s values may no longer be applicable for coping with the needs of the work environment. For many nurses who developed their values in keeping with the humanistic tradition, the ‘new’ organizational values may create confusion, frustration and conflict. The purpose of this study was to determine if the organizational domain (...) in the value sets of Israeli middle nursing managers in acute care hospitals reflect the process of shifting values needed in today’s management roles. Analysis of the results revealed that head nurses did not yet fully internalize the ‘new’ organizational values. Implications of the results for planning undergraduate and graduate programmes are detailed. (shrink)

Background Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners. Research Objective The aim of this research is (...) to explore the influence of a structured self-assessment tool called the ESA “Engagement Self-Assessment” on the alignment and creation of a brave space in a nursing ethics course. Research Design This study used an exploratory, cross-sectional survey design. Participants and Study Setting Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited. Ethical Considerations Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03). Findings The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual “commitment to others.” Conclusion A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space. (shrink)

The average age of women nursing students in Australia is rising. With this comes the likelihood that more now begin university with family responsibilities, and with their lives structured by the roles of mother and partner. Women with more traditionally gendered ideas of these roles, such as nurturing others and self‐sacrifice, are known to be attracted to nursing as a profession; once at university, however, these students can be vulnerable to gender role stress from the competing demands of study. A (...) qualitative research design, guided by Gadamer's hermeneutic philosophy, explored the gendered behaviours and experiences of 22 women nursing students, all of whom had children and began university in a heterosexual intimate relationship. The findings reveal traditional ideas of gender were almost universal among participants, and these ideas had a significant influence on the nursing degree experience. Participants commonly prioritised family over the university and practiced maternal gatekeeping (prevention of male partner involvement in domestic work). These traditionally gendered behaviours, coupled with experiences of gender role stress, had a detrimental impact on participants' capacity to study and their personal wellbeing. The importance of these findings to the burgeoning nursing workforce shortage nursing is considered in terms of student retention and the supply of graduates into the profession. The implications to the nursing profession are also explored against the evidence that nursing students with traditional gender beliefs are less likely to develop as autonomous, critical thinking nurses compared to their gender‐egalitarian peers. The introduction of gender theory via critical pedagogy in the undergraduate nursing degree curriculum is recommended to enlighten and empower women nursing students and promote the competence, agility, and sustainability of the nursing profession. (shrink)

Background Improving the competencies of nurses requires improving educational methods through the use of novel methods in teaching and learning. We aim to explore the perceptions of stakeholders (including nursing education directors, faculty members and nursing students) of the requirements of implementing innovative educational approaches in nursing. -/- Methods In this qualitative descriptive study, 19 participants, including educational directors, faculty members, and undergraduate and graduate nursing students, were selected through the purposeful sampling method. Achieving the theoretical saturation in extracted (...) categories was considered as a criterion for determining the sample size and the completion of sampling. The data were collected from December 2019 to May 2020 in nursing schools of Tehran, Iran, through in-depth semi-structured individual face-to-face interviews and were then analyzed based on the Graneheim and Lundman method. -/- Results Using qualitative content analysis, eight sub-themes and three themes were extracted. The extracted themes were ‘novel educational policymaking’, ‘Innovative education-oriented platform’, and ‘managing barriers of innovative educational approaches’. -/- Conclusions Developing and implementing innovative educational approaches entail providing appropriate context, structure, and required facilities by the policymaking system and educational authorities. In addition, developing capacity and related competencies of faculty members and students as the major stakeholders in employing these approaches is crucial. (shrink)

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

In lieu of an abstract, here is a brief excerpt of the content:To Nurse BetterJaime HenselWhen things were quiet again I asked him what training he’d had to become the director of hospital security. “I worked for 20 years in corrections,” he answered proudly, and I was saddened but not surprised.In September 2010 I started an accelerated graduate entry nurse practitioner program to become a family nurse practitioner. Accelerated programs leave little time for preamble, since the idea is to take (...) a total novice and turn her first into a nurse and then into a nurse practitioner in just three years. While the classroom information was vital, it was our clinical experiences that really initiated us into the profession. In just the second week of school, we were divided into small groups and assigned to clinical preceptors—hands–on teachers who introduced us to our first patients, curbed our mistakes, quelled our fears, and pushed and pulled and cajoled us into being nascent healthcare providers. In showing us how to give bed baths, suction secretions, insert Foley catheters, and hang IV bags, our preceptors really began showing us how to use our hands as healers.In that first semester my patients also proved to be invaluable instructors. Talking to them, administering their medication, washing their bodies made me keenly aware of the delicate balance of vulnerability and power and trust and respect and intimacy that underlies all healthcare relationships. I hope, wherever those patients are now, they know how deeply I appreciate their patience and good humor and their collusion in my education.In December, the first semester and the first clinical rotations ended. Four months into nursing school I had a basic understanding of what it means to be a nurse. Frankly, most days I still felt like an impostor in blue pajamas sporting a stethoscope I didn’t really know how to use and new Dansko clogs that squeaked with every step. But in an accelerated program, fast and furious is the name of the game. We went away for winter break—a much needed breather—and came back to something completely different: psychiatric nursing.In preparation for these new clinicals, we were taught in class that we should not wear dangly jewelry or stethoscopes. That we should never let the patient get between us and the door. That psychiatric (psych) patients could escalate quickly; psych patients could have surprising triggers; psych patients could be very unpredictable. And psych patients could be violent. We were taught about physical and chemical restraints, and about show of force. We were cautioned, as students, to stay out of the way if things got tense on the floor. In stark contrast to medical patients, psych patients were made to sound less like people who had diseases and more like adversaries. I drove to my first day on the floor with trepidation.My new preceptor had spent her entire career in psych. She loved her job, loved the care of psychiatric patients. She set up a rotation because she wanted our entire clinical group to get full exposure to the breadth of psychiatric services offered by this medium–sized community hospital. We would each get to spend shifts on the locked psych floor, observing outpatient group therapy sessions, and in the psych emergency department (ED).I rotated to the psych ED for the first time on a Friday night. The first couple hours of the shift were very slow. I started talking to the mustachioed guard on duty, who looked as bored as I felt. He told me about his kids, I told him about nursing school. He seemed nice.When our conversation flagged, I explored the psych ED. It didn’t take long—just a short hallway with a bathroom, the social workers’ office, and two patient rooms without doors. The majority of the designated psych beds were actually around the corner in the main room of the medical ED—stretchers lined against the wall, without curtains or any [End Page 98] other attempt at privacy. I noticed that from where the guard stood at the corner of the psych hall he had a pretty good view of all the beds. Then again, so did most of the other patients... (shrink)

ArgumentThis paper focuses on the Jewish nursing profession in Poland during the interwar period. We argue that the integration of Jewish women in medical activity under the AJDC (American Jewish Distribution Committee) and TOZ (Towarzystwa Ochrony Zdrowia Ludności Żydowskiej [the Society for the Protection of the Health of the Jewish People]) emerged in Poland less from the adoption of gender equality and more out of necessity. On the one hand, JDC and TOZ needed Jewish nurses and public health (...) class='Hi'>nurses to carry out their health campaigns and build a public health infrastructure. On the other hand, a new generation of Jewish women needed job opportunities that would enable them to make a living and be independent. More broadly this case study shows that the implementation of American “reformative” ideals into the local Polish reality, including in the newly emerging public health field, involved adaptation, negotiation, and in some cases, resentment. (shrink)

Mobility is becoming a defining feature of today’s globalising society. Individuals move for a variety of reasons, including finding employment or pursuing education. This paper focuses on the interrelationship between two different types of migrants who have all moved out of one specific country to another. It builds on the perceptions of Turkish graduates of German universities who moved cross-border recently to study in German universities, the self-styled ‘New Wave Turks’, to understand their place within the existing Turkish diaspora there. (...) Although the existing Turkish diaspora in Germany is well researched, as is how diasporas can facilitate further mobility, the interaction between these newcomers and the existing Turkish diaspora in Germany has received little scholarly attention. Through in-depth semi-structured interviews with recent Turkish graduates of German universities, we explored how the existing diaspora provides support but also challenges for the newcomers, complicating their experiences. We argue that international student mobility led to the emergence of a new form of ‘total diaspora’ in Germany, comprising both the existing Turkish diaspora and newly joined Turkish graduates of German universities. Social media was instrumental for these newcomers in setting themselves apart within the total diaspora, allowing them to create their own community identity. (shrink)

Nursing faces an uncertain future as technological developments, structural changes within health systems and rapidly evolving health needs create new and challenging possibilities. This article draws on the results of a qualitative study undertaken with a range of Queensland nurse leaders to explore their perceptions of these changes. The study re‐surfaced, and allows for a re‐examination of, four issues that have long created tension within nursing and which continue to have a negative impact on the profession as a whole. These (...) are as follows: professionalisation; preparation of graduates; myths and narratives of nursing; and leadership. We provide a metaphor that imagines all of these tensions operating in dynamic interplay. The image is that of a Newton's Cradle – a model for energy and momentum. The metaphor allows one to see the wide context of changes affecting nursing and the significance of the interconnections. If tensions within nursing maintain their own integrity through containment, understanding and development, they remain in alignment, and energy is conserved rather than wasted or misdirected. It suggests that with increased awareness and attention paid to internal challenges, and by taking a broad‐based approach to systemic improvements, nursing could become more effective, progressive and proactive in shaping its own future. (shrink)

Background:New graduate transition into the workforce is challenging and can involve managing ethical tensions. Ethical tensions cause new graduates to doubt their capabilities due to their lack of experience. To support new graduates, we need to know what these ethical tensions are.Objectives:To explore the ethical tensions perceived to occur in practice for new graduate health professionals.Research design:This qualitative systematic review involved a search of five databases (Medline, EMBASE, AMED, CINAHL and Scopus) which resulted in the retrieval of 3554 papers. After (...) the two-phased screening process, eight studies were identified that met the inclusion criteria and had rich data on the review question. Articles were read several times, critically appraised and analysed through thematic analysis.Ethical considerations:No ethical approval was required for the systematic review. The review was conducted following well-established reporting guidelines enabling transparency and rigour.Findings:Studies originated from Australia, United States, Iran and China. One study included speech pathologists and seven were with nurses. Four themes included the following: (1) enduring an unknown workplace culture that generates uncertainty without support for new graduates; (2) being vulnerable because of distress from bullying, exclusion and being a scapegoat; (3) constraining systems and institutional restrictions that cause dilemmas; and (4) experiencing disillusionment from lost ideals about ethical practice.Discussion:This review has brought to light the vulnerability of new graduates to negative workplace culture and collegial incivility. In addition, new graduates are subjected to ethical tensions created by institutional constraints which can create dilemmas and uncertainties through practice that does not align with what they anticipated.Conclusion:Understanding ethical tensions experienced by new graduates enables provision of informed support. There needs to be considerable cultural change for orientation and socialisation of new graduates to enable them to learn and manage ethical tensions. (shrink)

Background: Double degrees in nursing and midwifery have evolved in Australia as a proposed solution to possible impending shortages of qualified midwives in the healthcare workforce. The double degree is seen as a more acceptable option in non-metropolitan areas in particular. Concern has been expressed however, about dilution of midwifery philosophy and graduates opportunities in respect of future clinical practice. Aim: This study aimed to provide a better understanding of motivations and intentions of students who undertake the Bachelor of Nursing (...) Science/Bachelor of Midwifery double degree. Methods: A cross-sectional survey design was employed at four universities that offered double degrees in nursing and midwifery in three states of Australia. Students enrolled in first and fourth year of a double degree and graduates of a double degree were invited to complete an online survey comprised of Likertscales and items requiring free text responses. Quantitative data was analysed using SPSS and thematic analysis was used to analyse the qualitative data. Findings: Participants indicated a clear preference for midwifery as a career with this preference increasing for each cohort at each stage of study. Discussion: Primary reasons for selecting a double degree were perceived increased opportunity for employment and use of nursing skills to enhance midwifery practice in a population with growing co-morbidities. A strong identification with midwifery philosophy and identity was also demonstrated.Conclusion: An understanding of motivations and career intentions of students undertaking double degree studies can inform future program development and workforce planning. (shrink)