Ethics, agency and empowerment in nurse education

Ways of walking, speaking and listening: Nursing practices and professional identities among Polish nurses in Norway

This article explores the lived experiences of Polish nurses' transition into the Norwegian healthcare system and analyses the emerging differences in nursing practices and professional identities between Poland and Norway. It draws on ethnographic findings and argues that nursing is a complex practice, which involves not only nursing knowledge, but also less obvious and often taken for granted nursing imaginaries and actions. In doing so, the article looks at different ways of walking, speaking and listening, which are not merely nurses' daily habits, but also the embodiments of hierarchical relations, agency and empowerment in healthcare settings. This kind of analytical perspective of the existing differences in nursing practices and professional identities between Poland and Norway raises crucial questions about transitional contexts of nurse migration and shows that nursing is not static, but rather a dynamic and processual way of conduct.

Achieving moral health care: the challenge of patient partiality

Illness and hospitalization are sources of vulnerability; they arguably endow nurses and midwives with the moral obligation to develop caring relationships with patients. Fairness and the equal treatment of patients are central to moral practice; current government publications are giving this political emphasis. This article argues that patient partiality is one factor that may result in insidiously unequal caregiving. Data generated during a qualitative study into professional caring suggest that patient partiality is an accepted part of everyday practice. Factors such as the patient's personality, nurse-patient familiarity and the perceived level of patients' understanding and interest in their illness emerged as possible sources of partiality and influence on practitioners' interactions with patients. The article argues that patient partiality can be managed morally if practitioners develop self-awareness and constantly reflect on the moral integrity of everyday practice. Throughout the article, unless it is stated that specific reference is being made to either nurses or midwives, reference to a nurse or practitioner denotes both. It is also emphasized that no implication is intended that any study participants provided unequal care. Rather, data are utilized solely to generate focused discussion around the concept of patient partiality.

Preserving moral integrity: a follow-up study with new graduate nurses

The purpose of this follow-up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation. The method was qualitative, specifically grounded theory. The earlier study took place when informants were senior nursing students. The follow-up study began after the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to the 'real world' of hospital nursing? What do they describe as factors influencing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psycho-social process that explained how these new graduate nurses adapted to the real world of hospital nursing. Six stages of this process were identified: vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self-concept. Moral distress was a consequence of the effort to preserve moral integrity. It is the result of believing that one is not living up to one's moral convictions. Data supported that the most pervasive attributes of moral distress were self-criticism and self-blame, as informants judged their actions against their moral convictions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants questioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findings are grounded in social interaction and moral psychology theories.

Uncertainties in the teaching of ethics to students of nursing

Whilst ethics is now commonplace on nursing curricula in the United Kingdom there remains doubt as to how and what to teach. This doubt has its origins in interlinked uncertainties within nursing, ethics and education. In nursing there are uncertainties about whether we are teaching ethics to professionalize or because we are a profession, and about whether there is something which is uniquely 'nursing ethics'. In ethics there are competing paradigms of ethical theory and competing theories of moral development. In education there are competing epistemologies, theories of learning and models of curriculum planning. These uncertainties are interlinked and an understanding of them will help clarify the debate as to what to teach and how to teach it.