Preserving nurses' professional dignity: Six evidence-based strategies

Unveiling nurses' perspectives on decent work: A qualitative exploration

AIM

This study explores nurses' perspectives on the concept of "decent work" and the factors influencing their viewpoints.

DESIGN

This qualitative study employed a conventional content analysis approach using face-to-face interviews.

METHODS

In-depth interviews were conducted with 20 registered nurses at two tertiary hospitals in Hangzhou, China, from October to November 2023.

FINDINGS

Decent work for nurses refers to their engagement in a profession within a secure, fair, and friendly practice environment where they could receive respect, support, reasonable compensation, social security, and opportunities for career development, all of which could enable nurses to recognize their intrinsic values and achieve a state of professional and personal fulfillment. Key factors that influence decent work for nurses include the work environment, societal perceptions, and individual characteristics.

CONCLUSIONS

The concept of decent work holds paramount importance for nurses, necessitating collaborative efforts at the individual, family, institutional, and societal levels to promote the professional dignity of nurses and enhance the quality of nursing care.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policymakers should establish regional minimum wage standards for nurses, promote flexible scheduling, and support professional development through subsidized training programs. Additionally, national media campaigns and comprehensive mental health support can enhance the public image and resilience of nurses, respectively, improving their decent work perception.

Support needed by nursing students to develop professional dignity

BackgroundNursing students' professional dignity development during work-integrated learning is dependent on support from professional nurses. If they are left unsupported, such development is jeopardised.AimThe aim of the study was to explore and describe the support that nursing students need from professional nurses, including their lecturers, during work-integrated learning to develop professional dignity.Research designA qualitative, exploratory-descriptive research design applied. Through volunteer sampling, participants were invited for face-to-face in-depth individual interviews to discuss the question: 'What support did you need from others during work-integrated learning to feel dignified as nursing students?' Saturation of data determined the number of participants. Recording of the interviews and the writing of field notes were carried out with the permission of the participants. Manual coding in a thematic analysis was done to analyse the intricate data content with intuition and insight.Participants and research contextThe study was undertaken in South Africa at a designated nursing education institution and the hospital where the students performed the bulk of work-integrated learning. Fourteen third-year students were interviewed. They had sufficient experience with work-integrated learning and could provide rich data concerning support needed to develop professional dignity.Ethical considerationsThe Faculty of Health Sciences Research Ethics Committee at the University of Pretoria approved the proposal (Reference number 73/2023) and the applicable authorities gave written permission for the research to be conducted. Since the participants were students, the researchers made sure that they did not feel obliged to participate.FindingsFour categories were identified, namely, (a) improving work-integrated learning experience, (b) value students' professional development, (c) cooperate to benefit students' professional growth and (d) manage resources optimally.ConclusionStudents needed to be respected and their input to quality nursing care acknowledged. Positive role models and learning conducive clinical environments contributed to their development.

Development and Psychometric Testing of the Nurses' Professional Dignity Scale

Background/Objectives: Human dignity is an inalienable value central to human rights and ethics. Professional dignity is pivotal to fostering self-esteem, job satisfaction, and high-quality care in nursing. Despite its importance, no validated tool currently exists to measure nurses' professional dignity in English-speaking contexts. This study aimed to develop and psychometrically test the Nurses' Professional Dignity Scale (NPDS). Methods: The tool's development was guided by a theoretical model from a meta-synthesis. A consensus meeting with five nurse researchers identified three core dimensions for the NPDS: Respect, Professional Value, and Appreciation. Nineteen items were initially generated and refined through face and content validity assessments (all item-level content validity indices [I-CVIs] ≥ 0.80; scale-level content validity index/Ave [S-CVI/Ave] = 0.92). Psychometric testing was conducted with 227 nurses across clinical settings in the United States using confirmatory factor analysis (CFA) to validate a three-factor model. Results: The CFA confirmed the three-factor model with acceptable fit indices (CFI = 0.938, TLI = 0.923, RMSEA = 0.069), resulting in the retention of 15 items. The scale demonstrated excellent reliability, with composite reliability coefficients of 0.92 for Respect, 0.82 for Professional Value, 0.93 for Appreciation, and 0.91 for the overall scale. Conclusions: The NPDS is a valid and reliable measure of nurses' professional dignity, aligning with theoretical frameworks. It captures both status-dignity and condition-dignity aspects, encompassing respect, professional competence, and societal appreciation, offering a multidimensional structure for assessing individual domains and overall scores. The NPDS contributes to advancing nursing research and practice by addressing workplace dignity, enhancing job satisfaction, and fostering supportive organizational environments that recognize nurses' professional worth. Future studies are recommended to validate the scale in diverse populations and explore its stability over time through longitudinal research. This study highlights the importance of preserving nurses' dignity in improving professional identity, workplace environments, and patient care outcomes.

EQUANU: Equality in Societal and Professional Recognition of Nurses-A Cross-Sectional Study on Societal and Professional Recognition of European Nurses

Background: Despite trends towards greater professionalisation of the nursing profession and an improved public image in certain countries, studies also show that large proportions of the public still do not fully appreciate nurses' competencies. Mapping differences in the societal and professional recognition of nurses allows for benchmarking among countries. Aim: To investigate the level of societal recognition of the nursing profession in nine European countries, and the level of professional recognition perceived by European nurses themselves; to compare levels of recognition between countries; and to identify influencing factors. Methods: A cross-sectional study was conducted. Through an online survey, the study surveyed both the general public and nurses from various healthcare settings across nine countries between December 2022 and June 2023. The instrument used was a combination of self-developed questions on societal and professional recognition, the Work Motivation Scale and an adapted version of the Multidimensional Work Motivation Scale. Data were analysed using SPSS v.29.0, with socioeconomic prestige scores for the public and work environment/work motivation scores for nurses calculated accordingly. Results: A total of 1618 adult citizens and 2335 nurses participated. The public predominantly characterised nurses with attributes such as friendliness, warmth, empathy and compassion. The mean socioeconomic prestige score assigned to nurses was 7.2/10 (SD 1.9), with Portugal having the highest score (M 7.5/10, SD 2.0) and Norway the lowest (M 5.8/10, SD 1.4; p < 0.001). Professional recognition experienced by nurses was generally low (54% indicated rather low, 17% very low). Slovenia, the Netherlands and Belgium had slightly higher mean scores (all M 1.4/3) compared to other countries (p < 0.001). High professional recognition could be predicted for 33% by work environment score (OR = 1.21; 95% CI [1.19-1.24]), work motivation score (OR = 1.02; 95%CI[1.01-1.02]), expertise outside the hospital (OR = 1.57; 95% CI [1.25-1.97]) and work experience (OR = 1.01; 95% CI [1.00-1.02]) corrected for country. Conclusion: The study highlights the need for targeted interventions to improve the professional and public image of the nursing profession while addressing disparities in professional recognition between countries. Longitudinal studies are recommended to monitor changes in public perception and professional recognition among nurses.

Healthcare professionals' experiences of eHealth in palliative care for older people: challenges, compromises and the price of dignity

PURPOSE

To explore whether and how eHealth solutions support the dignity of healthcare professionals and patients in palliative care contexts.

METHOD

This qualitative study used phenomenographic analysis involving four focus group interviews, with healthcare professionals who provide palliative care to older people.

RESULTS

Analysis revealed four categories of views on working with eHealth in hierarchical order: Safeguarding the patient by documenting-eHealth is a grain of support, Treated as less worthy by authorities-double standards, Distrust in the eHealth solution-when the "solution" presents a danger; and Patient first-personal contact with patients endows more dignity than eHealth. The ability to have up-to-date patient information was considered crucial when caring for vulnerable, dying patients. eHealth solutions were perceived as essential technological support, but also as unreliable, even dangerous, lacking patient information, with critical information potentially missing or overlooked. This caused distrust in eHealth, introduced unease at work, and challenged healthcare professionals' identities, leading to embodied discomfort and feeling of a lack of dignity.

CONCLUSION

The healthcare professionals perceived work with eHealth solutions as challenging their sense of dignity, and therefore affecting their ability to provide dignified care for the patients. However, healthcare professionals managed to provide dignified palliative care by focusing on patient first.

Nurses' perception of threats to human dignity in caring for patients with COVID-19: A qualitative study

Purpose

Identifying threats to patients' dignity is crucial for maintaining and promoting their dignity. Preserving patient dignity should be regarded as both a patient's right and a moral obligation. This study was conducted to evaluate nurses' understanding of threats to human dignity in the care of patients with COVID-19.

Methods

This qualitative study was conducted using conventional content analysis in various clinical departments in Iran. Clinical nurses from different departments were selected through purposeful sampling. Data were collected via in-depth semi-structured interviews with 15 clinical nurses over two months in 2021 and analyzed using qualitative content analysis.

Results

During data analysis, two main categories and ten subcategories were identified: 1) Unethical behaviors (lack of respect for patient privacy, lack of patient involvement in decision-making procedures, ignoring the patient as an individual, aggressive behaviors, stigmatization, and failure to provide palliative and end-of-life care to patients and their families); 2) Organizational factors (inadequate financial support, lack of patient-care facilities, strict restrictions, and employing less experienced nurses in COVID wards).

Conclusion

The present study showed that most participants expressed concerns about violations of patients' dignity and identified many threats to it. Based on the findings, it is suggested that other factors threatening patients' dignity be identified, the threats eliminated, and healthy treatment environments created to promote patients' dignity.

Workplace dignity amongst clinical nurses

BACKGROUND

The workplace environment plays a pivotal role in employees' lives as they spend many hours there. Recently, greater attention has been placed on workplace conditions as a key social determinant of health. One way through which workplace conditions may affect health is workplace dignity. This study aimed to describe clinical nurses' workplace dignity.

METHODS

The study design was descriptive and cross-sectional. Clinical nurses within a tertiary institution were randomly sampled. Data collection included the Workplace Dignity scale which is an 18 item-seven-point Likert scale consisting of dignity and indignity questions (α.98, and 0.95, respectively). Data collection commenced with a pilot followed by a final data collection phase. Ethical considerations were included via informed consent, anonymity, and confidentiality. Data analysis included means, standard deviations, and Pearson correlations.

RESULTS

The pilot test yielded a reliability coefficient - α 0.93. Two hundred and thirty-six clinical nurses participated in the study resulting in a response rate of 87.4%. The average mean age of participants was 37.966 ± 0.635 (min 25- max 60) years. Most participants were female (92.8%) with a Bachelor of Science in Nursing Degree (77.5%). The overall mean experience as a registered nurse was 16.038 ± 0.589 years. Nationality responses were divided into Saudi (41.5%) and non-Saudi (58.5%). The construct of general dignity had the highest mean score of 5.52 (SD 1.46), with question 14: "I have dignity at work" having the highest overall mean score of 5.63 (SD 1.4). There was a positive correlation and statistical significance with a 'p < 0.000 i.e. as a nurses' experience as a registered nurse increased, workplace dignity scores increased.

CONCLUSION

The findings of this study indicated that inherent value and general dignity were the highest-scored constructs while indignity and respectful interaction scored the lowest. This study allows for reflection on the importance of workplace dignity, as an impactful and important organizational phenomenon that affects either positively or negatively on employee well-being and performance, hence workplace dignity must be prioritized within work environmental infrastructures.

Ethical issues experienced by nurses during COVID-19 pandemic: Systematic review

BACKGROUND

Frontline nurses who care for patients with COVID-19 work in stressful environments, and many inevitably struggle with unanticipated ethical issues. Little is known about the unique, ethically sensitive issues that nurses faced when caring for patients with COVID-19.

AIM

To better understand how frontline nurses who care for patients with COVID-19 experience ethical issues towards others and themselves.

METHODS

Systematic review of qualitative evidence carried out according to the Preferred Reporting Items for Systematic reviews and Meta-analyses on ethical literature (PRISMA-Ethics). The electronic databases PubMed, Embase, Cinahl, Web of Science, Philosopher's Index, and Scopus were queried to identify candidate articles. Articles appearing from March 1, 2020 to December 31, 2022 were considered if they met the following inclusion criteria: (1) Published qualitative and mixed method studies and (2) ethical issues experienced by nurses caring for patients with COVID-19. We appraised the quality of included studies, and data analysis was guided by QUAGOL principles.

FINDINGS

Twenty-six studies meeting our inclusion criteria for how nurses experience ethical issues were characterised by two key themes: (1) the moral character of nurses as a willingness to respond to the vulnerability of human beings and (2) ethical issues nurses acted as barriers sometimes, impeding them from responding to requests of vulnerable human beings for dignified care.

CONCLUSION

Our review provides a deeper understanding of nurses' experiences of ethically sensitive issues, while also highlighting the critical need for adjustments to be made at organisational and societal levels. Ethical issues that emerged in situations where organisational and situational constraints impeded nurses' ethical responses to patients' appeals suggests that early practical support should be made available to resolve ethical issues recognised by nurses. Such support contributes to protecting and promoting not only the dignity of patients with COVID-19 but also of fellow humans in need during crisis.

The association between appreciative management and work engagement among health- and social care professionals: A cross-sectional study

BACKGROUND

The importance of work engagement has been emphasised due to the increasing demand for health- and social care and the shortage of skilled labour. Improving organisational and managerial factors is important when enhancing professionals' work engagement. The association between management and work engagement has only been established in previous studies at a general level, but the association between appreciative management and work engagement has not received equivalent research interest.

AIM

This study aimed to describe the association between appreciative management and work engagement among health- and social care professionals.

METHODS

The study used a cross-sectional survey design. The data were collected in five health and social services centres in one city in Finland from September to October 2022 using the Appreciative Management Scale 2.0 and the Utrecht Work Engagement Scale-9. A total of 182 health- and social care professionals participated. The data were analysed using correlations, linear regression analyses, independent samples t-tests and two-way analyses of variance (ANOVAs).

RESULTS

A moderate association was found between appreciative management and work engagement and its dimensions of vigor, dedication and absorption. Systematic management had the strongest association and equality had the weakest association with work engagement. Among the dimensions of work engagement, appreciative management had the strongest association with vigour and the weakest association with absorption. Appreciative management and work type predicted 18% of the variance in work engagement. Full-time employees reported higher levels of work engagement and all its dimensions than did part-time employees.

CONCLUSION

The results indicate that appreciative management and full-time work predict work engagement among health- and social care professionals. Due to this positive association, it is important to promote managers' appreciative management skills by educating them to understand how appreciative management enables and supports professionals' vigour, dedication and absorption in health- and social care.

Implementation and effectiveness of a nurse navigation programme based on noddings' care theory in first-year undergraduate nursing students for professional identity and career planning: A quasi-experimental study

AIMS

Development and evaluation of the effectiveness of a Nurse Navigation programme based on Noddings' Care theory on two dependent variables which were professional identity and career planning among first-year undergraduate nursing students.

BACKGROUND

First-year undergraduate nursing students generally have a low sense of professional identity and career planning, resulting in a loss of nursing power after graduation. Implemention of a Nurse Navigation program based on Noddings' Care theory may be potentially useful in cultivating their professional identity and career planning.

DESIGN

A quasi-experimental study.

METHODS

A convenience sample of 122 first-year undergraduate nursing students from two medical universities was recruited between September 2021 and June 2022. Students in the experimental group (n = 63) participated in the Nurse Navigation programme based on Noddings' Care theory, which contained four core components, spreading over 50 lessons. Those in the control group (n = 59) underwent a traditional training programme with five components across 44 lessons. The two groups were compared in terms of their level of professional identity by Professional identity questionnaire for nurse students (PIQNS) and career planning by Career planning questionnaire (CPQ) after the training using the t-test.

RESULTS

The mean score of professional identity in the experimental group increased significantly from 51.02 ± 8.46 at baseline to 58.02 ± 8.81 after the intervention (p < 0.001), with a large effect size (Cohen's d=0.810). Also, this post-intervention score was statistically significantly higher than that (52.86 ± 9.27) in the control group (p = 0.002), with a medium effect size (Cohen's d=0.571). The mean score of career planning in the experimental group increased significantly from 81.76 ± 9.86 at baseline to 94.52 ± 10.81 after the intervention (p < 0.001), with a large effect size (Cohen's d = 1.233). Also, this post-intervention score was statistically significantly higher than that (88.25 ± 9.30) in the control group (p < 0.001), with a medium effect size (Cohen's d=0.623).

CONCLUSIONS

The Nurse Navigation programme based on Noddings' Care theory showed effectiveness in enhancing professional identity and career planning among first-year undergraduate nursing students in China. Further rigorous studies are needed to examine its effectiveness and long-term impacts on these students.

Threats to professional dignity of Iranian clinical nurses: A qualitative study

AIM

Identifying threats to the nurses' professional dignity has an important role in maintaining and promoting their dignity. This study aimed to evaluate the perception of Iranian nurses' experiences of threats to their professional dignity in clinical settings.

DESIGN

A qualitative directed content analysis approach was used.

METHODS

The present qualitative study was conducted in Iran.Clinical nurses were selected using the purposive sampling method. Data were collected through in-depth semi-structured interviews with 15 clinical nurses from October 2020 to March 2021. The qualitative content analysis method was used to analyze the data.

RESULTS

Two main categories and 16 subcategories were extracted as follows: (1) professional factors (containing seven subcategories) and (2) organizational factors (containing nine subcategories).

CONCLUSIONS

To promote the professional dignity of nurses, it is recommended to identify the factors threatening their professional dignity and create healthy work environments for them.

Guaranteeing dignity and decent work for migrant nurses and health care workers beyond the COVID-19 pandemic

AIM(S)

The main aim of this article is to outline the devastating aftereffects of COVID-19 in terms of ethical recruitment and the respect of dignity of nurses and health care professionals.

BACKGROUND

Nations experience the ominous impacts of the COVID-19 pandemic in terms of an exacerbated shortage of nurses worldwide. In this situation, migration flows of nurses are skyrocketing and the respect of the migrant nurses' dignity as human beings should be guaranteed.

EVALUATION

Data from reports elaborated by the International Centre on Nurse Migration (ICNM) were examined and outlined the central role of the respect of dignity of every nurse to prevent unethical exploitation of them.

KEY ISSUE(S)

The respect of human dignity is a complex concept. Human dignity denotes the inner nature of human beings but also their rights at work.

CONCLUSION(S)

In a post-COVID-19 world with increased flows of nurse migration, it is crucial to guarantee dignity at work for migrant nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders should prioritize the ethical recruitment of health care workers and give a prominent role to the WHO 'Code of Practice on the International Recruitment of Health Personnel' which recognizes the ethical bedrocks of employment.

Public health nurses' professional dignity: An interview study in Finland

BACKGROUND

Dignity is a central human value supported by nurses' professional ethics. In previous studies, nurses in clinical practice have experienced that dignity increased their work well-being and pride of work. Dignity is also strictly interweaved to professional identity in the different nursing' roles, but little is known about dignity among public health nurses and primary care settings.

PURPOSE

This study aimed to describe the perceptions of nursing's professional dignity of public health nurses in primary care in Finland.

RESEARCH DESIGN

An inductive qualitative descriptive approach with semi-structured focus group interviews was utilised.

PARTICIPANTS AND RESEARCH CONTEXT

Twenty-seven Finnish public health nurses were interviewed via eight semi-structured focus group interviews in primary health care settings.

ETHICAL CONSIDERATIONS

Before data collection, research permissions were obtained from participating health care centres. This type of research in Finland, with competent adult participants, does not require ethical pre-assessment but written and oral informed consent obtained before the interviews.

FINDINGS

Based on our findings, public health nurses perceived that professional dignity was (1) part of their self-respect, an observed daily value based on their acknowledged competence. Besides, they perceived that (2) service users' trust in public health nurses was a strong expression of professional dignity, and it could be uncovered when recipients of care utilised their services. In addition, public health nurses experienced that (3) professional dignity was an expression of different intertwined interprofessional and social factors.

DISCUSSION AND CONCLUSION

Professional dignity is simultaneously an essential prerequisite and an outcome of public health nurses' work. In future, more information would be needed to implement strategies in primary health care to foster nurses' professional dignity also in international public health arenas.

The Effect of Outcome vs. Process Accountability-Focus on Performance: A Meta-Analysis

Background

The foundation of a safe practice is accountability, especially outcome- rather than process-focused accountability, particularly during pandemics such as COVID-19. Accountability is an essential behavior that promotes congruence between nursing actions and standards associated with quality of care. Moreover, the scant research examining whether one accountability focus is superior in motivating humans to better task performance yields inconclusive results.

Aims

Systematically examine the effect of an outcome- vs. process-accountability focus on performance and identify any moderating variables.

Design

Systematic review and meta-analysis.

Data sources

PsycINFO, Medline, PubMed, Scopus, and CINAHL databases, with all publications to November 2020.

Review methods

A systematic search using Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Statistical analysis and forest plots were performed using MetaXL 5.3. Heterogeneity was presented using I² statistics and Q tests, and possible publication bias was assessed with a Doi plot and the LFK index.

Results

Seven studies representing nine experiments involving 1,080 participants were included. The pooled effect of the nine experiments on task performance failed to show significant differences (mean = −0.09; 95% Confidence Interval [95%CI]: −0.21, 0.03), but a significant moderating effect of task complexity was demonstrated. Specifically, outcome accountability exerts a beneficial effect in complex tasks (mean = −0.48 [95%CI: −0.62, −0.33]) whereas process accountability improves the performance in simpler tasks (mean = 0.96 [95%CI: 0.72, 1.20]).

Conclusion

These findings demonstrated that accountability focus by itself cannot serve as a sole motivator of better performance, because task complexity moderates the link between accountability focus and task performance. Outcome accountability exerts a beneficial effect for more-complex tasks, whereas process accountability improves the performance of simpler tasks. These findings are crucial in nursing, where it is typically assumed that a focus on outcomes is more important than a focus on processes.