Professional ethics as an important factor in clinical competency in nursing

Resilience and stress as predictors of work engagement: the mediating role of self-efficacy in nurses

Background

Nurses face high levels of stress and work demands, which can affect their work engagement and psychological well-being. Resilience and self-efficacy have been identified as important resources to improve nurses' adaptation and work engagement.

Objective

This study aimed to evaluate the mediating role of self-efficacy in the relationship between resilience and stress on work engagement in Peruvian nurses.

Methods

A cross-sectional design was used, and data were collected from a sample of 459 nurses. Self-report questionnaires were administered to measure self-efficacy, resilience, stress, and work engagement. SEM analyses were performed to examine the relationship between these variables, and a mediation analysis was conducted to evaluate the role of self-efficacy as a mediator in the relationship between resilience, stress, and work engagement.

Results

The results indicated a positive relationship between resilience, self-efficacy, and work engagement, as well as a negative relationship between stress and work engagement. Additionally, self-efficacy mediated the relationship between resilience and work engagement, as well as the relationship between stress and work engagement in nurses.

Conclusion

Personal resources such as self-efficacy are a key factor in the relationship between resilience (work resources), stress (work demands), and work engagement of Peruvian nurses. Strengthening self-efficacy and resilience can improve work engagement and personal satisfaction of nurses. Hospital administrators and nursing managers should consider the importance of resilience, stress, work engagement, and self-efficacy in registered nurses and develop effective strategies to improve them. This can have a positive impact on the quality of care provided to patients and on the job satisfaction of nurses.

Supporting the Professional Identity Development of Nursing Alumni: A Phenomenology Study

BACKGROUND: Professional identity is the expected outcome of nursing educational institutions reflected in the values, beliefs, attitudes, and behavior of nursing alumni as professional nurses. Nursing alumni’s experiences at the Bachelor nursing program in Universitas Muhammadiyah Yogyakarta (UMY) related to professional identity development (PID) at various nursing careers need to be explored. AIM: This study aims to describe Ners alumni in PID at Universitas Muhammadiyah Yogyakarta (UMY). METHODS: This study was a phenomenological approach with a maximum variation sampling technique. Seventeen nursing alumni who have been working as professional nurses for a minimum of two years and worked in various nursing careers were recruited. A semi-structured interview between 60-90 minutes was conducted. Data analysis used Colaizzi’s methods and Nvivo 12TM Plus. RESULTS: There were two themes emerged from data; 1) Internal motivation to enhancing nursing career, with two sub-themes: having a great personal motivation and developing expertise, 2) External support driving nursing career, with five sub-themes: family encouragement, supports from a leader, accreditation and credential, exemplary role model and positive nursing image. CONCLUSION: Nursing alumni engaged in a variety of professional roles that contributed to the nursing workforce. The supporting of PID impacts personal and professional capability and strengthens nurses’ careers.

Clinical commitment and competence: a qualitative study

Commitment, a component of clinical competence, includes accountability and responsibility for professional roles and tasks; and, it has a positive correlation with job satisfaction and performance. This study aimed to elaborate on the concept of commitment in the field of occupational therapy using qualitative content analysis. The data was collected through interviewing 13 occupational therapists both in a focus group interview (including four participants) and in one-to-one interviews (nine other participants). The collected data was analyzed based on the Grenheim method, and commitment concept was defined under three main themes: (i) commitment to patient (five subthemes), (ii) commitment to self (three subthemes), and (iii) commitment to profession (three subthemes). This study’s findings indicated that to acquire clinical competence, therapists should be committed to their patients, to themselves, and to their profession. Future research is needed to further examine how and to what extent these commitment themes affect clinical competence as well as the interaction among them.

Information Security in Nursing: A Concept Analysis

The concept of information security in nursing can improve the basic understanding of security issues in nursing. This study aimed to report on information security in nursing that considers the technical, physical, and administrative aspects of information. We used a hybrid model to analyze the concept and conducted on-site interviews. The analysis revealed 7 attributes: physical aspect: environmental control, facility stability; technical aspect: information accessibility, taking advantage of features; and administrative aspect: systematicity of work, execution of education, professional responsibility. Our model could help identify the physical, technical, and administrative attributes and definitions of information security in nursing.

Is nurses' clinical competence associated with their compassion satisfaction, burnout and secondary traumatic stress? A cross-sectional study

Aim

The current study aimed to investigate the relationship between clinical competence and subscale of professional quality of life (ProQOL).

Methods

This cross-sectional study was conducted from November 2018 to May 2019 on 291 nurses working in public hospitals in south Iran (Rafsanjan). The nurses were selected by convenience sampling method. Data were collected using the ProQOL questionnaire that included three subscales: compassion satisfaction, secondary traumatic stress and burnout and the Competency Inventory for Registered Nurse (CIRN) that measured clinical competence.

Results

A significant positive relationship was observed between compassion satisfaction and clinical competence. A significant negative association was found between compassion satisfaction and secondary traumatic stress/burnout and also between secondary traumatic stress and clinical competence. The results of regression analysis indicated that compassion satisfaction was the best predictor of secondary traumatic stress (R2 = 65%), burnout (R2 = 40%) and clinical competence (R2 = 12%). Moreover, secondary traumatic stress was found to be the best predictor of compassion satisfaction (R2 = 53%).

Ethical competence in a profession: Healthcare professionals' views

Aim

Ethical competence is a crucial component for enabling good quality care but there is insufficient qualitative research on healthcare professionals' views on ethical competence. The aim of this study was to investigate healthcare professionals' views on ethical competence in a student healthcare context.

Design

A qualitative design and a hermeneutical approach were used.

Methods

The material consists of texts from interviews with healthcare professionals (N = 10) in a student healthcare context. The method was inspired by content analysis.

Results

One main theme and four subthemes emerged. The main theme was as follows: safeguarding the vulnerability of the other. The subthemes were as follows: using sensitivity to establish a trustful relationship, acting in an objective and flexible manner, using a reflective process in decision-making, and maintaining confidentiality and honesty. Future research should focus on investigating ethical competence from various perspectives in student health care, for example the student perspective or observational studies.

Measuring professional nursing value development in students participating in international service learning: A quasi-experimental study

BACKGROUND

International service learning is becoming widely used in nursing education as a means to provide global learning opportunities as well as part of a clinical learning experiences. Concrete outcomes for these experiences have not been clearly supported in previous research. Professional nursing values are an important learning outcome for nursing students and development of professional nursing values has been found to occur through various learning experiences. Determining if international service learning experiences facilitate the development of professional nursing values can support the use of international service learning as a viable pedagogy.

OBJECTIVE

The purpose of the study was to determine if there was a difference in professional nursing values development in students who participate in international service learning as part of their clinical experiences compared to those who do not.

DESIGN

The research was a quasi-experimental study with a pre-test, post-test design.

SETTING/PARTICIPANTS

Undergraduate students participating in one week international service learning as part of their clinical hours were compared with students who did not participate in international service learning.

METHODS

Comparison of professional nursing values development between the experimental and control group was completed using the Nurses Professional Values Scale.

RESULTS

The study showed the use of international service learning as part of clinical was at least equivalent in the development of professional nursing values as traditional clinical. In addition, it supported the development of professional nursing values through clinical learning overall.

CONCLUSION

The use of international service learning is a viable option for clinical experiences as a means to develop professional nursing values.

Factors affecting professional ethics development in students: A qualitative study

BACKGROUND

Ethics development is one of the most important aspects of professional practice in health sciences students. Understanding factors affecting ethics development can enhance clinical and professional performance in students.

OBJECTIVE

This study was conducted to explore students' perceptions about factors affecting professional ethics development.

RESEARCH DESIGN

This study is a conventional content analysis. Data were collected through 20 semi-structured interviews and two focus group interviews (12 students) during 2017-2018. Data were analyzed concurrently with data gathering, using the conventional content analysis approach of Graneheim and Lundman.

PARTICIPANTS AND RESEARCH CONTEXT

In total, 8 students of nursing, 5 medical students, 4 students of anesthesia and 3 operating room students in individual interviews, and 12 students in two focus group interviews from one university in the south of Iran were selected through purposive sampling.

ETHICAL CONSIDERATIONS

The research was approved by the Ethics Committee of one university in the south of Iran.

FINDINGS

The findings revealed two themes: personal and background factors. Personal factors consisted of the two categories of individual motivation and tendencies and interpersonal interactions. Background factors consisted of the two categories of role and function of teachers and environmental agents.

DISCUSSION AND CONCLUSIONS

According to the findings, both background and individual factors affect development of professional ethics in students. Understanding these factors along with reinforcement of educational planning in this field can improve healthcare services.

Ethics in nursing: A systematic review of the framework of evidence perspective

Aim:

To determine the current state of knowledge on nursing and ethics and to assess the knowledge and experience based on the evidence in this regard.

Background:

Although ethics is at the center of the nursing profession and the ethical issues affecting nurses are given much importance, few studies have focused on professional ethics in nursing. In this respect, ethics has become a concept that contains controversial and ambiguous situations.

Design:

The Preferred Reporting Items for Systematic Reviews and Meta-analyses guide, a basic search algorithm, was taken.

Data sources:

Cochrane, PubMed, CINAHL Complete, PsycINFO, and ULAKBIM from 2012 to 2016.

Review methods:

Following a systematic search strategy, all papers were assessed in relation to inclusion criteria and type of study. When sufficient information was not available in the title and summary of the works, the necessary data were evaluated in full texts.

Results:

This review was completed with 27 articles meeting the research criteria. The evaluation identified six themes: (1) ethics and nursing, (2) ethical difficulties/ethical dilemmas and nursing, (3) ethical competence and nursing, (4) professional ethics and nursing, (5) ethics, education, and nursing, and (6) ethics in health research.

Conclusion:

As a result of the review, a synthesis of high evidence-level research relating to nursing ethics was obtained. The emphasis was on the importance of further research and education so that the ethical aspects of nursing can be better understood throughout the studies. Nursing researchers’ level of evidence on ethics and their orientation to high research design will shed light on uncertain and controversial aspects of the subject.

Ethical consideration:

Since this was a systematic review, no ethical approval was required. There is no conflict of interest in this literature review.

Caring for elder patients: Mutual vulnerabilities in professional ethics

BACKGROUND:

Neglect and abuse of elders in care institutions is a recurring issue in the media. Elders in care institutions are vulnerable due to their physical, cognitive, and verbal limitations. Such vulnerabilities may make them more susceptible to mistreatment by caregivers on whom they are heavily dependent.

OBJECTIVES:

The goal was to understand caregivers' concerns about ensuring correct and proper treatment, as well as their experiences with neglect and abuse of older patients. This article examines resources and challenges of professional ethics within the care setting.

RESEARCH DESIGN:

A study was conducted to explore the quality of care provided to older patients in nursing homes, geriatrics institutions, and ambulant care in the northwest region of Switzerland.

PARTICIPANTS AND RESEARCH CONTEXT:

A total of 23 semi-structured interviews were conducted with nursing staff of varying experience levels.

ETHICAL CONSIDERATIONS:

Ethical approval was granted by the competent regional ethics commission, Ethikkomission Nordwest-und Zentralschweiz EKNZ [Ethics Commission Northwest and Central Switzerland] (2014-015).

FINDINGS:

Three themes emerged from our data analysis: professional identity, professional context, and professional relationships. Our findings indicate mutual vulnerabilities within these three themes, characterizing the interactions between nursing staff and older patients. Study participants believe that incidences of error, neglect, and abuse are consequences of their own vulnerability since they are not able to meet the demands of an overstraining work situation.

DISCUSSION:

Different aspects of this mutual vulnerability are described and critically discussed as challenges for professional ethics.

CONCLUSION:

Early education, continuous training as well as better management and response from the institution are necessary to maintain professionalism while handling mutual vulnerabilities.

Assessing Emergency Nurses' Clinical Competency: An Exploratory Factor Analysis Study

Background:

Nursing as a clinical discipline is developing in the emergency wards. Health care systems should continuously assess and prioritize indicators of clinical competency in these wards. The lack of clear standards of clinical competency indicators challenges evaluation. The purpose of this study was to determine clinical competency indicators and its priority based on nurses' views in educational and therapeutic centers in Guilan.

Materials and Methods:

The Q methodology was conducted in three phases, that is, phase I (determining the clinical competency indicators), phase II (classifying clinical competency indicators by an expert panel), and phase III (prioritizing clinical competency indicators). The subjects were selected by convenience sampling among nurses working in the emergency wards of teaching hospitals affiliated to Guilan in 2013. Finally, clinical competency indicators were prioritized using exploratory factor analysis.

Results:

In the prioritizing phase, data were collected from 710 nurses over two months. Five factors with 30 general competencies were found in three domains: communication, professional maturity, and personality characteristics. Six factors with 37 specific competencies were also found in two domains: scientific and technical capabilities and basic clinical skills that can provide a structured instrument for assessing clinical competence in emergency nurses.

Conclusions:

Achieved competencies can be used as a reference for nursing education and practice in emergency. Further research on health care system is needed in order to achieve a reliable and valid instrument.

Clinical Competence and Its Related Factors of Nurses in Neonatal Intensive Care Units

Introduction: Clinical competence of nurses working in the neonatal intensive care units together with advancements in medical science and technology increased the survival rate of newborns that need specialized care. To ensure the quality of care and provide the safety of patients, evaluating the clinical competence of nurses seems necessary. This study aimed to evaluate the clinical competence of nurses in the neonatal intensive care units.

Methods: In this cross-sectional study, 117 nurses working in the neonatal intensive care units of the hospitals affiliated to Tehran University of Medical Sciences were selected by census method. The research tool was Development of Competency Inventory for Registered Nurses questionnaire which completed by self-assessment. The mean clinical competence scores of participants categorized into 3 levels: weak: <225, moderate: 225-273 and good: >273. Data were analyzed by SPSS version 13 using the Pearson correlation coefficient, t-test and Chi-square test.

Results: The highest levels of competence were related to critical thinking and research attitude and interpersonal relationships, and the lowest level was related to training and mentoring. There was a direct statistically significant relationship between marital status, employment status, level of interest in working in the neonatal intensive-care units and the clinical competence of nurses.

Conclusion: Since the clinical competence of nurses in the Neonatal Intensive Care Units is vital, some variables such as interest in the nursing profession, employment status, the neonatal intensive theoretical and practical training courses and the amount of overtime working hours should be taken into consideration.

The relationship between nurses' clinical competence and burnout in neonatal intensive care units

BACKGROUND

Nurses' clinical competency plays an important role in the care of preterm infants. On the other hand, burnout is one of the most important factors in reducing the nurses' efficiency. With regard to the importance of the role of nurses, and the vulnerability of the infants, the purpose of this study was to investigate the relationship between nurses' burnout and clinical competency in NICUs.

MATERIALS AND METHODS

The descriptive cross-sectional study was conducted with the participation of 86 nurses working in the NICUs of hospitals in Isfahan, Iran. Census sampling method was used in the NICUs of educational hospitals in 2014. Data were collected by a questionnaire including demographic characteristics, Patricia clinical competency, and Maslach burnout scales. Data were analyzed by the statistical tests of independent t-test and Pearson correlations test with the significance level of α < 0.05.

RESULTS

Six dimensions of clinical competency and three dimensions of nurses' burnout were assessed at three levels (weak, moderate, and strong levels). Statistical tests showed that clinical competency was at a moderate level in all fields. Of the dimensions of nurses' burnout, emotional exhaustion was moderate, depersonalization was weak, and personal performance was strong. The results showed that nurses' burnout and clinical competency in the NICUs were at a moderate level and had a significant negative relationship (r = -0.322, P = 0.003).

CONCLUSIONS

Results showed that burnout had a negative relationship with competency. Therefore, managers are suggested to improve nurses' competency and diminish their job burnout through better and more applicable planning.

Competence of nurses in the intensive cardiac care unit

INTRODUCTION

Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses' competences. This study aimed to explain nurses' competence in the ICCU.

METHODS

This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012-2013. Interviews were recorded, transcribed verbatim, and analyzed by using the content-analysis method.

RESULTS

The main categories were "clinical competence," comprising subcategories of 'routine care,' 'emergency care,' 'care according to patients' needs,' 'care of non-coronary patients', as well as "professional competence," comprising 'personal development,' 'teamwork,' 'professional ethics,' and 'efficacy of nursing education.'

CONCLUSION

The finding of this study revealed dimensions of nursing competence in ICCU. Benefiting from competence leads to improved quality of patient care and satisfaction of patients and nurses and helps elevate nursing profession, improve nursing education, and clinical nursing.

Becoming a nurse as a moral journey: A constructivist grounded theory

BACKGROUND

Nursing students, during their study, experience significant changes on their journey to become nurses. A major change that they experience is the development of their moral competency.

OBJECTIVE

The purpose of this study is to explore the process of moral development in Iranian nursing students.

RESEARCH DESIGN

A constructivist grounded theory method was adopted. Twenty-five in-depth, semi-structured, face-to-face intensive interviews with 22 participants were conducted from September 2013 to October 2014. All interviews were audio-taped, transcribed, and analyzed using writing memos and the constant comparative method. Participants and research context: The setting was three major nursing schools within Tehran, the capital of Iran. Nineteen nursing students and three lecturers participated in the study. Ethical considerations: The study was approved by the Tehran University of Medical Sciences Committee for Medical Research Ethics (92/D/130/1781). It was explained to all participants that their responses would be treated with confidentiality and that they would not be identified in any way in the research and any publication ensuing from the research. All participants agreed to be interviewed and signed written consent forms agreeing to the recording and analyses of the interview data gathered.

FINDINGS

Findings indicated three levels of moral development along with the formation of professional identity. The three levels of moral development, getting to know the identity of nursing (moral transition), accepting nursing identity (moral reconstruction), and professional identity internalization (professional morality), were connected to the levels of professional identity formation.

DISCUSSION

The proposed model added a new insight to professionalism in nursing.

CONCLUSION

From the findings, it was concluded that to enhance higher moral practice, nursing instructors should promote the professional identity of nursing students. Reinforcement of moral characteristics and professional identity within registered nurses occurs over a series of phases and, once fully integrated into the identity of nursing students, the moral characteristics that they acquire become part of their both professional and personal identities.

Factors affecting professional ethics in nursing practice in Iran: a qualitative study

Background

Professional ethics refers to the use of logical and consistent communication, knowledge, clinical skills, emotions and values in nursing practice. This study aimed to explore and describe factors that affect professional ethics in nursing practice in Iran.

Methods

This qualitative study was conducted using conventional content analysis approach. Thirty nurses with at least 5 years of experience participated in the study; they were selected using purposive sampling. Data were collected through semi-structured interviews and analyzed using thematic analysis.

Results

After encoding and classifying the data, five major categories were identified: individual character and responsibility, communication challenges, organizational preconditions, support systems, educational and cultural development.

Conclusions

Awareness of professional ethics and its contributing factors could help nurses and healthcare professionals provide better services for patients. At the same time, such understanding would be valuable for educational administrators for effective planning and management.

Ethical concerns and dilemmas of Finnish and Dutch health professionals

BACKGROUND

Healthcare professionals encounter ethical dilemmas and concerns in their practice. More research is needed to understand these ethical problems and to know how to educate professionals to respond to them.

RESEARCH OBJECTIVE

To describe ethical dilemmas and concerns at work from the perspectives of Finnish and Dutch healthcare professionals studying at the master's level.

RESEARCH DESIGN

Exploratory, qualitative study that used the text of student online discussions of ethical dilemmas at work as data.

METHOD

Participants' online discussions were analyzed using inductive content analysis.

PARTICIPANTS

The sample consisted of 49 students at master's level enrolled in professional ethics courses at universities in Finland and the Netherlands.

ETHICAL CONSIDERATIONS

Permission for conducting the study was granted from both universities of applied sciences. All students provided their informed consent for the use of their assignments as research data.

FINDINGS

Participants described 51 problematic work situations. Among these, 16 were found to be ethical dilemmas, and the remaining were work issues with an ethical concern and did not meet criteria of a dilemma. The most common problems resulted from concerns about quality care, safety of healthcare professionals, patients' rights, and working with too few staff and inadequate resources.

DISCUSSION

The results indicated that participants were concerned about providing quality of care and raised numerous questions about how to provide it in challenging situations. The results show that it was difficult for students to differentiate ethical dilemmas from other ethical work concerns.

CONCLUSION

Online discussions among healthcare providers give them an opportunity to relate ethical principles to real ethical dilemmas and problems in their work as well as to critically analyze ethical issues. We found that discussions with descriptions of ethical dilemmas and concerns by health professionals provide important information and recommendations not only for education and practice but also for health policy.

Relationship between ICU nurses’ moral distress with burnout and anticipated turnover

Background:

Moral distress is one of intensive care unit nurses’ major problems, which may happen due to various reasons, and has several consequences. Due to various moral distress outcomes in intensive care unit nurses, and their impact on nurses’ personal and professional practice, recognizing moral distress is very important.

Research objective:

The aim of this study was to determine correlation between moral distress with burnout and anticipated turnover in intensive care unit nurses.

Research design:

This study is a descriptive-correlation research.

Participants and research context:

A total of 159 intensive care unit nurses were selected from medical sciences universities in Iran. Data collection instruments included “demographic questionnaire,” “ICU Nurses’ Moral Distress Scale,” “Copenhagen Burnout Inventory” and “Hinshaw and Atwood Turnover Scale.” Data analysis was done by using SPSS19.

Ethical considerations:

Informed consent from samples and research approval was obtained from Shahid Beheshti Medical Sciences University Research Ethics Board in Tehran.

Findings:

The findings showed intensive care unit nurses’ moral distress and anticipated turnover was high, but burnout was moderate. The results revealed that there was a positive statistical correlation between intensive care unit nurses’ age, their work experience and the fraction of nurses’ number to number of intensive care unit beds with their moral distress and burnout. However, there were no correlation between gender, marriage status, educational degree and work shift and moral distress.

Discussion:

Some of the findings of this research are consistent with other studies and some of them are inconsistent.

Conclusion:

Similarly, moral distress with burnout and anticipated turnover did not have statistical correlation. However, a positive correlation was found between burnout and anticipated turnover. The results showed that increase in the recruitment of young nurses, and nursing personnel, and diminishing intensive care unit nurses’ moral distress, burnout and their turnover intention are essential.

The human degree of care. Professional loving care for people with a mild intellectual disability: an explorative study

BACKGROUND

Research has shown that care staff are not always able to offer quality care. Commercialisation and market forces within the care sector are often pointed to as an explanation for this shortcoming. In the present study, insight is gained into the possible connections between the commercialisation of care, on the one hand, and the shrinkage of possibilities and motivation to offer professional loving care, on the other hand, from the perspective of care staff working with people with mild intellectual disabilities.

METHOD

Semi-structured qualitative interviews were conducted with 28 care staff working with people with mild intellectual disabilities. Scientific research methods were combined with normative ethical reflection to examine the internal morals of the care staff.

RESULTS

According to participating care staff, an affiliation with and recognition of the client form the basis for professional loving care. Care staff recognise that their profession is increasingly being built upon manageability and accountability, and this is making their jobs more difficult.

CONCLUSION

We conclude that care staff perceive the precedence given to the smooth running of production processes over investment in direct contact with clients to be a real threat to the quality of care. Concerns about declining motivation and loss of work satisfaction as a result of the commercialisation of care are only partly acknowledged by care staff. While shrinkage of space for professional loving care is recognised, one can hardly speak of declining motivation.

The dignity of the nursing profession

Background:

Nursing continues to gain legitimation epistemologically and ontologically as a scientific discipline throughout the world. If a profession gains respect as a true autonomous scientific profession, then this recognition has to be put in practice in all environments and geographical areas. Nursing professional dignity, as a self-regarding concept, does not have a clear definition in the literature, and it has only begun to be analyzed in the last 10 years.

Objectives:

The purpose of this meta-synthesis was to determine the various factors that constitute the notion of nursing professional dignity. The target was to create a tentative model of the concept.

Research design:

The research design was a meta-synthesis (N = 15 original articles) of nursing professional dignity described in the literature, based on the guidelines by Noblit and Hare.

Method and findings:

Original studies were sought out from electronic databases and manual searches. The selection of literature was conducted on stages based on titles (n = 2595), abstracts (n = 70), and full-texts (n = 15) according to the inclusion and exclusion criteria. From this analysis, a clear definition of nursing professional dignity emerged that underscored two main macro-dimensions constituting this intertwined, multidimensional, and complex notion: characteristics of the human beings and workplace elements.

Conclusion:

The recognition of nursing professional dignity could have a positive impact on patients because the results clearly showed that nurses are more prone to foster patients’ dignity, patients’ safety, and a better quality of care if their own dignity is respected. If nurses are uncomfortable, humiliated, or not seen in their professional role, it is difficult to give to others good care, good support, or good relationships.

Impact of critical thinking disposition, general self-efficacy, and leadership on clinical competence in nursing students

PURPOSE

The purpose of this study was to evaluate the relationships among critical thinking disposition, general self-efficacy, leadership and clinical competence, and identify the factors influencing clinical competence in nursing students.

METHODS

In this descriptive study, 153 nursing students (from 2nd to 4th school year) of a university in South Korea were enrolled in December 2010. The instruments for this study were the Korean versions of the Critical Thinking Disposition Scale, General Self-Efficacy Scale, Leadership Inventory, and Clinical Competence Scale. Data were analyzed by descriptive statistics, t-test, MANOVA, Pearson correlation, and multiple linear regression with PASW 18.0 software.

RESULTS

The mean scores (ranging from 1 to 5) in nursing students for critical thinking disposition, general self-efficacy, leadership, and clinical competence were 3.44, 3.51, 3.55, and 3.42, respectively. Positive correlations were found for clinical competence with critical thinking disposition, general self-efficacy, and leadership. The strongest predictor of clinical competence was leadership. In addition, leadership, nursing school year, and subjective academic achievement accounted for 34.5% of variance in clinical competence.

CONCLUSION

This study revealed that developing leadership, critical thinking disposition, and self-efficacy in undergraduate nursing education is important to improve clinical competence of nursing students.

Iranian intensive care unit nurses’ moral distress

Researchers have identified the phenomena of moral distress through many studies in Western countries. This research reports the first study of moral distress in Iran. Because of the differences in cultural values and nursing education, nurses working in intensive care units may experience moral distress differently than reported in previous studies. This research used a qualitative method involving semistructured and in-depth interviews of a purposive sample of 31 (28 clinical nurses and 3 nurse educators) individuals to identify the types of moral distress among clinical nurses and nurse educators working in 12 cities in Iran. A content analysis of the data produced four themes to describe the nurses’ moral distress. The four themes were as follows: (a) institutional barriers and constraints; (b) communication problems; (c) futile actions, malpractice, and medical/care errors; (d) inappropriate responsibilities, resources, and competencies. The results demonstrate that moral distress for intensive care unit nurses is different and that the nursing leaders must reduce moral distress among nursing in intensive care.

Comparison of self-assessed competence and experience among critical care nurses

AIM

To determine the level of self-assessed nursing competence and the relationship to age and experience in nursing.

BACKGROUND

Nursing competence is a concern for all health-care stakeholders. Methods to measure competence have been evaluated worldwide. There is little agreement about the development or reliable measure of competence. Exploring these relationships can identify strategies for education, retention, professional growth and potentially affect patient outcome measures.

METHOD

The Nurse Competence Scale (NCS) was completed by 101 critical care nurses. Statistical methods were used to analyse the data.

RESULTS

The nurses self-assessed level of competence ranged from good to excellent along with an increased frequency of using competencies. Statistically significant relationships were found among the variables.

CONCLUSIONS

Measurable, significant relationships exist among the variables. The NCS proved to be a valid and reliable instrument to measure competence.

IMPLICATIONS FOR NURSING MANAGEMENT

Objective and reliable assessment of nursing competence is an important measure for leadership and education. Further studies to identify other factors affecting the nurses' experience and the effect on competence will help to develop and promote supportive strategies.

Organizational ethics: A literature review

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

First- and third-year student nurses’ perceptions of caring behaviours

The aim of this study was to investigate significant differences in the mean scores for the Caring Behaviors Inventory between first-year and third-year nursing students. There were two sample groups: group A comprised 117 first-year nursing students and group B included 49 third-year nursing students (n = 166). All participants were from one Slovenian university. Data were collected by questionnaire and ana- lysed using SPSS v. 17.0. Independent sample t-tests were used for the comparison of means for each item in both groups. The results showed that the students in group B (third year) often agreed more significantly with Caring Behaviors Inventory items than the students in group A (first year). Principles of right action indicate how nurses must behave in order to provide good nursing care. Nursing educators can prepare students through demonstrations of their own behaviour in practice

Teaching ethics in religious or cultural conflict situations: a personal perspective

This article portrays the unique aspects of ethics education in a multicultural, multireligious and conflict-based atmosphere among Jewish and Arab nursing students in Jerusalem, Israel. It discusses the principles and the methods used for rising above this tension and dealing with this complicated situation, based on Yoder's ;bridging' method. An example is used of Jewish and Arab students together implementing two projects in 2008, when the faculty decided to co-operate with communities in East Jerusalem, the Arab side of the city. The students took it upon themselves to chaperon the teachers who came to watch them at work, translate, and facilitate interaction with a guarded and suspicious community. This approach could also be relevant to less extreme conditions in any inter-religious environment when trying to produce graduates with a strong ethical awareness.

Self-concept in intensive care nurses and control group women

Our self-concept is how we see ourselves in our minds. The goal of this research was to discover any significant differences in the dimensions of self-concept between clinical nurses employed in an intensive care unit in Slovenia and Slovenian women from the general population, who represented the control group. The research included 603 women aged 20-40 years (mean 29.94; standard deviation +/-6.0) who had a high-school education. To determine the differences between the groups statistically we used one-way analysis of variance. The results revealed that clinical nurses had a more positive self-concept than members of the control group. Self-concept is very important in nursing because it is closely connected to the existing value system of individuals and their behaviour. Self-concept gives nurses a sense of how they use their abilities and how they perform in relation to patients.

Elder Abuse and Mistreatment in Residential Settings

Older people living in a residential setting have the right to respectful care based on professional ethics. The aim of this study was to describe employees' and clients' lived experiences of elder abuse. A qualitative phenomenological method was used with 26 employees and 20 residents from four homes for elderly people in the town of Ostrava, Czech Republic, and two managers from outside these institutions. All complaints about elder abuse ( n 5 11) received by Ostrava Municipal Authority during the period 2003 to 2007 were examined. Two main dimensions of the examined phenomenon were identified: forms of elder abuse and causes of elder abuse. Established forms of elder abuse were summarized as rights violation, financial abuse, psychological abuse, physical abuse and neglect. Causes of elder abuse included institution, employee and client characteristics. It is necessary in residential settings to create preventive policies that will focus on supervision regarding elderly people's rights violation and psychological and physical abuse, as well as on building organizational cultures that will respect ethical principles.