Public health nurses' experiences of ethical responsibility: A meta-ethnography

Public health nursing is grounded in public health ideologies and fundamental nursing values. Researchers have argued that ethical responsibility from the perspective of the nurse is an understudied phenomenon. This meta-ethnography provides in-depth knowledge of how public health nurses (PHNs) experience ethical responsibility when working to prevent injury and disease, and promote health and well-being in children, young people and their families. There are reciprocal findings across the 10 included studies. The findings reveal that these nurses often feel alone, have worries and uncertainties and are afraid of doing wrong. They describe unclear boundaries in their work, creating a heightened sense of responsibility. PHNs fight lonely battles. Yet they show courage and commitment and are ready to stand up and fight for children and families who do not receive adequate care. A line of argument is developed and the metaphorical phrase Chivalrous knights in moral armour is used to express the authors' overall interpretations of the findings. Reflection on the findings shows how the different dimensions of ethical responsibility are interconnected. The nurses' ethical sensitivity enables them to feel compassion for others and they show indignation when vulnerable others are not treated with dignity and respect. Indignation and compassion are interrelated, and when human life and dignity are threatened, the ethical demand to respond emerges. Indignation is a precursor to moral courage, and the nurses' moral sensitivity and respect for their clients emboldens them to stand up for vulnerable others. The findings also illustrate the paradoxical nature of freedom. Freedom of choice due to unclear boundaries heightens the nurses' sense of responsibility. This research is an important step in theory development and has implications for further research, education and practice.

The relationship between ethical position and whistleblowing: A cross-sectional study among nurses

AIM AND OBJECTIVES

The aim of this study is to determine nurses' ethical positions, whistleblowing intention and its causes, and to analyse the correlation between them, while revealing the personal and professional characteristics causing significant difference.

BACKGROUND

In today's challenging healthcare settings, ethical dilemmas are inherent to nursing practices, leading to situations whereby nurses must consider whistleblowing and reasons such as reporting medical errors or misbehaviors.

DESIGN

The study is descriptive, cross-sectional and correlational.

METHODS

The data were collected from a convenience sample consisting of 294 nurses between 1 April and 30 June 2019, in four hospitals in two cities. An introductory information form, Ethics Position Questionnaire, Whistleblowing Scale and Causes of Whistleblowing Scale were employed to collect data. The data were analysed with descriptive, correlational, comparative and internal consistency analyses (Guidelines for reporting cross-sectional studies (Data S1)).

RESULTS

It was found that nurses encountered (31.3%) and reported (85.9%) unethical incidents. According to the subscales, they obtained higher scores from idealism (4.37 ± 0.52), supportive whistleblowing (3.75 ± 0.72), and moral and professional values (3.77 ± 0.67). The Ethics Position Questionnaire, as well as the Whistleblowing Scale (r = .302) and the Causes of Whistleblowing Scale (r = .211) had a positive weak correlation (p < .001). Nurses' age, marital status, and professional and institutional experiences all created a significant difference (p < .05).

CONCLUSIONS

The nurses mostly encountered unethical incidents associated with management. The rates of reporting the unethical incidents were high, and they were found not hesitating to report using whistleblowing, yet intended to keep the incidents within the institution. In addition, idealistic nurses were more likely to whistleblow, and their causes for whistleblowing were mostly associated with moral and professional values.

RELEVANCE TO CLINICAL PRACTICE

It is recommended that nurses' ethical position, and whistleblowing intentions and causes should be supported and improved through the corporate culture.

The mechanism of anger and negative affectivity on the occurrence of deviant workplace behavior: An empirical evidence among Malaysian nurses in public hospitals

Background

Employees' work experience significantly impacts their cognition and workplace actions. Anger and negative affectivity are two personality traits that have been linked to workplace deviant behavior conduct.

Objective

This study aimed to empirically analyze the deviant workplace behavior and its antecedents among Malaysian nurses in public hospitals.

Methods

A cross-sectional design was employed in this study. The survey questionnaires were distributed proportionately to staff nurses in six government hospitals in 2020, with a total of 387 nurses selected using a simple random sampling. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used for data analysis.

Results

Trait anger triggered deviant workplace behavior in Malaysian nurses, thus supporting the argument that the personality trait could increase deviant behavior (β = 0.245, p = 0.000). At the same time, there was no evidence that negative affectivity could influence deviant behavior in the workplace among nurses in selected public hospitals in Malaysia (β = 0.074, p = 0.064).

Conclusion

The Malaysian nurses had positive affectivity, related to positive emotions like happiness, work interest, and attentiveness. On the other hand, the nurses were suffering from high levels of emotional tiredness. Further research should highlight a deeper understanding of Malaysian nurses' work experiences and workplace stress affecting their physical and mental health.

'Ethics Between the Lines' - Nurses' Experiences of Ethical Challenges in Long-Term Care

In long-term care, ethical challenges are becoming increasingly apparent as the number of older patients with complex care needs increases, in parallel with growing demands for more cost-efficient care. Scarce resources, cross-pressure and value conflicts are associated with missed care, moral stress and nurses wanting to leave the profession. Through five focus group interviews, this study aimed to explore how nurses working in nursing homes and homecare services perceive, experience and manage ethical challenges in everyday work. Content analysis revealed three main themes: striving to do good; failing and being let down and getting rid of frustrations and learning from experiences. The nurses’ morality was mainly expressed through emotions that arose in specific situations. Dedicated spaces for ethical reflection and leaders who recognize that organizational conditions affect the individual nurse-patient relationship are required. Facilitating ethical reflection is an important leadership responsibility, which may also require leaders to actually participate.

Current Approaches, Typologies and Predictors of Deviant Work Behaviors: A Scoping Review of Reviews

This study provides a scoping review of the recent conceptual developments about the deviant work behavior and counterproductive work behavior constructs. It also examines the specific types of deviant work behavior that have been more consistently investigated in the last decade, and whether they cover the interpersonal or organizational type of deviant behavior. In addition, individual, group, and organizational predictors of deviant work behaviors are examined. A scoping review of reviews was conducted on Scopus and Web of Science databases and 54 studies published from 2010 to June 2021 were taken into account. Results show that more recent conceptualizations are based on well established models in the literature and consider the hierarchical structure of these two constructs. Recent reviews examine the relationships of deviant work behavior with job performance and ethical behavior constructs, the multilevel nature of deviant work behavior, and the consequences for the actor of the deviance. The specific types of deviant work behavior more frequently reviewed in the last decade are workplace abuse, incivility, ostracism, bullying and sexual harassment, and abusive and destructive leadership; this evidence suggests a much greater attention to interpersonal, rather than organizational, forms of deviant work behavior. Regarding antecedents, results show the continuing prevalence of personality factors antecedents. Limitations of the study and theoretical and practical implications for the field are also provided.

When breaking the rule becomes necessary: The impact of leader-member exchange quality on nurses pro-social rule-breaking

Aim

Despite the literature on nursing leadership, the research on the quality of exchange relationship between nursing leaders and nurses is in its initial stages. Also, the underlying mechanism that exists between leader–member exchange and employee outcomes warrants further inquiry. This study aimed to fill these gaps by investigating the role of leader–member exchange relationships and organizational identification in nurses' intentional violation of hospital regulations to promote their patients' welfare, also called pro‐social rule‐breaking. In contrast to a vast number of previous studies, we argue that pro‐social rule‐breaking can be positive for organizations. Therefore, nurses should be given margin and autonomy to break hospital rules when needed by establishing a high‐quality exchange relationship with the supervisor.

Design

A quantitative study was conducted on nurses working in hospitals in Pakistan by utilizing a non‐probability convenience sampling technique.

Method

Data from nurses and their colleagues (n = 224) were collected at three‐time points between June 2019 and August 2019 through questionnaires.

Results

The results proved that nurses' possessing a high‐quality exchange relationship with their supervisor feels a higher level of identification with their organization. In turn, they are more likely to engage in pro‐social rule‐breaking as a form of constructive deviance.

Stigmatization in nursing: Theoretical pathways and implications

Stigmatization of patients exists in nursing and results in less than optimal nursing care and poor patient outcomes. It is also a violation of our code of ethics. In order to eliminate stigmatization from nursing practice, it is necessary to understand how it develops. Two possible theoretical pathways are proposed to explain the development of stigmatization in nursing. These pathways are informed by a conceptual understanding of stigma and theories of professional socialization, professional formation, symbolic interactionism, and social cognitive theory. Re-labeling and role-taking and moral disengagement are proposed as two possible processes that may lead to stigmatization of patients. Both proposed pathways have implications on professional socialization, formation, and the development of professional identity. Devoting attention to and reframing normative behavioral expectations, eliminating labeling, developing empathy, focusing on relationships, and cultivating ethical comportment and moral maturity during nursing formation may reduce the stigmatization of patients by nurses.

An aged life has less value: A qualitative analysis of moral disengagement and care failures evident in Royal Commission oral testimony

AIMS AND OBJECTIVES

To identify common themes about care failures in residential aged care as described from the perspectives of older people and their families in transcripts from hearings and submission to the Australian Royal Commission. These failures are explored through the lens of moral disengagement.

BACKGROUND

Previous inquiries into care failures have highlighted widespread harm from inhumane care, caused by staff carelessness, indifference and callousness. In health care, limited consideration has been given to the moral engagement or disengagement of staff and the relationship of moral engagement with care failures.

METHOD

Qualitative latent content analysis of 22 transcripts from the Royal Commission between March 2020-August 2020. Methods are reported using the SRQR.

RESULTS

This paper presents one theme, Dehumanisation of the care process: An aged life has less value, from a larger study. Care failures relating to morally disengaged staff were found to be widespread and influenced by the environments created by organisations.

CONCLUSION

This study highlights the need for further research to identify indicators of moral disengagement among staff and explore strategies to reduce or prevent moral disengagement within organisations trusted with providing care to older people.

RELEVANCE TO CLINICAL PRACTICE

Caregiving is necessarily associated with, and shaped by, moral dimensions. The erosion or disengagement of these moral dimensions among care staff reveals important aspects of residential aged care's lived experience. Studying dynamics within aged care facilities can provide a useful analytic lens for illuminating ways that residents and their family or those close to them, experience or are impacted by moral dimensions and behaviours.

Coping with moral distress - The experiences of intensive care nurses: An interpretive descriptive study

BACKGROUND

Over the last three decades, there has been a growing body of literature that has described moral distress as a prominent issue that negatively affects intensive care nurses. Yet, little focus has been given to how intensive care nurses cope and continue in their practice despite being exposed to moral distress.

OBJECTIVE

To describe intensive care nurses' experiences of coping with moral distress.

RESEARCH METHODS/SETTING

A qualitative design using an interpretative descriptive approach. Semi-structured interviews were conducted with seven intensive care nurses.

FINDINGS

The shared experience of coping with moral distress was explicated through the overarching theme of being Like Grass in the Wind. Four major themes emerged: Going Against What I Think is Best, Moral Distress - It's Just Inherent in Our Job, It Just Felt Awful, and Dealing with It. The findings also reflected actions associated with turning towards or turning away from morally distressing situations.

CONCLUSION

By developing coping strategies such as seeking social support, nurses can move forward in their practice and meaningfully engage with patients and families experiencing critical illness. When successful coping is not attained, nurses are at risk of becoming morally disengaged within their practice.

Moral reasoning explained by personality traits and moral disengagement: A study among Dutch nurse practitioners and physician assistants

AIM

To explore the direct and indirect effect of the personality meta-traits 'Stability' and 'Plasticity' on moral reasoning among nurse practitioners (NPs) and physician assistants (PAs).

BACKGROUND

Moral reasoning is influenced by being prone to moral disengagement and personality traits. Moral disengagement is observed among professionals in many fields, including healthcare providers. Moral disengagement is known to be provoked by environmental stressors and influenced by certain personality traits.

DESIGN

A cross-sectional approach was used including self-report questionnaires.

METHODS

A convenience sample of Dutch NPs (N = 67) and PAs (N = 88) was surveyed via online questionnaires between January and March 2015, using (a) the Defining Issues Test; (b) the BIG five inventory; and (c) the Moral Disengagement Scale. Structural equation modelling (SEM) was employed for estimating the construct validity of two meta-traits of personality and to test unidirectional influences on moral reasoning.

RESULTS

Only the Stability trait was a direct predictor of moral reasoning whereas both Stability and Plasticity were precursors of moral disengagement. Both personality meta-traits had statistically significant indirect effects on moral reasoning through a low level of moral disengagement. The influence of both personality traits on the level of moral reasoning was increased by strong self-censure on entering into morally disengaged interactions.

CONCLUSION

The personality meta-trait 'Stability' is an indicator of moral reasoning and is explained by a lower propensity to morally disengage among highly stable people. Although the meta-trait Plasticity exerts an indirect effect through moral disengagement on moral reasoning, it is not a direct indicator of moral reasoning.

'First, Do No Harm': The Role of Negative Emotions and Moral Disengagement in Understanding the Relationship Between Workplace Aggression and Misbehavior

Workplace aggression is a critical phenomenon particularly in the healthcare sector, where nurses are especially at risk of bullying and third-party aggression. While workplace aggression has been frequently examined in relation to health problems, less is known about the possible negative impact such aggression may have on the (un)ethical behavior of victims. Our research aims to fill this gap. Drawing on literature on counterproductive work behavior (CWB) and the social-cognitive literature on aggression we investigated in two independent studies (NStudy1 = 439; NStudy2 = 416), the role of negative emotions - in particular anger, fear, and sadness, - and of moral disengagement (MD) in the paths between workplace aggression, CWB and health symptoms. The focus on these relationships is rooted in two reasons. First, misbehavior at work is a pervasive phenomenon worldwide and second, little research has been conducted in the healthcare sector on this type of behavior despite the potential importance of the issue in this context. We empirically tested our hypotheses considering a specific form of workplace aggression in each study: workplace bullying or third-party aggression. Results from the two empirical studies confirm the hypotheses that being target of workplace aggression (bullying or third-party aggression) is not only associated with health symptoms but also with misbehavior. In addition, the results of structural equation modeling attest the importance of examining specific discrete negative emotions and MD for better understanding misbehavior at work. In particular, this research shows for the first time that anger, fear, and sadness, generally aggregated into a single dimension, are indeed differently associated with MD, misbehavior and health symptoms. Specifically, in line with the literature on discrete emotions, while sadness is only associated with health symptoms, anger and fear are related to both health and misbehavior.

Indian nurses in Italy: a qualitative study of their professional and social integration

AIMS AND OBJECTIVES

To investigate the lived subjective experiences of immigrant Indian nurses in Italy and specifically their professional and social integration.

BACKGROUND

To study the worldwide, nursing flux is a health priority in the globalised world. The growth in migration trends among nurses, not only from Philippines or India, has proliferated in recent years. The research on nurses' mobility for Southern European countries is underexplored, and in Italy, the out-migration flows of Indian nurses were never analysed.

DESIGN

Qualitative methodological approach.

METHODS

Semi-structured interviews (n = 20) were completed with Indian clinical nurses working in Italy for more than one year mainly in private organisations. A purposive sampling technique was used for recruitment. The data were then content-analysed using an inductive method.

RESULTS

The findings were categorised into four themes: (1) aspects of professional integration and working experience, (2) intra- and interprofessional relationships and perceptions of the IPASVI Regulatory Nursing Board, (3) initial nursing education and continuous professional development and (4) perceptions of social integration.

CONCLUSION

The results show that for Indian nurses in Italy emigration is important to gain opportunities to expand economic and social privileges as well as escape from historical assumptions of stigma associated with nursing work, especially for women. However, these conclusions have to be seen in wider socio-cultural complexities that are at the basis of transnational fluxes (Prescott & Nichter ).

RELEVANCE TO CLINICAL PRACTICE

The research offers an insight into the complicated reasons for Indian nurses out-migration to Italy. Without comprehending the interwoven textures of the political and social relations that are continually constructed and re-constructed among different nations, it is difficult to understand nurses out-migration and consequently have a better and safer collaborative teamwork in the host countries.