Ethical issues for neonatal nurses

Bridging the Gap: a study of general nurses’ perceptions of patient advocacy in Ireland

Advocacy has become an accepted and integral attribute of nursing practice. Despite this adoption of advocacy, confusion remains about the precise nature of the concept and how it should be enacted in practice. The aim of this study was to investigate general nurses’ perceptions of being patient advocates in Ireland and how they enact this role. These perceptions were compared with existing theory and research on advocacy in order to contribute to the knowledge base on the subject.

An inductive, qualitative approach was used for this study. Three focus group interviews with a total of 20 practising nurses were conducted with a sample representing different grades in a general hospital setting. Data analysis was carried out using elements of Strauss and Corbins’ approach to concept development. The findings indicate that the principal role of the nurse advocate is to act as an intermediary between the patient and the health care environment. The results highlight that advocacy did, however, result in nurses becoming involved in conflict and confrontation with others and that it could be detrimental to nurses both professionally and personally. It was also clear that when enacting advocacy, nurses distinguished between ‘clinical advocacy’ (acting directly for patients in the clinical environment) and organizational advocacy (acting on an organizational level for one or more patients).

Nursing Students’ Experience of Ethical Problems and Use of Ethical Decision-Making Models

Using a conceptual framework and method combining ethical enquiry and phenomenology, we asked 73 senior baccalaureate nursing students to answer two questions: (1) What is nursing students’ experience of an ethical problem involving nursing practice? and (2) What is nursing students’ experience of using an ethical decision-making model? Each student described one ethical problem, from which emerged five content categories, the largest being that involving health professionals (44%). The basic nature of the ethical problems consisted of the nursing students’ experience of conflict, resolution and rationale; 85% of the students stated that using an ethical decision-making model was helpful. Although additional research is needed, these findings have important implications for nursing ethics education and practice.

Narratives of Neonatal Intensive Care Unit Nurses: Experience with End-of-Life Care

The purpose of this interpretive narrative research is to explore the experiences of Neonatal Intensive Care Unit (NICU) nurses with end-of-life care of infants and their families. Guided by Newman's Research-as-Praxis, we met with nurse participants from a tertiary care NICU twice in small groups and once on the telephone to share their stories. Patterns of relationship were discerned and shared with our participants for their affirmation, challenge, and elaboration. NICU nurses' end-of-life experiences include relationship patterns, knowledge construction, and tensions of temporal and spatial proximity of suffering and death. Arts-based forms of dissemination of our findings have been developed to invite readers into reconstruction of their experiences and to demonstrate the transferability of the method.

Ethical advocacy based on caring: a model for neonatal and paediatric nurses

Advocacy has been identified as an ideal in nursing practice. National codes (Australian Nursing and Midwifery Council) and professional standards (Australian College of Neonatal Nurses) state that nurses are to respect their patients' autonomous choices and act as their advocates. This responsibility includes acting as advocates for the needs and welfare of patients, for the profession of nursing and for the interests of colleagues in nursing. However, ambiguous interpretations of the concept of patient advocacy continue to pose a number of problems for nurses in practice and in particular neonatal practice. Neonatal nurses often perceive themselves primarily as advocates for the rights of helpless and vulnerable infants in their care. Advocacy is underpinned by caring, which is a significant feature in the delivery of quality care for each baby and child. This advocacy may be expressed at the bedside, in committee meetings, in agency discussions or in the public arena.

Nursing ethics education: are we really delivering the good(s)?

The vast majority of research in nursing ethics over the last decade indicates that nurses may not be fully prepared to 'deliver the good(s)' for their patients, or to contribute appropriately in the wider current health care climate. When suitable research projects were evaluated for this article, one key question emerged: if nurses are educationally better prepared than ever before to exercise their ethical decision-making skills, why does research still indicate that the expected practice-based improvements remain elusive? Hence, a number of ideas gleaned from recent research about the current nature of nursing ethics, and especially teaching nursing ethics to student nurses, are analysed and critiqued in this article, which concludes with a cluster of ideas and conclusions based on that analysis. It is hoped that such a review may serve as a catalyst for nurse educators to re-examine their teaching practices with a view to enhancing good (i.e. ethical) nursing practice through educational means.

Enfermagem neonatal: análise das publicações indexadas nos índices de referências informatizados

O objetivo do estudo foi identificar e analisar a produção do conhecimento científico em enfermagem neonatal utilizando índices de referências informatizados. Estudo quantitativo, descritivo teve como fonte de informações as bases de dados MEDLINE, CINAHL e LILACS no período de 1990 a 2000. Utilizaram-se dos descritores "neonatal nursing", para acessar às primeiras duas bases de dados e "enfermagem neonatal e enfermeria neonatal" para o LILACS. Foram identificadas 3.576 publicações, 2.336 (61,12%) indexadas no CINAHL, 3.062 (85,58%) divulgadas em periódicos norte-americanos e ingleses. Analisaram-se 1940 resumos do total de publicações, processo de assistir foi a temática com o maior número de publicações - 804 (41,45%).

Registered nurses' lived experience of advocacy within a critical care unit: a phenomenological study

Anecdotally, it has often been expressed by registered nurses (RNs) working within critical care environments that they are patient advocates. However, to date, little systematic research has been undertaken to validate this assertion. Thus this project, which explored the lived experience of RNs working within a critical care unit in a country area of Australia, was conceived. The five participants of this study were all Division 1 RNs possessing a critical care certificate and a minimum of 4 years' nursing experience. Through their participation in an in-depth audiotaped interview they revealed a wealth of experiences and ideas about their involvement as patient advocates. The results of this research indicate that the phenomenon of nurse advocacy is a multi-faceted process and embraces many kinds of activities that nurses engage in on behalf of their clients. The findings of this study indicate that some of the participants' experiences are congruent with elements of advocacy contained within the nursing literature and statements of professional nursing bodies. However, there are some findings in this study that are not consistent with available literature. For instance, these participants markedly reject the notion that advocacy is an inappropriate concept for nurses, despite suggestions in the literature that this is an inappropriate role. Instead they wholeheartedly embrace this role, asserting it as central to their practice. Further, although the literature identifies potential controversies regarding enactment of the role of advocacy, the participants of this study are silent on these matters. It is not known what this silence implies and, in light of the study findings, it is recommended that nursing organisations, theorists and clinicians consider whether it is worthwhile to more clearly confirm the nature and role of advocacy within Australian nursing.