Moral neutralization: Nurses' evolution in unethical climate workplaces

An Exploration of Personally Mediated Racism Among Nursing Students Through the Participant-Driven Photo-Elicitation Method

In recent years, global forced migration due to conflict, violence, and persecution has increased dramatically, affecting numerous countries, with Türkiye being particularly impacted. Despite global trends showing a significant decline in positive attitudes toward refugees, the limited existing literature on racism in nursing education primarily focuses on themes related to white supremacy. This focus inadequately addresses the issue of personally mediated racism toward various ethnic groups, especially within the context of nursing education and research. Considering the ongoing migration influx, it is crucial to examine personally mediated racism and its underlying causes among nursing students in countries most affected by this issue. This study examined personally mediated racism among nursing students toward refugees in Türkiye by creating an environment conducive to productive discussions, utilizing a participant-driven photo-elicitation method. The study identifies two key themes to address gaps in the literature: "The Road to Personally Mediated Racism" and "Uncontrollable Exclusivism," emphasizing the existence of personally mediated racism among nursing students. This study's findings underscore the essential need to integrate antiracist education and promote open discussions about current societal developments and dynamics within nursing education.

Consequences of Moral Outrage among Nurses: A Scoping Review

Background

Clinical nurses often encounter situations that challenge their professional integrity and values. In the face of these issues, many nurses have been subjected to moral outrage (MO) in response to moral violations by others, which can have different outcomes. This scoping review aimed to synthesize and summarize findings from existing articles regarding the consequences of moral outrage among nurses.

Materials and Methods

This paper presents a scoping review based on the Joanna Briggs Institute (JBI) methodology. PubMed, Springer, Scopus, and ScienceDirect databases were systematically searched using the keywords "moral outrage", "nurses or nursing" and "consequences or outcomes or impacts or effects or influences of moral outrage" (viz., moral OR ethical AND outrage AND nurse*). The PRISMA checklist was used for the scoping review to evaluate articles thoroughly. The results were summarized using the inductive content analysis suggested by Elo and Kyngäs.

Results

In total, 1014 articles were identified as potentially relevant to this study with 34 articles synthesized, including 24 qualitative studies, 5 quantitative studies, and 5 reviews focused on the consequences of moral offenses in nursing. Negative consequences such as mental exhaustion, job burnout, and interpersonal failures were observed, alongside positive consequences like nurses' altruism, callousness, and professional solidarity.

Conclusions

These findings underscore the importance of addressing MO among nurses to prevent negative consequences such as burnout and moral degradation. Moreover, recognizing and fostering the altruistic and resilient aspects of nurses in response to moral outrage can lead to a more positive work environment and improved patient care.

Enhancing student nurses' ethical skills via simulation-based learning: barriers and opportunities

BACKGROUND

Nurses lack skills to analyse ethical problems, and some feel powerless and frustrated when encountering and having to deal with ethical dilemmas in clinical practice. The lack of ethical competence among nurses might somewhat be related to the neglect and side-lining of ethics in the education system. For those nurse educators who are facilitating ethics within their curriculum, their strategies and practices are inefficient due to lack of resources. Lack of efficient strategies to facilitate ethical competence create threats to ethical values in healthcare with a potential to jeopardise patients' health outcomes.

METHODS

This was a qualitative, descriptive, exploratory, and contextual research that was done in one higher education institution among 9 nurse educators and clinical nurse preceptors. Online semi-structured interviews were conducted, data were transcribed and analysed following Giorgi's thematic analysis method.

RESULTS

Two themes with 5 related subthemes emerged from the data. The theme of barriers that hinder the facilitation of ethical skills for nursing students indicated how Covid-19 pandemic lead to constraints that lead to facilitators focusing on clinical skills and procedures and side lining ethics education. While the theme transformative approaches to fostering ethical competency through simulation- based learning indicated some strategies that facilitators could adopt to ensure efficient ethics education for nursing students.

CONCLUSION

Barriers related to insufficient human resources and infrastructure made it almost impossible to facilitate ethics education among nursing students, especially during Covid-19 pandemic. This research offers some transformative solutions that could be adopted by higher education institutions to ensure that ethical competence is effectively facilitated.

Sources of moral distress in nursing professionals: A scoping review

This article presents a scoping review aimed at mapping the main sources of moral distress among nursing professionals. The review was conducted according to the Arksey and O'Malley methodology, using the SPIDER framework to guide the systematic search in the BVS, PubMed, PsycArticles, Scielo, and Scopus databases. Initially, 2320 publications were identified. After the application of inclusion and exclusion criteria, 83 studies were selected for analysis in terms of their methodological characteristics, objectives, practice contexts, and various sources of moral distress identified. The analysis facilitated the grouping of these sources into specific situations, reflecting the challenges experienced by nurses under different practice settings. This review augments the knowledge of the causes of moral distress in nursing, highlighting the impact of this phenomenon on the physical and mental health of professionals, as well as on the quality of care provided.

Moral sensitivity as a personal and work attribute of emergency care nurses: a cross-sectional study

OBJECTIVE

to analyze the moral sensitivity of Brazilian emergency care nurses according to their personal and work characteristics.

METHOD

this is a quantitative, descriptive, cross-sectional study with a convenience sample. A total of 422 nurses from emergency care services in the five regions of Brazil took part. Sociodemographic and work-related information was collected, as well as the Brazilian version of the Moral Sensitivity Questionnaire. After approval by the Research Ethics Committee, the data was collected using a self-administered form on the Google Forms Platform, organized using Excel software and analyzed using the R language.

RESULTS

nurses with longer experience in emergency care services showed higher levels in the interpersonal orientation, moral conflict and moral significance dimensions, while in the professional knowledge dimension, men showed higher levels, as evidenced by items that include confidence in nursing knowledge, intuition, experience and opinion.

CONCLUSION

the differences in the nurses' moral sensitivity were due to their professional experience. It should be emphasized that valuing the sharing of intergenerational experiences in service could be a possible strategy for fostering moral competencies in the field of practice.

Barriers to ethical treatment of patients in clinical environments: A systematic narrative review

Background and Aim

It is essential that healthcare providers display ethical behavior toward their patients. Despite development of codes of ethics for clinical practice, the occurrence of unethical behaviors toward patients is alarmingly high. The present study was conducted to identify the barriers to ethical treatment of patients in clinical environments.

Methods

Through systematic narrative review, the present study investigated the barriers to ethical treatment of patients. This study was carried out in line with Assessment of Multiple Systematic Reviews 2 and Preferred Reporting Items of Systematic reviews and Meta-Analyses guidelines.

Results

Ethical challenges in clinical environments can be classified into two categories: "organizational factors" and "personal factors." Organizational factors consist of three domains: managers and regulations, organizational environment, and human resources. Personal factors consist of two domains: factors related to patients and their families and factors related to care providers.

Conclusion

Research shows that encouraging healthcare teams to adopt ethical behaviors through education and having them persistently observe ethics in their clinical practice will not completely bridge the gap between theory and practice: it seems that the clinical environment, the personal characteristics of healthcare team members and patients, and the organizational values of the healthcare system pose the greatest barrier to bridging this gap. Accordingly, in addition to raising healthcare providers' awareness of the existing issues in clinical ethics, measures should be taken to improve organizational culture and atmosphere.

A study on different types of moral courage and coping styles of clinical nurses: based on potential profile analysis

BACKGROUND

In professional ethics-related events, there are various unpleasant and complex ethical issues that require strong moral courage. Our aim is to identify and describe the potential categories of moral courage among nurses and to clarify the coping styles of nurses under different categories.

METHOD

A cross-sectional study was conducted using three data collection tools: a self-designed general information questionnaire, a Chinese version of the Moral Courage Scale, and a Trait Coping Style Questionnaire. Three hundred fourteen nurses from a tertiary hospital in Heilongjiang Province, China, were analysed using potential profile analysis, descriptive analysis, and Mann-Whitney U test data.

RESULT

The latent profile analysis (LPA) results indicate that the two-profile model is the most suitable and supports the existence of two different moral courage profiles: the low moral courage group (60.51%) and the high moral courage group (39.49%), with a high relative entropy value (0.922). The results point to a good profile solution, and there are significant differences between the two profiles. The Mann-Whitney U-test results showed that the positive coping scores of the high moral courage group were significantly higher than those of the low moral courage group, and the negative coping scores of the high moral courage group were significantly lower than those of the low moral courage group.

CONCLUSION

Our results reveal the heterogeneity of moral courage in the nurse sample and indicate that nurses in the high moral courage group tend to choose positive coping styles, while nurses in the low moral courage group are more likely to develop negative coping emotions. This provides important significance and reference value for nursing managers, who can propose customised management plans based on the types of moral courage of the nursing community and the coping styles under different categories.

The birthing experiences of mothers with clinical healthcare professionals and community birth attendants in rural northern Ghana

BACKGROUND

The use of non-professional birth attendants, such as untrained family members and traditional birth attendants, contributes to birth-related complications such as neonatal and maternal mortality. Strategies such as professionally conducted home births and placement of community health professionals close to homes to ensure easy access to skilled birth attendants aim to reduce complications. However, women in labour continue to access the services of unskilled birth attendants in developing settings.

AIM

To explore the experiences of women in labour who received care from professional birth attendants and community birth attendants to understand the reasons for continued use of non-professional community birth attendants.

METHODS

A qualitative approach was used to explore the birthing experiences of nine mothers, aged 20-45 years. In-depth face-to-face interviews were conducted to generate data with the help of an interview guide. A content analysis approach was used to organise and interpret the data.

FINDINGS

The participants reported hostile interactions with professional birth attendants, imposition of birthing positions by professional birth attendants, high cost of birthing services by professional birth attendants, and safety risks with non-professional community birth attendants.

CONCLUSION

There is a need for explicit health financing systems that ensure mothers are aware and adequately prepared for labour-related costs. Mothers wish to receive care from professional birth attendants, but feel compelled by negative experiences to choose family members and non-professional birth attendants instead. The adherence of health professionals to the fundamental principles of 'Respectful Maternity Care' could reduce their negative attitudes towards women in labour.

Moral conflicts from the justice and care perspectives of japanese nurses: a qualitative content analysis

BACKGROUND

Healthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals' moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions.

METHOD

Semi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person's thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally's taxonomy.

RESULTS

Among 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The "rules" category of justice and the "welfare of others" category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective.

CONCLUSIONS

The nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider's responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended.

Nurses' Perception of Professionalism in Practice: A Review of Qualitative Studies

Professionalism is a fundamental concept in nursing and a central aspect of nursing care. The review aimed to synthesize evidence presented in qualitative studies related to the perception of professionalism in nursing practice. Six main analytical themes were generated from primary studies included in the literature review: everyday practice, ethical aspects of nursing care, nurses' identity, nurses' professional growth, achieving autonomy, complexity of relationships. Presented themes are considered key elements of nursing professionalism, are closely interconnected, and support the multidimensional structure of professionalism in nursing. Nursing professionalism means providing high-quality care while upholding the values of integrity, accountability, and respect.

Nurses' Lived Experiences of Moral Courage Inhibitors: A Qualitative Descriptive Study

Introduction

Moral courage (MC) has been characterized among the vital strategies, adopted by nurses, for dealing with moral distress; even though there are some factors hindering the development of this behavior in clinical settings.

Objective

The present study accordingly aimed to shed light on Iranian nurses' lived experiences regarding MC inhibitors.

Methods

This qualitative descriptive study was fulfilled, using conventional content analysis. For this purpose, the participants comprised of 15 nurses were recruited purposively from teaching hospitals in Iran. As well, in-depth, individual semistructured interviews in a face-to-face mode were held for data collection. The data were further analyzed by Graneheim and Lundman's method.

Results

The analysis of the interviews revealed some MC inhibitors, including the individual factors (viz., personality traits, fear of job loss, poor scientific/practical skills, lack of ethical knowledge, and phobia of unpleasant experience recurrence), and the organizational ones (namely, no reward system, lack of power at work and physician dominance, inadequate organizational support, and suppressive environment).

Conclusion

The study findings demonstrated that the MC inhibitors in the nursing practice could be split into two general themes, that is, the individual and organizational ones. Accordingly, organizations could motivate nurses to make ethical decisions courageously, using supporting strategies, such as giving importance to nurses and empowering them, applying appropriate evaluation criteria, and appreciating ethical performance in these frontline healthcare workers.

Ethikbildung in der Pflege – strukturelle Besonderheiten und didaktische Implikationen der Pflegeausbildung

Die Pflegeausbildung weist die Besonderheit auf, dass die berufliche Bildung an unterschiedlichen Lernorten erfolgt. Die jeweils beteiligten Lernorte (Lernort Theorie, Lernort Praxis, zunehmend erweitert durch den dritten Lernort, das Skillslab) beeinflussen und fördern die Entwicklung der Ethikkompetenzen der angehenden Pflegfachpersonen – lernortspezifisch als auch lernortübergreifend – in unterschiedlicher Weise. Diese besonderen strukturellen Gegebenheiten des Lehrens und Lernens wirken sich sowohl auf die Ausgestaltung der Ethikbildung als auch auf die Förderung der Ethikkompetenzentwicklung im Ausbildungsverlauf aus.

Die Ausführungen leitet die folgende Frage: Welche spezifischen pädagogischen und didaktischen Anforderungen, aber auch welche bildungsrelevanten Rahmungen ergeben sich angesichts der unterschiedlichen Lernorte für die Ethikbildung und die Ethikkompetenzentwicklung zukünftiger Pflegefachpersonen?

Der Beitrag unterstreicht die Relevanz einer systematischen, methodisch reflektierten und lernortabgestimmten Ethikbildung im Bereich der Pflegeausbildung wie auch die Relevanz der bewussten Einbindung ethischer Reflexionsräume in die Prozesse der Ethikkompetenzentwicklung an den jeweiligen Lernorten. Die Besonderheiten der Ethikbildung erschließen sich hierbei aus den pflegeberuflichen Anforderungen an das professionelle Pflegehandeln und aus den Erfahrungen der Lernenden an den unterschiedlichen Lernorten im Verlauf der Pflegeausbildung.

Nurses' ethical leadership and related outcome variables: Systematic Review and Meta-analysis

AIM

To investigate the outcomes and the effect sizes of ethical leadership in nursing practice BACKGROUND: Many meta-analysis of ethical leadership have conducted in other fields, but there are none of the effects of ethical leadership of nurse leaders and should be investigated EVALUATION: For a systematic literature review, we searched PubMed, EMBASE, the Cochrane Library, CINAHL, OVID, Web of Science, and Korean databases for studies published in Korean or English. We used CMA 2.0 and R 3.6.2 for the meta-analysis KEY ISSUES: We divided the outcomes of ethical leadership into three categories and investigated the effect sizes: subordinates' perceptions of their leaders (ES = 0.65), subordinates' ethical behaviors (ES = 0.04), and job or organizational outcomes (ES = 0.45). In addition, we identified 14 outcome variables, and transformational leadership showed the greatest effect size (ES = 0.77) among them CONCLUSION: This study confirmed the positive effects of ethical nursing leadership on individual nurses' perceptions about their leaders, their jobs, and organizations IMPLICATIONS FOR NURSING MANAGEMENT: Nursing organizations and nurse administrators should make efforts to highlight ethical leadership of nurse leaders to improve outcomes of organizational performance including individual nurses' perceptions about their leaders, their jobs, and organizations.

Iranian nurses' views on barriers to moral courage in practice: A qualitative descriptive study

Background

Nursing is a caring profession. Due to the nature of their work, nurses need to have the moral courage to deliver safe nursing care. Research results have reported a low level of moral courage in the majority of nurses. The current study aimed to identify the barriers to show moral courage in Iranian nurses.

Methods

This study was qualitative research that was conducted using conventional content analysis. Data was gathered using in-person, semi-structured, in-depth interviews. Interviews were conducted from March to September 2020. Purposeful sampling was used and sampling was continued until data saturation was reached. Participants were 19 nurses working in hospitals in Iran.

Results

According to data analysis, six categories and three themes were extracted. Themes are “organizational failure”, “deterrent personal identity” and “defeated professional identity”.

Conclusions

The results of this study revealed the barriers to show moral courage which were usually overlooked in previous quantitative studies. It appears that the elimination of these barriers is an effective step in the improvemalet of nurses’ competencies. The results of this study can be helpful in the developmalet of programs to address the factors affecting nurses’ moral courage.