Ethical Dilemmas in the Lived Experience of Nursing Practice

Gold, Carrol; Chambers, Jewell C.; Dvorak, Eileen McQuaid

doi:10.1177/096973309500200205

Cited by 25 publications

(18 citation statements)

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“…This points to a genuine need for CES activities in this area of health and care services: the ethics activities deal with complex and central matters, the handling of which most likely makes a difference for patients/users and next of kin. Apparently, the most common ethical challenges are also encountered in similar services in other countries, as other research indicates [9, 25, 26]. …”

Section: Discussionmentioning

confidence: 96%

The Norwegian national project for ethics support in community health and care services

et al. 2016

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BackgroundInternationally, clinical ethics support has yet to be implemented systematically in community health and care services. A large-scale Norwegian project (2007–2015) attempted to increase ethical competence in community services through facilitating the implementation of ethics support activities in 241 Norwegian municipalities. The article describes the ethics project and the ethics activities that ensued.MethodsThe article first gives an account of the Norwegian ethics project. Then the results of two online questionnaires are reported, characterizing the scope, activities and organization of the ethics activities in the Norwegian municipalities and the ethical topics addressed.ResultsOne hundred and thirty-seven municipal contact persons answered the first survey (55 % response rate), whereas 217 ethics facilitators from 48 municipalities responded to the second (33 % response rate). The Norwegian ethics project is vast in scope, yet has focused on some institutions and professions (e.g., nursing homes, home-based care; nurses, nurses’ aides, unskilled workers) whilst seldom reaching others (e.g., child and adolescent health care; physicians). Patients and next of kin were very seldom involved. Through the ethics project employees discussed many important ethical challenges, in particular related to patient autonomy, competence to consent, and cooperation with next of kin. The “ethics reflection group” was the most common venue for ethics deliberation.ConclusionsThe Norwegian project is the first of its kind and scope, and other countries may learn from the Norwegian experiences. Professionals have discussed central ethical dilemmas, the handling of which arguably makes a difference for patients/users and service quality. The study indicates that large (national) scale implementation of CES structures for the municipal health and care services is complex, yet feasible.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-016-0158-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 96%

The Norwegian national project for ethics support in community health and care services

et al. 2016

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“…However, the presupposition that mental illness involves limited autonomy cannot be taken to justify use of coercion, which is often poorly defined in mental health literature, resulting in problems considering coercion from an ethical perspective (O’Brien & Golding 2003). Previous research has already pointed out that nurses have taken a passive role when resolving ethical problems (Gold et al . 1995, Oddi et al .…”

Section: Discussionmentioning

confidence: 99%

Nurses’ ethical perceptions about coercion

Lind

Kaltiala-Heino

Suominen

et al. 2004

Psychiatric Ment Health Nurs

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In Finland, special attention has been paid to ethical questions related to the care of psychiatric patients and to the enhancement of patients' rights, yet the majority of the nurses participating in the survey did not perceive coercive measures as ethically problematic. More research on this issue as well as further education of the personnel and more extensive teaching of ethics in nursing schools are needed to support the ability of the psychiatric personnel to identify ethically problematic situations. In addition, it is important to consider new measures for generating genuine moral reflection among the personnel on the usage of coercive measures as well as on their effectiveness and legitimacy in the psychiatric care.

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“…Participants in one study concurred that ‘trust is built largely on communication’ 53 . Communicating less than truthful information will directly influence trust—essential for the helping relationship 54,55 …”

Section: Paternalism and Best Interestsmentioning

confidence: 99%

“…53 Communicating less than truthful information will directly influence trust-essential for the helping relationship. 54,55…”

Section: Paternalism and Best Interestsmentioning

confidence: 99%

On paternalism, autonomy and best interests: Telling the (competent) aged‐care resident what they want to know

Tuckett

2006

Int J of Nursing Practice

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This paper has been derived from a review of literature from a recent qualitative study that explored the meaning of truth-telling within the care provider-aged resident dyad in high-level (nursing home) care of elderly people. In the literature reviewed here, paternalism (as benevolent decision-making in another's best interests) is critically analysed. Autonomy is then described and its function in promoting health is underscored. Furthermore, this paper specifically challenges nurses to consider their capacity to really know another's best interests--particularly in the nursing home. Finally, a very simple recommendation is proposed for determining and managing the (competent) aged-care resident's informational disclosure preferences: ask them.

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Ethical Dilemmas in the Lived Experience of Nursing Practice

Cited by 25 publications

References 0 publications

The Norwegian national project for ethics support in community health and care services

The Norwegian national project for ethics support in community health and care services

Nurses’ ethical perceptions about coercion

On paternalism, autonomy and best interests: Telling the (competent) aged‐care resident what they want to know

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