BACKGROUND Complexity in health care environments causes practice problems. Nurses bear responsib... more BACKGROUND Complexity in health care environments causes practice problems. Nurses bear responsibility for recognizing, addressing, and preventing ethical problems. Inadequacies in ethics education are partly to blame and contribute to nurse moral distress, attrition, and suboptimal care. Foundational curricula structures adequate for developing nurse moral agency are needed. METHOD The state of the science of ethics education in nursing was explored in-depth by a subcommittee of the American Nurses Association Ethics Advisory Board. A framework based in nursing goals was designed by nurse ethics experts to address ethics education across levels of curricula and practice. Rest's four-component model of moral behavior structures guidelines. RESULTS The model captures three facets of nurse moral agency: necessary characteristics, knowledge and skills, and motivation. A case is provided to illustrate its utility. CONCLUSION This framework provides the means to meet the profession's goal of preparing ethically competent nurses who will exercise moral agency. [J Nurs Educ. 2022;61(3):123-130.].
Ethical Issues Experienced By Psychiatric/Mental Health And Substance Abuse Nurses: Frequency And... more Ethical Issues Experienced By Psychiatric/Mental Health And Substance Abuse Nurses: Frequency And Disturbance Levels Conference Sponsor: Eastern Nursing Research Society Conference Year: 2001 Author: Grace, Pamela PI Institution Name: Boston College ...
Because health care professions exist to provide a good for society, ethical questions are inhere... more Because health care professions exist to provide a good for society, ethical questions are inherently part of them. Such professions and their members can be assessed based on how effective they are in developing knowledge and enacting practices that further the health and well-being of individuals and society. The complexity of contemporary health care environments makes it important to prepare clinicians who can anticipate, recognize, and address problems that arise in practice or that prevent a profession from fulfilling its service goals and obligations. Different health care professions have evolved distinct perspectives about appropriate goals for, and the purposes of, their clinicians, even when the goal of improving health and well-being for society is shared across professions. While medicine and nursing goals are shared in principle, they differ in the particulars. Given the centrality to nursing of ethical questions, the profession has a collective responsibility to help clinicians at all levels of practice become ethically savvy and to reinforce their moral agency as needed. Both knowledge of nursing ethics and knowledge of the interdisciplinary field of bioethics are critical to nursing work.
This article summarizes a virtual live-streamed panel event that occurred in August 2020 and was ... more This article summarizes a virtual live-streamed panel event that occurred in August 2020 and was cosponsored by the International Philosophy of Nursing Society (IPONS) and the University of California, Irvine's Center for Nursing Philosophy. The event consisted of a series of three self-contained panel discussions focusing on the past, present and future of IPONS and was moderated by the current Chair of IPONS, Catherine Green. The first panel discussion explored the history of IPONS and the journal Nursing Philosophy. The second panel involved a reflection on the challenges of doing nursing philosophy in a research-intensive context of a Canadian university and the history and current movements in nursing philosophy in the Nordic countries. The final panel involved presentations on the future potential for philosophy in/and for nursing, the critical connections between nursing philosophy and nursing theory, dismantling racism in nursing and the potential for process philosophy to help explore nursing's unique efficacy in creating possibilities for health. The panels were followed by a lively Q&A session with participants, of which there were 252 registrants from across the globe. The event underscored the wide and diverse interests of nurses in philosophical discussion and the need for more virtual events and other connective modalities bringing nurses together to discuss and analyze the value and potential of philosophy to better understand and advance nursing theory and practice.
BACKGROUND More older couples are living independently while managing chronic health conditions. ... more BACKGROUND More older couples are living independently while managing chronic health conditions. Though research is replete in identifying the influence of spouse's behaviours on each other's health, there is little known of the specific factors underlying the older couples' relational processes to explain this dynamic. Knowledge development is needed to provide a grounding for interventions to address such influences to improve health and well-being. AIM The aim of this study was to advance the understanding of older couples' experiences of living with chronic health conditions to gain insights into the potential benefits of 'being a couple' to manage behavioural health and life adjustments. METHOD A hermeneutic-dialectic phenomenology design based on Newman's theory of Health as Expanding Consciousness was used. Fourteen older couples were jointly interviewed. The interviews were non-structured and designed to capture their experience as a couple. RESULTS Three themes emerged (a) living meaningfully through mutual caregiving, (b) a pattern of spousal movement facilitating change and (c) co-creating as an older couple to move forward. CONCLUSION The study supports reframing older couple's care as a 'dyad of care'. This approach provides an opportunity to leverage the couples' mutuality to support health management as a couple. A motivation to action process between the spouses appeared to enable mutual caregiving, a reliance of each spouse on the another for identity, socialisation, health and daily living, which facilitated an evolving understanding of their lives and its meaning. IMPLICATIONS FOR PRACTICE Mutual caregiving should be acknowledged as a significant relational dynamic within older couples, as a dyad of care, when managing health and well-being.
Advocacy is an important concept in nursing practice; it is frequently used to describe th nurse-... more Advocacy is an important concept in nursing practice; it is frequently used to describe th nurse-client relationship. The term advocacy, however, is subject to ambiguity of interpretation. Such ambiguity was evidenced recently in criticisms levelled at the nursing profession by hospital ethicist Ellen Bernal. She reproached nursing for using 'patient rights advocate' as a viable role for nurses. We maintain that, for nursing, patient advocacy may encompass, but is not limited to, patient rights advocacy. Patient advocacy is not merely the defence of infringements of patient rights. Advocacy for nursing stems from a philosophy of nursing in which nursing practice is the support of an individual to promote his or her own well-being, as understood by that individual. It is an ethic of practice. La défense des malades joue un grand rôle dans la pratique des infirmiers/ères. Le terme est souvent utilisé pour définir les rapports entre malades et soignants. Le mot 'defénse'...
The patient says, 'I don&... more The patient says, 'I don't trust hospitals and I don't want strangers in my home!'--how should clinicians respond?
Doctorally prepared nurses must be able to represent the unique nursing perspective within interd... more Doctorally prepared nurses must be able to represent the unique nursing perspective within interdisciplinary teams to address contemporary health challenges. This article provides a student exemplar applying the unifying focus of facilitating humanization as described by Willis, Grace, and Roy to science on nature and health. As scientific knowledge becomes more complex, nurses must be skilled in translating information through the nursing lens to support individuals in realizing meaning, choice, quality of life, and healing in living and dying. In order for doctoral students to shepherd the discipline, they must first integrate nursing's philosophical underpinnings into their practice.
This article expands upon previous work by the authors to develop a model of nursing essential an... more This article expands upon previous work by the authors to develop a model of nursing essential and effective freedom to facilitate nursing action in behalf of social justice. The article proposes that while social justice is rooted in nursing's ontological, epistemological, and moral foundations, the discipline's social justice mandate is constrained by its historical and contemporary location within an institutionalized medical paradigm. We present a model of nursing "essential" and "effective" freedom based on the philosophy of Bernard Lonergan to illustrate how nursing can transcend these barriers. This humanizing model is illustrated through personal narratives of the authors.
An expansive and growing body of literature documents the problem of nurses’ moral distress when ... more An expansive and growing body of literature documents the problem of nurses’ moral distress when they are unable to carry out actions that they perceive to be in the best interests of patients. Further, nurse leaders and educators are not always well prepared to help nurses to develop moral agency. Moral agency is the ability to provide good care and overcome obstacles to good practice. One reason for the lack of preparation is that ethics education in academia, and in ongoing nurse education, has been inconsistent or has focused more on dilemmas than the ubiquitous everyday practice issues. The purpose of this article is to discuss goals of the nursing profession, contemporary challenges to good nursing practice, and leadership from those educated as Doctors of Nursing Practice (DNP). The author argues that the proliferation of (DNP) programs, focused as they are on leadership in practice settings, presents a unique opportunity to prepare nurse leaders who are, first and foremost, ...
Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated... more Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed to graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of...
BACKGROUND Complexity in health care environments causes practice problems. Nurses bear responsib... more BACKGROUND Complexity in health care environments causes practice problems. Nurses bear responsibility for recognizing, addressing, and preventing ethical problems. Inadequacies in ethics education are partly to blame and contribute to nurse moral distress, attrition, and suboptimal care. Foundational curricula structures adequate for developing nurse moral agency are needed. METHOD The state of the science of ethics education in nursing was explored in-depth by a subcommittee of the American Nurses Association Ethics Advisory Board. A framework based in nursing goals was designed by nurse ethics experts to address ethics education across levels of curricula and practice. Rest's four-component model of moral behavior structures guidelines. RESULTS The model captures three facets of nurse moral agency: necessary characteristics, knowledge and skills, and motivation. A case is provided to illustrate its utility. CONCLUSION This framework provides the means to meet the profession's goal of preparing ethically competent nurses who will exercise moral agency. [J Nurs Educ. 2022;61(3):123-130.].
Ethical Issues Experienced By Psychiatric/Mental Health And Substance Abuse Nurses: Frequency And... more Ethical Issues Experienced By Psychiatric/Mental Health And Substance Abuse Nurses: Frequency And Disturbance Levels Conference Sponsor: Eastern Nursing Research Society Conference Year: 2001 Author: Grace, Pamela PI Institution Name: Boston College ...
Because health care professions exist to provide a good for society, ethical questions are inhere... more Because health care professions exist to provide a good for society, ethical questions are inherently part of them. Such professions and their members can be assessed based on how effective they are in developing knowledge and enacting practices that further the health and well-being of individuals and society. The complexity of contemporary health care environments makes it important to prepare clinicians who can anticipate, recognize, and address problems that arise in practice or that prevent a profession from fulfilling its service goals and obligations. Different health care professions have evolved distinct perspectives about appropriate goals for, and the purposes of, their clinicians, even when the goal of improving health and well-being for society is shared across professions. While medicine and nursing goals are shared in principle, they differ in the particulars. Given the centrality to nursing of ethical questions, the profession has a collective responsibility to help clinicians at all levels of practice become ethically savvy and to reinforce their moral agency as needed. Both knowledge of nursing ethics and knowledge of the interdisciplinary field of bioethics are critical to nursing work.
This article summarizes a virtual live-streamed panel event that occurred in August 2020 and was ... more This article summarizes a virtual live-streamed panel event that occurred in August 2020 and was cosponsored by the International Philosophy of Nursing Society (IPONS) and the University of California, Irvine's Center for Nursing Philosophy. The event consisted of a series of three self-contained panel discussions focusing on the past, present and future of IPONS and was moderated by the current Chair of IPONS, Catherine Green. The first panel discussion explored the history of IPONS and the journal Nursing Philosophy. The second panel involved a reflection on the challenges of doing nursing philosophy in a research-intensive context of a Canadian university and the history and current movements in nursing philosophy in the Nordic countries. The final panel involved presentations on the future potential for philosophy in/and for nursing, the critical connections between nursing philosophy and nursing theory, dismantling racism in nursing and the potential for process philosophy to help explore nursing's unique efficacy in creating possibilities for health. The panels were followed by a lively Q&A session with participants, of which there were 252 registrants from across the globe. The event underscored the wide and diverse interests of nurses in philosophical discussion and the need for more virtual events and other connective modalities bringing nurses together to discuss and analyze the value and potential of philosophy to better understand and advance nursing theory and practice.
BACKGROUND More older couples are living independently while managing chronic health conditions. ... more BACKGROUND More older couples are living independently while managing chronic health conditions. Though research is replete in identifying the influence of spouse's behaviours on each other's health, there is little known of the specific factors underlying the older couples' relational processes to explain this dynamic. Knowledge development is needed to provide a grounding for interventions to address such influences to improve health and well-being. AIM The aim of this study was to advance the understanding of older couples' experiences of living with chronic health conditions to gain insights into the potential benefits of 'being a couple' to manage behavioural health and life adjustments. METHOD A hermeneutic-dialectic phenomenology design based on Newman's theory of Health as Expanding Consciousness was used. Fourteen older couples were jointly interviewed. The interviews were non-structured and designed to capture their experience as a couple. RESULTS Three themes emerged (a) living meaningfully through mutual caregiving, (b) a pattern of spousal movement facilitating change and (c) co-creating as an older couple to move forward. CONCLUSION The study supports reframing older couple's care as a 'dyad of care'. This approach provides an opportunity to leverage the couples' mutuality to support health management as a couple. A motivation to action process between the spouses appeared to enable mutual caregiving, a reliance of each spouse on the another for identity, socialisation, health and daily living, which facilitated an evolving understanding of their lives and its meaning. IMPLICATIONS FOR PRACTICE Mutual caregiving should be acknowledged as a significant relational dynamic within older couples, as a dyad of care, when managing health and well-being.
Advocacy is an important concept in nursing practice; it is frequently used to describe th nurse-... more Advocacy is an important concept in nursing practice; it is frequently used to describe th nurse-client relationship. The term advocacy, however, is subject to ambiguity of interpretation. Such ambiguity was evidenced recently in criticisms levelled at the nursing profession by hospital ethicist Ellen Bernal. She reproached nursing for using 'patient rights advocate' as a viable role for nurses. We maintain that, for nursing, patient advocacy may encompass, but is not limited to, patient rights advocacy. Patient advocacy is not merely the defence of infringements of patient rights. Advocacy for nursing stems from a philosophy of nursing in which nursing practice is the support of an individual to promote his or her own well-being, as understood by that individual. It is an ethic of practice. La défense des malades joue un grand rôle dans la pratique des infirmiers/ères. Le terme est souvent utilisé pour définir les rapports entre malades et soignants. Le mot 'defénse'...
The patient says, 'I don&... more The patient says, 'I don't trust hospitals and I don't want strangers in my home!'--how should clinicians respond?
Doctorally prepared nurses must be able to represent the unique nursing perspective within interd... more Doctorally prepared nurses must be able to represent the unique nursing perspective within interdisciplinary teams to address contemporary health challenges. This article provides a student exemplar applying the unifying focus of facilitating humanization as described by Willis, Grace, and Roy to science on nature and health. As scientific knowledge becomes more complex, nurses must be skilled in translating information through the nursing lens to support individuals in realizing meaning, choice, quality of life, and healing in living and dying. In order for doctoral students to shepherd the discipline, they must first integrate nursing's philosophical underpinnings into their practice.
This article expands upon previous work by the authors to develop a model of nursing essential an... more This article expands upon previous work by the authors to develop a model of nursing essential and effective freedom to facilitate nursing action in behalf of social justice. The article proposes that while social justice is rooted in nursing's ontological, epistemological, and moral foundations, the discipline's social justice mandate is constrained by its historical and contemporary location within an institutionalized medical paradigm. We present a model of nursing "essential" and "effective" freedom based on the philosophy of Bernard Lonergan to illustrate how nursing can transcend these barriers. This humanizing model is illustrated through personal narratives of the authors.
An expansive and growing body of literature documents the problem of nurses’ moral distress when ... more An expansive and growing body of literature documents the problem of nurses’ moral distress when they are unable to carry out actions that they perceive to be in the best interests of patients. Further, nurse leaders and educators are not always well prepared to help nurses to develop moral agency. Moral agency is the ability to provide good care and overcome obstacles to good practice. One reason for the lack of preparation is that ethics education in academia, and in ongoing nurse education, has been inconsistent or has focused more on dilemmas than the ubiquitous everyday practice issues. The purpose of this article is to discuss goals of the nursing profession, contemporary challenges to good nursing practice, and leadership from those educated as Doctors of Nursing Practice (DNP). The author argues that the proliferation of (DNP) programs, focused as they are on leadership in practice settings, presents a unique opportunity to prepare nurse leaders who are, first and foremost, ...
Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated... more Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed to graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of...
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