Nursing ethics

Moral comfort, an emerging concept in nursing, is defined as an individual’s feelings of ease with decisions and actions related to a moral dilemma. Moral comfort for nurses is the positive outcome of a moral situation or dilemma, while moral distress, a widely explored issue in nursing, is the negative outcome. However, nursing literature on the concept of moral comfort is limited. While several instruments to measure moral distress exist, an instrument to measure moral comfort was not found. The Moral Comfort Questionnaire (MCQ) was theoretically developed. The purpose of this study was psychometric evaluation of this new 35-item instrument.
Direct-care hospital-based registered nurses (n = 466) participated from February
2019 to September 2019 in this IRB-approved study. Participants completed demographic information, the MCQ, and the Moral Distress Scale revised (MDSR). Psychometric evaluation included a priori content validation and multiple statistical analyses: Cronbach’s alpha, Spearman’s correlation coefficient, weighted kappa, Bland- Altman analysis (B&A), discriminant validity, and confirmatory factor analysis (CFA).

The ability to gain payment for services is strongly linked to the ability of a
profession to define the value of its service. Valuation as an economic term is used to
define an entity's worth or value. As an approach, valuation encourages a company to
document the financial value of both the tangible and intangible assets associated with
the services provided. Today there are a limited number of studies that document the
value of nursing services. Valuation studies related to nursing are challenged by the need
to include the complexity of patient services that causes variation in research results. This
historical case study examines one nursing initiative undertaken by the Daughters of
Charity who were trained in nursing and finance and were able to demonstrate their value
to the community of Jacksonville, Florida. In 1916, the Daughters of Charity came to
Jacksonville to provide health care to the sick and the poor. They endured the hardships
found in this southern city and endeared themselves to the community. They purchased a 42-bed Sanatorium and expanded this facility into a 528-bed hospital and health system.
Across ninety years, the community supported and demonstrated their willingness to pay
in order to sustain the Sisters mission. The themes identified in the study included an
unwavering commitment to Jive the mission of the Daughters of Charity, an implicit
authority allowing these Sisters to enter into business arrangements, an emphasis on
ensuring that all Sisters gained education and mentorship in finance and nursing, the
growth of a strong bond with the community of Jacksonville, and an ability to obtain
funding needed to carry out their mission. Themes appearing to be in opposition to the
Sisters mission included racial separation and the limited recognition given to nurses at
the Sisters' hospital. In conclusion, the study tells the story of Sisters who were able to
enhance their valuation by blending their knowledge of the health care business and
nursing, while successfully obtaining the funding needed to fulfill their mission.

The purpose of this study was to evolve a description of values of nurses who were recent graduates of associate degree nursing programs. Six new nurses who were employed in hospitals were asked for illustrations of nursing situations that described values important to their practice. Giorgi's method of interpretation for phenomenological studies was utilized for data analysis. Caring was the value that emerged as central to nursing. New graduates expressed this value as caring promoting growth. Subsumed within the value of caring for new nurses are hope, conscience, courage, honesty, humility, empathy and human connectedness.

An exploratory-descriptive study of the processes involved in ethical evaluations by nephrology nurse administrators is presented. Five participants provided data from open interviews. Category coding involved Ray's (1989) Theory of Bureaucratic Caring, and Husted & Husted's (1995) definitions of ethical principles. It was discovered that the nurses most frequently utilized the principle of beneficence, and were often affected by the contextual factors of past experiences. It was determined that the nurses engaged in a common process of ethical evaluation, identified in the Common Ethical Ground Conceptual Model. The common nursing goal was the well-being of patients, and the creation of environments which enhanced patient well-being. Patient education was identified as a method to reach this goal during an era of economic constraint.

The purpose of this study was to examine nursing values as expressed in the practice of nurses pursuing the Master of Science Degree in Nursing. Two stories representing nursing situations reflective of nurses' values guiding practice were chosen for analysis. Content analysis was the method used to study the stories to identify values guiding the practice of nursing. The analysis revealed the following nursing values guiding practice: compassion, respect for the other, competence, commitment, inner harmony, patience, hope, courage, humility, and trust. Caring was identified as the central value of nursing.

This research study addresses the personal, professional and organizational values held by nurse administrators, utilizing the phenomenological method of Paul Colaizzi (1978). The study investigates the values of eight nurse administrators in two acute care hospitals. Based on the significant statements which were formulated into clusters of themes and the formulation of essential values and themes, three common values emerged: communication, education, and honesty. A better understanding of these values will help guide nurse administrators in their current roles.

Moral judgment scores of student nurses, nurses, and non-nurses were compared on various nursing dilemmas. It was hypothesized that there were no differences in the moral judgment scores of the three groups and that the level of nursing education, the length of clinical nursing experience, and the subject's religious preference would not affect the moral judgment scores. The total sample number of 195 completed the six nursing dilemmas of Crisham's Nursing Dilemmas Test. This test represents various moral issues specifically applied to clinical areas of nursing. Scoring of the test was based on Kohlberg's levels of moral reasoning. Statistical analyses included three one-way analyses of variance (ANOVAS) with post-hoc Duncan's multiple range test. Intensive care unit nurses, and associate degree nurses and diploma or associated degree nurses with extra college credits, scored significantly more toward principled thinking. Significant relationships were found between length of experience and a prior philosophy course to subjects' principled thinking scores. Recommendations as a result of this study included the need for nursing ethics courses in nursing curricula, in continuing education programs, as well as increasing efforts toward retention of mature experienced nurses as role models. Future research is recommended to assess the effects of nursing ethics courses on subjects' levels of moral reasoning and behavior in the work setting.

A new role has been developed in nursing named the Clinical Nurse LeaderSM (CNL®). This new role positions the masters prepared nurse at the patient's bedside to oversee care coordination and serve as a resource for the clinical nursing team, and to bridge the gaps in health care delivery to better meet the needs of patients in all health care delivery settings. Since this is a new role, there is a paucity of research that has been conducted surrounding these nurses. A phenomenological investigation examined the lived experiences of CNLs® to gain understanding about the meaning of leadership at the point of care and to discover the unique expressions of living caring that CNLs® experience as they embark upon this new role in the acute care hospital setting. Ten CNL® participants were interviewed for this study. Their stories about patient situations and relationships with other disciplines were shared with rich description and emotion. Hermeneutic analysis of the text revealed six essential themes. Six essential themes emerged revealing the essence of leading at the bedside and living caring in the CNL® role: navigating safe passage, pride in making a difference, bringing the bedside point of view, knowing the patient as person, helping nurses to grow, and CNLs® needing to be known, understood and affirmed. Taken as a whole through a synthesis of the themes, the understanding of the meaning of leading to CNLs® includes keeping their patients safe, being proud of their accomplishments and the respect gained from others, as well as being a helper and advocate for other nurses.