Bakgrund: Sjuksköterskor har ett etiskt ansvar för sina handlingar och bedömningar i vården. Etisk kompetens utgör en del av sjuksköterskans profession. Syfte: Syftet med denna litteraturöversikt var att undersöka hur den etiska kompetensen hos sjuksköterskan beskrivs. Metod: Denna litteraturöversikt grundas i tolv vårdvetenskapliga artiklar vilka har lästs upprepade gånger. Nyckelfynd har kunnat identifieras avseende den etiska kompetensen hos sjuksköterskan. En sammanfattning av varje studie utfördes för att sedan utmynna i en sammanställning där två huvudteman urskildes. Därefter bildades nya underteman vilka presenterar resultatet. Resultat: I resultatet beskrivs den etiska kompetensen med dess komponenter. Det framkom i resultatet att etiska värderingar ofta underskattas på grund av att sjuksköterskor i högre grad prioriterar medicinska åtgärder, vilket ledde till att god omvårdnad i vissa fall försummades då det tenderade att inte erkännas och därmed inte sågs som något produktivt. Upplevelser av hinder för tillämpning av etisk kompetens förekommer i en majoritet av studierna vilket anses bero på tidsbrist och hög arbetsbelastning. Sjuksköterskor har teoretisk kompetens om vad som är etiskt rätt att göra men omsätter inte alltid denna i det dagliga arbetet. Sjuksköterskor får heller inte möjlighet att lyfta fram etiska frågor i daglig vårdkontext. Sensibiliteten visar sig vara en återkommande aspekt i utövandet av god vård. I flera studier framkommer att det föreligger ett behov av etisk kompetensutveckling. Diskussion: Resultatet diskuteras med stöd i Lévinas teori om etisk sensibilitet samt konsensusbegreppet vårdande. / Background: Nurses' have an ethical responsibility for their actions and assessment within health care. Ethical competence is part of the nurses profession. Aim: The purpose of this literature review was to examine how nurse’s ethical competence can be described. Method: This literature review is based on twelve scientific articles on nursing that have been read repeatedly and key findings were identified regarding nurses´ ethical competence. Each study was summerized and results concluded two main identified themes. Subsequently, new sub-themes arose where results are presented. Results: The results explain the ethical competence and its components. It appears in the results that ethical values are underestimated because nurses’ seem to value medical priorities higher, which in turn leads to a lack of focus on providing good care because it tends to be unrecognized and therefore not seen as something productive. Perception of barriers for the use of ethical competence appears in a majority of the studies. The main factors identified are lack of time and heavy workload. It was also clear that nurses’ have theoretical knowledge on what is ethically correct but have problems applying this in their daily work. Nurses’ are not given the opportunity to highlight ethical issues in a daily care context. Sensitivity is an important aspect in the practice of giving high quality care. In several studies, the need for further education within ethical nursing was identified. Discussions: The results are discussed on the basis of Lévinas theoretical approach comprising of ethical sensibility, and caring.

Purpose The purpose of our study is to contribute to an understanding of the role of storytelling when increasing ethical competence. The research is related to a multicultural context and from the perspective of leaders with experience of organizational change. Method In order to get closer to our phenomenon, this study applies a deductive approach. The empirial data was contructed by semi-structured interviews with eight leaders. Based on the theory, we have developed eight different propositions on which the interview questions are based. Further on, the empirical data was analyzed with a thematic approach.  Conclusions Our conclusion shows there are different motives for using storytelling among leaders and that it is used on a daily basis, both consciously and unconsciously. Leaders find it easier to communicate and relate to ethical perspectives by placing them in a context through stories. By integrating storytelling in intercultural dialogues, it can increase ethical competence.

Aim: To describe and interpret patients’, family members’ and ambulance personnel’s experiences with regard to survival, attendance, and caring at cardiac arrests and deaths, and to analyze ethical conflicts that arise in relation to families and how the personnel’s ethical competence can affect caring and the ability to handle ethical problems. Method: The three interview studies were guided by a reflective lifeworld approach grounded in phenomenology and analyzed by searching for the essence of the phenomenon in two studies and by attaining a main interpretation in one study. In the fourth study, the general approach was supplemented by “reflective equilibrium” that guided the ethical analysis. Results: The survivors are striving towards a good life by means of efforts to reach meaning and coherence, facing existential fear and insecurity as well as gratitude and the joy of life. Family members lose everyday control through feelings of unreality, inadequacy and overwhelming responsibility. Ambulance personnel’s care mediates hope and despair until the announcement of survival or death. After the event, family members risk involuntary loneliness and anxiety about the future. For the ambulance personnel, caring for families involves a need for mobility in decision making, forcing the personnel to balance their own perceptions, feelings and reactions against interpretative reasoning. To base decision making on emotional reactions creates the risk of erroneous conclusions and a care relationship with elements of dishonesty, misdirected benevolence and false hopes. Identification with family members can promote recognition of and response to their existential needs, but also frustrate meeting family members emotions’ and handling one’s own vulnerability and inadequacy. It was found that futile cardiopulmonary resuscitation, administered to patients for the benefit of family members, is not an acceptable moral practice, due both to norms of not deliberately treating persons as mere means and to norms of taking care of families. Conclusions: Ethical conflicts exist when it comes to conveying realistic hope, relief from guilt, participation, responsibility for decision making, and fairness in the professional role. Ambulance personnel need support to enhance ethical caring competence and to deal with personal discomfort, as well as clear guidelines on family support.

<p>Ongoing structural and financial changes in the health care sector have resulted in increased risks for ethical dilemmas and moral distress. It is purported that increased ethical competence will help staff manage ethical dilemmas and hence decrease moral distress. To enhance ethical competence several approaches may be used – theoretical education, and methods focusing on reflection and decision-making abilities.</p><p>Ethics rounds are a widespread systematic method hypothesized to improve ethical competence, nurture a reflective climate, and help in ethical decision-making. Despite its popularity, its effects on moral distress have hitherto never been evaluated in a controlled study.</p><p>The purpose of this thesis was to evaluate the impact of an intervention, including ethics rounds; the hypothesis being that the intervention would decrease perceived moral distress. An additional aim was exploring the concept of moral distress in various health care establishments, including pharmacies.</p><p>Focus groups were conducted to explore the concept of moral distress. To evaluate the intervention a scale assessing staff-perceived moral distress was designed, validated, and implemented.</p><p>Results showed that moral distress is evident in diverse health care settings. Some factors associated with this were lack of resources, conflicts of interest, and rules that are incompatible with practice. An expanded definition of moral distress was presented.</p><p>The training program was much appreciated by participants. However, no significant effects on perceived moral distress were found. Reasons could be that the intervention was too short or otherwise ineffective, there is no association between ethical competence and moral distress, the assessment scale was not sensitive enough, or management was not sufficiently involved.</p><p>There is a need to further refine the various aspects of ethical dilemmas in clinical settings, and to evaluate the most efficient means to enhance skills for dealing with ethical dilemmas, for the benefit of staff, patients, institutions, and society.</p>

Ongoing structural and financial changes in the health care sector have resulted in increased risks for ethical dilemmas and moral distress. It is purported that increased ethical competence will help staff manage ethical dilemmas and hence decrease moral distress. To enhance ethical competence several approaches may be used – theoretical education, and methods focusing on reflection and decision-making abilities. Ethics rounds are a widespread systematic method hypothesized to improve ethical competence, nurture a reflective climate, and help in ethical decision-making. Despite its popularity, its effects on moral distress have hitherto never been evaluated in a controlled study. The purpose of this thesis was to evaluate the impact of an intervention, including ethics rounds; the hypothesis being that the intervention would decrease perceived moral distress. An additional aim was exploring the concept of moral distress in various health care establishments, including pharmacies. Focus groups were conducted to explore the concept of moral distress. To evaluate the intervention a scale assessing staff-perceived moral distress was designed, validated, and implemented. Results showed that moral distress is evident in diverse health care settings. Some factors associated with this were lack of resources, conflicts of interest, and rules that are incompatible with practice. An expanded definition of moral distress was presented. The training program was much appreciated by participants. However, no significant effects on perceived moral distress were found. Reasons could be that the intervention was too short or otherwise ineffective, there is no association between ethical competence and moral distress, the assessment scale was not sensitive enough, or management was not sufficiently involved. There is a need to further refine the various aspects of ethical dilemmas in clinical settings, and to evaluate the most efficient means to enhance skills for dealing with ethical dilemmas, for the benefit of staff, patients, institutions, and society.

Bakgrund: Sjuksköterskan som arbetar inom den rättspsykiatriska heldygnsvården befinner sig i en position där utmanande situationer och etiska dilemman uppstår. Detta ställer krav på sjuksköterskans etiska kompetens. I de fall sjuksköterskan är hindrad att arbeta enligt sin etiska kompetens kan etisk stress uppstå. Etisk stress kan påverka sjuksköterskans hållbarhet på ett negativt sätt. Syfte: Syftet var att belysa hur sjuksköterskor inom rättspsykiatrisk heldygnsvård värderar sin etiska kompetens, förekomst av etisk stress samt hur detta är kopplat till hållbarhet i yrkeslivet. Metod: En kvantitativ metod användes och ett representativt urval gjordes. Sjuksköterskor inom rättspsykiatrisk heldygnsvård tillfrågades om att fylla i en enkät. Insamlade data omvandlades till deskriptiv och analytisk statistik. Resultat: Medelvärdet för nivå av etisk kompetens var 7,8 av 10 och 4,5 av 10 för etisk stress. En högre skattad etisk kompetens och/eller en lägre skattad etisk stress korrelerade med en högre grad av hållbarhet. En låg skattning av etisk kompetens korrelerade med en högre grad av etisk stress. 63,3% av respondenterna ansåg att den rättspsykiatriska vården ställer högre krav på etisk kompetens än något annat vårdområde. Slutsats: Grad av etisk kompetens och etisk stress påverkar sjuksköterskans yrkesmässiga hållbarhet inom rättspsykiatrisk heldygnsvård. / Background: Nurses in inpatient forensic psychiatry will face challenging situations and ethical dilemmas. These situations require the ability to practice ethical competence. When this ability is somehow inhibited, moral distress can occur. Moral distress may affect the nurse’s sustainability in a negative way. Purpose: The purpose of this study was to examine nurses’ estimation of their ethical competence, occurrence of moral distress and the impact these had on the work sustainability. Method: A quantitative method was chosen for the study, and a representative selection was made. Nurses in inpatient forensic psychiatry was given a survey. Collected data was transformed into descriptive and analytical statistics. Findings: The mean value of rated ethical competence was 7,8 out of 10, the mean value of rated moral distress was 4,5 out of 10. A higher rated ethical competence and/or lower rating of moral distress correlated with a higher sustainability. A lower rating of ethical competence correlated with a higher rate of moral distress. 63.3% of the respondents considered the inpatient forensic psychiatry as the most demanding care-related working field of all regarding ethical competence. Conclusion: The level of ethical competence and moral distress will affect the work sustainability for nurses in inpatient forensic psychiatry.

Life scientists have increasingly been asked to incorporate a dual use responsibility in their research conduct. In this thesis, different aspects of what constitutes a reasonable responsibility in terms of avoiding harmful misuse of research for biological weapon purposes have been explored. The first study investigated the claim that scientists have a dual use responsibility, and also outlined some of its possible content. Criteria for what may constitute preventable harm were used to analyze some proposed obligations in the field, and it was concluded that reasonable obligations include: e.g. considering the potential negative implications of one’s research and reporting activities of concern. In the second study, the conditions for a Precautionary Principle (PP) were explored and applied to the dual use research context. The study found that the main conditions of the PP frequently appear in present discussions and formulations of life scientists’ responsibility. It was also concluded that the PP is applicable to the dual use field and that it is meaningful and useful as a normatively guiding principle. The third study suggested an ethics of dissemination, based on the assumption that scientists have a responsibility to occasionally constrain the dispersion of their research findings. Three core aspects were proposed for an ethics of dual use dissemination. Additionally, to help scientists understand when constraints may be justified, three corresponding conditions for their application were suggested. In the fourth study, the concept of ethical competence was introduced and explored within a dual use context. It was concluded that competence-building is important in the nurturing of individual responsibility and, subsequently, in achieving a culture of dual use responsibility in the life sciences. Finally, the discussion on ethical competence was included in a proposed ethic of deliberation, in which various stakeholders in the dual use debate are conceived to participate in communicative processes. It was argued that spaces for deliberative activities should be institutionalized by the scientific community to ensure structural opportunities for individuals to both assume responsibility and share it. Moreover, it was argued that deliberation can constitute a cornerstone of responsible dual use governance.

In diploma theses, I focused on the theme of the educational field and the school subject Ethic Education. The work is divided into two parts. The theoretical part deals with the concept of ethic education in a broad context, with the history of ethic education in the Czech Republic, as well as with the polemic about the (non) dispensability of ethic education as an independent teaching subject. The last chapter focuses on an overview of how ethic education is succeeding today along with outlining its next possible development for the future. The aim of this diploma thesis was to find out the opinions of Ethic education teachers on issues related to the concept and curriculum of ethic education in the Czech Republic. Also differences in answers of Czech and Slovak respondents on the same research questions. The research shows that Czech teachers are identified with the current concept of ethic education, its aims, teaching methods, they are pleased by teaching ethic education. Compared to Slovak respondents, Czech teachers responded less critically, consensually. They have shown greater satisfaction with the amount and quality of the methodical materials they have at their disposal.

While research concerning ethical competence in medical practice is frequent, ethical competence in health care management is less often studied. This thesis focuses ethical competence and its preconditions, particularly with regard to health care managers’ identification and handling conflicts of interest. Based on the empirical analysis it also discusses what kind of ethical competence health care managers need, and how this competence can be developed in the organization. The study is based in action theory and takes an organizational pedagogical point of departure. Qualitative, semi-structured interviews were carried out twice with ten health care managers in the Stockholm region. Data were analysed using a thematic, step-wise method. The analysis revealed several examples of conflicts of interest and different ways in which they were managed. The all-embracing conflict involved weighing and prioritizing patients’ needs, patient safety, and work environment against political and economical goals. In most cases the informants did not manage to strike a balance between professional ethics and business management. The dominance of purposive/instrumental rationality tended to inhibit the managers’ ethical competence. At the same time, as shown by the analysis, some of the managers were able to use ethical competence to pursue value/belief-oriented rationality in achieving such a balance. Of great importance for success are having rational emotions and an adequate ethical language, and organizing for the task of handling conflict of interests in order to support action and provide qualifying experiences to learn from in the work processes. But the political and administrative control system also needs to clearly articulate the ethical dimensions of the managers’ task, allocate resources, and ensure that support systems and evaluation focus not only on finances but also on the value-rational aspects.

Dans la foulée du mouvement de professionnalisation, l’éthique professionnelle enseignante est portée par une compétence professionnelle, plus précisément par la compétence éthique, laquelle est présentée dans le référentiel de compétences professionnelles (MEQ, 2001a). Bien que la compétence éthique comporte un caractère ambigu, telle qu’elle se décline dans le référentiel ministériel, elle est marquée d’une obligation de réussite, notamment pour les stagiaires finissants. Devant l’ambiguïté entourant le sens de la compétence éthique, nous avons mené une recension des écrits sur cette compétence afin de mettre en relief ce que signifie être compétent sur le plan éthique. Nous avons ainsi constaté que la compétence éthique entretient un lien étroit avec la réflexion. Dès lors, à l’aide d’une recension sur le concept de raisonnement, nous avons posé l’hypothèse que le raisonnement professionnel, constitué du discours et de points de repère, puisse soutenir le développement de la compétence éthique. Par conséquent, trois intentions se sont précisées : mettre en évidence les repères personnels (valeurs personnelles) et institutionnels (encadrement légal et réglementaire, normes et savoirs théoriques) que comporte le raisonnement professionnel des stagiaires en matière d’agir éthique et rendre compte de la contribution de la formation pratique ainsi que de la formation initiale au regard de ces repères. Pour ce faire, nous avons effectué deux phases de collecte de données lors desquelles ont été favorisés deux outils afin de recueillir des données de nature qualitative. Lors de la première phase, nous avons mené des entrevues semi-dirigées auprès des stagiaires, de leur enseignant associé et de leur superviseur de stage respectifs. En ce qui a trait à la deuxième phase de collecte de données, nous avons assuré la tenue d’un groupe de discussion constitué de stagiaires finissants. Nos résultats suggèrent que les repères dont disposent les stagiaires afin de soutenir leur raisonnement en matière d’agir éthique sont liés à leurs valeurs personnelles et à certaines valeurs professionnelles bien que les mots pour évoquer ces dernières ne soient pas explicites. Toutefois, les repères institutionnels que constituent l’encadrement légal et réglementaire, les normes et les savoirs théoriques sont peu présents dans leur discours. Par ailleurs, la contribution des enseignants associés et des superviseurs de stage au regard des repères se révèle modeste alors qu’elle passe principalement par la rétroaction. Les résultats à propos de la contribution des activités d’enseignement en formation initiale suggèrent que l’agir éthique est traité notamment à titre de mises en garde. Nos résultats mettent ainsi en évidence que les repères qui constituent le raisonnement professionnel des stagiaires peuvent agir à titre de levier de la compétence éthique à la condition qu’en amont les futurs enseignants aient été entraînés dans ce sens. / To follow in the footsteps of the movement of professionalisation, the professional ethical teacher is characterized by a professional competence, more precisely by the ethical competence, which is presented in the reference system of professional competence (MEQ, 2001a). Even if the ethical competence comprises an ambiguous character, as it is stated in the ministerial reference, it is marked by a successful obligation, more particularly by the graduating student teachers. In view of the ambiguity surrounding the meaning of the ethical competence, we have conducted a census of records on this competence in order to verify what it means to be competent on the ethical plan. We have therefore established that the ethical competence has a close link with reflection. From now on, by means of a review on the concept of reasoning, we have put forth the hypothesis that the professional reasoning established by the discourse and by the indicators can support the development of the ethical competence. Therefore, three intentions were specified : to showcase the personal reference points (personal values) and institutional (to target legal and regulatory , norms and theoretical knowledge) which includes the professional reasoning of student teachers the matter of ethical behavior and that would result in the contribution of pratical training in relation to the transmission of these indicators as well as the initial training to the transmission of these indicators. To achieve this, we have carried out two phases of data in which two quality tools were favored in order to collect data of qualitative nature. During the first phase, we conducted partly directed interviews with the student teachers, their cooperating teachers and their supervisor of their respective practice teaching session. Our findings suggest that student teachers make use of their references to support their reasoning in the matter of ethical behavior as well as their personal values and certain professional values since the words to evoke these are not explicit. However the institutionnel references which constitutes the legal and reglementary framework, the norms and theoretical knowledge are slightly present in their discourse. However the feedback of the cooperating teachers and stage supervisors concerning these indicators is confirmed modestly even though it passes principally by feedback. The results concerning the contribution of teaching activities in the initial training suggests that ethical behavior is particularly as a caution. Our results show that professional reasoning, with the aid of discourse and reference points can act as a lever of ethical competence on condition that progressively, the future teachers have been formed in this manner.