Over the last three decades there has been a greater need for health care practitioners to base their decision on the best available in order to optimise quality and cost-effective patient care. Evidence-based practice necessitates guideline development, education and review in order to achieve improved patient outcomes. However, initiatives that endeavour to disseminate and implement evidence-based practice have faced barriers and opposition. Barriers that might hamper the implementation of evidence-based practice include characteristics of the evidence itself, personal, institutional or organizational factors. The research study explored and described the barriers to implementation of evidence-based practices in a critical care unit. Based on the data analysis, recommendations were made to enhance the implementation of evidence-based practices in the critical care unit. A quantitative, explorative, descriptive and contextual research design was used to operationalize the research objectives. The target population comprised professional nurses in the critical care unit. Non-probability sampling was used to obtain data by means of a structured self-administered questionnaire. Descriptive data analysis was applied, using a statistical programme and the aid of a statistician. The results are graphically displayed using bar graphs and tables. Recommendations for nursing practice, education and research were made. Ethical principles have been maintained throughout the study.

Pursuit of university education for nurses has been a controversial and poorly understood ideal. It has been difficult to clearly demonstrate and articulate the benefits of higher education for nurses and nursing. In this research the mission of undergraduate education in general, and the Canadian Nurses Association position paper on baccalaureate education served as the basis of inquiry into aspects of university education for nurses and nursing. From these sources and review of the literature it was ascertained that a primary value of education is seen as helping individuals develop intellectual and ethical maturity which allows them to make judgments and commitments in a relativistic world. This theorectical orientation was operationalized through Perry's theory of intellectual and ethical development (1970). The Measure of Epistemological Reflection (MER), a tool based on this theory, was developed to measure a person's level of intellectual and ethical maturity. In this study the MER was administered to diploma and baccalaureate nursing graduates to determine if this construct could be used to differentiate the effects of the two levels of education. The findings indicated that there was no difference between diploma and baccalaureate groups of nurses on their scores on the MER. There was no correlation between scores on the MER and age or experience. There was, however, a significant difference between a group of nurses who participated in university education in addition to their basic nursing program, and a group who had no other university credit outside of their basic nursing program. These findings, and their implications for nursing practice, education, and research are discussed. / Applied Science, Faculty of / Nursing, School of / Graduate

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). / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

Nursing faculty are charged with the responsibility of being stewards of the profession by ensuring that today’s nursing graduates are cultivated to practice as competent, safe, and caring nurses of tomorrow, as well as to foster future nurse scientists, researchers, and educators. The profession of nursing is facing an ever-increasing shortage of nursing faculty as well as a registered nurse shortage, which in turn reinforces the urgency for increasing the number of qualified nursing faculty and faculty retention. An investigation of professional generosity among nursing faculty in academia may help to understand workplace nursing relationships within academia and offer insight into healthy nursing faculty relationships and promote faculty retention. Understanding the experience of professional generosity can add much value to the profession of nursing, particularly among nursing faculty within academia. The researcher of this qualitative study used a phenomenological method designed to illuminate the lived experience of professional generosity among nursing faculty in academia. Van Manen’s phenomenological research method of the six activities was used to examine the participants’ experiences, describe each experience as it appeared, and attempted to understand its interpreted meaning. Eight full-time, tenured nursing faculty members with an earned PhD, EdD, or nursing research doctorate were interviewed about their experiences of giving or receiving professional generosity or kindness while working in academia. The researcher analyzed the transcripts of the study participants’ interviews and found four essential themes that shed light on these nursing faculty’s experiences of professional generosity in academia: (1) I Feel Valued, (2) Core Relationships, (3) Reciprocity, and (4) Growing our Profession through Connectedness.

Nursing ethics in end-of-life care is often framed in reference to dramatic moral dilemmas and resulting moral distress that nurses experience in practice. While important, this framing obscures the moral significance of nurses’ everyday practice. The purpose of this study was to explore nurses’ moral experiences of palliative and end-of-life care, including situations that are enriching. The research question was: What are the moral experiences of nurses engaged in ethically meaningful situations in end-of-life care? Semi-structured interviews were conducted with five nurses from across Canada who practice in settings where palliative and/or end-of-life care are an important part of their role. Informed by interpretive description and a theoretical scaffold about nurses’ moral practice, a descriptive and thematic analysis of the data was performed. The participants described ethical challenges relating to patient autonomy, futility, prognostication, and navigating requests for medical assistance in dying. Experiences that were ethically enriching involved situations where the nurse, patient, and family worked together to create a peaceful and dignified death. Taken together, the participants’ narratives revealed them as morally engaged in their everyday practice, where such moral engagement is both reflective and relational. This study expands understanding about how nurses’ stories of end-of-life care reveal their capacity for moral sensitivity. This study also contributes to the articulation of a theoretical lens for examining the moral dimensions of nursing work. By explicating the relational dimensions of ethically meaningful experiences, including relationships with wider structures that facilitate and constrain the possibility for ethical action, this theoretical lens can support researchers to think creatively about palliative and end-of-life nursing from an explicitly ethical perspective.

Background: The patient with a substance abuse often felt ignored and mistrusted in the caring relation with the nurse. To recreate and maintain the patient´s dignity in the caring relation the nurse needs to create a relationship that is characterized by togetherness. Aim: To illustrate the nurse’s experiences of treating patients with a substance abuse in the somatic health care. Method: To illustrate the contemporary state of knowledge related to the aim the authors carried out a literature review. The findings are based on ten scientific articles published during the last ten years. The articles where collected from the databases Cinahl Complete and Pubmed.  Results: The findings are presented in five themes; Mistrust mainly covered the nurses perceived difficulties to find trust in the patients self valuation of pain and information about taken substances; Fear that brought up how the nurses feeling of insecurity related to the patients actions; Feeling of being manipulated that described how the nurses perceived that the patient in a deceitful way tried to turn things into their own advantage in the caring relationship; The patients responsibility described how the nurses perceived that the abusing patients didn’t take responsibility for their own health; Ignorance where the nurses described how they feel that they lack of adequate education and knowledge to provide good care for patients with substance abuse. Discussion: Both the nurse´s and the patient´s dignity is affected in the caring relationship.  Insecurity, lack of knowledge and trust creates patterns that make both parties act in ways that damages their own and the others dignity either knowingly or subconsciously. / Bakgrund: Den missbrukande patienten känner sig ofta ignorerad och misstrodd i vårdrelationen med sjuksköterskan. För att återskapa och bibehålla patientens värdighet i vårdrelationen krävs att sjuksköterskan skapar en relation som är karaktäriserad av gemenskap. Syfte: Att belysa sjuksköterskans erfarenheter av hur det är att vårda patienter med ett substansmissbruk inom den somatiska sjukvården ur ett vårdetiskt perspektiv. Metod: För att belysa det aktuella kunskapsläget relaterat till syftet har författarna gjort en litteraturöversikt. Resultatet grundar sig i tio vetenskapliga artiklar som publicerats under de senaste tio åren. Artiklarna är hämtade från databaserna Cinahl Complete och Pubmed. Resultat: Resultatet presenteras i fem teman; Misstro som främst handlade om sjuksköterskans upplevda svårighet att finna tillit till patientens självskattade smärta; Rädsla som tog upp sjuksköterskans känsla av osäkerhet kring patientens agerande; Känsla av att bli manipulerad som beskrev hur sjuksköterskan upplevde att patienten på ett oärligt sätt försökte vända saker till sin egen fördel i vårdsituationen; Patientens ansvar beskrev hur de missbrukande patienterna inte tog ansvar för sin egen hälsa; Okunskap där sjuksköterskor beskriver hur de känner att de saknar tillräcklig utbildning och kunskap inför att kunna ge god vård till patienter med substansmissbruk. Diskussion: Både patientens och sjuksköterskans värdighet påverkas i vårdrelationen. Osäkerhet, okunskap och brist på tillit skapar mönster som gör att båda parter handlar på sätt som skadar sin egen och den andres värdighet antingen medvetet eller omedvetet.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Aim: This study aimed to explore the perceptions of third year nursing students regarding the ethics module at Shifa College of Nursing, Islamabad, Pakistan. Methods: Third year nursing students (n=26) completed a retrospective pre/post survey rating their knowledge before and after the ethics module. Focus group discussions (FGDs) addressed the importance of ethics teaching in nursing, the content, teaching and learning strategies of the module as well as whether the application of the concepts learned in the classroom were practiced in the clinical setting. Results: Participants rated their knowledge higher in the post-test (4.00) than the pretest questionnaire (2.26) (p=0.003). The main themes identified during the focus group discussions were: understanding their responsibilities towards the patient; an appreciation of the patient as a human being; applicability of the module to the clinical setting; the role of student nurses in ethical decision making in the clinical setting; and the teaching and learning strategies. The context of the nurse’s practice was also identified as being important. Conclusion: The participants valued the ethics module and its applicability to the clinical setting, but changes in the content of the module and the teaching and learning strategies were suggested.

The purpose of this study was to determine the extent to which Neonatal Intensive Care Unit (NICU) nurses participate in ethical decision making, and to describe the role NICU nurses have in the ethical decision making process.This study replicated a 1991 study conducted by Elizondo. According to Lowe, 1991, replication research is the repeating of a study for the purposes of validating the findings of the original investigation. The traditional theory of utilitarianism provides the theoretical framework for this study, a goal-based approach to ethical decison making that focuses on consequences of actions. Findings provide information about satisfaction and conflicts related to nurse participation in ethical deecision making in the NICU.The Nurse Participation in Ethical Decision Making (NPEDM) questionnaire (Elizondo, 1991) was used for data collection. Of fifty NICU nurses, seventeen (34%) of the sample completed the questionnaire. Confidentiality was maintained. Results showed that all respondents were able to identify methods that are used for participation in ethical decision making. Informal conversations with physicians was identified as the primary method of participation. Forty-one percent of respondents were satisfied with the nurse's role in ethical decision making. Forty-seven percent were only somewhat satisfied.An indication of satisfaction demonstrated by 100% of the study sample was that nurses' ideas are respected by other health care professionals.Findings indicated that a significant positive relationship exists between role satisfaction and study variables. Eighty-eight percent of respondents stated that conflicts related to participation were experienced. Overwhelmingly, respondents felt that the primary source of conflicts were with physicians. These findings are consistent with results reported in the original study.When asked what factors impact on how decisions are made, 40% of respondents indicated that ethical decisions are often impacted by generalized decisions based on viability of the neonate as determined by the gestational age, and "quality of life."Seventy-six percent of respondents believed nurses should be more involved in the ethical decision making. Conferences with physicians and parents was identified by 69% of the study sample. This study found that the older the nurse, the more satisfied with role in the ethical decison making process. Length of employment also contributed positively to satisfaction in ethical decision making. The more educated the nurse, the more satisfied with role in the ethical decision making process. Nurses were less satisfied if conflicts were experienced or identified.Findings suggest that collaborative relationships exist between nurses and other health team members and that nurses feel some sense of fulfillment with their role in the ethical decision making process. It was concluded that many issues were unsolved and need to be discussed. / School of Nursing

Submitted in fulfillment of the requirements for the Degree in Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Introduction Moral distress is a widely recorded phenomenon in the nursing profession. It can be described as a form of distress that occurs when one knows the ethically correct thing to do, but is prevented from acting on that perceived obligation. Moral distress impacts patients, nurses and the organization. If the nurse is unable to advocate for her or his patient and avoidance behaviour occurs, increased patient suffering result. Moral distress results in high staff turnover, decreased quality patient care and low patient satisfaction. Unrelieved moral distress jeopardizes nurse’s sense of self-worth and threatens their integrity. Aim of the study The aim of the study was to determine the impact of moral distress on the provision of nursing care amongst critical care nurses. Methodology A quantitative descriptive design was used to determine the intensity and frequency of moral distress amongst critical care nurses, to assess the impact of moral distress on the provision of nursing care to the patient as well as to evaluate the effectiveness of organisational strategies implemented to reduce moral distress. Critical care nurses from both private and public hospitals were selected to participate in the study. Data was collected by means of a survey using the moral distress scale which was revised to meet the objectives of the study. A non-probability purposive sampling technique was utilised to gather data from a sample size of 100 critical care nurses currently working in the critical care environment. Results The study indicates that the frequency and intensity of moral distress is related to specific clinical situations in the critical care environment. The study also specifies that moral distress continues to have a negative effect on the provision of nursing care. Critical care nurses feel that some strategies are effective whereas others are not at all effective. Impact of the research study This study reveals that there is a significant negative effect of moral distress on the provision of nursing care. Nurses experience challenges in the clinical environment that result in them experiencing moral distress. Nurses more attuned to the ethical dimensions of care may be more at risk for moral distress since these nurses see the moral dimensions of nursing being neglected. Nurses may find themselves distancing themselves from patient care, resulting in a perceived lack of care and concern for the patient. / M

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. / This is accomplished through their privileged place at the bedside, where they come to know their patients as person and work hand in hand with nursing colleagues. When CNLs® are supported by management, and their roles are planned and understood, they are more fully able to optimally practice and live and grow in caring. / by Barbara C. Sorbello. / Thesis (Ph.D.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.