As mudanças sociais ocorridas nas últimas três décadas fizeram com que o respeito à autonomia do usuário e o direito ao consentimento livre e esclarecido assumissem posição de destaque na ética em saúde e fossem incorporados aos Códigos de Ética Médica e de Enfermagem vigentes no país. Estudos desenvolvidos em serviços de saúde, mormente os hospitalares, têm evidenciado que os usuários obtêm poucas informações sobre suas condições de saúde, tratamento, cuidado e que a prática profissional tem oscilado entre o paternalismo, o autoritarismo e o respeito à autonomia. Esta investigação foi realizada com o objetivo verificar como o consentimento esclarecido é concebido na prática das enfermeiras de quatro Centros de Saúde Escola (CSE) de São Paulo. A análise do material empírico, obtido através de entrevistas junto a essas profissionais foi feita à luz da ética principialista. O resultados demonstram que essas profissionais, apesar de desconhecerem o termo consentimento esclarecido, respeitam as suas normas básicas, reconhecem o direito dos usuários em participar de decisões que digam respeito à sua saúde, oferecem informações para subsidiar essas decisões. O padrão de informação é personalizado, porém, alternativas de decisão, além daquelas estipuladas em programas e protocolos, raramente são apresentadas. Assim, o consentimento esclarecido na prática das enfermeiras em CSE é limitado por esses programas e protocolos. As enfermeiras têm como preocupação o benefício do usuário, o estímulo às participação dos usuários no seu cuidado e a prevenção ou remoção de riscos e danos. No geral, estas enfermeiras acatam a decisão tomada pelo usuário, mesmo quando há recusa em seguir a orientação dada, mas por vezes demonstram dificuldade em aceitá-la quando a mesma põe em risco a saúde de terceiros. Enquanto profissionais que participam na implementação políticas de saúde demonstram preocupação com sua \"missão\", sentem-se impotentes e demonstram desconhecer aliados e instrumentos que poderiam ser utilizados nessa situação. / The social changes occurred in the last three decades were instrumental for causing the customers\' autonomy and right to free-informed consent to be respected assuming a leading rank in the health ethics as well as being incorporated into the Nursing and Medical Ethical Codes in force in the country. Studies carried out in health services, moreover in hospital facilities, disclosed that the customers usually obtain few information on their health condition, treatment and, care and that the professional practice has been oscillating among being either paternalistic, authoritarian or respecttul regarding the patient\'s autonomy. The purpose of this investigation was to ascertain how the informed consent is conceived by the nurses\' practice in four School/Health Centers in São Paulo, State of São Paulo. Brazil. The empirical material obtained in interviews along with these professionals was analyzed in the light of Bioethics principles. Results were as follows: these professionals do not know the term informed consent; however, they act in accordance with its basic norms, recognizing the customers\' right to participate in the decision-making regarding their health, besides providing information in order to subside these decisions: the pattern of the information provided is personalized, although decision alternatives other than those stipulated in programs and protocols are rarely presented. Informed consent, in nursing practice in School/Health Centers is restricted within these programs and protocols. These nurses are concerned about users\' beneficence, their participation in self care and about preventing or removig risks or harm. In general, these nurses respect the decision taken by the customers, even when they refuse to comply with the orientation provided, however showing sometimes difficulties in accepting it when the health of a third-part is in jeopardy; while professionals participating in the implementation of health policies, they demonstrate being concerned with their \"mission\", sometimes feeling themselves impotent to deal with this situation, disclosing therefore a lack of knowledge concerning allied institutions and instruments which might be used to face these kind of circumstances.

As ocorrências éticas, na assistência de enfermagem, são uma realidade com a qual não devemos nos acostumar, mas que, por outro lado, não podemos negar. O enfrentamento e especialmente a prevenção de tais ocorrências representam um constante desafio para o enfermeiro. Este estudo foi realizado com 25 Enfermeiros Responsáveis Técnicos (RTs) de Hospitais de Ensino que, em maio de 2007, compunham a lista de hospitais participantes do Sistema de Avaliação dos Hospitais de Ensino da Secretaria de Saúde do Estado de São Paulo (SAHE). Trata-se de um estudo quantiqualitativo que teve como objetivos: identificar e discorrer sobre as estratégias usadas pelos Enfermeiros Responsáveis Técnicos das referidas instituições para prevenir e/ou enfrentar as ocorrências éticas que envolvem a equipe de enfermagem; identificar a existência das Comissões de Ética de Enfermagem nestes Hospitais de Ensino e descrever as atividades que elas desenvolvem nestes locais; discorrer acerca da existência e finalidade dos registros estatísticos das ocorrências éticas de enfermagem. Além da aprovação pelo Comitê de Ética em Pesquisa da Instituição vinculada, por exigência de nove das instituições participantes do estudo, foi necessário submeter o projeto à aprovação dos Comitês locais. Os dados foram coletados no período entre julho de 2007 e março de 2008, após o estudo ter sido autorizado pelas instituições participantes e ter aquiescência dos RTs. Os resultados quantitativos foram dispostos em tabelas e discutidos com base na literatura acerca do tema, os qualitativos foram tratados segundo a Análise de Conteúdo de Bardin (2007), dispostos em categorias e unidades temáticas e posteriormente discutidos, também, com base em referências bibliográficas sobre o assunto. Os resultados mostraram que, dos 25 Hospitais de Ensino (HE), oito estão situados na cidade de São Paulo e 17 no interior do Estado; 16 são públicos e nove privados. Quanto ao porte, 14 são considerados de grande porte, cinco de porte especial, três de médio porte e três não possuem leitos de internação.Quanto ao número de profissionais, dos 17.442 profissionais dos 25 HEs, 3.349(19,20%) são enfermeiros, 3.242(18,58%), técnicos de enfermagem e 10.851(62,21%) são auxiliares de enfermagem. No que se refere às estratégias preventivas, os RTs utilizam o treinamento como primeira escolha, enquanto para o enfrentamento das ocorrências éticas, predominam as ações gerenciais, seguidas das ações da CEE. Das 25 instituições, três não tinham CEE. Dos 22 HEs que possuem CEE, 13 referem que estas foram constituídas em cumprimento às exigências legais e nove para atender às necessidades do Serviço de Enfermagem. Em relação às atividades desenvolvidas pelas CEEs, nove RTs referem a de fiscalização e 13 as educativas e de orientação. Os registros das ocorrências acontecem em 21 HEs e, na sua maioria, são feitos através de livro-ata ou relatórios. Apenas 13 RTs responderam sobre a finalidade dos registros, sendo que quatro os utilizam para direcionar a educação continuada ou ações gerenciais, e os demais procedem o arquivamento, abertura de sindicância ou encaminhamento ao Conselho Regional de Enfermagem, quando necessário. / The ethical occurrences in nursing care, are a reality that we should not get used to, but, on the other hand, we can not deny. The confrontation and especially the prevention of such occurrences represent a constant challenge to nurse personal. This study was conducted with 25 Nurse Responsible Technician (RTs) from Teaching Hospitals that in May 2007, were working in hospitals that participated in the System for the Evaluation of Teaching Hospitals, Health Department from State of Sao Paulo (SAHE). This is a quantitative and qualitative study aimed to: identify and talk about the strategies used by the Nurses Technical Responsible of those institutions to prevent and / or face the ethical occurrences involving the nursing staff, identify the existence of Nursing Ethics Committees (NEC) in Nursing Education Hospitals and describe the activities that they develop in these places; talk about the existence and purpose of statistical records of nursing ethical events. Besides the approval by the Research Ethics Committee of the Institution bound by the requirement of nine institutions participating in the study, it was necessary to bring the project to the approval of local committees. Data were collected between July 2007 and March 2008, after the study has been approved by participating institutions and acquiescence by RTs. The quantitative results were arranged on tables and discussed in the literature based on the theme, the qualitative were treated according to Content Analysis of Bardin (2007), arranged in categories and thematic units and subsequently discussed, too, based on references on the subject. The results showed that the 25 Education Hospitals (EH) under study, eight are located in Sao Paulo city (capital) and 17 in Sao Paulo state, 16 are public and nine private. Regarding size, 14 are considered large-scale, five are especial size, three mid-size and three does not have beds for internment. Referring to the number of professionals the 17,442 professionals from the 25 EHs, 3,349 (19.20%) are nurses , 3,242 (18.58%), nursing technicians and 10,851 (62.21%) are auxiliary nurses. With regard to preventive strategies, (RTs) use the training as the first choice while the confronting of ethical events, dominate the management actions, followed by EEC actins. From the 25 institutions, three had no NEC. From 22 HEs with NEC, 13 stated that they were formed in compliance with legal requirements and nine to meet the needs of the Nursing Department. In relation to activities undertaken by NECs (CEE), nine RTs refer to the supervisory and 13 to the education and guidance. The records of occurrences happen in 21 EHs and, mostly, are made through minutes-book or reports. Only 13 RTs responded on the purpose of the records, four of which use them to direct the continuing education or managerial actions, and the others do the filling, inquiry opening or the guiding to the Regional Council of Nursing, when necessary.

As mudanças sociais ocorridas nas últimas três décadas fizeram com que o respeito à autonomia do usuário e o direito ao consentimento livre e esclarecido assumissem posição de destaque na ética em saúde e fossem incorporados aos Códigos de Ética Médica e de Enfermagem vigentes no país. Estudos desenvolvidos em serviços de saúde, mormente os hospitalares, têm evidenciado que os usuários obtêm poucas informações sobre suas condições de saúde, tratamento, cuidado e que a prática profissional tem oscilado entre o paternalismo, o autoritarismo e o respeito à autonomia. Esta investigação foi realizada com o objetivo verificar como o consentimento esclarecido é concebido na prática das enfermeiras de quatro Centros de Saúde Escola (CSE) de São Paulo. A análise do material empírico, obtido através de entrevistas junto a essas profissionais foi feita à luz da ética principialista. O resultados demonstram que essas profissionais, apesar de desconhecerem o termo consentimento esclarecido, respeitam as suas normas básicas, reconhecem o direito dos usuários em participar de decisões que digam respeito à sua saúde, oferecem informações para subsidiar essas decisões. O padrão de informação é personalizado, porém, alternativas de decisão, além daquelas estipuladas em programas e protocolos, raramente são apresentadas. Assim, o consentimento esclarecido na prática das enfermeiras em CSE é limitado por esses programas e protocolos. As enfermeiras têm como preocupação o benefício do usuário, o estímulo às participação dos usuários no seu cuidado e a prevenção ou remoção de riscos e danos. No geral, estas enfermeiras acatam a decisão tomada pelo usuário, mesmo quando há recusa em seguir a orientação dada, mas por vezes demonstram dificuldade em aceitá-la quando a mesma põe em risco a saúde de terceiros. Enquanto profissionais que participam na implementação políticas de saúde demonstram preocupação com sua \"missão\", sentem-se impotentes e demonstram desconhecer aliados e instrumentos que poderiam ser utilizados nessa situação. / The social changes occurred in the last three decades were instrumental for causing the customers\' autonomy and right to free-informed consent to be respected assuming a leading rank in the health ethics as well as being incorporated into the Nursing and Medical Ethical Codes in force in the country. Studies carried out in health services, moreover in hospital facilities, disclosed that the customers usually obtain few information on their health condition, treatment and, care and that the professional practice has been oscillating among being either paternalistic, authoritarian or respecttul regarding the patient\'s autonomy. The purpose of this investigation was to ascertain how the informed consent is conceived by the nurses\' practice in four School/Health Centers in São Paulo, State of São Paulo. Brazil. The empirical material obtained in interviews along with these professionals was analyzed in the light of Bioethics principles. Results were as follows: these professionals do not know the term informed consent; however, they act in accordance with its basic norms, recognizing the customers\' right to participate in the decision-making regarding their health, besides providing information in order to subside these decisions: the pattern of the information provided is personalized, although decision alternatives other than those stipulated in programs and protocols are rarely presented. Informed consent, in nursing practice in School/Health Centers is restricted within these programs and protocols. These nurses are concerned about users\' beneficence, their participation in self care and about preventing or removig risks or harm. In general, these nurses respect the decision taken by the customers, even when they refuse to comply with the orientation provided, however showing sometimes difficulties in accepting it when the health of a third-part is in jeopardy; while professionals participating in the implementation of health policies, they demonstrate being concerned with their \"mission\", sometimes feeling themselves impotent to deal with this situation, disclosing therefore a lack of knowledge concerning allied institutions and instruments which might be used to face these kind of circumstances.

Thesis ( M.Cur.) --University of Limpopo, 2011 / The purpose of this study was to determine the factors that influence professional nurses’ time management at Mankweng Hospital campus, a tertiary hospital in Limpopo Province, South Africa. The objectives of this study were to identify and describe factors that influence professional nurses’ time management at a tertiary hospital campus and describe the recommendations on effective time management at a tertiary hospital campus to improve quality of patient care. A quantitative research method was used in this study to describe factors that influence professional nurses’ time management. Data were collected by means of a structured questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS). The study revealed that professional nurses were unable to manage time due to interruptions in between work performance, and this affected their productivity. The study recommended there is a need for professional nurses to attend in-service education related to management of time.

Thesis (M.Sc. (Curations)) --University of Limpopo, 2015 / The purpose of the study was to determine the experiences of professional nurses with ethical dilemmas at the Witbank hospital Nkangala district Mpumalanga province. The objectives of the study were to describe the experiences of professional nurses with ethical dilemmas in nursing practice and to determine supportive measures to help professional nurses to deal with ethical dilemmas encountered in nursing practice. The research question was: what are the ethical dilemmas that professional nurses experience in nursing practice? Kohlberg theory of moral development was used as a theoretical framework. A qualitative exploratory, descriptive and contextual research design was used to describe the experiences of professional nurses with ethical dilemmas in nursing practice. Purposive sampling was used to sample fourteen (14) professional nurses. Data was collected using semi-structured interviews. Open-coding method of data analysis was used and four themes and sub-themes emerged. The study found that professional nurses experience ethical dilemmas related to death and dying, distribution of both human and material resources, respect of patients’ autonomy and the nurses’ rights. The study recommends continuous ethics education and the inclusion of ethics in nursing curricula, creation of a supportive working environment, knowledge and understanding of the pledge of service, Inter- disciplinary teams to discuss ethical issues, availability of ethics experts and ethics mentors in the wards.

The notion of 'Care' has occupied a central place as foundation in nursing theory, ethics and practice. An examination of critical and authoritative documents reveals that the term is vague and ill defined. The literature on care does not theorise the concept as fully as expected in a profession where the concept is considered central. Moreover, even the best theories of care neglect justice. Applying Wittgenstein's concept of family resemblance allows the debate to move on from definitional issues to assess the applicability of 'care' to the practice of the profession. An examination of a range of assessments of nursing practice shows that although 'care' is frequently used in connection with nursing, it does not appear to be a major consideration in key areas of appraisal. This thesis explores the relationship between care and justice in nursing and proposes that they be integrated within nursing theory. A theory for nursing that does not exclude care, but that has justice as its basis is proposed. Care, when used in the context of justice provides nursing with a theory that is appropriate not only for nursing theory and ethics but also assists the profession meet the demands of modern practice.

The establishment of effective relationships is fundamental to good nursing practice and the fulfillment of nurses’ moral responsibilities. While intrapartum nurses are uniquely placed to establish relationships that can directly influence the woman’s experience of childbirth, there has been limited investigation of the relationships, identities and values that underlie nurses’ varied approaches and responses to labouring women. The purpose of this study was to explore intrapartum nurses’ understanding of their moral responsibilities from a social-moral perspective, using Margaret Urban Walker’s “expressive-collaborative” model of morality. Interviews were conducted with fourteen registered nurses working in a birthing unit of a Canadian teaching hospital. Four themes were identified that captured nurses’ moral responsibilities, including: organizing and coordinating care, responding to the unpredictable, recognizing limits of responsibilities to others, and negotiating care with women and families. Nurses enacted their moral responsibilities to labouring women in a variety of ways depending on their personal and professional experience, the circumstances, the people involved and the context of care. A key factor influencing responses to women was the degree to which understandings and expectations related to birth were deemed to be reasonable and mutually agreed upon among nurses, physicians, women and their families. Nurses also described limits on their responsibilities to others. Their choice of response to circumstances in which practice was constrained departed from the idealized expectations and ‘expert’ practices often reflected in professional guidelines. While nurses were able to identify contextual influences that constrained their ability to maintain effective relationships with women, the influence of their own values on the care they provided was less apparent. This suggests a need to challenge normative assumptions related to care of women in childbirth, including the provision of choice and family centred care, in order to create environments that can support and sustain practices that build understanding, mutuality and trust between nurses and birthing woman. In addition, given the contested nature of childbirth and the lack of shared understandings of what constitutes ‘best’ care, there is a need to develop collaborative models of inter-professional maternity care that include the voices of women as a central component.

Bakgrund: Fasthållning av barn används vid ett flertal kliniska procedurer. Barns samt vårdnadshavares upplevelse av situationen är ofta negativ. Etiska principer samt lagar och riktlinjer utgör en teoretisk grund i en fasthållningssituation. Barnets autonomi samt sjuksköterskans omvårdnadsplikt är två utgångspunkter i fasthållning som fenomen. Syfte: Att beskriva sjuksköterskors erfarenhet av fasthållning av barn vid kliniska procedurer inom somatisk vård. Metod: Litteraturstudien är baserad på tio vetenskapliga artiklar med både kvalitativ och kvantitativ ansats. En textanalys, inspirerad av kvalitativ innehållsanalys, har gjorts i resultatet. Resultat: Fem kategorier framkom: Användandet skiljer sig åt, Fasthållning möjliggör kliniska procedurer, Optimera situationen för barnet, Kommunikation underlättar fasthållningen samt Fasthållning är en svårighet. Sjuksköterskornas syn på fasthållning skiljdes åt beroende på den specifika situationen samt på sjuksköterskornas egna kunskaper och förutsättningar. Sjuksköterskorna upplevde en känslomässig konflikt i användandet av fasthållning men ansåg också att fasthållning är en nödvändighet vid många kliniska procedurer på barn, särskilt i akuta sammanhang. Slutsats: Erfarenheten av fasthållning av barn vid kliniska procedurer är mångfacetterad. Sjuksköterskor bör ha god kunskap om barns rättigheter och om etiska principer för att kunna optimera de kliniska procedurerna. Klinisk betydelse: Studien kan ge ett ökat etiskt medvetande som stärker sjuksköterskans professionella roll samt ha betydelse för vårdrelationen. / Background: Restraint of children is used in multiple clinical procedures. The experience of the situation is usually negative on children and legal guardians. Ethical principles, laws and guide lines represents the theoretical foundation in a restraint situation. The autonomy of the child as well as the caring duty of the nurse make up two basis for the phenomena of restraint. Aim: To describe nurses' experiences of restraint of children during clinical procedures in somatic health care. Method: This literature review is based on ten scientific papers with both qualitative and quantitative approach. A textual analysis, inspired by qualitative content analysis, represents the result. Result: Five categories emerged in the result: The usage differs, Restraint enables clinical procedures, Optimizing the situation for the child, Communication facilitates the use of restraint and Restraint is a difficulty. The nurses' view on restraint differed depending on the specific situation as well as the skills and abilities of the nurse. The nurses experienced an emotional conflict in the use of restraint but considered it to be necessary in multiple clinical procedures, especially during emergency contexts. Conclusion: The experience of restricting children during clinical procedures is multifaceted. Nurses need to have good knowledge about children's rights and ethical principles to optimize the clinical procedures. Clinical significance: The study can provide a greater ethical awareness that strengthens the professional role of the nurse and also have significance for the nurse-patient relationship.

The study describes the founding and growth of professional nursing at Indiana Wesleyan University in Marion, Indiana, from the program's initial planning in 1972 to 1992. The review of literature traces the historical development of professional nursing education schools in the United States from early 1800 training schools to teaching advanced nursing technology in 1992. A chronological approach involving both primary and secondary sources will be used to identify educational and developmental changes in administration, facilities, faculty positions and qualifications, curriculum, policies related to students and graduates, accreditation by the state of Indiana and the National League for Nursing, and the impact of religious-based program on student graduates.The historical research study will show the development of professional nursing education at Indiana Wesleyan University in Marion, Indiana. The development of the baccalaureate degree curriculum was facilitated by its founders with a goal to enable the school to meet accreditation requirements.The findings indicated that professional nursing education at Marion College/Indiana Wesleyan University in Marion, Indiana, followed the average trend in the development of a baccalaureate of science degree in nursing in the United States. A strength was Marion College/Indiana Wesleyan University developed a nursing program that had a strong Christian, multicultural foundation. This theme was interwoven throughout the curriculum, the uniqueness of the program lay in its development when compared to other nursing programs in Indiana and across the nation.The nursing directors and faculty members contributed to the quality of the education that was offered to nursing students. The nursing program expanded in 1981, and a graduate program in community health nursing was offered. / School of Nursing

The purpose of the study was to examine critical care nurses' perceptions of the usefulness of hospital ethics committees as a coping strategy for resolving ethical dilemmas. The conceptual framework was Lazarus and Folkman's theory of stress, appraisal, and coping (1984).The convenience sample was five critical care nurses from five midwestern hospitals. Confidentiality was maintained by identifying participants as numbers.The research design for the study was an exploratory case study. The research question, nurses perceptions' of the usefulness of hospital ethics committees as a coping strategy to resolve ethical dilemmas, was analyzed using a qualitative methodology. Findings indicated that the nurses did not perceive hospital ethics committees as useful resources in ethical conflicts. Barriers to use of committees included lack of education about the committees, lack of timely intervention by committees in a crisis and risks involved in confronting physicians via committees.Conclusions were that ethics committees were not fulfilling a role as support systems empowering nurses to act as patient advocates in ethical dilemmas. Results can be used to develop strategies to increase the ethics committees' effectiveness in ethical dilemmas. / School of Nursing