Background: There has been wide interest shown in the manner in which ethical dimensions in nursing practice are approached and addressed. As a result a number of ethical decision making models have been developed to tackle these problems. However, in this thesis it has been argued that the ethical dimensions of nursing practice are still not clearly understood and responded in Brunei. Design and method: This thesis describes a qualitative analysis into the Bruneian nurses’ perceptions of ethical dimensions in nursing practice. Drawing on constructivist grounded theory as a method of inquiry, twenty eight practicing and administrative nurses were individually interviewed. The nurses described how ethical dimensions were perceived in their practice, by means of the difficulties they are facing in the real world of nursing practice; how they have responded to these difficulties, and why they make such responses. Findings: The nurses described three ethical dimensions in their practice, namely ‘nurse at work’ which illustrates the ethical dimensions within the work environment; ‘nurse and doctor’ that elucidates the ethical dimensions in the nurse and doctor relationship and ‘nurse and patient’ which further examines ethical aspects in patient care. ‘Taking responsibility’ and ‘shifting responsibility to others’ were identified as approaches that the nurses took in responding to the ethical dimensions with the aim of avoiding the conflict and maintaining ward harmony. These responses provide new insights into how nurses’ response to ethical dimension in the ward settings where it puts strong emphasis on the nurses’ understanding of responsibility placed upon them as a professional nurse. ‘Negotiating ethical responsibility’ emerged as a core category within the data which illustrate that nurses’ responses to the ethical dimensions form a continuous process, involving constant consideration of the two types of responses. The core category described that ethical dimensions in the nurses’ practice were contextualised in the ‘ethical responsibility’ that is placed upon them within the nursing organisation. This thesis has expanded the current theoretical knowledge of ethical dimensions by elaborating on the concerns experienced in nursing practice and the responses individual nurses utilise to negotiate and discharge their ethical responsibilities at work. The study has also extended emphasis to the reasoning and responses that nurses are engaged in, whilst at the same time, negotiating ethical responsibility regarding the context in which they are placed during their working hours. This core category provides a number of possible implications for future research, nursing practice, education and policy, which would facilitate the exploration of ethical understanding for nurses in Brunei, and enable the provision of an ethical environment, so making ethical dimensions more transparent.

O objetivo do presente trabalho foi investigar a relação profissional/paciente na área da Ortodontia. Foram estudados os aspectos éticos e legais que permeiam o tratamento ortodôntico. A literatura estudada permite afirmar que a busca de auxílio legal por pacientes descontentes aumentou significativamente nos últimos anos. E que a ortodontia é uma especialidade em que os tratamentos são de longa duração e onde se estabelece uma estreita relação profissional/paciente, envolvendo uma grande expectativa em relação aos resultados. A pesquisa foi realizada por meio de dois questionários, o primeiro dirigido a 10 profissionais da área de ortodontia e o segundo a 100 pacientes em tratamento ortodôntico dos respectivos profissionais. A análise das respostas obtidas demonstrou que a preocupação estética é a principal motivação que leva os pacientes aos consultórios ortodônticos (61%) Todos os profissionais acreditam existir fatores imprevisíveis que podem interferir no desenvolvimento e no resultado do tratamento ortodôntico (100%). Apesar deste fato, 40% dos profissionais asseguram ao paciente o sucesso do tratamento. Os profissionais afirmam fornecer esclarecimentos sobre o tratamento e seus possíveis desdobramentos, porém de forma verbal. Para ambos, profissional e paciente, o mais importante nesta relação é a capacidade técnica do profissional. Para os profissionais, o principal meio de defesa do ortodontista frente a um processo de responsabilidade civil é o prontuário completo. Porém, a grande maioria dos entrevistados (90%) não possui em seu prontuário a ficha de procedimentos executados com as intercorrências anotadas e com a assinatura do paciente. Concluiu-se que a principal motivação que leva o paciente ao consultório ortodôntico é a preocupação estética e que o bom relacionamento profissional/paciente com atitudes como fornecer esclarecimentos sobre o tratamento e seus desdobramentos e possuir um prontuário completo são condutas prudentes a fim de evitar que o profissional venha a ser objeto de uma ação civil indenizatória impetrada pelo paciente. / The major objective of the present research work was to investigate the relationship between the dentistry professional and his/her patient in the orthodontics area. Ethical and legal aspects involved in the orthodontics treatment were profoundly analyzed. In the last years the searching for legal aid by unsatisfied patients has significantly increased. The orthodontics area is normally characterized by long term treatments. At any orthodontic treatment a much closed professional/ patient relationship is established together with a huge expectation on results. This research was developed using two questionnaires. The first one was submitted to ten orthodontics professionals and the second questionnaire to one hundred patients treated by those ten professionals. The percentile analysis of the patients' reply (61%) has demonstrated that the aesthetic aspects are the main reason that impels the patients to the orthodontics doctor's office. All the interviewed professionals (100%) believe in the existence of unexpected factors that intervene in both the development and the results of the treatment. Despite the aforementioned fact 40% of the professionals assure to the patient a successful treatment. About 20% of those 40% professionals cited guarantee to the patients a treatment according to their expectations. Although orally mentioned only, all the professionals affirm to provide to the patients the necessary information about the development of the treatment and its eventual implications. For both, professional and patient, the most important aspect to attain a successful treatment is the technical knowledge of the orthodontics professional. For the majority of the orthodontics professionals the main means against any civil prosecution is the complete and detailed treatment documentation. However, the great majority (90%) of the professionals interviewed do not possess in their files the executed treatment procedures with the signature of the patient on them. Any sort of misunderstanding relationship among the orthodontics professional and his/her patient on keeping a well understood treatment may lead to legal problems. It is also very important to remark that the patient can carry out an indemnity question against the professional if he/she does not have a good understanding on the legislation.

O objetivo do presente trabalho foi investigar a relação profissional/paciente na área da Ortodontia. Foram estudados os aspectos éticos e legais que permeiam o tratamento ortodôntico. A literatura estudada permite afirmar que a busca de auxílio legal por pacientes descontentes aumentou significativamente nos últimos anos. E que a ortodontia é uma especialidade em que os tratamentos são de longa duração e onde se estabelece uma estreita relação profissional/paciente, envolvendo uma grande expectativa em relação aos resultados. A pesquisa foi realizada por meio de dois questionários, o primeiro dirigido a 10 profissionais da área de ortodontia e o segundo a 100 pacientes em tratamento ortodôntico dos respectivos profissionais. A análise das respostas obtidas demonstrou que a preocupação estética é a principal motivação que leva os pacientes aos consultórios ortodônticos (61%) Todos os profissionais acreditam existir fatores imprevisíveis que podem interferir no desenvolvimento e no resultado do tratamento ortodôntico (100%). Apesar deste fato, 40% dos profissionais asseguram ao paciente o sucesso do tratamento. Os profissionais afirmam fornecer esclarecimentos sobre o tratamento e seus possíveis desdobramentos, porém de forma verbal. Para ambos, profissional e paciente, o mais importante nesta relação é a capacidade técnica do profissional. Para os profissionais, o principal meio de defesa do ortodontista frente a um processo de responsabilidade civil é o prontuário completo. Porém, a grande maioria dos entrevistados (90%) não possui em seu prontuário a ficha de procedimentos executados com as intercorrências anotadas e com a assinatura do paciente. Concluiu-se que a principal motivação que leva o paciente ao consultório ortodôntico é a preocupação estética e que o bom relacionamento profissional/paciente com atitudes como fornecer esclarecimentos sobre o tratamento e seus desdobramentos e possuir um prontuário completo são condutas prudentes a fim de evitar que o profissional venha a ser objeto de uma ação civil indenizatória impetrada pelo paciente. / The major objective of the present research work was to investigate the relationship between the dentistry professional and his/her patient in the orthodontics area. Ethical and legal aspects involved in the orthodontics treatment were profoundly analyzed. In the last years the searching for legal aid by unsatisfied patients has significantly increased. The orthodontics area is normally characterized by long term treatments. At any orthodontic treatment a much closed professional/ patient relationship is established together with a huge expectation on results. This research was developed using two questionnaires. The first one was submitted to ten orthodontics professionals and the second questionnaire to one hundred patients treated by those ten professionals. The percentile analysis of the patients' reply (61%) has demonstrated that the aesthetic aspects are the main reason that impels the patients to the orthodontics doctor's office. All the interviewed professionals (100%) believe in the existence of unexpected factors that intervene in both the development and the results of the treatment. Despite the aforementioned fact 40% of the professionals assure to the patient a successful treatment. About 20% of those 40% professionals cited guarantee to the patients a treatment according to their expectations. Although orally mentioned only, all the professionals affirm to provide to the patients the necessary information about the development of the treatment and its eventual implications. For both, professional and patient, the most important aspect to attain a successful treatment is the technical knowledge of the orthodontics professional. For the majority of the orthodontics professionals the main means against any civil prosecution is the complete and detailed treatment documentation. However, the great majority (90%) of the professionals interviewed do not possess in their files the executed treatment procedures with the signature of the patient on them. Any sort of misunderstanding relationship among the orthodontics professional and his/her patient on keeping a well understood treatment may lead to legal problems. It is also very important to remark that the patient can carry out an indemnity question against the professional if he/she does not have a good understanding on the legislation.

This study aimed at exploring chronic illness from both the perspectives of the patient, living with the illness and the professional, treating the illness. The epistemological framework is social constructionism. Qualitative research was selected as the research approach. Three in-depth interviews with three patients, suffering with a chronic illness were conducted, as well as three interviews with professionals, who had experience with patients diagnosed with chronic illnesses. Thematic analysis was the method used for the analysis of data. The stories of the participants were reconstructed in terms of themes. A comparative analysis for both participants groups was done, and linked to the relevant literature This study created an understanding of the complexity of chronic illness. The themes identified, highlighted the importance of the patient-professional relationship, specifically in the context of chronic illness. / Psychology / M.A. (Clinical Psychology)

This study aimed at exploring chronic illness from both the perspectives of the patient, living with the illness and the professional, treating the illness. The epistemological framework is social constructionism. Qualitative research was selected as the research approach. Three in-depth interviews with three patients, suffering with a chronic illness were conducted, as well as three interviews with professionals, who had experience with patients diagnosed with chronic illnesses. Thematic analysis was the method used for the analysis of data. The stories of the participants were reconstructed in terms of themes. A comparative analysis for both participants groups was done, and linked to the relevant literature This study created an understanding of the complexity of chronic illness. The themes identified, highlighted the importance of the patient-professional relationship, specifically in the context of chronic illness. / Psychology / M.A. (Clinical Psychology)