Joyce Cappiello, Margaret W Beal, Kim Gallogly-Hudson
Journal of Obstetric, Gynecologic & Neonatal Nursing
Abstract Using a case study that incorporates patient, nurse practitioner, and student perspectives, we address ethical principles of respect for autonomy, beneficence, and fairness; professionals’ right of conscience; and a social justice model for the discussion of prevention and management of unintended pregnancy. Through an ongoing process of self-reflection and values clarification, nurses can prepare for the challenge of applying ethical principles to the reproductive health care of women.
Extract . . .It behooves us always to strive to understand and search for the roots of other’s humanity without which we are left with dangerous assumptions and fear. All violence breeds tragic consequences for the victims and for the perpetrators who are betraying the consciences they have been given. In sum, the tragedy is not that the perpetrators have no conscience but that they are by their actions betraying the conscience they have in denying the humanity of others.
Extract Conclusion This Comment analyzes the PCR, which is currently under review by the Obama Administration. As currently written, the PCR promises to have devastating effects on the healthcare system. . .
Commenters have predicted that the PCR will be used to discriminate against patients based on their sexual orientation. 196 And because reproductive healthcare remains so controversial in this country, women will be disproportionately disadvantaged by the PCR, which now allows almost all employees-not only the doctor, but potentially the nurse, the pharmacist, the pharmacist’s assistant, the receptionist, the ambulance driver, and the janitor-to have a say in whether she can access her chosen healthcare without interference.
The PCR brought the ongoing debate over conscience clauses into the national spotlight. . . .this Comment argues that any analysis of conscience clauses must recognize that what is at stake is access to healthcare services, and that reduction of healthcare access can be accomplished not only explicitly, for example through the explicit redefining of the term “abortion,” but also through “strategic ambiguity.” . . .
Christina Juthberg, Sture Eriksson, Astrid Norberg, Karin Sundin
Journal of Advanced Nursing
Abstract Aim.: This paper is a report of a study of patterns of perceptions of conscience, stress of conscience and burnout in relation to occupational belonging among Registered Nurses and nursing assistants in municipal residential care of older people.
Background.: Stress and burnout among healthcare personnel and experiences of ethical difficulties are associated with troubled conscience. In elder care the experience of a troubled conscience seems to be connected to occupational role, but little is known about how Registered Nurses and nursing assistants perceive their conscience, stress of conscience and burnout.
Method.: Results of previous analyses of data collected in 2003, where 50 Registered Nurses and 96 nursing assistants completed the Perceptions of Conscience Questionnaire, Stress of Conscience Questionnaire and Maslach Burnout Inventory, led to a request for further analysis. In this study Partial Least Square Regression was used to detect statistical predictive patterns.
Result.: Perceptions of conscience and stress of conscience explained 41·9% of the variance in occupational belonging. A statistical predictive pattern for Registered Nurses was stress of conscience in relation to falling short of expectations and demands and to perception of conscience as demanding sensitivity. A statistical predictive pattern for nursing assistants was perceptions that conscience is an authority and an asset in their work. Burnout did not contribute to the explained variance in occupational belonging.
Conclusion.: Both occupational groups viewed conscience as an asset and not a burden. Registered Nurses seemed to exhibit sensitivity to expectations and demands and nursing assistants used their conscience as a source of guidance in their work. Structured group supervision with personnel from different occupations is needed so that staff can gain better understanding about their own occupational situation as well as the situation of other occupational groups.
Abstract Purpose: This research used a descriptive and explorative design to determine the levels of nurses’ organizational trust and organizational citizenship and to investigate relationships between the levels of organizational trust and organizational citizenship behaviors.
Design and Methods: Nurses who had completed their orientation from a total of 11 hospitals with bed capacities of 100 and located in the European district of Istanbul were included in the sample for this study. Formal, written applications and approval of the ethical committee were obtained from concerned institutions before proceeding with the data collection step. The Organizational Trust Inventory and the Organizational Citizenship Level Scale, a questionnaire form including five questions regarding nurses’ personal characteristics, were used in data collection. Data collection tools were distributed to 900 nurses in total, and usable data were obtained from 482 nurses. Number and percentage calculations and Pearson correlation analysis were used to assess research data.
Findings: The results of the present research showed that nurses had a higher than average level of trust in their managers and coworkers and they trusted more in their managers and coworkers than their institutions. The Organizational Citizenship Level Scale indicated that the behavior most frequently demonstrated by the nurses was conscientiousness, followed by courtesy and civic virtue, whereas sportsmanship was displayed to an average extent. An analysis of relationships between nurses’ level of organizational trust and their organizational citizenship behaviors revealed that nurses who trust in their managers, institutions, and coworkers demonstrated the organizational citizenship behaviors of conscientiousness, civic virtue, courtesy, and altruism more frequently.
Conclusions: The findings attained in this study indicated that the organizational trust the staff had in their institutions, managers, and coworkers influenced the organizational citizenship behaviors of conscientiousness, civic virtue, altruism, and courtesy, whereas it had no effect on sportsmanship behavior. Nurse managers should introduce studies to improve their subordinates’ organizational trust to ensure that they develop organizational citizenship behaviors, and they should support them in this process.
Clinical Relevance: These topics for nursing services will provide guidance to managers, particularly to managers of nursing services, in establishing processes to predict nurses’ organizational commitment, job satisfaction, performance, intention to leave, and other relevant issues.
Extract The United States has embarked on a dangerous course. When the right of healthcare workers to refuse participation in certain procedures based on conscience is denied, we have started down the path of preparing rightminded, conscience-driven people to abandon ethical practice and in some situations to become killers. Anytime people are forced to act against what they believe to be right and coerced to do what they consider to be wrong, a very treacherous gulf has been crossed. When the right of conscience is removed from healthcare workers, we will have healthcare workers without conscience.
Paula N Kagan, Marlaine C Smith, W Richard Cowling, eggy L Chinn
Nursing Philosophy
Abstract The purpose of this paper is to present the theoretical and philosophical assumptions of the Nursing Manifesto, written by three activist scholars whose objective was to promote emancipatory nursing research, practice , and education within the dialogue and praxis of social justice. Inspired by discussions with a number of nurse philosophers at the 2008 Knowledge Conference in Boston, two of the original Manifesto authors and two colleagues discussed the need to explicate emancipatory knowing as it emerged from the Manifesto. Our analysis yielded an epistemological framework based on liberation principles to advance praxis in the discipline of nursing. This paper adds to what is already known on this topic, as there is not an explicit contribution to the literature of this specific Manifesto, its significance, and utility for the discipline. While each of us have written on emancipatory knowing and social justice in a variety of works, it is in this article that we identify, as a unit of knowledge production and as a direction towards praxis, a set of critical values that arose from the emancipatory conscienceness and intention seen in the framework of the Nursing Manifesto.
Abstract Background: In elderly care registered nurses (RNs) and nurse assistants (NAs) face ethical challenges which may trouble their conscience.
Objective: This study aimed to illuminate meanings of RNs’ and NAs’ lived experience of troubled conscience in their work in municipal residential elderly care.
Design: Interviews with six RNs and six NAs were interpreted separately using a phenomenological hermeneutic method.
Settings: Data was collected in 2005 among RNs and NAs working in special types of housings for the elderly in a municipality in Sweden.
Participants: The RNs and NAs were selected for participation had previously participated in a questionnaire study and their ratings in the questionnaire study constituted the selection criteria for the interview study.
Results: The RNs’ lived experience of troubled conscience was formulated in two themes. The first theme is ‘being trapped in powerlessness’ which includes three sub-themes: being restrained by others’ omission, being trapped in ethically demanding situations and failing to live up to others’ expectations. The second theme is ‘being inadequate’ which includes two sub-themes: lacking courage to maintain one’s opinion and feeling incompetent. The NAs’ lived experience of troubled conscience was formulated in the two themes. The first is ‘being hindered by pre-determined conditions’ which includes two sub-themes: suffering from lack of focus in one’s work and being restrained by the organisation. The second theme is ‘being inadequate’ which includes two sub-themes: lacking the courage to object and being negligent.
Conclusions: The RNs’ lived experience of troubled conscience were feelings of being trapped in a state of powerlessness, caught in a struggle between responsibility and authority and a sense of inadequacy fuelled by feelings of incompetence, a lack of courage and a fear of revealing themselves and endangering residents’ well-being. The NAs’ lived experience of troubled conscience was feelings of being hindered by pre-determined conditions, facing a fragmented work situation hovering between norms and rules and convictions of their conscience. To not endangering the atmosphere in the work-team they are submissive to the norms of their co-workers. They felt inadequate as they should be model care providers. The findings were interpreted in the light of Fromm’s authoritarian and humanistic conscience.
Abstract Aims: To highlight the potential difficulties in the management of staff with a conscientious objection to abortion, in light of expanding role of nurses.
Background: Recent years have seen changes in the provision of abortion services. Medical procedures are now gaining popularity and some areas are seeing the integration of outpatient clinics into ward settings. This may involve nurses being required to provide care to women undergoing termination of pregnancy, which may not have previously been within their remit. This has implications for staff with a conscientious objection.
Methods: A review of the academic literature.
Results: The advent of medical abortion has led to changes in the way in which abortion services are provided which in turn has re-ignited the debate of the competing rights of nurses with a conscientious objection and those of the patient accessing abortion services.
Conclusions: This extended role of nurses creates challenges for staff working in clinical areas offering termination of pregnancy and these are further compounded when staff have expressed a conscientious objection to abortion.
Implications for Nursing Management: Managers face new challenges in achieving the fine balance between the rights of staff with a conscientious objection to abortion and women accessing abortion services.
Extract In formulating a response to the abortion issue, the nursing profession needs to be careful not to lose sight of its moral obligation to ensure that women receive the care they require. Nurses also need to be wary of the politicisation of conscience and the corrupting influence this can have on authentic debate about complex moral issues.
