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  • 1.
    Abelsson, Anna
    et al.
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Lindwall, Lillemor
    Karlstads universitet, Institutionen för hälsovetenskaper.
    What is dignity in prehospital emergency care?2017In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, no 3, p. 268-278Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation.

    OBJECTIVE: To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care.

    RESEARCH DESIGN: The study had a qualitative approach.

    METHOD: Data were collected by Flanagan's critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis.

    ETHICAL CONSIDERATIONS: The study followed the ethical principles in accordance with the Declaration of Helsinki.

    FINDINGS: The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient's world and make professional decisions. The ambulance nurse respects the patient's will and protects the patient's body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient.

    DISCUSSION: It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human.

    CONCLUSION: Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students' ethical obligation results in the courage to see when a patient's dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.

  • 2.
    Enskär, Karin
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. CHILD.
    Ethical aspects of judging the alternative treatment of children with cancer1995In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 2, no 1, p. 51-62Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study quality of life and subjective post-concussion symptoms in adults (16-60 years) with a mild traumatic brain injury (MTBI) 3 months and 1 year after injury.

    METHODS: Of a total of 489 patients 173 responded to questionnaires at 3 months and at 1 year, including the SF-36 health-related quality of life survey, which is a standardized measure validated for Swedish conditions. Post-concussion symptoms were rated as either existing or non-existing in a 21-item checklist [a modified version of Comprehensive Psychopathological Rating Scale (CPRS)].

    RESULTS: SF-36 showed impaired scores in all dimensions. Existing post-concussion symptoms were reported by 1545%. Significantly, more symptoms were present at 3 months than at 3 weeks after injury. Furthermore, a significant correlation between higher rates of post-concussion symptoms and lower SF-36 scores was found. CONCLUSIONS:

    The SF-36 results were significantly impaired compared with an age- and gender-matched normative control group and the rate of post-concussion symptoms was significantly higher at 3 months than at 3 weeks after injury. As a significant correlation between higher rates of symptoms and low SF-36 scores was also found we assume SF-36 to be a sensitive enough measure of MTBI-related effects.

  • 3.
    Jonasson, Lise-Lotte
    et al.
    Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Liss, Per-Erik
    Westerlind, Björn
    Berterö, Carina
    Empirical and normative ethics: a synthesis relating to the care of older patients2011In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 18, no 6, p. 814-824Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to synthesize the concepts from empirical studies and analyze, compare and interrelate them with normative ethics. International Council of nurses (ICN) and the Health and Medical Service Act are normative ethics. Five concepts were used in the analysis; three from the grounded theory studies and two from the theoretical framework on normative ethics. A simultaneous concept analysis resulted in five outcomes; interconnectedness, interdependence, corroboratedness, completeness and good care are all related to the empirical perspective of the nurse’s interaction with the older patient, and the normative perspective, i.e. that found in ICN code and SFS law. Empiric ethics and normative ethics are intertwined according to the findings of this study. Normative ethics are supporting documents for nurses as professionals and by extension also beneficial for older patients.

  • 4.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Status and trends of research ethics in Swedish nurses' dissertations2010In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 17, no 3, p. 383-392Article, review/survey (Refereed)
    Abstract [en]

    Research ethics is increasingly formally regulated, but little is known about how ethical considerations are reported in dissertations. The aim of this literature study was to describe the status and trends of ethical considerations in Swedish doctoral dissertations written by registerednurses. A total of 77 dissertations from 1987, 1997, and 2007 met the inclusion criteria and were analyzed by descriptive statistics. Ethical considerations were mostly overlooked in 1987, but almost ubiquitous by 2007. All dissertations in 2007, except one, had a section on ethical considerations; however, these were short, lacking in references, and short on content. The most common topic was informed consent and approval from research ethics review boards, followed by confidentiality and ethical aspects of methodological issues. Our results imply that the quantity and quality of ethical considerations must be improved in order to assure ethical soundness for participants, patients, researchers, and society.

  • 5.
    Lundberg, Kristina
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. University of Borås, Sweden.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sandman, Lars
    University of Borås, Sweden.
    Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 2, p. 480-495Article in journal (Refereed)
    Abstract [en]

    Background:

    When healthcare personnel take part in military operations in combat zones, they experience ethical problems related to dual loyalties, that is, when they find themselves torn between expectations of doing caring and military tasks, respectively.

    Aim:

    This article aims to describe how Swedish healthcare personnel reason concerning everyday ethical problems related to dual loyalties between care and military tasks when undertaking healthcare in combat zones.

    Design:

    Abductive qualitative design.Participants and research context:Individual interviews with 15 registered nurses and physicians assigned for a military operation in Mali.

    Ethical considerations:

    The participants signed up voluntarily, and requirements for informed consent and confidentiality were met. The research was approved by the Regional Ethics Review Board in Gothenburg (D no. 816-14; 24 November 2014).

    Findings:

    Three main categories emerged: reasons for not undertaking combat duties, reasons for undertaking combat duties and restricted loyalty to military duties, and 14 subcategories. Reasons for not undertaking combat duties were that it was not in their role, not according to ethical codes or humanitarian law or a breach towards patients. Reasons for undertaking combat duties were that humanitarian law does not apply or has to be treated pragmatically or that it is a case of force protection. Shortage of resources and competence were reasons for both doing and not doing military tasks. Under some circumstances, they could imagine undertaking military tasks: when under threat, if unseen or if not needed for healthcare duties.

    Discussion/conclusion:

    These discrepant views suggest a lack of a common view on what is ethically acceptable or not, and therefore we suggest further normative discussion on how these everyday ethical problems should be interpreted in the light of humanitarian law and ethical codes of healthcare personnel and following this, further training in ethical reflection before going on military operations.

  • 6.
    Namjoo, Shamsedin
    et al.
    University of Social Welfare and Rehabilitation Sciences, Iran.
    Allahverdipour, Hamid
    Research Center of Psychiatry and Behavioral Sciences & Department of Health Education and Promotion, Tabriz University of Medical Sciences, Iran.
    Shaghaghi, Abdolreza
    Department of Health Education and Promotion, Tabriz University of Medical Sciences, Iran.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Psychometric properties of Jacelon's Attributed Dignity Scale with Iranian older people2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, article id 969733019845125Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The main purpose of this study was the psychometric assessment of Jacelon's Attributed Dignity Scale among Iranian older population.

    METHODS: Using a standard "forward-backward" translation procedure, the original English version of Jacelon's Attributed Dignity Scale was translated into Persian. Internal consistency of the scale was checked by the Cronbach's α coefficient. Convergent validity of the instrument was appraised by the Social Skills Scale and General Health Questionnaire. Factor structure of the Iranian version of Jacelon's Attributed Dignity Scale and possible interplay between its subscales were checked through recruiting a convenient sample of 300 Iranian older people and performing the confirmatory factor analysis.

    FINDINGS: The estimated Cronbach's α and intraclass correlation coefficients for the Iranian version of Jacelon's Attributed Dignity Scale were in the vicinity of acceptable range, that is, 0.87 and 0.93, respectively. The output of confirmatory factor analysis revealed that a four-factor model best fitted the study data (χ2 = 323.49; df = 129; p < 0.001; comparative fit index = 0.913; Tucker-Lewis index = 0.901; root mean square error approximation = 0.074; standardized root mean square residual = 0.078). Rasch estimates of item difficulty ranged from -1.28 (less difficult) to 1.33 (more difficult). No significant cross-gender differences were observed regarding the Iranian version of Jacelon's Attributed Dignity Scale's items indicating its invariant psychometric properties for use in the Iranian men and women subgroups.

    ETHICAL CONSIDERTAION: This study was approved by the Ethics Committee at the Tabriz university of medical science. Informed consent, information confidentiality, and voluntary participation were guaranteed.

    CONCLUSION: The study findings were indicative of applicability of the Iranian version of Jacelon's Attributed Dignity Scale as a reliable tool in measurement of the perceived social dignity among Iranian and probably other Persian-speaking older populations.

  • 7.
    Silén, Marit
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Sidenvall, Birgitta
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Svantesson, Mia
    Centre for Care Science, Örebro universitet.
    What actions promote a positive ethical climate? A critical incident study of nurses’ perceptions2012In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 19, no 4, p. 501-512Article in journal (Refereed)
    Abstract [en]

    There is a lack of qualitative studies exploring the phenomenon of positive ethical climate and what is perceived as promoting it. Therefore, the aim of this study was to explore and describe actions that acute care ward nurses perceive as promoting a positive ethical climate. The critical incident technique was used. Interviews were conducted with 20 nurses at wards where the ethical climate was considered positive, according to a previous study. Meeting the needs of patients and next of kin in a considerate way, as well as receiving and giving support and information within the work group, promoted a positive ethical climate. Likewise, working as a team with a standard for behaviour within the work group promoted a positive ethical climate. Future research needs to investigate other conditions that might also promote a positive ethical climate.

  • 8.
    Silén, Marit
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Svantesson, Mia
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Nurses' conceptions of decision making concerning life-sustaining treatment2008In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 2, p. 160-173Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician-nurse collaboration, lack of confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed.

  • 9. Svantesson, Mia
    et al.
    Sjökvist, Peter
    Thorsén, Håkan
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Nurses' and physicians' opinions on aggressiveness of treatment for general ward patients2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, p. 147-162Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate agreement between nurses' and physicians' opinions regarding aggressiveness of treatment and to investigate and compare the rationales on which their opinions were based. Structured interviews regarding 714 patients were performed on seven general wards of a university hospital. The data gathered were then subjected to qualitative and quantitative analyses. There was 86% agreement between nurses' and physicians' opinions regarding full or limited treatment when the answers given as 'uncertain' were excluded. Agreement was less (77%) for patients with a life expectancy of less than one year. Disagreements were not associated with professional status because the physicians considered limiting life-sustaining treatment as often as the nurses. A broad spectrum of rationales was given but the results focus mostly on those for full treatment. The nurses and the physicians had similar bases for their opinions. For the majority of the patients, medical rationales were used, but age and quality of life were also expressed as important determinants. When considering full treatment, nurses used quality-of-life rationales for significantly more patients than the physicians. Respect for patients' wishes had a minor influence.

  • 10. Tang, Ping Fen
    et al.
    Johansson, Camilla
    Wadensten, Barbro
    Wenneberg, Stig
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Chinese nurses' ethical concerns in a neurological ward.2007In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, no 6, p. 810-824Article in journal (Refereed)
    Abstract [en]

    Our aim was to describe Chinese nurses' experiences of workplace distress and ethical dilemmas on a neurological ward. Qualitative interviews were performed with 20 nurses. On using latent content analysis, themes emerged in four content areas: ethical dilemmas, workplace distress, quality of nursing and managing distress. The ethical dilemmas were: (1) conflicting views on optimal treatment and nursing; (2) treatment choice meeting with financial constraints; and (3) misalignment of nursing responsibilities, competence and available resources. The patients' relatives lacked respect for the nurses' skills. Other dilemmas could be traced to the transition from a planned to a market economy, resulting in an excessive workload and treatment withdrawal for financial reasons. Lack of resources was perceived as an obstacle to proper patient care in addition to hospital organization, decreasing the quality of nursing, and increasing moral and workplace distress. The nurses managed mainly by striving for competence, which gave them hope for the future.

  • 11.
    Wadensten, Barbro
    et al.
    Uppsala University.
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Ethical values in personal assistance: narratives of people with disabilities2009In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 16, no 6, p. 759-774Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the experiences of persons with severe functional disabilities who receive personal assistance in their homes, the focus being on their daily life in relation to the ethical principles represented in the Swedish Disability Act: autonomy, integrity, influence and participation. Qualitative interviews were performed with 26 persons and thereafter subjected to qualitative latent content analysis. The experiences of personal assistance were very much in accordance with the said principles, the most important factor being that one is met with understanding. The participants described situations in which their integrity was violated in that they were not treated as competent adults. This indicates the importance of future efforts in nursing to support personal assistants with ethical knowledge and supervision so that they can empower people with disabilities and thereby enable them to maintain their self-esteem and dignity.

  • 12.
    Wadensten, Barbro
    et al.
    Department of Public Health and Caring, Uppsala University, Uppsala, Sweden.
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. CHILD.
    The struggle for dignity by people with severe functional disabilities2009In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 16, no 4, p. 453-465Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate what strategies people with severe functional disabilities who receive personal assistance in their homes use in their daily life to achieve autonomy, integrity, influence and participation. Qualitative interviews were carried out and subjected to qualitative latent content analysis. The main finding was expressed in terms of six subthemes: trying to keep a private sphere; striving to communicate; searching for possibilities; taking the initiative; striving to gain insight; and using one's temperament. These generated the overall theme: maintaining dignity in close relationships. This study contributes an understanding of the strategies used by people who are dependent on personal assistance. Future efforts in nursing must focus on supporting personal assistants with ethical knowledge and guidance in order that people with severe functional disabilities are empowered to achieve autonomy, integrity, influence and participation in their daily lives.

  • 13.
    Wadensten, Barbro
    et al.
    Uppsala universitet.
    Wenneberg, Stig
    Växjö universitet.
    Silén, Marit
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Tang, Ping Fen
    Kunming Medical College.
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    A cross-cultural comparison of nurses' ethical concerns2008In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 6, p. 745-760Article in journal (Refereed)
    Abstract [en]

     

    The aim of this study was to compare Swedish and Chinese nurses' experiences of ethical dilemmas and workplace distress in order to deepen understanding of the challenges neuroscience nurses encounter in different cultures. Qualitative interviews from two previously performed empirical studies in Sweden and China were the basis of this comparative study. Four common content areas were identified in both studies: ethical dilemmas, workplace distress, quality of nursing and managing distress. The themes formulated within each content area were compared and synthesized into novel constellations by means of aggregated concept analysis. Despite wide differences in the two health care systems, the nurse participants had similar experiences with regard to work stress and a demanding work situation. They were struggling with similar ethical dilemmas, which concerned seriously ill patients and the possibilities of providing good care. This indicates the importance of providing nurses with the tools to influence their own work situation and thereby reducing their work-related stress.

     

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