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  • 1.
    Blomberg, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bisholt, Birgitta
    Karlstad University, Karlstad, Sweden; The Swedish Red Cross University College, Stockholm, Sweden.
    Clinical group supervision for integrating ethical reasoning: Views from students and supervisors2016In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 23, no 7, p. 761-769Article in journal (Refereed)
    Abstract [en]

    Background: Clinical group supervision has existed for over 20 years in nursing. However, there is a lack of studies about the role of supervision in nursing students' education and especially the focus on ethical reasoning.

    Aim: The aim of this study was to explore and describe nursing students' ethical reasoning and their supervisors' experiences related to participation in clinical group supervision.

    Research design: The study is a qualitative interview study with interpretative description as an analysis approach.

    Participants and research context: A total of 17 interviews were conducted with nursing students (n = 12) who had participated in clinical group supervision in their first year of nursing education, and with their supervisors (n = 5).

    Ethical conciderations: The study was based on the ethical principles outlined in the Declaration of Helsinki, and permission was obtained from the Regional Ethical Review Board in Sweden.

    Findings: The analysis revealed that both the form and content of clinical group supervision stimulated reflection and discussion of handling of situations with ethical aspects. Unethical situations were identified, and the process uncovered underlying caring actions.

    Disscusion and conclusion: Clinical group supervision is a model that can be used in nursing education to train ethical reflection and to develop an ethical competence among nursing students. Outcomes from the model could also improve nursing education itself, as well as healthcare organizations, in terms of reducing moral blindness and unethical nursing practice.

  • 2. Dwyer, Lise-Lotte
    et al.
    Nordenfelt, Lennart
    Ternestedt, Britt-Marie
    Three nursing home residents speak about meaning at the end of life2008In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 1, p. 97-109Article in journal (Refereed)
    Abstract [en]

    This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in two nursing homes in Sweden. A secondary analysis was carried out on data obtained from three of the primary participants interviewed over a period of time (18-24 months), with a total of 12 interviews carried out using an inductive hermeneutic approach. The study reveals that sources of meaning were created by having a sense of: physical capability, cognitive capability, being needed, and belonging. Meaning was created through inner dialogue, communication and relationships with others. A second finding is that the experience of meaning can sometimes be hard to realize.

  • 3.
    Eldh, Ann Catrine
    et al.
    Capio St. Göran Hospital, Stockholm.
    Ekman, Inger
    Sahlgrenska Academy, Göteborg University, Institute of Health and Care Sciences, Göteborg.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Conditions for patient participation and non-participation in health care2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 5, p. 503-14Article in journal (Refereed)
    Abstract [en]

    This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making.

  • 4.
    Eldh, Ann Catrine
    et al.
    Örebro University, Department of Health Sciences.
    Ekman, Inger
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Conditions for patient participation and non-participation in health care2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 5, p. 503-514Article in journal (Refereed)
    Abstract [en]

    This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making.

  • 5.
    Franklin, Lise-Lotte
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ternestedt, Britt-Marie
    Nordenfelt, Lennart
    Views on dignity of elderly nursing home residents2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, p. 130-146Article in journal (Refereed)
    Abstract [en]

    Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence.

  • 6.
    Hemberg, Jessica
    et al.
    Åbo Akademi University, Vaasa, Finland.
    Bergdahl, Elisabeth
    Örebro University, School of Health Sciences.
    Dealing with ethical and existential issues at end of life through co-creation2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, article id UNSP 0969733019874496Article in journal (Refereed)
    Abstract [en]

    Background: In research on co-creation in nursing, a caring manner can be used to create opportunities for the patient to reach vital goals and thereby increase the patient's quality of life in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. Nurses must be extra sensitive to patients' and their relatives' needs with regard to ethical and existential issues and situations in home care encounters, especially at the end of life.

    Aim: The aim of this study was to explore nurses' experiences of dealing with ethical and existential issues through co-creation at the end of life in palliative home care.

    Research design, participants, and research context: The material consisted of texts from interviews with 12 nurses in a home care context. A hermeneutical approach was used, and the method was inspired by a thematic analysis.

    Ethical considerations: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Ethical permission to conduct the study was given from organizations that participated in this study.

    Findings: A main theme and four subthemes emerged. The main theme was "Deep co-creative relationships are needed to manage ethical and existential issues at the end of life." A model was created to display the findings and relations between ethical issues and situations and the need for a deep trustful caring relationship to solve problems in palliative home care.

    Discussion: Together, the themes can be considered as a tool for learning and dealing with ethical and existential issues at the end of life in home care. The themes can also be seen as a part of nurses' ethical competence within this context.

    Conclusion: The quality of life at the end of life can be improved through co-creation, despite difficult ethical and existential issues. Future research should focus on co-creation from the patients' perspective.

  • 7.
    Hemberg, Jessica
    et al.
    Åbo Akademi University, Åbo, Finland.
    Bergdahl, Elisabeth
    Örebro University, School of Health Sciences.
    Ethical sensitivity and perceptivness in palliative home care through co-creation2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Article in journal (Refereed)
    Abstract [en]

    Background: In research on co-creation in nursing, a caring manner can be used to create opportunities whereby the patient’s quality of life can be increased in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. To promote quality of life, nurses must be sensitive to patients’ and their relatives’ needs in care encounters. Co-creation can be defined as the joint creation of vital goals for patients through the process of shared knowledge between nurses, patients and their relatives.

    Aim: The aim of this study was to explore nurses’ experiences of caring encounters and co-creation in palliative home care from an ethical perspective.

    Research design, participants, and research context: A hermeneutical approach was used. The material consisted of texts from interviews with 12 nurses in a home care context. The method was inspired by thematic analysis.

    Ethical considerations: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes.

    Findings: An overall theme, a main theme and four sub-themes emerged. Through ethical sensitivity and perceptivity, nurses can balance their actions in the moment and change their nursing care actions accordingto the patient’s wishes through co-creation in encounters. Here the time is crucial, as the time needed is unique to each patient.

    Discussion: The themes together can be considered prerequisites for good palliative home care. If nurses fail to be sensitive and perceptive in encounters with dying patients, good palliative home care cannot be achieved. Ethical sensitivity and perceptiveness can also be considered a part of nurses’ ethical competence.

    Conclusion: Patients’ dignity can be preserved through ethical sensitivity and perceptiveness, which is fundamental for good palliative care. Co-creation from patients’ perspectives should be the focus of future research.

  • 8. Häggstrom, Elisabeth
    et al.
    Kihlgren, Annica
    Örebro University, Department of Nursing and Caring Sciences.
    Experiences of caregivers, and relatives in public nursing homes2007In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, no 5, p. 691-701Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was, by means of discussion highlighting ethical questions and moral reasonings, to increase understanding of the situations of caregivers and relatives of older persons living in a public nursing home in Sweden. The findings show that these circumstances can be better understood by considering two different perspectives: an individual perspective, which focuses on the direct contact that occurs among older people, caregivers and relatives; and a societal perspective, which focuses on the norms, values, rules and laws that govern a society. Relatives and caregivers thought that the politicians were sending out mixed messages: they were praising caregivers and relatives for their efforts, but at the same time the public health care sector was subjected to significant cutbacks in resources. Both caregivers and relatives were dissatisfied and frustrated with the present situation regarding the care of older persons in public nursing homes.

  • 9.
    Rasoal, Dara
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Svantesson, Mia
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    What healthcare teams find ethically difficult: Captured in 70 moral case deliberations2016In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 23, no 8, p. 825-837Article in journal (Refereed)
    Abstract [en]

    Background: Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss.

    Aim: To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation.

    Research design: A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis.

    Ethical considerations: An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation.

    Findings: Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient's/next-of-kin's emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient's autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have.

    Discussion: The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders.

    Conclusion: MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.

  • 10.
    Sahlberg-Blom, Eva
    et al.
    Örebro University, Department of Health Sciences.
    Ternestedt, Britt-Marie
    Johansson, Jan-Erik
    Patient participation in decision making at the end of life as seen by a close relative2000In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 7, no 4, p. 296-313Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to describe variations in patientparticipation in decisions about care planningduring the final phase of life for a group of gravely ill patients, and how the different actors’manner of acting promotes or impedes patientparticipation. Thirty-seven qualitative research interviewswere conducted with relatives of the patients.The patients’ participation in the decisionscould be categorized into four variations: self-determination,co-determination, delegation and nonparticipation.The manner in which patients, relatives andcaregivers acted differed in the respective variations; thisseemed either to promote or to impede the patients’opportunities of participating in the decisionmaking. The possibility for participation seems to be context dependent and affected by many factors suchas the dying patient’s personality, thesocial network, the availability of different forms of care,cultural values, and the extent to which nursesand other caregivers of the different formsof care can and want to support the wishes of the patients andrelatives in the decision-making process.

  • 11. Silén, Marit
    et al.
    Svantesson, Mia
    Örebro University, School of Health and Medical Sciences.
    Ahlström, Gerd
    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.

  • 12.
    Svantesson, Mia
    et al.
    Örebro University, School of Health Sciences. University of Warwick, Coventry, UK.
    Silén, Marit
    University of Gävle, Gävle, Sweden; Uppsala University, Uppsala, Sweden.
    James, Inger
    Örebro University, School of Health Sciences.
    It's not all about moral reasoning: Understanding the content of Moral Case Deliberation2018In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 25, no 2, p. 212-229Article in journal (Refereed)
    Abstract [en]

    Background: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain.

    Objective: To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces.

    Methods: A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority.

    Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation.

    Findings: Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%).

    Conclusion: The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

  • 13.
    Svantesson, Mia
    et al.
    Örebro University, Department of Clinical Medicine.
    Sjökvist, Peter
    Thorsén, Håkan
    Örebro University, Department of Health Sciences.
    Ahlström, Gerd
    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.

  • 14.
    Sørlie, Venke
    et al.
    University of Oslo, Norway, Institute of Nursing and Health Sciences, PO Box 1153, Blindern, 0318 Oslo, Norway.
    Kihlgren, Annica
    Örebro University, Department of Nursing and Caring Sciences.
    Kihlgren, Mona
    Örebro University, Department of Nursing and Caring Sciences.
    Meeting ethical challenges in acute nursing care as narrated by registered nurses2005In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 12, no 2, p. 133-42Article in journal (Refereed)
    Abstract [en]

    Five registered nurses were interviewed as part of a comprehensive investigation by five researchers into the narratives of five enrolled nurses (study 1, published in Nursing Ethics 2004), five registered nurses (study 2) and 10 patients (study 3) describing their experiences in an acute care ward at one university hospital in Sweden. The project was developed at the Centre for Nursing Science at Orebro University Hospital. The ward in question was opened in 1997 and provides care for a period of up to three days, during which time a decision has to be made regarding further care elsewhere or a return home. The registered nurses were interviewed concerning their experience of being in ethically difficult care situations in their work. Interpretation of the theme 'ethical problems' was left to the interviewees to reflect upon. A phenomenological hermeneutic method (inspired by the French philosopher Paul Ricoeur) was used in all three studies. The most prominent feature revealed was the enormous responsibility present. When discussing their responsibility, their working environment and their own reactions such as stress and conscience, the registered nurses focused on the patients and the possible negative consequences for them, and showed what was at stake for the patients themselves. The nurses demonstrated both directly and indirectly what they consider to be good nursing practices. They therefore demand very high standards of themselves in their interactions with their patients. They create demands on themselves that they believe to be identical to those expected by patients.

  • 15.
    Sørlie, Venke
    et al.
    University Hospital, Sweden, and University of Oslo, Norway.
    Kihlgren, Annica Larsson
    Örebro University Hospital, Sweden.
    Kihlgren, Mona
    Örebro University Hospital, Sweden.
    Meeting ethical challenges in acute care work as narrated by enrolled nurses.2004In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 11, no 2, p. 179-88Article in journal (Refereed)
    Abstract [en]

    Five enrolled nurses (ENs) were interviewed as part of a comprehensive investigation into the narratives of registered nurses, ENs and patients about their experiences in an acute care ward. The ward opened in 1997 and provides patient care for a period of up to three days, during which time a decision has to be made regarding further care elsewhere or a return home. The ENs were interviewed concerning their experience of being in ethically difficult care situations and of acute care work. The method of phenomenological-hermeneutic interpretation inspired by the French philosopher Paul Ricoeur was used. The most prominent feature was the focus on relationships, as expressed in concern for society's and administrators' responsibility for health care and the care of older people. Other themes focus on how nurse managers respond to the ENs' work as well as their relationships with fellow ENs, in both work situations and shared social and sports activities. Their reflections seem to show an expectation of care as expressed in their lived experiences and their desire for a particular level and quality of care for their own family members. A lack of time could lead to a bad conscience over the 'little bit extra' being omitted. This lack of time could also lead to tiredness and even burnout, but the system did not allow for more time.

  • 16. Tang, Ping Fen
    et al.
    Johansson, Camilla
    Wadensten, Barbro
    Wenneberg, Stig
    Örebro University, Department of Nursing and Caring Sciences.
    Ahlström, Gerd
    Chinese nurses' ethical concerns in a neurological ward2007In: 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.

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