Search

Background: The phenomenon of 'moral distress' has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice., Research Aim: To explore the concept of moral distress in nursing both empirically and conceptually., Methodology: Feminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen's six steps for data analysis., Ethical Considerations: The study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom., Findings: The empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants' narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas., Discussion: We suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, 'moral-uncertainty distress'. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress., Conclusion: The empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as 'moral distress'.

Background: In this paper we discuss the emergence of many different methods for doing a literature review. Referring back to the early days, when there were essentially two types of review; a Cochrane systematic review and a narrative review, we identify how the term systematic review is now widely used to describe a variety of review types and how the number of available methods for doing a literature review has increased dramatically. This led us to undertake a review of current practice of those doing a literature review and the terms used to describe them., Method: We undertook a focused mapping review and synthesis. Literature reviews; defined as papers with the terms review or synthesis in the title, published in five nursing journals between January 2017-June 2018 were identified. We recorded the type of review and how these were undertaken., Results: We identified more than 35 terms used to describe a literature review. Some terms reflected established methods for doing a review whilst others could not be traced to established methods and/or the description of method in the paper was limited. We also found inconsistency in how the terms were used., Conclusion: We have identified a proliferation of terms used to describe doing a literature review; although it is not clear how many distinct methods are being used. Our review indicates a move from an era when the term narrative review was used to describe all 'non Cochrane' reviews; to a time of expansion when alternative systematic approaches were developed to enhance rigour of such narrative reviews; to the current situation in which these approaches have proliferated to the extent so that the academic discipline of doing a literature review has become muddled and confusing. We argue that an 'era of consolidation' is needed in which those undertaking reviews are explicit about the method used and ensure that their processes can be traced back to a well described, original primary source.

Globalisation describes the increasing economic and social interdependence between countries. This article examines globalisation in terms of the opportunities and threats it poses to health, in particular increasing rates of non-communicable diseases. Nursing is challenged with responding to the changing health needs of the global population that have arisen as a result of globalisation.

Aim: This paper is a discussion of the use of poststructuralism as a means of exploring power and empowerment in nursing., Background: Power and empowerment are well-researched areas of nursing practice, but the issue of how to empower nurses and patients continues to cause debate. Power and empowerment are complex issues and other researchers have provided some clarity by proposing three theoretical approaches: critical social theory, organizational theory and social psychological theory. We support their work and propose an additional poststructural approach as a means of analyzing power and empowerment in nursing., Discussion: The concept of power in nursing may be critiqued by drawing on the work of Michel Foucault and paying particular attention to two areas: disciplinary power and knowledge/power relationships. Foucault's contention was that behaviour is standardized through disciplinary power and that power and knowledge are intertwined. Nurses who seek an understanding of empowerment must first grasp such workings as hierarchical observation, normalizing judgement, the examination, and power/knowledge relationships, and that cognizance of such issues can promote nursing practice that is empowering. They need to adopt a more critical stance to understanding power and empowerment in nursing, and one way of fostering such criticism is to view nursing practice through a poststructural lens., Conclusion: A poststructural approach merits a place alongside other approaches to understanding power and empowerment in nursing.

An editorial is presented which emphasizes the need for a multi-faceted response to intimate partner violence (IPV) due to its complex nature influenced by social, environmental, and political factors. It focuses on advancing nursing education on IPV, promoting person-centered and trauma-and violence-informed care, and supporting healthcare organizations' initiatives in addressing IPV.

Aims and Objectives: To explore moral distress empirically and conceptually, to understand the factors that mitigate and exacerbate moral distress and construct a model that represents how moral distress relates to its constituent parts and related concepts. Background: There is ongoing debate about how to understand and respond to moral distress in nursing practice. Design: The overarching design was feminist empirical bioethics in which feminist interpretive phenomenology provided the tools for data collection and analysis, reported following the COREQ guidelines. Using reflexive balancing, the empirical data were combined with feminist theory to produce normative recommendations about how to respond to moral distress. The Moral Distress Model presented in this paper is a culmination of the empirical data and theory. Methods: Using feminist interpretive phenomenology, critical care nurses in the United Kingdom (n = 21) were interviewed and data analysed. Reflexive Balancing was used to integrate the data with feminist theory to provide normative recommendations about how to understand moral distress. Results: There are five compounding factors that exacerbate/ mitigate nurses' experiences of moral distress: epistemic injustice; the roster lottery; conflict between one's professional and personal responsibilities; ability to advocate and team dynamics. In addition to the causal connection and responses to moral distress, these factors make up the moral distress model which can guide approaches to mitigate moral distress. Conclusions: The Moral Distress Model is the culmination of these data and theorising formulated into a construct to explain how each element interacts. We propose that this model can be used to inform the design of interventions to address moral distress. [ABSTRACT FROM AUTHOR]

Aims: To synthesise the current, global evidence‐informed guidance that supports nurses and midwives to recognise and respond to intimate partner violence (IPV), and how these practices can be translated from face‐to‐face encounters to care that is delivered through telehealth. Background: COVID‐19‐related social and physical distancing measures increase the risk for individuals who are socially isolated with partners who perpetuate violence. Providing support through telehealth is one strategy that can mitigate the pandemic of IPV, while helping patients and providers stay safe from COVID‐19. Design and Methods: In this discursive paper, we describe how practical guidance for safely recognising and responding to IPV in telehealth encounters was developed. The ADAPT‐ITT (Assessment, Decisions, Administration, Production, Topical Experts, Integration, Testing, Training) framework was used to guide the novel identification and adaptation of evidence‐informed guidance. We focused on the first six stages of the ADAPT‐ITT framework. Conclusions: This paper fills a gap in available guidance, specifically for IPV recognition and response via telehealth. We present strategies for prioritising safety and promoting privacy while initiating, managing or terminating a telehealth encounter with patients who may be at risk for or experiencing IPV. Strategies for assessment, planning and intervention are also summarised. System‐level responses, such as increasing equitable access to telecommunication technology, are also discussed. Relevance to clinical practice: Integrating innovative IPV‐focused practices into telehealth care is an important opportunity for nurses and midwives during the current global COVID‐19 pandemic. There are also implications for future secondary outbreaks, natural disasters or other physically isolating events, for improving healthcare efficiency, and for addressing the needs of vulnerable populations with limited access to health care. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Over the past decade, the potential harms regarding young people's use of technology have attracted mounting political, media and research attention worldwide. One practice engaged in by many young people is that of "sexting" and the sharing of partially, or complete nude images ("selfies"). Such images are not always retained within private spaces and are prone to be shared, with significant psychosocial consequences for young people involved. A significant risk is the hidden nature of some online interactions, with potential for grooming and child sexual exploitation. As key professionals working with young people, public health nurses have potential to educate and explore the risks with them. Yet to date, to our knowledge there has been no research in relation to public health nurses' understandings of the practices involved or their potential harms. A qualitative study was undertaken drawing theoretically on the common‐sense model (CSM) to frame the analysis. Eighteen semi‐structured interviews were conducted with public health nurses in a region of England in 2016. Data were analysed through thematic analysis, and mapped to the five domains of CSM. Public health nurses' understandings of young people's sexting practices were shaped largely by media reports, rather than scientific, disciplinary knowledge. Sexting did not resonate with many public health nurses' own experiences of being a young person and was therefore difficult to understand. All were able to express an opinion about the causes and consequences of sexting and we present these as a "perceived hierarchy of risk". All public health nurses acknowledged the importance of their role in dealing with harm reduction associated with sexting among young people, but they need education and support to do this effectively and confidently. Findings can be transferred carefully to many contexts and countries because sexting is a practice among young people that transcends geographical boundaries. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to report the findings of a qualitative case study that investigated abused women's experiences of an identification and referral intervention and to discuss the implications for nurses, specifically those working in primary and community care. Background Domestic violence and abuse is a significant public health issue globally but it is a hidden problem that is under-reported. In the UK, Identification and Referral to Improve Safety is a primary care-based intervention that has been found to increase referral rates of abused women to support and safety services. This paper reports on the findings of an evaluation study of two sites in England. Design Qualitative study with a case study design. Methods In line with case study design, the entire evaluation study employed multiple data collection methods. We report on the qualitative interviews with women referred through the programme. The aim was to elicit their experiences of the three aspects of the intervention: identification; referral; safety. Data collection took place March 2016. Findings Ten women took part. Eight had exited the abusive relationship but two remained with the partner who had perpetrated the abuse. Women were overwhelmingly positive about the programme and irrespective of whether they had remained or exited the relationship all reported perceptions of increased safety and improved health. Conclusion Nurses have an important role to play in identifying domestic violence and abuse and in referral and safety planning. As part of a portfolio of domestic violence and abuse interventions, those that empower women to take control of their safety (such as Identification and Referral to Improve Safety) are important. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this article is to discuss critically the theoretical concepts of awareness, recognition and empowerment as manifested in intimate partner violence and to show how these can be translated into a practice framework for improving nurses' response. Background Intimate partner violence is a universal problem and is considered a significant public health issue. Nurses are in an ideal position to recognise and respond to intimate partner violence, but many lack confidence in this area of practice. In our previous empirical work, we identified three concepts through which nurses' responses to intimate partner violence can be understood: awareness, recognition and empowerment. In this article, we advance nursing knowledge by showing how these concepts can form a practice framework to improve nurses' responses to intimate partner violence. Design A discussion paper and development of a practice framework to improve nurses' responses to intimate partner violence. Discussion The framework comprises three principal needs of women and three related key requirements for nurses to meet these needs. Arising from these are a range of practice outcomes: enhanced understanding of intimate partner violence, increased confidence in recognising intimate partner violence, establishment of trusting relationships, increased likelihood of disclosure and optimised safety. Conclusions Nurses sometimes lack confidence in recognising and responding to intimate partner violence. Awareness, recognition and empowerment are important concepts that can form the basis of a framework to support them. When nurses feel empowered to respond to intimate partner violence, they can work together with women to optimise their safety. Relevance to clinical practice Access to adequate and timely intimate partner violence education and training is important in improving nurses' responses to intimate partner violence. Getting this right can lead to enhanced safety planning and better health outcomes for women who experience intimate partner violence. Although difficult to measure as an outcome, nurses' improved responses can contribute to higher rates of referral for help and reduction in intimate partner violence rates. [ABSTRACT FROM AUTHOR]

Aims and objectives To provide a snapshot of how vicarious trauma is considered within the published nursing research literature. Background Vicarious trauma (secondary traumatic stress) has been the focus of attention in nursing practice for many years. The most pertinent areas to invoke vicarious trauma in research have been suggested as abuse/violence and death/dying. What is not known is how researchers account for the risks of vicarious trauma in research. Design Focused mapping review and synthesis. Empirical studies meeting criteria for abuse/violence or death/dying in relevant Scopus ranked top nursing journals ( n = 6) January 2009 to December 2014. Methods Relevant papers were scrutinised for the extent to which researchers discussed the risk of vicarious trauma. Aspects of the studies were mapped systematically to a pre-defined template, allowing patterns and gaps in authors' reporting to be determined. These were synthesised into a coherent profile of current reporting practices and from this, a new conceptualisation seeking to anticipate and address the risk of vicarious trauma was developed. Results Two thousand five hundred and three papers were published during the review period, of which 104 met the inclusion criteria. Studies were distributed evenly by method (52 qualitative; 51 quantitative; one mixed methods) and by focus (54 abuse/violence; 50 death/dying). The majority of studies (98) were carried out in adult populations. Only two papers reported on vicarious trauma. Conclusion The conceptualisation of vicarious trauma takes account of both sensitivity of the substantive data collected, and closeness of those involved with the research. This might assist researchers in designing ethical and protective research and foreground the importance of managing risks of vicarious trauma. Relevance to clinical practice Vicarious trauma is not well considered in research into clinically important topics. Our proposed framework allows for consideration of these so that precautionary measures can be put in place to minimise harm to staff. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore patterns of help-seeking in women who have sexual dysfunction and the implications for nursing practice. Background Female sexual dysfunction is a common problem that is under-reported and untreated. Barriers to help-seeking reported in existing literature relate to the perception among many women that sexual dysfunction is: part of the normal ageing process; not bothersome or does not exist; an issue that health professionals are reluctant to address; a taboo subject. However, little is known about patterns of help-seeking in women with sexual problems. This leaves a potential gap in nursing knowledge regarding appropriate, supportive strategies. Design Discursive inquiry framed theoretically by Vogel's model. Methods A literature review was undertaken by searching relevant databases. A combination of keywords was used to identify peer-review papers relating to women's help-seeking behaviour for sexual dysfunction. Vogel's model was used as a framework to extract relevant information from the papers and structure the discussion. Results Vogel's model comprises four steps: encoding and interpreting, generating options, decision-making and evaluation of behaviour. Using this stepwise approach helped elucidate the complex mechanisms associated with help-seeking in a structured manner. The key issues associated with help-seeking intention are concerned with women's personal awareness of and interaction with the environment. Conclusions Vogel's model offers a new approach to understanding the dynamics that underpin women's decisions to seek professional help when sexual concerns arise and also provides a useful framework for nurses to consider women's specific sexual concerns. Relevance to clinical practice Implications for nursing practice are focused on public awareness, women's empowerment and the provision of effective sexual health care. Because sexual dysfunction is a global phenomenon, it is likely that the discussion in this paper will be relevant to an international, nursing readership. [ABSTRACT FROM AUTHOR]

Aims and objectives To present the findings of a structured literature review that aimed to identify the influences on the health, safety and welfare of adults with learning disabilities in acute hospitals. Background There is increasing evidence regarding the inadequacy of care for people with learning disabilities in acute care settings. However, few studies have specifically addressed their health, safety and welfare in such contexts. Design Four key electronic databases (Medline; PsycINFO; British Nursing Index and archive; Cumulative Index to Nursing and Allied Health Literature) were searched for relevant literature published between 2000 and 2011. Methods Publications assessed as meeting the inclusion criteria were retrieved in full. Data were extracted regarding methods used; primary aims of the study being reported; and key findings. Results Of the 3505 papers identified in the initial search, eight met the inclusion criteria. Analysis revealed six areas of influence on the health, safety and welfare of adults with learning disabilities in acute hospitals: care provision (meeting health and personal needs); communication; staff attitudes; staff knowledge; supporters; and carers (valuing their role); physical environment. Conclusions We represent these six areas diagrammatically, as concentric rings. These influence on health, safety and welfare form an inner (direct) layer and an outer (indirect) layer consisting of liaison services and education/training. This new conceptualisation of influences as being multi-layered assists in the identification of similarly multi-layered improvement strategies. Relevance to clinical practice Adults with learning disabilities can exert their own influence on health, safety and welfare and should be supported to make decisions about their own care. More broadly they should be involved with policy development, nurse education and research. This can be achieved through inclusive approaches, for example, inviting people with learning disabilities to input into nursing curricula or to engage in research as coinvestigators. [ABSTRACT FROM AUTHOR]

The author comments on "Phenomenology as research method or substantive metaphysics? An overview of phenomenology's uses in nursing," by V. Earle. She refers to "Ideas" by Husserl and raises concerns inspired by him. She opines that the issue of principal explanations for why nurse researchers appear to struggle with phenomenology: the reasons why they get it wrong, is overlooked. She also argues on Earle's part citing writings by Heidegger, Gadamer and Merleau-Ponty.

Aim The aim of this study was to gain insight into registered nurses' experiences of caring for older people in the UK and Japan. Method Critical incident technique was used because of its ability to capture actual incidents from practice. Written, anonymous self-report data were collected during 2010. Participants were asked to recall two critical incidents where they had felt either rewarded or challenged at work. Data were analysed using thematic analysis. Findings Analysis revealed striking similarities in the experiences of nurses from both countries. Four main themes emerged: the challenges of a complex work environment; the challenges of resolving ethical conflicts; the rewards of establishing meaningful relationships; and the rewards of achieving excellence in individual patient care. Conclusion The study provides new evidence from two different countries that although there are some challenges, nurses reap many rewards from working with older people. [ABSTRACT FROM AUTHOR]

Summary: Aims and objectives: This paper reports the findings of part of a larger study that explored the empowerment of nursing students in clinical practice. The focus here is on the phenomenon of ‘voice’ and the extent to which nursing students are able to exercise voice during their clinical practice experiences. Background: There is evidence to suggest that nursing students are ‘silenced’ in clinical practice and that they are unable to make their voices heard, even when they witness poor nursing practice. Methods: This study explored the experiences of thirteen nursing students in the UK as they progressed through their undergraduate nursing programme. The study was underpinned by hermeneutic phenomenology. Data were generated through annual, semi-structured interviews and focus group discussions. Findings: In situations that called for nursing students to ‘speak up’ they did one of two things: exit or voice. However, there was bridging of these actions in the form of ‘negotiating voice’. Discussion: Theoretically, findings of this study can be understood in relation to Hirschman''s notions of ‘exit and voice’. However, rather than being dichotomised extremes, an exit–voice continuum is proposed. Conclusions: Students are often silenced in clinical practice, but to overcome this they negotiate situations in an attempt to be heard. This paper provides new insight into the means by which nursing students can be supported to avoid the exit option, in favour of exercising voice. [Copyright &y& Elsevier]

Title. Exploring research supervision through Peshkin’s I’s: the yellow brick road Aim. This paper is a report of a systematic approach used to explore subjectivity as a research student and demonstrates how the process enhanced the quality of the research experience. Background. High non-completion rates of research students are of global concern and means of enhancing the quality of the doctoral experience are needed. Among the literature on doctoral education, very little is authored by students. This paper is influenced by the work of Peshkin from the discipline of education. Peshkin articulated the need for researchers to systematically identify their subjectivity by searching for their subjective I’s. I share my experience of adopting this approach as a research student by using reflexive journal entries made during 2005–2007 as data. Findings. I use the analogy of the ‘Yellow Brick Road’ from The Wizard of Oz to represent my experience of being a doctoral student and draw comparisons between my subjectivity and the characters in the story. I demonstrate how a systematic approach to exploring my subjectivity revealed aspects of my being as a research student that had potential for influence throughout the entirety of my experience. I argue that cognizance of my subjective I’s improved the quality of my research endeavour. Conclusion. The approach is offered for consideration by other research students as a means of exploring subjectivity. I argue that the resultant self-awareness can enhance the quality of the doctoral experience. The flexibility of the approach means it has transferability across a number of disciplines and cultural contexts. [ABSTRACT FROM AUTHOR]

The authors comment on the movement of nurse training in Great Britain into higher education and the increased emphasis on nursing as an academic discipline. They mention the concerns that nurse education has become distanced from practice. They note that longitudinal clinical credibility will be determined by impact on the profession and not by how many hours a month lecturers can spend in a clinical department.