Background: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts. Aim: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies. Research design: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses. Participants: The 69 participants attended a 1-year educational programme for ambulance nurses at a Swedish university. Ethical consideration: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study. Findings: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care. Discussion: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation. Conclusion: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability.

Background: Ambulance professionals often address conflicts between ethical values. As individuals’ values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. Objectives: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles in Spain and Sweden. Methods: The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. Ethical considerations: This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. Findings: Spanish professionals favoured justice and Swedish professionals’ rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. Discussion: Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals’ moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. Conclusion: A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally – especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care.

BACKGROUND: Ambulance professionals often address conflicts between ethical values. As individuals' values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. OBJECTIVES: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals' value profiles in Spain and Sweden. METHODS: The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. ETHICAL CONSIDERATIONS: This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. FINDINGS: Spanish professionals favoured justice and Swedish professionals' rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. DISCUSSION: Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals' moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer's professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. CONCLUSION: A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally - especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care.

It has been reported as an ethical problem within prehospital emergency care that ambulance professionals administer physiologically futile cardiopulmonary resuscitation (CPR) to patients having suffered cardiac arrest to benefit significant others. At the same time it is argued that, under certain circumstances, this is an acceptable moral practice by signalling that everything possible has been done, and enabling the grief of significant others to be properly addressed. Even more general moral reasons have been used to morally legitimize the use of futile CPR: That significant others are a type of patient with medical or care needs that should be addressed, that the interest of significant others should be weighed into what to do and given an equal standing together with patient interests, and that significant others could be benefited by care professionals unless it goes against the explicit wants of the patient. In this article we explore these arguments and argue that the support for providing physiologically futile CPR in the prehospital context fails. Instead, the strategy of ambulance professionals in the case of a sudden death should be to focus on the relevant care needs of the significant others and provide support, arrange for a peaceful environment and administer acute grief counselling at the scene, which might call for a developed competency within this field.

Background: Within nursing, the concepts of home and homelike have been used indiscriminately to describe characteristics of health care settings that resemble a home more than an institution.

Objectives: The aim of this study was to investigate the concept of home (hem in Swedish). The main questions were as follows: What does the concept of home entail etymologically and semantically? Of what significance is the meaning of the concept to caring science and nursing?

Design and methods: This study had a qualitative design with a hermeneutical approach guided by Gadamer. Eriksson’s model of concept determination was partly used to determine the etymology and semantics, the essence and epistemic category of the concept of home. In this study, etymological dictionaries and 17 Swedish language dictionaries published between 1850 and 2001 were investigated.

Findings: The home, framed as the ethos of caring, can be drawn as a three-dimensional picture where the three dimensions have a common core, enclosed and inviolable. Symbolically, the picture of home can be seen as the ethos of the human being’s innermost room, the human being’s manner of being and the tone cxpressed in the external or abstract room where the human being lives and interacts with others.

Conclusions: Based on the findings in this study we conclude that home as ethos is an inner ethical dimension within the human being. Human beings who are in contact with their ethos, the self, feel at home and dare to follow the voice of their heart. Nurses who experience at-homeness have an ability to invite the patient into a caring relationship. The home and the feeling of being at home have significant meaning in terms of human beings’ health and well-being.

Abstract Background: Decision-making and assessment in emergency situations are complex and result many times in ethical conflicts between different healthcare professionals. Aim: To analyse and describe situations that can generate ethical conflict among nurses working in emergency situations. Methods: Qualitative analysis. A total of 16 emergency nurses took part in interviews and a focus group. Ethical considerations: Organisational approval by the University Hospital, and informed consent and confidentiality were ensured before conducting the research. Result/conclusion: Two categories emerged: one in ‘ethical issues’ and one in ‘emotions and feelings in caring’. The four ethical subcategories are presented: Autonomy, the first sub category: first, the nurse’s ability to practise care on an emergency ward and, second, to support the patient and/or relatives in terms of care and medical treatment. The conflicts arise when the nurse ends up in the middle between the patient and the physician responsible for the diagnosis and treatment from a nature scientific perspective. Reification of injured body: patient was often reified and fragmented, becoming just a leg or arm. Different factors contributed in this perspective. Pain: pain relief was often inadequate but more effectively treated in the emergency medical services than at the emergency department. The nurses highlighted the phenomenon of suffering because they felt that pain was only an object, forgetting the patients’ care need, like separating mind from body. Death: the nurses felt that the emergency services are only prepared to save lives and not to take care of the needs of patients with ‘end-of-life’ care. Another issue was the lack of ethical guidelines during a cardiac arrest. Resuscitation often continues without asking about the patient’s ‘previous wishes’ in terms of resuscitation or not. In these situations, the nurses describe an ethical conflict with the physician in performing their role as the patient’s advocate. The nurses express feelings of distress, suffering, anger and helplessness.

The aim of this study was to synthesize the concepts from empirical studies and analyze, compare and interrelate them with normative ethics. The 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. Empirical ethics and normative ethics are intertwined according to the findings of this study. Normative ethics influence the nurse's practical performance and could be supporting documents for nurses as professionals.

Background: The majority (70%) of cardiac arrests in Sweden are experienced in the patient’s home. In these situations, the ambulance nurses may encounter several ethical dilemmas.

 Aim: The aim was to investigate Swedish specialist ambulance nurses’ experiences of ethical dilemmas associated with cardiac arrest situations in adult patients’ homes.

Methods: Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis.

Ethical considerations: Ethical principles mandated by the Swedish Research Council were carefully followed during the whole process.

Findings: Two main themes with six sub-themes were identified: The scene – creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients’ integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being’s dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human.

Conclusion: The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient’s dignity and to serve life and health.

Background

Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence.

Research aim

This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic.

Research design

This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews were conducted and analysed thematically.

Participants and research context

Healthcare teachers (n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated.

Ethical considerations

This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research.

Findings

Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students’ ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone’s needs, and who gets my time?

Conclusions

This study highlights the importance of healthcare teachers’ continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible consequences for students and healthcare teachers.

Background: The midwifery profession in Sweden has a history since the early 1700s when government training for midwives began. Midwifery is historically well described, but the idea of caring within midwifery is not described.

Aim: The aim was to describe the patterns of ideas of caring as they appeared in midwifery during the first half of the 20th century.

Research design: This study has a hermeneutic approach and the method is history of ideas. Sources of material are taken from the journal Jordemodern (Midwifery), textbooks for midwives, and midwifery regulations. The study has a caring science perspective according to Eriksson.

Ethical considerations: This study is conducted in accordance with the ethical guidelines for good scientific practice issued by The Finnish Advisory Board on Research Integrity. The special demands on approach to the analyzed text in history of ideas have been met.

Findings: Three themes were identified: Serving as a way of life, Acting in a redemptive spirit, and Having independence with heavy responsibility. The various themes are not refined, but current ideas are woven into the weave that were characteristic of midwifery during the first half of the 20th century.

Conclusion: History of ideas is a fruitful method for understanding and re-finding valuable cultural goods. We can once more stress the manner of being within the midwife’s profession where inner values, ethos, shape the manner of conduct in the care of women in childbirth.

This article analyses and presents a survey of ethical conflicts in prehospital emergency care. The results are based on six focus group interviews with 29 registered nurses and paramedics working in prehospital emergency care at three different locations: a small town, a part of a major city and a sparsely populated area. Ethical conflict was found to arise in 10 different nodes of conflict: the patient/carer relationship, the patient’s selfdetermination, the patient’s best interest, the carer’s professional ideals, the carer’s professional role and self-identity, significant others and bystanders, other care professionals, organizational structure and resource management, societal ideals, and other professionals. It is often argued that prehospital care is unique in comparison with other forms of care. However, in this article we do not find support for the idea that ethical conflicts occurring in prehospital care are unique, even if some may be more common in this context.

The aim of this article is to analyse and discuss the ethically problematic conflict raised by patients with stroke who refuse nutritional treatment. In analysing this conflict, the focus is on four different aspects: (1) Is nutritional treatment biologically necessary? (2) If necessary, is the reason for refusal a functional disability, lack of appetite or motivation, misunderstanding of the situation or a genuine conflict of values? (3) If the latter, what values are involved in the conflict? (4) How should we deal with the different kinds of refusal of nutritional treatment? We argue that patients' autonomy should be respected as far as possible, while also considering that those who have suffered a stroke might re-evaluate their life as a result of a beneficial prognosis. However, if patients persist with their refusal, health care professionals should force nutritional treatment only when it is clear that the patients will re-evaluate their future life.

Background

Healthcare professionals, especially professional nurses, experience various types of moral suffering due to inevitable ethical conflicts. Moral resilience is recently proposed as a resource to address moral suffering. However, there is no tool to measure moral resilience in Chinese professional nurses.

Aim

This study aimed to translate the Rushton Moral Resilience Scale (RMRS) into Chinese and evaluate the psychometric properties of the Chinese version of RMRS (Chi-RMRS).

Research design

A methodological and descriptive research design.

Participants and research context

A convenience sample of 411 Chinese professional nurses was recruited through an online survey platform between February and March 2023.

Ethical considerations

This study was approved by the Research Ethics Committees of the University and hospitals involved.

Results

The RMRS was translated and culturally adapted into a Chinese version. Neither floor nor ceiling effects were observed. The scale-level content validity index (CVI) was 0.922 with the item-level CVIs ranging from 0.833 to 1.000. The explanatory factor analysis (EFA) generated a three-factor structure for the Chi-RMRS, and the confirmatory factor analysis (CFA) demonstrated the three-factor structure with factor loadings for each item ranging from 0.42 to 0.80. The scale-level Cronbach’s α coefficient was 0.811 with each dimension ranging from 0.717 to 0.821, and composite reliability (CR) coefficient for the overall scale was 0.920, with each dimension varying from 0.739 to 0.824. The standard error of measurement (SEM) and smallest detectable change (SDC) were 3.522 and 9.763, respectively.

Discussion

The Chi-RMRS is able to measure moral resilience of Chinese professional nurses, and has good validity and reliability. It can be used in research and practice to determine the level of moral resilience, thus helping nursing managers to monitor the status of Chinese professional nurses, then develop interventions to maintain the well-being of professional nurses and to ensure quality of care.

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care.

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection.

One aim of this study was to explore the role, or subject position, patients take in the care they receive from nurses in their own home. Another was to examine the subject position that patients say the nurses take when giving care to them in their own home. Ten interviews were analysed and interpreted according to a discourse analytical method. The findings show that patients constructed their subject position as ‘safeguard’, and the nurses’ subject position as ‘substitute’ for themselves. These subject positions provided the opportunities, and the obstacles, for the patients’ possibilities to receive care in their home. The subject positions described have ethical repercussions and illuminate that the patients put great demands on tailored care.

The aim of this study was to explore and interpret the diverse subject of positions, or roles, that nurses construct when caring for patients in their own home. Ten interviews were analysed and interpreted using discourse analysis. The findings show that these nurses working in home care constructed two positions: `guest' and `professional'. They had to make a choice between these positions because it was impossible to be both at the same time. An ethics of care and an ethics of justice were present in these positions, both of which create diverse ethical appeals, that is, implicit demands to perform according to a guest or to a professional norm.