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Issue 130 - 1 April 2010



1. The trouble with 'transcultural nursing ethics'.
by Gallagher A. Nursing Ethics, 2010 Mar; 17 (2): p155-6
In June of last year the International Centre for Nursing Ethics, in collaboration with colleagues at the University of KwaZulu-Natalin Durban, organized a conference on the theme of transcultural nursing ethics. Despite, or perhaps as a result of, excellent plenary lectures and subsequent discussions I have become increasingly sceptical regarding the meaning and helpfulness of the label ‘transcultural nursing ethics’. During the conference we agreed that articles on this theme would be invited for a special section of a future issue of Nursing Ethics.

2. From health care reform to health care with dignity: reflections on my mother's care.
by Matsuda M. Nursing Ethics, 2010 Mar; 17 (2): p157-8

We now live in days of unprecedented change accelerated by globalization, which is said to represent the 'economics of the jungle’, implying a world where the strong prey upon the weak. People who are socioeconomically vulnerable may be deprived of their access to health care, medical care, social welfare and education. How, then, can we deal with such a situation? In 2008 the World Health Organization (WHO) published Primary health care – now more than ever.It stated that: ‘People are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and changing needs, and with their failure to provide services in ways that correspond to their expectations. ’Here I will reflect on this statement,drawing on my personal experience in taking care of my mother who had been ill for many years. My mother was diagnosed with diabetes at the age of 55.

3. Truth-telling in cancer: Examining the cultural incompatibility argument in Turkey
by Guven T. Nursing Ethics, 2010 Mar; 17 (2): p159-66
This article aims to examine critically the ‘cultural incompatibility’ argument, which asserts that disclosure of cancer-related information to patients is incompatible with Turkey’s cultural context. For this purpose, a brief overview of the approach to truth-telling in Turkey will first be provided, followed by the claims of two different Turkish authors on the issue and a critical analysis oftheir approach. It will be contended that this argument has actually been formulated with paternalistic concerns and it may be playing an important role in shaping the approach of Turkish healthcare professionals to the issue.The article will then examine, in the light of study findings and case reports from Turkey, the concept of patient autonomy as it applies to truth-telling issues. It will be concluded that truth-telling can be compatible with Turkey’s cultural context, provided that health care professionals place more emphasis on good communication with their patients.

4. Patients' privacy and satisfaction in the emergency department: a descriptive analytical study
by Nayeri, N D & Aghajani M. Nursing Ethics, 2010 Mar; 17 (2): p167-77

Respecting privacy and patients' satisfaction are amongst the main indicators of quality of care and one of the basic goals of health services. This study, carried out in 2007, aimed to investigate the extent to which patient privacy is observed and its correlation with patient satisfaction in three emergency departments of Tehran University of Medical Science, Iran. Questionnaire data were collected from a convenience sample of 360 patients admitted to emergency departments and analysed using SPSS software. The results indicated that, according to 50.6% of the patients, the extent to which their privacy was respected was described as either 'weak' or 'average'. Spearman's coefficient indicated a significant correlation between respecting privacy and the patients' satisfaction about the various aspects of privacy studied. Considering the levels of privacy observed together with the patients' degree of satisfaction, it is imperative that clinical professionals address both aspects from conceptual and practical viewpoints.

5. Informed consent practices of Chinese nurse researchers
by Olsen, D P & Pang, S. Nursing Ethics, 2010 Mar; 17 (2): p179-87

Nursing research in China is at an early stage of development and little is known about the practices of Chinese nurse researchers. This interview study carried out at a university in central China explores the informed consent practices of Chinese nurse researchers and the cultural considerations of using a western technique. Nine semistructured interviews were conducted in English with assistance and simultaneous translation from a Chinese nurse with research experience. The interviews were analyzed by one western and two Chinese researchers and major themes were identified. All participants endorsed informed consent as ethically required. Differences were noted between some of the informed consent practices typically recommended in the USA and those identified in this study, such as: recruitment using local and government officials, recruiting directly from medical records without special permission, family consultation in consent and consent control, and not revealing randomization to intervention groups receiving different treatments.

6. Encompassing multiple moral paradigms: a challenge for nursing educators
by Caldwell, E S & Harding, T. Nursing Ethics, 2010 Mar; 17 (2): p189-99

Providing ethically competent care requires nurses to reflect not only on nursing ethics, but also on their own ethical traditions. New challenges for nurse educators over the last decade have been the increasing globalization of the nursing workforce and the internationalization of nursing education. In New Zealand, there has been a large increase in numbers of Chinese students, both international and immigrant, already acculturated with ethical and cultural values derived from Chinese Confucian moral traditions. Recently, several incidents involving Chinese nursing students in morally conflicting situations have led to one nursing faculty reflecting upon how moral philosophy is taught to non-European students and the support given to Chinese students in integrating the taught curriculum into real-life clinical practice settings. This article uses a case study involving a Chinese student to reflect on the challenges for both faculty members and students when encountering situations that present ethical dilemmas.

7. Utilitarian and common-sense morality discussions in intercultural nursing practice
by Hanssen, I & Alpers, L. Nursing Ethics, 2010 Mar; 17 (2): p201-11

Two areas of ethical conflict in intercultural nursing - who needs single rooms more, and how far should nurses go to comply with ethnic minority patients' wishes? - are discussed from a utilitarian and commonsense morality point of view. These theories may mirror nurses' way of thinking better than principled ethics, and both philosophies play a significant role in shaping nurses' decision making. Questions concerning room allocation, noisy behaviour, and demands that nurses are unprepared or unequipped for may be hard to cope with owing to physical restrictions and other patients' needs. Unsolvable problems may cause stress and a bad conscience as no solution is 'right' for all the patients concerned. Nurses experience a moral state of disequilibrium, which occurs when they feel responsible for the outcomes of their actions in situations that have no clear-cut solution.

8. Moral stress, moral climate and moral sensitivity among psychiatric professionals
by Lützén, K et al. Nursing Ethics, 2010 Mar; 17 (2): p213-24

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants' experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place's moral climate as well as by two aspects of the mental health staff's moral sensitivity. The nurses' experience of 'moral burden' or 'moral support' increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency.

9. Moral distress among nursing and non-nursing students
by Range, L M & Rotherham, A L. Nursing Ethics, 2010 Mar; 17 (2): p225-32

Their nursing experience and/or training may lead students preparing for the nursing profession to have less moral distress and more favorable attitudes towards a hastened death compared with those preparing for other fields of study. To ascertain if this was true, 66 undergraduates (54 women, 9 men, 3 not stated) in southeastern USA completed measures of moral distress and attitudes towards hastening death. Unexpectedly, the results from nursing and non-nursing majors were not significantly different. All the present students reported moderate moral distress and strong resistance to any efforts to hasten death but these factors were not significantly correlated. However, in the small sample of nurses in training, the results suggest that hastened death situations may not be a prime reason for moral distress.

10. Perception of ethical climate and its relationship to nurses' demographic characteristics and job satisfaction.
by Goldman, A & Tabak, N. Nursing Ethics, 2010 Mar; 17 (2): p233-46
In this study, we examined the perception of actual and ideal ethical climate type among 95 nurses working in the internal medicine wards of one central hospital in the state of Israel. We also examined whether nurses' demographic characteristics influence that perception and if a relationship between perceptions of an actual and an ideal ethical climate type influences nurses' job satisfaction. A questionnaire composed of three subquestionnaires was administered and the responses analyzed using multiple linear regressions, analysis of variance and Pearson's correlation coefficient. The results demonstrated that demographic characteristics (such as: gender, job tenure and level of education) partially influence the perception of an ideal ethical climate. Incongruence in perceptions of 'caring' and 'independence' climate types indicated a decline in nurses' job satisfaction, while perception of actual 'caring' and 'service' climates positively influenced all aspects of job satisfaction. We recommend constructing training programs emphasizing the ethics of nursing practice and also to help lead nurses to clarify an ethical framework and guide nursing staff in dealing with ethical dilemmas.

11. Individual patient advocacy, collective responsibility and activism within professional nursing associations
by Mahlin,M. Nursing Ethics, 2010 Mar; 17 (2): p247-54
The systemic difficulties of health care in the USA have brought to light another issue in nurse-patient advocacy - those who require care yet have inadequate or non-existent access. Patient advocacy has focused on individual nurses who in turn advocate for individual patients, yet, while supporting individual patients is a worthy goal of patient advocacy, systemic problems cannot be adequately addressed in this way. The difficulties nurses face when advocating for patients is well documented in the nursing literature and I argue that, through collective advocacy, professional nursing associations ought to extend the reach of individual nurses in order to address systemic problems in health care institutions and bureaucracies.

12. Development and testing of an instrument to measure protective nursing advocacy
by Hanks, R G. Nursing Ethics, 2010 Mar; 17 (2): p255-67

Patient advocacy is an important aspect of nursing care, yet there are few instruments to measure this essential function. This study was conducted to develop, determine the psychometric properties, and support validity of the Protective Nursing Advocacy Scale (PNAS), which measures nursing advocacy beliefs and actions from a protective perspective. The study used a descriptive correlational design with a systematically selected sample of 419 medical-surgical registered nurses. Analysis of the 43-item instrument was conducted using principal components analysis with promax rotation, which resulted in the items loading onto four components. The four subscales have sufficient internal consistency, as did the overall PNAS. Satisfactory evidence of construct, content, and convergent validity were determined. Implications for nursing practice include using the PNAS in conjunction with an educational program to enhance advocacy skills, which may help to improve patient outcomes.

13. Interview. Nursing Ethics, 2010 Mar; 17 (2): p269-70
This is the first in a series of interviews with, and by, members of the Nursing Ethics Editorial Board. The interviewee is Masami Matsuda from Japan and the interviewer is Cristina Paganini from Brazil.They met at the 10th Anniversary ICNE conference at the University of Surrey and the interview was conducted by email.

Journals - Table of Contents

14. From Midwifery News, Issue 56, March 2010
New Zealand College of Midwives (Inc)
The evolution of midwifery education; Feminism, Equity and education; Bill of Rights for Midwives and Women claiming our right to being treated as equals
14B. NZCOM Education Framework: Looking back over the last 10 years
14C. Continuing Education 2010; Mentoring workshops 2010; Nationally facilitated workshops by regions 2010; CTA changes MFYP mentor and graduate funding; The Midwifery First Year of Practice (MFYP) Programme
14D. Midwifery education with a difference!: Report on rural midwives video conference education project 2009; Antenatal and Newborn Screening Education Modules
14E. Rural LMC Midwifery Recruitment and Retention Services
14F. MERAS The Midwifery Quality and Leadership Programme (QLP); Nga Maia; Midwifery Undergraduate Clinical Placement Grant
The Canterbury/West Coast NZCOM Continuing Education Committee; Breastfeeding in the park
Profile: Undergraduate Heads of School [Sally Pairman - Otago Polytechnic; Jackie Gunn - AUT; Mary Kensington - CPIT; Jacqui Anderson - CPIT; Liz James - Waikato Institute of Technology]
14I. The midwife-woman relationship: critical for normal birth
14J. North-South, East-West: Rewards and challenges of education on the road
14K. Mifepristone in Australasia Conference
14L. DHB educators - Regional Challenges & Successes [Lindsay fergusson - Waikato Hospital; Sarah Paley - Hawkes Bay DHB
14M. Quality improvements to antenatal screening for Down syndrome and other conditions
14N. Remote Midwifery Training in Country New South Wales
14O. Smoking in Pregnancy + Smokefree education
14P. PHARMAC Seminar Series; Is your client eligible for free maternity services?
14Q. New Zealand visit by Cecily Begley
Combining education, knowledge and intuition
Comment on "Delivery of Better, Sooner, More Convenient Primary Health Care" Government Paper; Mr Keys visits Tararua early Years Service (TEYS); letters re Celvapan A/H1N1 Vaccine
14T. New Zealand College of Midwives Membership Questionnaire; H1N1 early Protection Immunisation Programme; BJOG release; The pregnancy complications of maternal obesity; Bisphenol A update; Latest XT mobile Network Update - Goodwill Gesture for Clients; Changes to prescribing Iron with Vitamin C; Congratulations to new members of Midwifery Council; Breastfeeding is the first line of defence in a disaster - breast milk from milk banks shipped to Haiti; Changes for Irish Midwives; Female genital mutilation (FGM) guidelines; Nelson region - planting of the Whenua; Face It Cleft
New Zealand Inc; Paradex and Capadex to be withdrawn from New Zealand market
14U. Directory - Contact details for the New Zealand College of Midwives Inc.

15. From The Tube, Volume 25, Issue 1. March 2010

15A. Workload issues; the bowel screening programme
15B. Reflections from Conference 2009; Bowel Cancer Screening Taskforce
15C. Leadership begins within you; Article about Hepatitis B by Michelle Lau, Wellington Regional Hospital
15D. Gastro 2009 UK
15E. From Spa Pool to World Congress London Nov 2009
15F. Australia and New Zealand Medical Surgical Gastrointestinal week, Sydney 21-24 October 2009
15G. Changing ways & saving money
15H. Bowel cancer screening taskforce update from conference 2009 - Part 1 bowel cancer screening
15I. Contact details for New Zealand Endoscopy Units 2010

16. From Nursing Economics, Volume 28, Number 1, January/February 2010
16A. S
ecure your seat at the table: An invitation for nurses leaders
Supporting Nursing Residency Programs
CNE Series
The diabetes disease state management exemplar
16D. Characteristics of internationally educated nurses in the United States: An update from the 2004 national sample survey of registered nurses
16E. Key elements of large survey data sets
16F. Nursing workload measurement in ambulatory care
16G. Expanding the role of nursing in health care governance
16H. Sensible compromise: Will there be health care reform
16I. Health care payment reform: Implications for nurses
16J. The human side of staffing
16K. Development of the role of Director of Advanced Practice

Conferences, Training, Seminars

17. Breathing New Life into Maternity Care: Working together - learning from each other
3rd Biennial Conference
Alice Springs Convention Centre, Northern Territory, Australia
Date: 1-4 July 2010
More information:

18. The Forum on Health care Leadership
10th Anniversary Program
July 30-August 2, 2010
Venue: Washington DC
More information:

19. New Zealand College of Midwives Conference 2010
Strengthening Midwifery... Stengthening Families

Date: 3-5 September 2010
Venue: Rotorua, New Zealand
More information:

News – National

20. Pay rise of 2% accepted by health sector unions
ODT - 1 April 2010
Three key unions in the health sector have accepted a 2% pay rise.
The New Zealand Nurses Organisation, the Public Service Association, and the Service and Food Workers Union formally accepted District Health Boards New Zealand's offer yesterday of a 2% pay rise, taking effect nine months into the 18-month agreement. As reported in yesterday's Otago Daily Times, the unions opted to negotiate as a bloc for the first time, rather than individually.

21. Wairarapa DHB's non-existent cuts
Wairarapa News - 31 March 2010
Wairarapa District Health Board has come up with a novel way of saving money - it plans to cut jobs that currently don't exist. The cash-strapped DHB, already recording a $1.6 million deficit for the financial year to date, has just completed a review of "tier three positions", which report to the senior leadership team. The review proposes a reduction of 9.5 full time equivalent positions (FTEs), 5.5 of which are already vacant.

22. Managers' jobs face cut in DHB shake-up
Wairarapa Times-Age - 27 March 2010
Cash-strapped Wairarapa District Health Board plans to axe the equivalent of about 10 management jobs in a bid to slash costs while throwing more money toward frontline clinicians. The DHB's new senior leadership team has just reviewed the ''third-tier'' positions below them and is now proposing to cut 9.5 fulltime equivalent positions (FTEs half of which are currently vacant. The job cuts would free up about $300,000, with $160,000 being invested back into clinical positions.

News - International

23. New doctors feel `ill prepared', study of anatomy teaching finds
The Australian - 1 April, 2010
MEDICAL students are being asked to spend time on "creative writing" assignments that further reduce teaching time for basic sciences such as anatomy, leaving some feeling ill prepared for dealing with patients. Many doctors and medical students yesterday backed concerns about minimal teaching time being devoted to anatomy, some claiming the reduced tuition left them with "minimal idea" why patients were sick.

24. Immigrant women hurt by barriers to health care: StudySouth Asian, West Asian or Arab women reported problems
The Star (Toronto) - 30 March 2010
Language issues and a lack of knowledge as to how the health system works are stopping some immigrant women from getting medical help. Rabah Mohamadi, an immigrant from Kabul, was without a family doctor for four months upon her arrival from Afghanistan last year; the mother of four ended up using a neighbour’s glucose machine to measure her
blood sugar and sharing the friend’s diabetes medications and pills for a cervical cyst.



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