Kara Schick Makaroff

Nurses’ perceptions of and responses to morally distressing situations:

Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change.

Take Me to My Leader: The Importance of Ethical Leadership Among Formal Nurse Leaders

Although ethical leadership by formal nurse leaders is critical to enhancing ethical health-care practice, research has shown that many nurses feel unsupported by their leaders. In this article, we consider the limited attention directed toward ethical leadership of formal nurse leaders and how our own research on ethical nurse leadership compares to other research in this field. In searching Nursing Ethics since its inception 20 years ago, we found only a dozen articles that directly addressed this topic. We then reviewed nurses’ professional codes of ethics in Canada and found significant retractions of ethical guidelines for formal nurse leaders’ ethical responsibilities over the past decade. We began to seek explanations of why this is so and offer some recommendations for the study and enhancement of ethics for formal nurse leadership.

Searching for ethical leadership in nursing

Background: Attention to ethical leadership in nursing has diminished over the past several decades. Objectives: The aim of our study was to investigate how frontline nurses and formal nurse leaders envision ethical nursing leadership. Research design: Meta-ethnography was used to guide our analysis and synthesis of four studies that explored the notion of ethical nursing leadership. Participants and research context: These four original studies were conducted from 1999-2008 in Canada with 601 participants. Ethical considerations: Ethical approval from the original studies covered future analysis. Findings: Using the analytic strategy of lines-of-argument, we found that 1) ethical nursing leadership must be responsive to practitioners and to the contextual system in which they and formal nurse leaders work, and 2) ethical nursing leadership requires receiving and providing support to increase the capacity to practice and discuss ethics in the day-to-day. Discussion and conclusion: Formal nurse leaders play a critical, yet often neglected role, in providing ethical leadership and supporting ethical nursing practice at the point of patient care.

Nursing: Whose Discipline is it Anyway?:

Nursing is variously described as a profession, a discipline, an occupation. The meanings we assign to such words and the expectations, demands, and responsibilities that each reveals to and/or exacts from those of us privileged to call ourselves registered nurse provides a splendid arena for viewing the struggle of nursing as an intellectual endeavor embedded in its own distinctive knowledge base, experiences, purposes, and values. Currently, pressure exerted within and without nursing to adopt the self-limiting potential and subordinated position that a professional discipline orientation and applied degree education confer on nursing is mounting. This article examines the relationships among historical events, contemporary influences, and confounding definitions that are integral to how we choose to guide and shape the evolution of nursing scholarship, practice, and education. The authors contend that the full significance of these relationships must be appreciated if nursing is to advance as a scholarly academic discipline and practice profession.

Dare we speak of ethics? Attending to the unsayable amongst nurse leaders:

There is increasing emphasis on the need for collaboration between practice and academic leaders in health care research. However, many problems can arise owing to differences between academic and clinical goals and timelines. In order for research to move forward it is important to name and address these issues early in a project. In this article we use an example of a participatory action research study of ethical practice in nursing to highlight some of the issues that are not frequently discussed and we identify the impact of things not-named. Further, we offer our insights to others who wish to be partners in research between academic and practice settings. These findings have wide implications for ameliorating misunderstandings that may develop between nurse leaders in light of collaborative research, as well as for participatory action research.

Let's Go to Camp! An Innovative Pediatric Practice Placement

Each year, children living with disabilities escape from their families for 1 week at camp armed with their sun block, sleeping bags and talent-show costumes. In British Columbia, Canada, Easter Seals Camps offer such adventures to over 800 children/teens with physical/mental disabilities, providing free, overnight camping with on-site nurses. Easter Seals Camps offer pediatric placements to nursing students to work with nurses in a multidisciplinary team. In this paper, we describe this partnership, explain the role of camp nurse, portray student learning opportunities and offer recommendations to pediatric nurses who may consider participating in similar innovative placements in pediatric camps.