Kathryn Weaver

Ethical sensitivity in professional practice: concept analysis

AIM This paper is a report of a concept analysis of ethical sensitivity. BACKGROUND Ethical sensitivity enables nurses and other professionals to respond morally to the suffering and vulnerability of those receiving professional care and services. Because of its significance to nursing and other professional practices, ethical sensitivity deserves more focused analysis. DATA SOURCES A criteria-based method oriented toward pragmatic utility guided the analysis of 200 papers and books from the fields of nursing, medicine, psychology, dentistry, clinical ethics, theology, education, law, accounting or business, journalism, philosophy, political and social sciences and womens studies. This literature spanned 1970 to 2006 and was sorted by discipline and concept dimensions and examined for concept structure and use across various contexts. The analysis was completed in September 2007. FINDINGS Ethical sensitivity in professional practice develops in contexts of uncertainty, client suffering and vulnerability, and through relationships characterized by receptivity, responsiveness and courage on the part of professionals. Essential attributes of ethical sensitivity are identified as moral perception, affectivity and dividing loyalties. Outcomes include integrity preserving decision-making, comfort and well-being, learning and professional transcendence. Our findings promote ethical sensitivity as a type of practical wisdom that pursues client comfort and professional satisfaction with care delivery. CONCLUSION The analysis and resulting model offers an inclusive view of ethical sensitivity that addresses some of the limitations with prior conceptualizations.

Understanding Women’s Journey of Recovering From Anorexia Nervosa

Previous studies of recovery from anorexia nervosa (AN) have concentrated on discrete behavioral responses of individual women. Little is understood about the subjective process of women’s recovery in the context of family, community, or society. In this feminist grounded theory study, the authors explored the perceptions of 12 women who considered themselves recovered or recovering from AN. They discovered a substantive theory of selfdevelopment that explains, within the current social context, women’s journey from the perilous self-soothing of devastating weight loss to the informed self-care of healthy eating and problem-solving practices. The findings provide an urgently needed explanatory framework to inform women, clinicians, and health policy makers in their prevention and recovery efforts.

Nursing concept analysis in North America: state of the art

The strength of a discipline is reflected in the development of a set of concepts relevant to its practice domain. As an evolving professional discipline, nursing requires further development in this respect. Over the past two decades in North America there have emerged three different approaches to concept analysis in nursing scholarship: Wilsonian-derived, evolutionary, and pragmatic utility. The present paper compares and contrasts these three methods of concept in terms of purpose, procedures, philosophical underpinnings, limitations, guidance for researchers, and ability to contribute to nursing knowledge and disciplinary advancement. This work extends prior criticisms of concept analysis methods, especially as formulated by Morse and colleagues, by promoting further critical discussion regarding the direction and effectiveness of nursing efforts to meet the basic needs of disciplinary development. Its central thesis is that nursing concept analysis must advance beyond the Wilsonian-derived methods of Walker and Avant by devoting greater attention to understanding the domain of concepts to be analysed and deriving features from these contexts.

Ethical Sensitivity: State of Knowledge and Needs for Further Research:

Ethical sensitivity was introduced to caring science to describe the first component of decision making in professional practice; that is, recognizing and interpreting the ethical dimension of a care situation. It has since been conceptualized in various ways by scholars of professional disciplines. While all have agreed that ethical sensitivity is vital to practice, there has been no consensus regarding its definition, its characteristics, the conditions needed for it to occur, or the outcomes to professionals and society. The purpose of this article is to explore the meaning of the concept of ethical sensitivity based on a review of the professional literature of selected disciplines. Qualitative content analysis of the many descriptors found within the literature was conducted to enhance understanding of the concept and identify its essential characteristics. Ethical sensitivity is considered to be an emerging concept with potential utility in research and practice.

From Shame to Shame Resilience: Narratives of Counselor Trainees With Eating Issues

Using narrative analysis, the experiences of 7 Canadian counselor trainees with eating issues were explored for meanings of shame and resilience. Shame was experienced as layers of discounting and disconnection from self and others, which served as barriers to help seeking and recovery. Trainees’ attempts to overcome shame were characterized by a dialectic conflict of protecting shame vs. prioritizing recovery. Finding a culture of safety and belonging, invalidating perfection, and redefining ideals emerged as elements that fostered resilience from the layers of shame. Recommendations for future research include exploring the important features of social support and examining how safe disclosure contributes to overcoming shame. Potential implications for counselor education programs include introducing self-care initiatives, discussions about counselor wellness and ethical practice, and education on eating issues.

Primary care of female adolescents with type 1 diabetes mellitus and disordered eating

AIM To identify the role of the nurse practitioner in caring for female adolescents with type 1 diabetes mellitus at risk for disordered eating behaviour and to formulate clinical recommendations for nurse practitioners in the primary care setting. BACKGROUND Transition into adulthood can be difficult for female adolescents with type 1 diabetes mellitus. Challenges associated with management of this illness may place adolescent females at an increased risk for disordered eating. DESIGN Discussion paper. DATA SOURCES Sourced literature from 1991-2013, located through CINAHL, Health Source, Proquest, PubMed, PsychInfo, Web of Science and Medline databases. IMPLICATIONS FOR NURSING Nurses involved in the primary care of female adolescents with type 1 diabetes mellitus need to be aware of the increased risk for disordered eating behaviours and develop the competencies to care for both the adolescent and her family to reduce the serious consequences of these behaviours. CONCLUSION Awareness and acquisition of the skills required to intervene will enable nurse practitioners to recognize clients at risk for disordered eating, gain appreciation of the motivation of female adolescents with type 1 diabetes mellitus towards disordered eating behaviours and give optimal opportunity for education, counselling and recovery. Future direction for research includes exploration of the experiences of adolescents with type 1 diabetes mellitus; early interventions in the primary care setting; effective educational, preventative or supportive services for adolescents with this illness and their families; and outcomes to emerging technologies for insulin therapy on disordered eating occurrence.

Gaining clinical wisdom from adversity: Nurse leaders' ethical conflict and resilience experiences

Developing effective nurse leaders in today’s “reengineered” corporate healthcare cultures requires that more attention be given to the preparation of ethical leadership during undergraduate programs and nurses’ formative years in practice. Through analyzing the experiences of three nurse leaders dealing with ethical conflicts and the meaning they made of these experiences, we identified that nurses need practical guidance to successfully negotiate ethical conflicts, take risks to uphold their ethical codes, and foster collaborative relationships. According to these nurse leaders, it was important to mentor student and novice nurses in working through workplace ethical conflicts and help guide them through the formulation of successful practical strategies. Our findings showed that these nurses developed resilience and clinical wisdom which they carried through to their leadership practice and future situations.

PROMOTING A CULTURE OF REFLEXIVITY IN UNDERGRADUATE NURSING EDUCATION

Intentionally reflecting on action to improve practice is mandated as a method for continuing competence by nursing regulatory bodies in most Canadian provinces. Accordingly, nursing education must prepare students as reflective practitioners. Nurse educators typically use the medium of postclinical conferences (i.e., having students engage in self-appraisal of learning and discussing their learning strategies with peers) to help students build their reflective capacity. It is widely held that such post conferences enable students to share knowledge, connect theory to practice, unload stress and confusion, examine perceptions, and deconstruct failures and successes. However, the role of clinical post-conference participation in developing student reflective capacity is not known. To help address this gap in evidence, we elicited information via a confidential online survey of students’ perceptions about their experiences within post-clinical conferences. Combining their quantitative responses to Likert scale questions about attitudes and beliefs with their qualitatively described clinical learning situations, we identified sociocultural influences that inform students’ values and meaning making processes. Our findings depict the development of reflective practice through experiences of peer support, safety, and nurse educator leadership style. Peer support requires students to respect one another and establish positive group dynamics. Students’ perceptions of safety are paramount to their participation. Nurse educators who lead post conferences by modelling reflective practice and promoting a safe environment for students contribute to strengthening a culture of reflexivity in nursing education. Critical to the development of student nurse reflective capacity is confidentiality, the encouragement and timing of feedback, and seniority level of students. In this article, we will provide a detailed, contextually grounded understanding of the development of reflective clinical practice and its barriers and facilitators. Following this, we suggest pedagogical strategies and resources to promote a culture of reflexivity in nursing education.

EMPOWERING LEARNERS THROUGH ONLINE REFLECTIVE JOURNALING IN GRADUATE NURSING THEORIES EDUCATION

Driven by the increasingly expanding higher educational environments and expectations of nurses as lifelong agents of reflective practice, Schools of Nursing continue to explore new pedagogical approaches to graduate level learning. In this article, we showcase the context, design, and effectiveness of one such pedagogical approach in a graduate nursing theories course. We share our approach (including educational aids) in implementing online reflective journaling within an asynchronous threaded online discussion forum to complement our videoand tele-conferenced classroom teaching. Despite it being a common nursing educational method, we believe journaling has not been used to its fullest potential. For example, traditional journaling often results in isolated writing and unshared entries. According to our graduate students, the online reflective journaling approach facilitates connections to self and others through the dissemination of practice experiences in peer-to-peer learning of major course concepts that inform their evolving philosophies of nursing. We briefly review the literature on the benefits and outcomes of online discussion forums in graduate nursing education. We explain the approach, constructivist conceptualization, and methodology adopted in designing and implementing our semi-structured reflective journaling activity. Finally, we provide our analysis of online reflective journaling and discuss the characteristics of an effective online discussion environment that renders student-centred learning, in which students are invited to imagine, construct, and reconstruct their learning individually and with their peers.

Vaccinate-or-mask: Ethical duties and rights of health care providers in obtaining or refusing the influenza vaccination

There is much controversy over the effectiveness of the influenza vaccination; yet, globally, many health institutions are implementing policies that require health providers to either receive the influenza vaccination or wear a surgical mask. This vaccinate-or-mask policy has caused great hullabaloo among health care providers and the institutions wherein they work. In light of the limitations to best practice evidence, we conducted an analysis of the policy and its implications based first on the bioethical principles of beneficence, nonmaleficience, respect for autonomy, and justice and then on the ethical theories of Immanuel Kant and John Stuart Mill. The most important ethical issue was threat to patient safety and welfare in the event of receiving care from a health provider who chose to forego the influenza vaccination and surgical mask requirement. We concluded that policies requiring health care providers to receive the influenza vaccination or wear a surgical mask are only partially supported by the bioethical principle approach; however, they are clearly justified from a deontological standpoint. That is, Kant would argue the rightness of the policy as a moral imperative for health care providers to not impose a health risk to those they serve and for health care institutions to ensure professional care giver vaccination. In further considering the vaccinate-or-mask policy in terms of the utilitarian “greatest good for the greatest number”, we determined that Mill would argue that this type of policy is ethically right and just, but also that policies solely requiring immunization would be ethical as public well-being is promoted.