Nursing ethics
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Two questionnaire surveys are reported describing the attitudes of 127 Japanese nurses towards developing a do not resuscitate (DNR) policy. The background information features the Japanese health care situations: a lack of policies for end-of-life care decisions; frequent life-prolonging treatments initiated without the patient's knowledge or consent; ethical dilemmas confronting nurses in relation to such treatments; and the public's growing concern over end-of-life care. A hypothetical DNR policy was used in which a health professional asked patients about their decision regarding DNR. ⋯ However, they noted that this policy was at variance with Japanese culture. Recommendations for Japanese nurses emerged from the data. In order to make an impact on end-of-life decision making, nurses should take culturally appropriate actions: (1) teach patients about their rights; and (2) work with physicians to provide patients with accurate information about their condition.
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The aim of this article is to argue for the need for a context-sensitive approach to the understanding of ethical issues in nursing practice as we face the next millennium. This approach means that the idea of universalism must be questioned because ethics is an interpersonal activity, set in a specific context. ⋯ Nursing practice must include thoughtful reflection on the meaning of moral concepts and principles in terms of culture. Theoretical developments in nursing ethics must be based on empirical research focusing on contextual aspects of health care.
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In this article, the author describes ethical decision-making in unique circumstances. A dichotomy exists between the dual roles of nurse and disaster manager in a wartime setting. The circumstances of the situation had never been faced before and no precedents existed for the type of decisions being made. ⋯ The circumstances required the author to challenge the concepts of teleology and deontology in a search for the most fitting answers to a unique problem. His aim was to try to create the greatest good out of an impossible situation. The author reflects on his actions in the light of ethical thinking and considers whether his decisions were right.
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Ethical decision-making is inherent in nursing practice. Although a definite portion of the nursing literature is devoted to ethics and ethical decision-making, the profession is just beginning to ground its ethics research in the actual experience of nurses. Therefore, the purpose of this phenomenological study was to examine the experience of staff nurses as they engage in ethical decision-making. ⋯ Interviews were subsequently transcribed and Giorgi's method of data analysis applied. The emerging description revealed four common aspects of ethical decision-making among staff nurses: context, trigger, ethical decision-making process (i.e. deliberation and integration), and outcomes. This description provides a foundation for future research regarding a descriptive theory of ethical decision-making in nursing.