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A comprehensive picture of ethical values in caring encounters, based on experiences of those involved: Analysis of concepts developed from empirical studies
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Older people should have a life with a sense of value and should feel confident. These ethical values, which are expressed in normative ethics, are expected to prevail in empirical ethics. Central components of nursing are the ethical issues of autonomy, beneficence, non-maleficence and the principles of justice. The general aim of this thesis is to identify and describe the ethical values that are apparent in the caring encounter and their influence on the people involved. This is done from the perspective of the older person in study (I), next of kin in study (II) and nurses in study (III). In study (IV) the aim was to synthesize the concepts from empirical studies (I- III) and analyze, compare and interrelate them with normative ethics. Studies (I, III) were empirical observational studies including follow-up interviews. Twenty-two older people participated voluntarily in study (I), and in study (III) 20 nurses participated voluntarily. In study (II) fourteen next of kin were interviewed. In studies (I- III) constant comparative analysis, the core foundation of grounded theory, was used. Five concepts were used in the analysis in study (IV); three from the grounded theory studies (I- III) and two from the theoretical framework on normative ethics i.e. the ICN code and SFS law. Five categories; being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category ‚Approaching‛ in study (I). ‘Approaching’ indicates the ethical values that guide nurses in their caring encounters with older people. These ethical values are noted by the older people and are greatly appreciated by them, and also lead to improved quality of care. Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category ‚Being amenable‛, a concept identified in the next of kin’s description of the ethical values that they and the older patients perceive in the caring encounter. In study (III), three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category ‚Corroborating‛. Corroborating deals with support and interaction. Empirical ethics and normative ethics are intertwined, according to the findings of this study (IV). Normative ethics influence the nurse’s practical performance and could have a greater influence in supporting nurses as professionals. Criteria of good ethical care according to this thesis are: showing respect, invitation to participation, allowing self-determination, and providing safe and secure care. These criteria are elements of the concept of being professional. Professionalism of nurses is shown by: the approach nurses adapt to the performance of their duties, and their competence and knowledge, but also how they apply laws and professional codes

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2011. , 74 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1227
Keyword [en]
Ethical values, grounded theory, older patient, next of kin, nursing care, qualitative methods, empirical ethics, normative ethics
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-67878ISBN: 978-91-7393-230-1OAI: oai:DiVA.org:liu-67878DiVA: diva2:413988
Public defence
2011-05-27, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-05-02 Created: 2011-05-02 Last updated: 2013-09-12Bibliographically approved
List of papers
1. The importance of ‘approaching’ older people: a grounded theory
Open this publication in new window or tab >>The importance of ‘approaching’ older people: a grounded theory
2012 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, Vol. 7, no 1, 29-36 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. The aim of this study was to identify and describe the ethical values in caring encounters as experienced by older patients in their daily interaction with nurses in wards for older people.

Background. Ethical values and morals are important aspects that influence the quality of care.

Methods. Empirical observational study including follow-up interviews. Twenty-two older patients participated voluntarily in this study. Constant comparative analysis, the core foundation of grounded theory was used.

Results. Five categories: being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the bases for the core category.

Approaching. Approaching concerns how people become closer to each other in a physical space. It also includes how people become closer to each other in a dialogue, involving verbal or bodily communication.

Conclusions and relevance to clinical practice. Approaching indicates the ethical values that guide nurses in their caring encounters with older patients. These values are noted by the patient and have an individual value as well as leading to improved quality of their care. The older patient will be confident and satisfied with the caring encounter if the desired components in the nurse's approaching are exhibited.

Place, publisher, year, edition, pages
Wiley, 2012
Keyword
Ethics, nursing care, older people, qualitative methods
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67874 (URN)10.1111/j.1748-3743.2010.00248.x (DOI)
Available from: 2011-05-02 Created: 2011-05-02 Last updated: 2013-09-12Bibliographically approved
2. Ethical values in caring encounters on a geriatric ward from the next of kin´s perspective: An interview study
Open this publication in new window or tab >>Ethical values in caring encounters on a geriatric ward from the next of kin´s perspective: An interview study
2010 (English)In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 16, no 1, 20-26 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Interviews with fourteen next of kin were conducted and data were analysed by Constant comparative analysis. Four categories were identified: Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: “Being amenable”, a concept identified in the next of kin’s description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and the next of kin. Nurses’ focusing on elderly patients’ well-being as a final criterion affects the next of kin and their experience of this fundamental condition for high quality care seems to be fulfilled.

Place, publisher, year, edition, pages
Wiley, 2010
Keyword
Ethical values, geriatric wards, grounded theory, nursing ethics, next of kin
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-51737 (URN)10.1111/j.1440-172X.2009.01805.x (DOI)000274177000004 ()
Note

On the day of the defence day the status of this article was: Manuscript. This is the author’s version of the following article: Lise-Lotte Jonasson, Per-Erik Liss, Björn Westerlind and Carina Berterö, Ethical values in caring encounters on a geriatric ward from the next of kin´s perspective: An interview study, 2010, International Journal of Nursing Practice, (16), 1, 20-26. which has been published in final form at: http://dx.doi.org/10.1111/j.1440-172X.2009.01805.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.html

Available from: 2009-11-16 Created: 2009-11-16 Last updated: 2014-01-16Bibliographically approved
3. Corroborating indicates nurses’ ethical values in a geriatric ward
Open this publication in new window or tab >>Corroborating indicates nurses’ ethical values in a geriatric ward
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aim. The aim of the study was to identify nurses’ ethical values, which become apparent through their behavior in the interactions with older patients in caring encounters at a geriatric clinic.

Background. Descriptions of ethics in caring practice are a problem since they are vague compared with the four principles of autonomy, beneficence, non-maleficence, and justice.

Methods. A Grounded Theory methodology was used. In total, 65 observations and follow-up interviews with 20 nurses were conducted, and data were analysed by constant comparative analysis.

Findings. Three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category: ―Corroborating‖. In corroborating the focus is on the person in need of integrity and self-determination, that is, the autonomy principle. A similar concept was earlier described in regard to confirming. Corroborating deals more with support and interaction. It is not enough to be kind and show consideration, i.e. to benefit someone; nurses must also connect and care for the older person, i.e. demonstrate nonmaleficence, in order to corroborate that person.

Conclusion. The findings of this study can improve the ethics of nursing care. There is a need for research on development of a high standard of nursing care to corroborate the older patients in order to maintain their autonomy, beneficence and non-maleficence. The principal of justice was not specifically identified as a visible nursing action. However, all older patients received treatment, care and reception in an equivalent manner.

Keyword
Ethical values, geriatric wards, grounded theory, nursing ethics, nurses’ behaviour, nursing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67875 (URN)
Available from: 2011-05-02 Created: 2011-05-02 Last updated: 2013-09-12Bibliographically approved
4. Empirical and normative ethics: a synthesis relating to the care of older patients
Open this publication in new window or tab >>Empirical and normative ethics: a synthesis relating to the care of older patients
2011 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 18, no 6, 814-824 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to synthesize the concepts from empirical studies and analyze, compare and interrelate them with normative ethics. 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 are supporting documents for nurses as professionals and by extension also beneficial for older patients.

Place, publisher, year, edition, pages
Sage Publications, 2011
Keyword
Empirical ethics, Normative ethics, ICN code, Health and Medical Service Act, Beneficence, Nurse
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-67876 (URN)10.1177/0969733011405875 (DOI)000297476000007 ()
Available from: 2011-05-02 Created: 2011-05-02 Last updated: 2013-09-12Bibliographically approved

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