Nursing Ethics

This article aims to initiate a discussion on the demarcation of the ethics of care. This discussion is necessary because the ethics of care evolves by making use of insights from varying disciplines. As this involves the risk of contamination of the care ethical discipline, the challenge for care ethical scholars is to ensure to retain a distinct care ethical perspective. This may be supported by an open and critical debate on the criteria and boundaries of the ethics of care. As a contribution, this article proposes a tentative outline of the care ethical discipline. What is characteristic of this outline is the emphasis on relational programming, situation-specific and context-bound judgments, a political-ethical perspective, and empirical groundedness. It is argued that the ethics of care is best developed further by means of an intradisciplinary approach. Two intradisciplinary examples show how within the frame of one discipline, other disciplines are absorbed, both with their body of knowledge and their research methodology.

In 1939, Hitler authorized a programme of 'euthanasia' of children and adults with physical and psychiatric disorders. Initially, gas chambers were established at six psychiatric institutions in Germany and Austria. This programme was discontinued in August 1941 but the killings continued on an individual basis. Physicians selected patients who were unable to work or who required extensive care, and ordered the nurses to administer lethal doses of sedatives. Meseritz-Obrawalde was a site for 10,000 of these killings. Using documents from the trial of one of Obrawalde's physicians, Hilde Wernicke, the era of 'wild euthanasia' is described and her rationale for participating in the killings is explored.

Aim: To explore graduating nursing students' perception of nurse educators' teaching of codes of ethics in polytechnics providing basic nursing education in Finland. Background: Codes of ethics are regarded as an essential content in most nursing ethics curricula. However, little is known about how their teaching is implemented. Methods: Descriptive, cross-sectional design was used in this study. A total of 214 nursing students responded to a structured questionnaire with one open-ended question. The data was analysed statistically by SPSS and content analysis. Findings: Students perceived teaching of the codes as fairly extensive. The emphasis was on the nurse-patient relationship. Less attention was paid to nursing in wider social contexts. Educators' use of teaching and evaluation methods was narrow. Students whose teaching had been integrated into clinical training perceived that teaching had been more extensive. However, students did not perceive integration to clinical training as a much used teaching format. Students assessed their own knowledge and ability to apply the codes as mediocre. Those educators, whose knowledge about the codes students had assessed as adequate, were also perceived to teach the codes more extensively. Conclusions: Regardless of the responding students' positive description of the teaching, the findings should be interpreted with caution, due to the students' limited interest to respond. In teaching ethics, particular attention should be paid to more versatile use of teaching and evaluation methods, organization of integrated teaching, educators' competence in ethics, and student outcomes so that the importance of ethics would come across to all nursing students.

This article draws on two studies that have used an ethic of care analysis to explore lay, nursing and social work care for people with dementia. It discusses the political as well as the practice application of ethic of care principles and highlights the necessity to understand both what people do and the meanings with which such practices are imbued in order to identify 'good care' and the relationship between this and social justice. Examples of care for people with dementia are discussed by reference to core principles of an ethic of care: attentiveness, responsibility, competence, responsiveness and trust. These illustrate the potential for the development of a shared language within which different disciplines, lay carers and people with dementia can communicate about how needs could best be met in complex and difficult circumstances.

Assessmg mental competence of patients and relatives Tbis paper presents a discussion on tbe assessment of mental competence of patients and relatives m tbe bealtb care settmg Tbeir decision-makmg ability is explored witb particular reference to tbe giving of consent for nursing mtervention and medical treatment It is suggested tbat, in addition to obvious psychological or neurological disorders, decision-making ability will be influenced by psychological stress and tbe ability to communicate effectively It bigbligbts tbe ambiguity of mental competence assessment and concludes that sucb assessments will, to a greater or lesser extent, be subject to value-laden judgement

Background: The development of ethical leadership approaches plays an important role in achieving better patient care. Although studies that analyze the impact of ethical leadership on ethical climate and job satisfaction have gained importance in recent years, there is no study on ethical leadership and its relation to ethical climate and job satisfaction in our country. Objectives: This descriptive and cross-sectional study aimed to determine the effect of nurses’ ethical leadership and ethical climate perceptions on their job satisfaction. Methods: The study sample is composed of 285 nurses who agreed to participate in this research and who work at the internal, surgical, and intensive care units of a university hospital and a training and research hospital in İzmir, Turkey. Data were collected using Ethical Leadership Scale, Hospital Ethical Climate Scale, and Minnesota Satisfaction Scale. While the independent sample t-test, analysis of variance, Mann–Whitney U test, and Kruska...

Background: The magnitude of the HIV epidemic and the prevailing lack of sexual health interventions targeting young people in sub-Saharan Africa calls for a wider awareness and strategic approach-based advocacy. Although adolescents are pivotal to manpower development and technological advancement in Nigeria, HIV epidemic is on the increase among this vulnerable group due to lack of sexuality education and rightful intervention programs. Design: This is a cross-sectional descriptive study. Objective: The main objective of the study was to determine the level of awareness, knowledge and attitude towards HIV/AIDS among secondary school students in Atisbo Local Government Area, Nigeria. Methods: Two-stage clustered sampling method was deployed to recruit participants into the study. Instrument: A pilot-tested questionnaire developed from review of literatures was administered on 343 participants upon their consent. Result: The Mean age of the participants was 16 ±2 years and nearly two-third (209, 63.0%) of them were females. The study discovered that half of the participants (165, 50.9%) live with both parents and a little more than one-third (113, 34.5%) belong to well-educated parents. Most participants (296, 91.9%) were quite awareof HIV/AIDS and about a quarter (79, 24.2%) of them have had sexual encounter. A greater portion of them (213, 64.9%) discuss sexual matters with their parents and the majority (205, 63.9%) would care for their HIV/AIDS positive relatives. Overall, father's education, discussion of sexual matters with parents and age were all associated with participants' awareness and behaviour toward sex and sexuality, HIV/AIDS and people living with HIV/AIDS. Conclusion: The surveyed secondary school students possess relatively good knowledge of HIV/AIDS, reasonable sexual practices and positive attitude towards sexuality, HIV/AIDS and people living with HIV/AIDS. Social settings and parental sexuality communication as a result of educational attainment, played significant roles in the attitude of their children. Efforts should be intensified to provide more comprehensive information on sexuality and HIV/AIDS through the mass media. This possibly will improve students' attitudes toward abstinence, safer sex and behaviour toward people already infected with HIV/AIDS.

Respect for autonomy is well known as a core element of normative views on good care. Most often it is interpreted in a liberal way, with a focus on independence and self-determination. In this article we argue that this interpretation is too narrow in the context of care in nursing homes. With the aim of developing an alternative view on respect for autonomy in this setting we described four interpretations and investigated the moral intuitions (i.e. moral judgements) of caregivers regarding these approaches. We found that these caregivers seemed to value different notions relating to respect for autonomy under different circumstances. There was no significant difference in moral judgements between men and women or between doctors and nurses. We conclude that a multidimensional understanding of this principle would best fit this context. We end this article with a description of a modest theory of respect for autonomy in nursing homes.

Academic dishonesty is growing among nursing students. Reasons for this growth can be categorized into student, faculty, and system factors. Nursing faculty designed a study to explore this problem. CONCLUSIONS. We identified three themes: characteristics of students with academic integrity, patient safety, and professional outcomes. Exploring student perceptions of academic integrity can help faculty design measures to prevent dishonesty in these three areas. PRACTICE IMPLICATIONS. We recommend fostering culture change through strategies that target students, faculty, and systems. These strategies include peer mentoring, role modeling integrity, enhancing awareness of what constitutes cheating, and developing policies that promote honesty.

The right-to-die means that the terminally ill person has the right to refuse further treatment. The duty-to-die means that terminally ill persons feel that they have no choice and must refuse treatment because of social factors such as family burden or financial cost to society. This article describes the perceptions of a sample of 72 Japanese nurses and 71 counterparts from the West. The right-to-die received support from all of the western and from a majority of the Japanese sample. However, the duty-to-die received weaker support from the West and rather strong disagreement from Japan. Themes emerged in the two groups from a content analysis of their reactions to the major concepts of right-to-die and duty-to-die, and these included autonomy, values surrounding life, justice, family as a possible coercive agent and family as a partner in decision making. Differences and similarities across the cultures in the meaning of these themes were explored.

Aim: To determine the impact of reforms to fitness to practice procedures, within preparatory programmes for nurses and midwives, and the implications for public and patient protection. Background: Professional regulation has seen considerable reform across all health care professions. Higher Education Institutions providing preparatory programmes are required to demonstrate procedures which ensure students are of good health and character in order to ensure public safety. Method: A critical review and evaluation of fitness to practice systems, operating in one large school of nursing and midwifery delivering a wide range of programmes, was undertaken using a case study approach. Findings: The review revealed the need for effective collaborative management of fitness to practice panels within achievable timescales and complimentary and responsive communication processes. Good technical support was required to achieve a student friendly, confidential, on-line self-declaration process, with complementary procedures for effective follow-up, to ensure emerging issues were addressed in a timely manner. Conclusion: Public protection and confidence are high priorities. Case studies are vital to develop good practice, but effective systems challenge available resources. The processes reported contributed positively to a culture of partnership and transparency where self monitoring becomes inculcated into the students' behaviour, leading to early recognition of the importance of high professional standards.

The aim of this study was to reveal doctors' and nurses' attitudes to euthanasia in intensive care units and surgical, internal medicine and paediatric units in Turkey. A total of 205 doctors and 206 nurses working in several hospitals in Istanbul participated. Data were collected by questionnaire and analysed using SPSS v. 12.0. Significantly higher percentages of doctors (35.3%) and nurses (26.6%) working in intensive care units encountered euthanasia requests than those working in other units. Doctors and nurses caring for terminally ill patients in intensive care units differed considerably in their attitudes to euthanasia and patient rights from other health care staff. Euthanasia should be investigated and put on the agenda for discussion in Turkey.

Patient advocacy has been a topic of much discussion in the nursing literature for a number of decades. Ambiguities remain, however, concerning definitions of advocacy in nursing. This qualitative grounded theory-type study aimed to inquire into the meaning of patient advocacy from Iranian nurses' perspective. A purposive sample of 24 nurses (staff nurses, head nurses and supervisors) working in a large university hospital in Tehran was used. Data were collected using in-depth semistructured interviews and reflective diaries kept by the participants. The data were analyzed using elements of Strauss and Corbin's' approach. Advocacy was defined by the participants as: informing and educating; valuing and respecting; supporting; protecting; and promoting continuity of care for patients. The participants also believed that advocacy could take place only if there was respect for patients' individuality and their inherent human dignity. Many of the descriptions given by the participants are consistent with previous research in this area and represent a comprehensive account of their perceptions of patient advocacy.

Pain assessment in neonates often presents problems. The problem of inadequate or inaccurate assessment is complicated by issues related to the nature, consistency, and variability of the infant's physiologic and behavioral responses; the reliability, validity, specificity, sensitivity, and practicality of existing neonatal pain measures or measurement approaches; ethical questions about pain research in infants; and uncertainty about the responsibilities of health care professionals in managing pain in clinical settings. Despite these many issues, neonates need to be comfortable and as free of pain as possible to grow and develop normally. Valid and reliable assessment of pain is the major prerequisite for attaining this goal. Issues embodied in neonatal pain responses, measurement, ethical, and clinical considerations are explored. Suggestions for resolving some of these problems are presented.

Ethical conflicts, often leading to poor teamwork and moral distress, are very challenging to patients, patients' families, and health care providers. A proactive approach to ethical conflicts may improve patient care outcomes. To examine acceptability and feasibility of an ethics screening and early intervention tool for use by nurses caring for critically ill patients. Twenty-eight nurses in 2 medical centers applied the ethics screening tool to 55 patient situations. Nurses assessed situations for risk factors and early indicators of ethical conflicts and analyzed level of risk. At study completion, nurses participated in focus group discussions about the tool's benefits and challenges. Frequency counts were performed on risk factors and early indicators of ethical conflicts. Content analysis was used on written explanations regarding high-, medium-, and low-risk situations and on focus group data. Older patients with multiple comorbid conditions and aggressive treatments...

This historical research report presents and analyzes 2 recently identified narratives of women who underwent sterilization experiments at the Auschwitz concentration camp during World War II. A description of the historical and contextual background is presented in which involvement of the prisoner nurse occurred in the sterilization experiments. Using a critical feminist perspective, the ethics of nursing involvement are discussed in these experiments, with an emphasis on the political dimension. Salient implications are explored for contemporary nursing.

This article calls nursing to engage in the study of religions and identifies six considerations that arise in religious studies and the ways in which religious faith is expressed. It argues that whole-person care cannot be realized, neither can there be a complete understanding of bioethics theory and decision making, without a rigorous understanding of religiousethical systems. Because religious traditions differ in their cosmology, ontology, epistemology, aesthetic, and ethical methods, and because religious subtraditions interact with specific cultures, each religion and subtradition has something distinctive to offer to ethical discourse. A brief example is drawn from Native American religions, specifically their view of 'speech' and 'words'. Although the example is particular to an American context, it is intended to demonstrate a more general principle that an understanding of religion per se can yield new insights for bioethics.

This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform 'hands on' nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the philosopher Emanuel Levinas . From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses' stories, the following themes emerge: personal responsibility ; boundaries ; temporality ; worry, fear, and uncertainty ; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses' responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable.

This review aimed to explore nursing literature and research on dignity in care of inpatients and to evaluate how the care patients received in the hospital setting was related to perceived feelings of being dignified or undignified. Studies conducted between 2000 and 2010 were considered, using Cumulative Index to Nursing and Allied Health Literature and MEDLINE, and the search terms 'patient dignity', 'dignity in care', 'human dignity and nursing' and 'dignity and nursing ethics'. Findings revealed, from the perspectives of nurses and patients, that dignity in care in the hospital setting is seen to be influenced by physical environment, staff attitude and behaviour, organisational culture and patient independence. This review can help nurses to better understand dignity in care, and for policy makers, there are implications about determining the physical environment, staff attitude and behaviour and organisational culture needed to promote patient dignity in nursing. By identifying the most important factors from patients' and nurses' perspectives that contribute to dignity in care, nursing interventions, such as campaigns and education in clinical practice, can be developed. Downloaded from expectations for dignity in the health-care system with regard to ending unnecessary invasions of privacy. Moreover, they indicated that nurses should discuss measures that enhance dignity in care and the reasons they do not implement dignity-promoting measures.

Personal integrity is often seen as a core value for delivering ethical healthcare. This paper will explore what this might mean and particularly what place integrity has in a multi-professional healthcare system. Two opposing arguments can be made: the first is that the multi-professional nature of modern healthcare means that personal integrity is at best a futile luxury and at worst, an obstacle to delivering affordable high-quality care to large populations. The converse is that without personal integrity healthcare loses its humanity and becomes mere biological and social engineering. Part of the analysis rests on whether integrity is primarily a personally held moral framework or whether it is a social concept. Chester Calhoun's analysis, in which she identifies the integrated-self, personal identity, and (morally) clean-hands as three pictures of integrity, is used as the basis for suggesting that integrity is a rich and complex social virtue through which the individual ...

In general, most, but not necessarily all, patients want truthfulness about their health. Available evidence indicates that truth-telling practices and preferences are, to an extent, a cultural artefact. It is the case that practices among nurses and doctors have moved towards more honest and truthful disclosure to their patients. It is interesting that arguments both for and against truth-telling are established in terms of autonomy and physical and psychological harm. In the literature reviewed here, there is also the view that truth-telling is essential because it is an intrinsic good, while it is argued against on the grounds of the uncertainty principle. Based on this review, it is recommended that practitioners ought to ask patients and patients' families what informational requirements are preferred, and research should continue into truth-telling in clinical practice, particularly to discover its very nature as a cultural artefact, and the other conditions and contexts in which truth-telling may not be preferred.

Throughout the history invertebrate and vertebrate models have been used in fundamental and goal-oriented scientific research to gain new information on cell and organ anatomy, mechanisms of the diseases and methods to prevent them, behavioral research, for production, development, testing of quality and safety of drugs, food, cosmetic and other products, and to answer scientific questions that would have been impossible to be gathered directly from humans. Although researchers are continually developing non-animal models, research on complex multigenic diseases and therapeutics testing sometimes require the use of in vivo models. It is generally recognized that in the absence of human data, animal research in many cases can offer most accurate approximations and predictions of human responses.

Quadro 1 Caracterização da amostra do estudo. 72 Parte III Quadro 1 Problemas éticos identificados, integrados na categoria informação 81 Quadro 2 Problemas éticos identificados, integrados na categoria acompanhamento em fim de vida. 83 Quadro 3 Problemas éticos identificados, integrados na categoria decisão do destinatário dos cuidados. 86 Quadro 4 Problemas éticos identificados, integrados na categoria respeito pela pessoa 87 Quadro 5 Problemas éticos identificados, integrados na categoria sigilo profissional. 88 Quadro 6 Problemas éticos identificados, segundo categorias de Lucília Nunes 91 Quadro 7 Características do problema ético de enfermagem, segundo a categoria conflito entre princípios: científicos e éticos 97 Quadro 8 Características do problema ético de enfermagem, segundo a categoria conflito entre normas. 99 Quadro 9 Características do problema ético de enfermagem, segundo a categoria desrespeito pela dignidade humana. Quadro 10 Características do problema ético de enfermagem, segundo a categoria conflito entre valores. Quadro 11 Características do problema ético de enfermagem, segundo a categoria violação de direitos. Quadro 12 Características do problema ético de enfermagem, segundo a categoria risco do bem-estar. Quadro 13 Características do problema ético de enfermagem, segundo a categoria risco para a saúde. Quadro 14 Características do problema ético de enfermagem, segundo a categoria conflito entre direitos. Quadro 15 Categorização das características de problema ético de enfermagem. Quadro 16 Fases de construção da decisão, enquanto categorias emergentes. Quadro 17 Fundamentos éticos ponderados na construção da decisão ética de enfermagem. Quadro 18 Fundamentos científicos ponderados na construção da decisão ética de enfermagem. Quadro 19 Fundamentos jurídicos ponderados na construção da decisão ética de enfermagem.

Analysis of the moral habitability of the nursing work environment Background. Following health reform, nurses have experienced the tremendous stress of heavy workloads, long hours and difficult professional responsibilities. In recognition of these problems, a study was conducted that examined the impact of the working environment on the health of nurses. After conducting focus groups across Canada with nurses and others well acquainted with nursing issues, it became clear that the difficult work environments described had significant ethical implications. Aim. The aim of this paper is to report the findings of research that examined the moral habitability of the nursing working environment. Methods. A secondary analysis was conducted using the theoretical work of Margaret Urban Walker. Moral practices and responsibilities from Walker's perspective cannot be extricated from other social roles, practices and divisions of labour. Moral-social orders, such as work environments in this research, must be made transparent to examine their moral habitability. Morally habitable environments are those in which differently situated people experience their responsibilities as intelligible and coherent. They also foster recognition, cooperation and shared benefits. Findings. Four overarching categories were developed through the analysis of the data: (1) oppressive work environments; (2) incoherent moral understandings;

Title. Lamentation and loss: expressions of caring by contemporary surgical nurses Aim. This paper is a report of a phenomenological study of caring from the perspective of nurses working on surgical wards. Background. While care and caring are complex foundational nursing concepts which have received considerable and ongoing attention from theorists, researchers and clinicians, there has been little research into caring on surgical units. Method. A convenience sample of ten nurses working on surgical units in a public teaching hospital in Canada was interviewed using van Manen's phenomenological approach. Data were collected during 2001 using semi-structured interviews. Findings. The major theme of lamentation and loss was identified from the data. Participants revealed a dichotomous tension between what caring should be and what actually occurs. This tension was pervasive and generated lament-an expression of grief and mourning for the loss of caring. The essential structures supporting this theme included lack of time, lack of caring support, tasking, increased acuity, lack of continuity of care, emotional divestment and not caring for each other. Loss and sadness were articulated and participants lamented and grieved about the loss of care in contemporary practice. Conclusion. The forces and influences described by participants undermined caring in the new practice milieu. If this is a glimpse of the future, then the values of the nursing profession may be under siege. Caring as the central core, the essence or unifying concept of nursing may be subject to marginalization in contemporary practice.

The faceless encounter: ethical dilemmas in telephone nursing Aim. This paper aims to present the findings of a study designed to describe ethical dilemmas, in the form of conflicting values, norms and interests, which telenurses experience in their work. Background. Telephone nursing is an expanding part of health care. Telephone nurses in Sweden assess care needs, provide advice, support and information, and recommend and coordinate healthcare resources. Lately, ethical demands on healthcare professionals in general have increased. The reasons include new biomedical competence, an ageing population and constrained resources which have made priority setting a primary concern for doctors and nurses. When ethical problems arise, colleagues need open dialogue. Despite this, nurses lack such a dialogue. Method. A purposeful sample of 12 female telenurses in Sweden was interviewed twice during 2004 and 2005. The transcribed interviews were analysed thematically. Results. Five themes were found: talking through a third party; discussing personal and sensitive problems over the phone; insufficient resources and the organization of health care; balancing callers' information needs with professional responsibility; and differences in judging the caller's credibility. Conclusion. The present study has identified five different themes in which Swedish telenurses experience ethical dilemmas in their work. This shows how ethical dilemmas in various forms are present in telenursing. Questions of autonomy, integrity and prioritizing are particularly highlighted by the participating nurses. Telenurses in Sweden also experience new ethical demands due to a multicultural society. Although several of the identified dilemmas also occur in other areas of nursing we argue that these situations are particularly challenging in telenursing. Relevance to clinical practice. The work organization should provide opportunities for ethical competence-building, where ethical dilemmas in telenursing are highlighted and discussed. Such a strategy might lead to decreased moral uncertainty and distress among telenurses, with positive consequences for callers.

The significance of the question 'Is caring a virtue?' lies in the fact that both the ethics of virtue and the ethics of care have been proposed as alternatives to what may be termed 'bioethics'. The ethics of care has been of particular interest to nursing theorists, especially those who want to say that there is a body of distinctively nursing ethical theory which is different from bioethics. In answering the main question there are three supplementary aims: first, to explore the relationship between virtue ethics and the ethics of care, it is suggested that caring is not a virtue, but that the virtues involve caring correctly; second, to give a broad outline of what is meant by an ethics of virtue, including what it means to care correctly; and third, to examine implications of the theory for nursing.

Research ethics is always important. However, it is especially crucial with sensitive research topics such as family violence. The aim of this article is to describe and discuss some crucial issues regarding intimate partner violence and child maltreatment, based on the authors' own research experiences. We focus on and discuss examples concerning the definition of family violence, research design, ethical approval, participant recruitment and safety and data collection and processing. During the research process, the significance of teamwork is emphasized. Support provided by the participants to each other and support given by experienced researchers within the team is very important for high ethical standards.

Ethical practice is acknowledged as an essential feature of good nursing, yet defining what comprises such practice is complex. This article examines aspects of ethical practice from the perspectives of healthcare professionals, service users and carers. The relationship between ethical practice and decision making is discussed, recognising the importance of context and the responsibilities of the nurse. To demonstrate ethical practice, the nurse needs to act as a moral agent. Practising ethically means not only knowing the right thing to do, but also being prepared to put this into action. With this in mind, the complexities of ethical practice and opportunities to practise skills in ethical reasoning are explored.

Care as a matter of courage: vulnerability, suffering and ethical formation in nursing care The aim of the study was to explore nurses' experience of how their own vulnerability and suffering influence their ethical formation and their capacity to provide professional care when they are confronted with the patient's vulnerability and suffering. Care is shaped in the meeting between human beings. Professional care is informed by the patient's appeal for help as it is expressed in the meeting. Ethical formation is understood as a personal ethical and existential process, resulting in the capacity to provide professional care. A nurse must have the sense of being a complete human being with own personal attributes and sensitivity in order to be able to relate to other people. The study is based on qualitative interviews with 23 experienced nurses from Sweden, Finland and Denmark. The analyses and interpretation were carried out in line with Steinar Kvale's three levels of interpretation. The study clarifies that ethical formation is a union of the nurse's personal attributes and professional qualifications and that ethical formation is developed over time. Moreover, it also demonstrates that the nurse's personal and professional life experiences of vulnerability and suffering influence ethical formation. Vulnerability and suffering have proven to be sensitive issues for nurses, like a sore point that either serve as an eye-opener or cause the development of blind spots. Furthermore, vulnerability, suffering and the sore points are seen to shape the nurse's courage in relation to care. Courage appears to be a significant unifying phenomenon that manifests itself as the courage to help patients face their own vulnerability and suffering, to bear witness to patients' vulnerability and suffering and to have faith in oneself in arguing for and providing professional care. Courage thus seems to play a significant role in nurses' ability to engage in care. Nurses' own vulnerability, suffering and sore points seem to shape their courage.

From a strict biological point of view, humans are just one species among other species, albeit one with very special capacities, characteristics, and skills. Among scientists, it is generally acknowledged that we share many features with other animal species, which are certainly relevant when the concepts of health and disease are discussed. The term 'One Health' is used in many different contexts and by people with varying backgrounds. However, there appears to be some confusion as to what the term really means, and it is used in a wide range of contexts, often including or bordering concepts such as infection biology, contagious diseases, zoonotic infections, evolutionary medicine, comparative medicine, and translational medicine. Without claiming to present the one and only true interpretation, we will argue for a wide approach using the 'umbrella' depiction developed by One Health Sweden. We argue that this one should, compared to other demarcations, be more useful to science. We will also analyze the concept of health on different levels: individual, population, and ecosystem health, and describe how these levels inherently influence each other for both humans and animals. Both these choices are normative and have practical consequences for research and education, a way of reasoning which we develop further in this paper. Finally, we conclude that the choice of term for the approach might be normative in deciding which disciplines or parts of disciplines that may be included.

It is argued that dignity can be considered both subjectively, taking into account individual differences and idiosyncrasies, and objectively, as the foundation of human rights. Dignity can and should also be explored as both an other-regarding and a self-regarding value: respect for the ...

Aim. This article is a report of an analysis of the concept of social justice. Background. Nursing's involvement in social justice has waned in the recent past. A resurgence of interest in nurses' roles about social justice requires a clear understanding of the concept. Data sources. Literature for this concept analysis included English language articles from CINAHL, PubMed, and broad multidisciplinary literature databases, within and outside of health-related literature, for the years 1968-2010. Two books and appropriate websites were also reviewed. The reference lists of the identified sources were reviewed for additional sources. Review methods. The authors used Wilsonian methods of concept analysis as a guide.

Results, One third (34%) of the perceived ethical conflicts fell in the child/parent/practitioner relationship category. Most canflicts (3 I %I were experienced as a moral dilemma where 2 or more clear moral principles apply but they support mutually inconsistent courses of action. Most ethical conflicts (22%) were unresolved.