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  • 1.
    Berggren, Ingela
    et al.
    University West, Department of Nursing, Health and Culture, Division of Nursing.
    Severinsson, Elisabeth
    University of Oslo.
    The influence of clinical supervision on nurses' moral decision making.2000In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 7, no 2, p. 124--133Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the influence of clinical supervision on nurses´

    moral decision making. The sample consisted of 15 registered nurses who took part in

    clinical supervision sessions. Data were obtained from interviews and analysed by a

    hermeneutic transformative process. The hermeneutic interpretation revealed four

    themes: increased self-assurance, an increased ability to support the patient, an increased

    ability to be in a relationship with the patient, and an increased ability to take responsibility.

    In conclusion, it seems that clinical supervision enhances nurses´ ability to provide

    care on the basis of their decision making. However, the qualitative and structural aspects

    of clinical supervision have to be investigated further in order to develop professional

    insight into the way that nurses think and react. 

  • 2.
    Karlsson, Christina
    et al.
    University West, Department of Nursing, Health and Culture, Division of Nursing.
    Berggren, Ingela
    University West, Department of Nursing, Health and Culture, Division of Nursing.
    Dignified end-of-life care in the patients’ own homes2011In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 18, no 3, p. 374-385Article in journal (Refereed)
    Abstract [en]

    Nowadays it is increasingly common that the patients in the end of life phase choose to be cared for in their own home. Therefore it is vital to identify significant factors in order to prevent unnecessary suffering for dying patients and their families in end-of-life homecare. This study aimed to describe 10 nurses’ perceptions of significant factors that contribute to good end-of-life care in the patients own home. The transcribed texts from the interviews’ were analyzed using phenomenological hermeneutical method, which focuses on the life-world of human beings. The results demonstrate that good end-of-life care presupposes that the aim of the caring staff is to provide safety, autonomy and integrity for the patient and family in order to create the respect required for as good and dignified a death as possible.

  • 3.
    Rejnö, Åsa
    et al.
    University West, Department of Health Sciences, Specialist Nursing programme. University West, Department of Health Sciences, Section for nursing - graduate level. Skaraborg Hospital Skövde, Sweden.
    Berg, Linda
    University of Gothenburg.
    Strategies for handling ethical problems in end of life care: obstacles and possibilities2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 7, p. 778-789Article in journal (Refereed)
    Abstract [en]

    Background: In end of life care, ethical problems often come to the fore. Little research is performed on ways or strategies for handling those problems and even less on obstacles to and possibilities of using such strategies. A previous study illuminated stroke team members’ experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. These findings have been further explored in this study. Objective: The aim of the study was to illuminate obstacles and possibilities perceived by stroke team members in using strategies for handling ethical problems when caring for patients afflicted by sudden and unexpected death caused by stroke. Research design: A qualitative method with combined deductive and inductive content analysis was utilized. Participants and research context: Data were collected through individual interviews with 15 stroke team members working in stroke units of two associated county hospitals in western Sweden. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Permission was also obtained from the director of each stroke unit. Findings: All the studied strategies for handling of ethical problems were found to have both obstacles and possibilities. Uncertainty is shown as a major obstacle and unanimity as a possibility in the use of the strategies. The findings also illuminate the value of the concept “the patient’s best interests” as a starting point for the carers’ ethical reasoning. Conclusion: The concept “the patient’s best interests” used as a starting point for ethical reasoning among the carers is not explicitly defined yet, which might make this value difficult to use both as a universal concept and as an argument for decisions. Carers therefore need to strengthen their argumentation and reflect on and use ethically grounded arguments and defined ethical values like dignity in their clinical work and decisions. © 2014, © The Author(s) 2014.

  • 4.
    Rejnö, Åsa
    et al.
    University West, Department of Health Sciences, Section for nursing - graduate level. Skaraborg Hospital Skövde, Sweden.
    Silfverberg, Gunilla
    Ersta Sköndal University College, Stockholm, Sweden.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Stockholm, Sweden.
    Reasoning about truth-telling in end-of-life care of patients with acute stroke2017In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, no 1, p. 100-110Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as 'incompetent' decision makers regarding their own care. OBJECTIVE: The aim of the study was to deepen the understanding of stroke team members' reasoning about truth-telling in end-of-life care due to acute stroke. RESEARCH DESIGN: Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis. PARTICIPANTS AND RESEARCH CONTEXT: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. ETHICAL CONSIDERATIONS: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. FINDINGS: The main findings were the team members' dynamic movement between the categories 'Truth above all' and 'Hide truth to protect'. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. DISCUSSION: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient's best interest first. CONCLUSION: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.

  • 5.
    Rejnö, Åsa
    et al.
    University West, Department of Health Sciences, Section for nursing - graduate level. Skaraborg Hospital Skövde, Sweden.
    Ternestedt, Britt-Marie
    Ersta Sköndal Bräcke University College, Sweden.
    Nordenfelt, Lennart
    Ersta Sköndal Bräcke University College, Sweden.
    Silfverberg, Gunilla
    Ersta Sköndal Bräcke University College, Sweden.
    Godskesen, Tove E
    Ersta Sköndal Bräcke University College, Sweden; Uppsala University, Sweden.
    Dignity at stake: Caring for persons with impaired autonomy2020In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 27, no 1, p. 104-115Article in journal (Refereed)
    Abstract [en]

    Dignity, usually considered an essential ethical value in healthcare, is a relatively complex, multifaceted concept. However, healthcare professionals often have only a vague idea of what it means to respect dignity when providing care, especially for persons with impaired autonomy. This article focuses on two concepts of dignity, human dignity and dignity of identity, and aims to analyse how these concepts can be applied in the care for persons with impaired autonomy and in furthering the practice of respect and protection from harm. Three vignettes were designed to illustrate typical caring situations involving patients with mild to severely impaired autonomy, including patients with cognitive impairments. In situations like these, there is a risk of the patient's dignity being disrespected and violated. The vignettes were then analysed with respect to the two concepts of dignity to find out whether this approach can illuminate what is at stake in these situations and to provide an understanding of which measures could safeguard the dignity of these patients. The analysis showed that there are profound ethical challenges in the daily care of persons with impaired autonomy. We suggest that these two concepts of human dignity could help guide healthcare professionals to develop practical skills in person-centred, ethically grounded care, where the patient's wishes and needs are the starting point.

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