Nurses’ perceptions of nursing presence and the relationship between nursing presence and moral sensitivity in nurses working with people with dementia in residential care

Aim: The aim of this study was to measure nursing presence among nurses caring for people with dementia in residential care settings, and to investigate the relationship between nursing presence and moral sensitivity. Background: Nursing presence is a core relational skill in nursing and holds many benefits for nurses and their patients. Moral sensitivity is defined as how one recognises the moral elements of a situation, and how one’s moral or ethical decision making may impact on an individual. Methods: A descriptive, cross sectional quantitative methodology was used with a sample of 150 registered nurses. The Presence of Nursing Scale for Registered Nurses was used to investigate nursing presence, and the Moral Sensitivity Questionnaire for moral sensitivity. Results: Findings from the study demonstrated that participants agreed with the majority of elements of nursing presence, (mean 76.97, SD= 7.51). A mean score of 36.22 was evidence of a well developed level of moral sensitivity in participants. Nurses who perceived themselves to be highly present to their patients also scored highest on certain elements of moral sensitivity such as moral strength. Nursing presence was also found to be more developed in those participants that rated themselves as having higher levels of expertise based on Benner’s (1984) definitions. Older nurses also scored higher on nursing presence. There was a high level of agreement that factors such as lack of time (n=133), and heavy workload influenced nursing presence. Nurses, who were older and had longer clinical experience, were shown to have greater moral strength. There were differences in elements of moral sensitivity between groups of nurses who ranked themselves according to Benner’s (1984) competence framework with higher scores evident in the more expert groups. Conclusion: Overall, this study showed that participants had a well developed level of nursing presence, and certain elements of moral sensitivity are positively related to nursing presence. Nursing presence appears to be linked to the level of expertise of the nurse but factors such as time and workload do influence nursing presence.

A study of the situations, features, and coping mechanisms experienced by Irish psychiatric nurses experiencing moral distress

Purpose: The purpose of this study was toinvestigate moral distress in Irish psychiatric nurses. Design: A qualitative descriptive methodology was used. Findings: The study confirmed the presence of moral distress and the situations that gave rise to moral distress within psychiatric nurses working in acute care settings. Practice Implications: The findings indicate that while multidisciplinary teams appear to function well on the surface, situations that give rise to moral distress are not always acknowledged or dealt with effectively. Furthermore, unresolved moral conflict impacts upon the quality of clinical decision-making by not allowing open and transparent discussions that allow clinicians the opportunity to address their concerns adequately.

The emergence of borders: moral questions mapped out

In this paper, we examine the extent to which the concept of emergence can be applied to questions about the nature and moral justification of territorial borders. Although the term is used with many different senses in philosophy, the concept of “weak emergence” - advocated by, for example, Sawyer (2002, 2005) and Bedau (1997 ) - is especially applicable, since it forces a distinction between prediction and explanation that connects with several issues in the discussion of territory. In particular, we argue, weak emergentism about borders allows us to distinguish between (a) using a theory of territory to say where a border should be drawn, and (b) looking at an existing border and saying whether or not it is justified (Miller, 2012; Nine, 2012; Stilz, 2011). Many authors conflate these two factors, or identify them by claiming that having one without the other is in some sense incoherent. But on our account - given the concept of emergence - one might unproblematically be able to have (b) without (a); at the very least, the distinction between these two issues is much more significant than has often been recognised, and more importantly gives us some reason to prefer “statist” as opposed to “cultural” theories of territorial borders. We conclude with some further reflections on related matters concerning, firstly, the apparent causal powers of borders, and secondly, the different ways in which borders are physically implemented (e.g., land vs. water).