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The persistent nursing shortage is challenging the values and beliefs of the nursing profession and causing nurses to ask how they can fulfill their ethical responsibilities to patients when there are an insufficient number and a maldistribution of nurses. Nurses are expressing job dissatisfaction, experiencing moral distress, and wondering about their inability to provide quality patient care. In this article, the author addresses the commitment to care for patients and the ethical dilemma with which nurses are grappling: caring for self versus caring for others. Recommendations for possible action include reenvisioning the profession of nursing, empowering nurses, providing support, and restructuring the work environment. Taken together, these actions have the potential to reduce the moral distress that nurses are experiencing and to enable them to honor their commitment to patient care.

Aim To examine the mediating role of social support on the relationship of depressive symptoms to medication adherence and self-care activities in Korean adults. Background Recent evidence suggests that higher levels of social support are associated with improved medication adherence and self-care activities; however, the role of social support on the relationship of depressive symptoms to medication adherence and self-care activities is less well understood. Design A cross-sectional survey. Methods The data were collected from 311 Korean adults with type 2 diabetes who were taking hypoglycaemic agents in the period 2012-2013. Depressive symptoms, social support, medication adherence and self-care activities were assessed using structured questionnaires. Multiple regression analysis with adjustment for covariates and the Sobel test were used to examine the mediating effect of social support on the relationship of depressive symptoms to medication adherence and self-care activities. Results There were statistically significant differences by subgroups with and without depressive symptoms in social support, medication adherence and self-care activities of diet, physical activity and stress management. The Sobel test confirmed that social support mediated the effect of depressive symptoms on medication adherence and self-care activities of diet, physical activity and stress management. Conclusion The evidence from this study suggests that social support-enhancing interventions that also manage depressive symptoms may be more timely and effective than interventions that target depressive symptoms alone in promoting adherence to medication adherence and self-care activities in this population. [ABSTRACT FROM AUTHOR]

Nursing workarounds have garnered increased attention over the past 15 years, corresponding with an increased focus on patient safety and evidence-based practice and a rise in the use of health information technologies (HITs). Workarounds have typically been viewed as deviations from best practice that put patients at risk for poor outcomes. However, this narrow view fails to take into consideration the multifactorial origins of workarounds. The authors explore the ways in which evidence-based protocols and HIT, designed to improve patient safety and quality, can have an unintended consequence of increasing the likelihood of nurses engaging in workarounds. The article also examines workarounds considering the ethical obligations of both nurses and administrative leaders to optimize patient safety and quality. [ABSTRACT FROM AUTHOR]

colbert a.m., sereika s.m. & erlen j.a. (2012) Functional health literacy, medication-taking self-efficacy and adherence to antiretroviral therapy. Journal of Advanced Nursing 69(2), 295-304. doi: 10.1111/j.1365-2648.2012.06007.x Abstract Aims. To report a study of the relationship between functional health literacy and medication adherence, as mediated by medication-taking self-efficacy, while controlling for the effect of key demographic variables (such as race, income and level of education). Background. Medication adherence is critical to successful HIV/AIDS self-management. Despite simplified regimens and the availability of tools to assist with medication-taking, adherence remains a challenge for many people living with HIV/AIDS. Design. Cross-sectional, secondary analysis. Methods. Data for this study of 302 adults living with HIV/AIDS who were taking antiretroviral medications were collected from January 2004-December 2007. Medication adherence was measured using electronic event monitors. Bivariate analyses and stepwise regression were conducted to examine the associations among functional health literacy, medication-taking self-efficacy and HIV medication adherence. Results. Overall, functional health literacy was much higher than expected; however, adherence in this sample was sub-optimal. Higher medication-taking self-efficacy was associated with higher medication adherence; however, functional health literacy was not significantly related to either medication adherence or self-efficacy beliefs. Hence, medication-taking self-efficacy did not mediate the relationship between functional health literacy and medication adherence. Conclusions. Medication adherence continues to be an issue for people living with HIV/AIDS. Additional research is needed to understand the disparate findings related to functional health literacy and medication adherence in this and other studies examining this association. [ABSTRACT FROM AUTHOR]

erlen j.a., cha e.s., kim k.h., caruthers d. & sereika s.m. (2010) The HIV Medication Taking Self-efficacy Scale: psychometric evaluation. Journal of Advanced Nursing 66(11), 2560-2572. Aim. This paper is a report of an examination of the psychometric properties of the HIV Medication Taking Self-efficacy Scale. Background. Self-efficacy is a critically important component of strategies to improve HIV medication-taking; however, valid and reliable tools for assessing HIV medication-taking self-efficacy are limited. Method. We used a cross-sectional, correlational design. Between 2003 and 2007, 326 participants were recruited from sites in Pennsylvania and Ohio in the United States of America. Six self-report questionnaires administered at baseline and 12 weeks later during 'Improving Adherence to Antiretroviral Therapy' were used to examine the variables of interest. Means and variances, reliability, criterion, and construct validity of the HIV Medication Taking Self-efficacy Scale were assessed. Findings. Participants reported high self-confidence in their ability to carry out specific medication-related tasks (mean = 8·31) and in the medication's ability to effect good outcomes (mean = 8·56). The HIV Medication Taking Self-efficacy Scale and subscales showed excellent reliability (α = 0·93∼0·94). Criterion validity was well-established by examining the relationships between the HIV Medication Taking Self-efficacy Scale and selected physiological and psychological factors, and self-reported medication adherence ( r = −0·20∼0·58). A two-factor model with a correlation between self-efficacy belief and outcome expectancy fitted the data well (model χ2 = 3871·95, d.f. = 325, P < 001; CFA = 0·96; RMSEA = 0·046). Conclusion. The HIV Medication Taking Self-efficacy Scale is a psychometrically sound measure of medication-taking self-efficacy for use by researchers and clinicians with people with HIV. The findings offer insight into the development of interventions to promote self-efficacy and medication adherence in persons with HIV. [ABSTRACT FROM AUTHOR]

Conflict of interest as it relates to healthcare is gaining increasing attention. Pharmaceutical companies and manufacturers that produce medical devices are coming under greater scrutiny because of the influence that their marketing practices may have on the patient management decisions made by healthcare professionals. The result is that healthcare agency administrators are developing conflict of interest policies and procedures for their professional employees. The driving force behind many of these policies is the need to maintain the trust of the public by refraining from questionable professional conduct. This article presents 2 hypothetical cases to provide nurses with an understanding of the concept of conflict of interest and the ethical considerations this issue raises, and describes the subtle and not-so-subtle influences on professional practice decisions. Recommendations are offered to help nurses avoid conflict of interest and preserve their professional integrity. It is incumbent upon nurses to become cognizant of the types of situations that may present a conflict of interest for them and to take the necessary steps to avoid such professional impropriety. [ABSTRACT FROM AUTHOR]

As science and technology in genetics continue to expand, complex ethical questions arise that require difficult decisions for all concerned. Rather than having ready-made answers, there may be only more challenging questions for patients, families, and healthcare professionals. These complicated questions may have no straightforward, correct answers, thus creating an ethical quandary. This article discusses some selected ethical issues that occur when patients are considering undergoing genetic testing and counseling, including respecting autonomy and the patient's right to decide, establishing patient-healthcare provider trust, and disclosing private information to others. Several strategies are presented that nurses can use as they assist patients and their families who are facing these challenging ethical dilemmas. [ABSTRACT FROM AUTHOR]

Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) to protect patients' basic rights to privacy and their control over the disclosure of their personal health information. Advances in and the more widespread use of communication technology were increasing the public's concerns over the ease with which their health information could be transmitted, how protected that information was during such transmissions, and their lack of approval for the use of that information by known and unknown third parties. This article, the first of two papers focusing on HIPAA, discusses HIPAA from the clinical perspective and focuses primarily on the HIPAA Privacy Rule. Under what circumstances can a covered entity disclose protected health information? What are the ethical issues inherent in HIPAA? What does HIPAA require of covered entities? What are the implications of HIPAA for professional nurses? The goal of HIPAA is to ensure the protection of confidential health information through having appropriate security systems to guard against unintentional disclosure of that information. [ABSTRACT FROM AUTHOR]

Reports on the inclusion of complementary and alternative therapies in nursing curricula in the U.S. Changes in professional and societal attitudes towards the use of such therapies; Identification of future directions for incorporating content on such therapies into nursing education programs; Suggestions that undergraduate nursing programs need to introduce the philosophy of Oriental medicine.

Functional health illiteracy is a silent disability demanding the attention of healthcare professionals because it affects millions of people in the United States. Patients are reluctant to disclose this problem because they fear discrimination and stigmatization. Inadequate health literacy raises ethical questions because it is a barrier to healthcare and results in poor health outcomes. The purposes of this article are to provide an overview of functional health illiteracy, identify related ethical concerns, and discuss selected, relevant nursing implications. Nurses are in a unique position to serve as advocates, mediators, and translators for their patients who are functionally health illiterate. [ABSTRACT FROM AUTHOR]

Eradicating health disparities and increasing health-related quality of life are the overall goals of Healthy People 2010. To achieve these goals requires that healthcare providers have an understanding of respect for individuals, trust, and implications of distributing resources equitably within society. The purposes of this article are to discuss health disparities and to briefly describe how ethics helps healthcare providers address health disparities. In addition, strategies that professional nurses can incorporate into their clinical practice in order to reduce health disparities are presented. [ABSTRACT FROM AUTHOR]

Form and style are not the only considerations that authors need to address when preparing a manuscript for possible publication. Writing for publication also requires attention to matters of ethics such as authorship, submitting the paper to several journals simultaneously, plagiarism, the integrity of the information, human subjects considerations, and conflict of interest on the part of the author. The purposes of this article are to describe ethical situations that may arise when writing for publication and to provide recommendations for addressing these issues. [ABSTRACT FROM AUTHOR]

The purpose of this study was to characterize, from multiple professional perspectives, current management approaches and systems of care for long-term ventilator-dependent patients. This study was preliminary in nature and served to generate questions to be explored with subsequent research. A focus group methodology was used. Three focus sessions were held, with participants representing nursing, social services, and respiratory therapy. Field notes were recorded by two independent observers. The primary themes arising from the narrative data were: (i) caregiver impact, (ii) system barriers to appropriate care, (iii) communication difficulties among professionals and between patients and professionals, (iv) ethical concerns, and (v) patient characteristics that influence medical management and patient outcomes. Implications include the need for systematic research regarding caregiver impact, ethical practice of health care professionals, and the epidemiology of ventilator dependency, as well as evaluative studies of different system approaches to caring for these patients. [ABSTRACT FROM AUTHOR]

Background/Purpose: Limited research addresses health literacy among informal caregivers who manage medications for community-dwelling persons experiencing memory loss. Health literacy is an important concept when providing interventions to assist informal caregivers with medication management. This study used the Ability, Skill and Knowledge (ASK) Model to characterize health literacy in family caregivers of community-dwelling persons with memory loss and examine relationships between health literacy and caregivers' demographics, cognitive abilities, academic skills, and medication knowledge. Methods: We used baseline data from a randomized controlled trial of a problem solving intervention to improve caregiver's medication management. Instruments included a sociodemographic tool, the Newest Vital Sign (health literacy), the Blessed Orientation-Memory-Concentration Test (global cognition), Letter-Number Sequencing (working memory), Trail Making Test Part B (executive function), and the Medication Management Instrument for Deficiencies in the Elderly (medication knowledge). Descriptive statistics, correlations, and linear regression were used for data analysis. Results: Our sample of 91 caregivers included primarily women (70%; n=64) who were white (85%; n=77) with an average (±SD) age of 67.4 (±11.8) years. The average years of education was 14.9 (±3.3); their average number of comorbidities was 6.9 (±3.6). The average health literacy score was 4.02 (±1.8) indicating adequate literacy; 38% (n=35) had scores suggesting limited health literacy. Health literacy was negatively associated with age (r=-.40; p<.001), global cognitive functioning (r=-.54, p<.001), and executive function (r=-.34, p=.001) and was positively associated with education (r=.37; p<.001), working memory (r=.28, p=.007), and medication knowledge (r=.25, p=.020). Regression analysis showed that health literacy was explained by age (b=-.065, p=.001), global cognitive functioning (b=-.266, p<.001), working memory (b=.219, p=.005), and academic ability/education years (b=.121, p=.008). Conclusions/Implications: Findings suggest that health literacy could be characterized by the constructs of cognitive ability and academic skill of the ASK Model. However, medication knowledge may not independently explain caregiver's health literacy. Age seems to be an important factor in the assessment of health literacy. Assessing health literacy provides an important bridge when designing interventions to improve caregiver medication management. [ABSTRACT FROM AUTHOR]

The article comments on the paper "Moral Reckoning in Nursing," by Alvita K. Nathaniel. Nathaniel gave the nurses an opportunity to recount a past troubling experience within a safe environment and to tell the story to someone who was definitely interested in what was being said. She analyzes moral distress and considers both what precedes the distress and its aftermath rather than focusing solely on the concept of moral distress. The process of moral reckoning aids in understanding what is occurring as nurses live with the troubling situations.

Background: Understanding caregiver's perceptions of their family member's memory loss is a necessary step in planning nursing interventions to detect and address caregiver burden. Objective: The purpose of this study was to characterize caregivers' perceptions of their family members' memory loss and identify potential correlates within Leventhal's common sense model (CSM). Methods: This secondary analysis used baseline data from a larger randomized controlled trial. Patients with memory loss and their caregivers (N = 83 dyads) from the community were included. The adapted Brief Illness Perception Questionnaire (BIPQ) assessed caregivers' illness perceptions. Eight additional instruments measured correlates within the CSM. Responses were described; multiple linear regression was used to predict BIPQ dimension scores, and logistic regression was used to predict dichotomized BIPQ scores. Results: Most caregivers were female, White, and spouses of the patients; they reported a range of perceptions on the nine BIPQ dimensions. Patients' cognitive function consistently emerged as a significant correlate of caregivers' illness perceptions, explaining the most variance in caregivers' perceived consequences, identity, and treatment control (p < .01). Caregivers' reactions to patients' behavioral symptoms and caregivers' trait anxiety were associated with perceived illness coherence (p < .01). Caregivers with higher severity of daily hassles and White caregivers perceived that their family members' memory loss would last longer (p < .001). Discussion: Caregivers' perceptionsof family members' memory loss varied; distinct dimensions of caregivers' illness perception were associated with a range of clinical and psychosocial factors. This exploratory study demonstrates the complexity of applying the CSM to caregivers of persons with memory loss. [ABSTRACT FROM AUTHOR]

The article discusses a study to describe the assessment of fidelity to the structured intervention protocol in an examination of a nurse-delivered telephone intervention designed to improve medication adherence for individuals with HIV/AIDS. It offers details related to fidelity assessment that involved random selection and review of the audiorecorded intervention sessions, stratified by interventionist, and the use of visual analog scales. Also discussed is the result of the study.