Search

The majority of healthcare professionals regularly witness fragility, suffering, pain and death in their professional lives. Such experiences may increase the risk of burnout and compassion fatigue, especially if they are without self-awareness and a healthy work environment. Acquiring a deeper understanding of vulnerability inherent to their professional work will be of crucial importance to face these risks. From a relational ethics perspective, the role of the team is critical in the development of professional values which can help to cope with the inherent vulnerability of healthcare professionals. The focus of this paper is the role of Communities of Practice as a source of resilience, since they can create a reflective space for recognising and sharing their experiences of vulnerability that arises as part of their work. This shared knowledge can be a source of strength while simultaneously increasing the confidence and resilience of the healthcare team.

The good health and well-being of health care professionals is increasingly an important issue and one that is under threat due to dominant neo-liberal economic factors. These factors influence health care service delivery which in turn focuses less on employee workplace satisfaction and more on profit-making corporate business models. More work with less pay/benefits, less time to work with clients and the focus on outcomes has created workplaces in which employees are experiencing negative organisational cultures that, in turn, affects their health and well-being. One negative effect is compassion fatigue (CF). In Canada, a national inter-disciplinary research project was conducted for health professionals (n = 52) who self-identified as experiencing CF. From this research, an analysis of a sub-sample of the data of fourteen social workers was conducted identifying specific institutional factors that participants described as creating conditions for their CF. These factors are presented including: (i) cost-effective services within time constraints and political climates; (ii) erosion of relationship building; (iii) lack of communication between managers and front line workers; (iv) cutbacks in services; (v) climate of fear; and (vi) outcome measurement requirements. These concerns related to workplace environments and the health and well-being of health professionals are discussed.

People with mental illness are subjected to stigma and discrimination and constantly face restrictions in the exercise of their political, civil and social rights. Considering this scenario, mental health, ethics and human rights are key approaches to advance the well-being of persons with mental illnesses. The study was conducted to review the scope of the empirical literature available to answer the research question: What evidence is available regarding human rights and ethical issues regarding nursing care to persons with mental illnesses? A scoping review methodology guided by Arksey and O’Malley was used. Studies were identified by conducting electronic searches on CINAHL, PubMed, SCOPUS and Hein databases. Of 312 citations, 26 articles matched the inclusion criteria. The central theme which emerged from the literature was “Ethics and Human Rights Boundaries to Mental Health Nursing practice”. Mental health nurses play a key and valuable role in ensuring that their interventions are based on ethical and human rights principles. Mental health nurses seem to have difficulty engaging with the ethical issues in mental health, and generally are dealing with acts of paternalism and with the common justification for those acts. It is important to open a debate regarding possible solutions for this ethical dilemma, with the purpose to enable nurses to function in a way that is morally acceptable to the profession, patients and members of the public. This review may serve as an instrument for healthcare professionals, especially nurses, to reflect about how to fulfil their ethical responsibilities towards persons with mental illnesses, protecting them from discrimination and safeguarding their human rights, respecting their autonomy, and as a value, keeping the individual at the centre of ethical discourse.

In 2015, the Canadian Counsel of Registered Nurse Regulators released a report that identified entry-to-practice core competencies for adult, family/all ages, and pediatric nurse practitioners (NPs) across Canada. The report is expected to guide future decisions about NP entry-to-practice examinations and allow for Canadian Counsel of Registered Nurse Regulators member organizations to develop pan-Canadian requirements for licensure. Optimistically, it could set the stage for a national approach to NP education. This is an opportune time to highlight various stakeholders' call for increased mental health education for NPs and identify challenges and promising strategies for reaching that goal.

The purpose of this study was to determine how Canadian nurse practitioners (NPs) rate their levels of therapeutic commitment, role competency, and role support when working with persons with mental health problems. A cross-sectional descriptive, co-relational design was used. The Therapeutic Commitment Model was the theoretical framework for the study. A sample of 680 Canadian NPs accessed through 2 territorial and 9 provincial nursing jurisdictions completed a postal survey. NPs scored highest on the therapeutic commitment subscale and lowest on the role support subscale. The 3 subscales were correlated: role competency and therapeutic commitment were the most strongly associated (r = .754, p.001). To have a positive impact on the care of persons with mental health problems, educators, policy-makers, and NPs need to assess and support therapeutic commitment, role support, and role competency development.Cette étude a pour objectif de déterminer la façon dont les infirmières praticiennes canadiennes (IP) déterminent leur degré d'engagement thérapeutique, leur compétence de rôle et leur soutien de rôle dans des contextes de travail avec des personnes atteintes de troubles de santé mentale. Un cadre descriptif transversal corelationnel a été utilisé. Le modèle d'engagement thérapeutique a servi de cadre théorique. Un échantillon de 680 IP canadiennes recrutées dans deux juridictions territoriales et neuf juridictions provinciales infirmières ont rempli un sondage envoyé par la poste. Les IP ont obtenu le score le plus élevé quant à la sous-échelle de l'engagement thérapeutique et le score le plus faible quant à la sous-échelle du soutien de rôle. Les trois sous-échelles ont été corrélées: la compétence de rôle et l'engagement thérapeutique affichaient l'association la plus élevée (r = 0,754, p0,001). Pour assurer un impact positif sur les soins aux personnes atteintes de troubles de santé mentale, les éducateurs, les décideurs et les IP doivent évaluer et soutenir l'engagement thérapeutique, le soutien de rôle et le développement de compétences de rôle.

Les professionnels de la santé sont des agents moraux dont la relation fiduciaire avec le public est animée par la responsabilité et la promesse de puiser dans leurs connaissances et leurs habiletés pour aider les personnes sous leurs soins. Lorsque leur capacité à tenir cette promesse est freinée ou compromise, ils risquent de souffrir de détresse morale. Le concept de détresse morale est défini et mis en contexte dans le milieu de la santé. Les contraintes et les facteurs qui en sont à l’origine sont présentés, de même que les moyens utilisés par les professionnels de la santé et les organisations de santé pour la soulager. Un changement transformateur s’impose pour vaincre la culture du silence et maintenir un système de santé où il est possible de vivre avec sa conscience.

BACKGROUND: ~30% cancer patients develop brain metastases (BM), reflected by ~1600 BM patients treated at MD Anderson Cancer Center annually. With advances in systemic therapy and extracranial disease control, BM is a growing challenge. Multi-disciplinary BM management is critical and complex requiring coordination of multiple oncology sub-specialties. There is limited data on pragmatic clinic models to streamline and advance care. METHODS: Recognizing deficiency in BM treatment and research, a steering committee was formed at MDACC to establish an interdisciplinary BM clinic (BMC), with a multi-disciplinary BM research retreat held in 2016. The goal of BMC was to centralize patient referrals, improve patient outcomes and experience, and advance research by developing clinical trials and biomarker discovery programs. Meetings were held to address BMC format, workflow, EMR integration, data collection infrastructure, and staffing model. RESULTS: MDACC BMC clinic opened in 01/2019 with two half-day clinics staffed by neurosurgery, neuro-radiation oncology, neuro-radiology and medical/neuro oncology. A dedicated advanced practice provider screens the referrals according to a well-developed algorithm. A multidisciplinary conference is held immediately before each clinic where patient images are reviewed, cases are discussed and consensus recommendations are developed. The treatment plan and follow up appointments are arranged at the completion of the clinic visit to expedite care. ~50 patients have been seen with excellent patient satisfaction response and reduced time to treatment. ~20% patients had major change in treatment plan following multi-disciplinary evaluation. Additional efforts to develop a central BM database along with clinical and translational research programs are on-going. CONCLUSIONS: Establishment of a multi-disciplinary BMC to facilitate care and centralize research programs addresses a critical need for coordinated patient-centered BM management. This endeavor has enhanced patient experience through multi-specialty collaboration. Our program demonstrates the feasibility and effectiveness of a dedicated BMC in the treatment of this complex patient population.

Background: Limited knowledge of the experiences of conflicts of conscience found in nursing literature. Objectives: To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta. Research design: Interpretive description was selected to help situate the findings in a meaningful clinical context. Participants and research context: Five interviews with neonatal nurses working in Neonatal Intensive Care Units throughout Alberta. Ethical consideration: Ethics approval from the Health Research Ethics Board at the University of Alberta. Findings: Three common themes emerged from the interviews: the unforgettable conflict with pain and suffering, finding the nurse’s voice, and the unique proximity of nurses. Discussion and conclusion: The nurses described a conflict of conscience when the neonate in their care experienced undermanaged pain and unnecessary suffering. During these experiences, they felt guilty, sad, hopeless, and powerless when they were unable to follow their conscience. Informal ways to follow their conscience were employed before declaration of conscientious objection was considered. This study highlights the vital importance of respecting a conflict of conscience to maintain the moral integrity of neonatal nurses and exposes the complexities of conscientious objection.

Healthcare professionals are moral agents whose fiduciary relationship with the public is animated by responsibility and the promise to use knowledge and skills to aid those in their care. When their ability to keep this promise is constrained or compromised, moral distress can result. Moral distress in healthcare is defined and outlined. Constraints and factors that lead to moral distress are identified as are the means that individual professionals and organizations use to address it. A call is made for transformative change to overcome a culture of silence and to sustain a healthcare system that is morally habitable.

Purpose To describe parental perceptions of decision making concerning their extremely premature newborns who received care in a level III neonatal intensive care unit (NICU). Subjects Seven parents of preterm infants who were born at 24 to 26 weeks' gestation at a western Canadian tertiary NICU. Design Qualitative, interpretive description, semistructured interviews. Methods The first author conducted interviews with both parents together or the mother alone. Interviews were recorded, transcribed, and analyzed. Results Three main themes related to decision making, culture shock, and relationships emerged: (1) decision making before and in the NICU: moving beyond information, (2) culture shock in the NICU: plunging into a strange land, and (3) relationships in the NICU: enduring in a strange land. Conclusions Although information and decision making are interconnected and fundamental to parents' experiences of their preterm baby's NICU stay, they also identified the culture and language of the NICU and genuine relationships formed with healthcare professionals as significantly influencing their experiences.

Once a term used primarily by moral philosophers, "moral distress" is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? "Plight" encompasses not only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of "efficiency," is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals' moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim.

Corporate and commercial values are inducing some healthcare organizations to prescribe a customer service model that reframes the provision of nursing care. In this paper it is argued that such a model is incommensurable with nursing conceived as a moral practice and ultimately places nurses at risk. Based upon understanding from ongoing research on compassion fatigue, it is proposed that compassion fatigue as currently experienced by nurses may not arise predominantly from too great a demand for compassion, but rather from barriers to enacting compassionate care. These barriers are often systemic. The paradigm shift in which healthcare environments are viewed as marketplaces rather than moral communities has the potential to radically affect the evolution of nursing as a discipline.

It is considered the right of children to have their pain managed effectively. Yet, despite extensive research findings, policy guidelines and practice standard recommendations for the optimal management of paediatric pain, clinical practices remain inadequate. Empirical evidence definitively shows that unrelieved pain in children has only harmful consequences, with no benefits. Contributing factors identified in this undermanaged pain include the significant role of nurses. Nursing attitudes and beliefs about children’s pain experiences, the relationships nurses share with children who are suffering, and knowledge deficits in pain management practices are all shown to impact unresolved pain in children. In this article, a relational ethics perspective is used to explore the need for nurses to engage in authentic relationships with children who are experiencing pain, and to use evidence-based practices to manage that pain in order for this indefensible suffering of children to end.

The words well-being, health, and wellness are commonly used in an interchangeable manner by health care professionals and the lay public. We undertook a hermeneutic phenomenological study of well-being and discovered a soulful strength and a rhythmic flow to this lived experience. There is a letting go that is experienced as a tension and rhythmic interchange, as in breathing. Harmony and balance lie at its foundation. Well-being requires a personal drive to exist. It is not experienced through purposeful means; rather, it is experienced in a self-forgetful way, in the free space where life unfolds and where people come to see their worlds in different ways. The results of this research suggest the experience of well-being holds a significant place within nursing practice for clients and for nurses.

Forensic psychiatry has been described as a ‘moral minefield’. The competing obligations at the interface of the justice and healthcare systems raise questions about the very viability of an ethical framework for guiding practice. The explicit need for security and detention, and the implicit ‘untrustworthiness’ of forensic patients shape practitioners' everyday reality. Suspicion colors client–practitioner relationship and fundamental care concepts, such as patient advocacy, take on different nuances in this milieu. Despite the complex ethical demands of this unique practice area, it has received little attention within mainstream bioethics. There is, however, a growing imperative to find a theory of ethics for the specialty. In this article, the ethics of forensic psychiatry is examined, and it is argued that relational ethics is a fitting framework for forensic practice and, further, that forensic settings are the very place to test the validity of such an ethic.

Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.

The term compassion fatigue has come to be applied to a disengagement or lack of empathy on the part of care-giving professionals. Empathy and emotional investment have been seen as potentially costing the caregiver and putting them at risk. Compassion fatigue has been equated with burnout, secondary traumatic stress disorder, vicarious traumatization, secondary victimization or co-victimization, compassion stress, emotional contagion, and counter-transference. The results of a Canadian qualitative research project on nurses’ experience of compassion fatigue are presented. Nurses, self-identified as having compassion fatigue, described a change in their practice by which they began to shield and distance themselves from the suffering of patients and families. Time to help patients and families cope with suffering seemed unavailable, and many felt they were running on empty and, ultimately, impotent as nurses. Feelings of irritability, anger, and negativity arose, though participants described denying or i...

In this Canadian study, a participatory action research approach was used to examine the relationships between families of residents of traditional continuing care facilities and the health care team. The objectives were to (a) explore the formation and maintenance of family—staff relationships, with attention paid to the relational elements of engagement and mutual respect; (b) explore family and staff perspectives of environmental supports and constraints; and (c) identify practical ways to support and enhance these relationships. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships. The nature of these relationships are discussed using the themes of “Everybody Knows Your Name,” “Loss and Laundry,” “It's the Little Things That Count,” and “The Chasm of Us Versus Them.” Families' and staff's ideas of behaviors that support or undermine relationships are identified, as are concrete suggestions for improving family— staff relationships in traditional continuing care settings in Canada.

Community treatment orders (CTOs) are legal mechanisms by which an individual with a mental illness and a history of non-compliance and potential for violence can be mandated (against their will) to undergo psychiatric treatment in an outpatient setting. Although CTOs are increasingly being adopted by governments as a means of protecting both mentally ill persons and society itself, their use continues to stimulate considerable debate. While there is some evidence of their potential benefits in promoting treatment compliance and reducing hospital stays, there is concern that they infringe on the mental health client's human rights and freedoms. Consideration of the ethical and practical implications of the use of CTOs must continue. In this paper, some of the most pressing issues are identified and discussed.

Healthcare practitioners make many important ethical decisions in their day-to-day practices. Questions arising in daily practice require practitioners to make prudent, balanced and good decisions, which are most effectively made interpersonally and reflectively. It is commonly assumed that the team-based structure of healthcare delivery can provide practitioners with the support needed to address ethical questions in their practice, especially if the team involves multidisciplinary collaboration. A phenomenological study was conducted in which the impact of the team and the larger organization on practitioners' experiences of dealing with moral challenges was uncovered. Various mental healthcare professionals shared their experiences of ethically challenging situations in their practices and described the ways in which their teammates and supervisors affected how they faced these troubling situations. These findings allow us to see that there is considerable room for healthcare managers, many of whom are nurses, to facilitate supportive, ethical environments for healthcare professionals. An understanding of the essential experience of practising ethically allows for an appreciation of the significance of the team's role in supporting it and enables healthcare managers to target support for ethical healthcare work.

In this article, we report on a web-based survey of 517 qualitative researchers' perceptions of the risks inherent in qualitative unstructured interviews. Although emotions manifest during these qualitative interviews may be viewed as “natural” in the context of the types of losses experienced by the interviewees, the emotional responses cannot be identified in an Institutional Review Board (IRB) review of the proposal. The mitigation of this emotional response is, however, the responsibility of the researcher, and ethics education and short courses must include such instruction. Psychological harm to the researcher, although rare, is a possibility for which researchers must be prepared. The authors conclude by suggesting six principles of ethical conduct for qualitative researchers. These principles should be useful to IRBs and included in ethics and qualitative methods courses.

The specialization of contemporary academia necessitates the adoption of a multidisciplinary approach to study topics that cross multiple disciplines, including the area of medical ethics. However, the nature of multidisciplinary research is limited in some regards, further requiring some researchers to use interdisciplinary and transdisciplinary approaches. The authors present as a case study a research project in bioethics that began as an interdisciplinary study and which, through the research process, moved to being a transdisciplinary study in health ethics. They outline not only this transformation but also the strengths and difficulties of transdisciplinary research in the area of ethics.

Experiences of moral distress encountered in psychiatric practice were explored in a hermeneutic phenomenological study. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychiatrists describe struggling 'to do the right thing' for individual patients within a societal system that places unrealistic demands on psychiatric expertise. Certainty on the part of the psychiatrist is an expectation when judgments of dangerousness and/or the need for coercive treatments are made. This assumption, however, ignores the uncertainty and complexity of reality. Society entrusts psychiatrists to care for and treat those among its most vulnerable members: persons deemed to have a severely diminished capacity for autonomy due to a mental disorder. Simultaneously, psychiatrists are held accountable by society for the protection of the public. Moral distress arose for psychiatrists in their efforts to fulfill both roles. They described an 'outsider/insider' status and the ways in which they attempted to cope with moral distress.

There are many ethical issues arising for practitioners in what are termed the boundaries of professional helping relationships. In this article, the authors argue that the boundary metaphor is not sufficient for conceptualizing these ethical issues and propose that alternative metaphors be considered. The use of a different metaphor might allow practitioners to re-vision the relationship issues in a more realistic, richer, and holistic way. Those explored here include highway, bridge, and territory. For the authors, it is territory that seems to hold the greatest promise.

When health practitioners' moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non-professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe the experience of moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses' possible responses to intolerable situations.

The ethical conduct of nursing research is of importance to all registered nurses: those caring for persons who are research participants; those involved in recruitment for research; those who are nurse research assistants; those on research ethics boards (REBs); and those preparing the next generation of nurse researchers. A very useful guide that speaks to nurses across research-related roles is the Ethical Research Guidelines for Registered Nurses (Canadian Nurses Association, 2002). This guide underscores the broad and deep involvement of nurses in research and the responsibilities that such involvement entails.

This article reports the findings of a qualitative study (secondary analysis) that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units (PICUs) across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were identified. This study provides a rare and important multi-disciplinary perspective on this topic and the findings have implications for administrators and leaders who seek to improve the moral climate of healthcare delivery.

1. The pressure of the competing demands of custody and caring shapes the moral climate of forensic settings. 2. A relational approach to health care ethics, requiring the opening of dialogue, consideration of multiple perspectives, and attention to context, can guide nurses as they strive to engage and respect even their most estranged patients. 3. The core elements of relational ethics include mutual respect, engagement, and attention to the environment.

Canadian psychiatric nurses (N = 1,701) participated in a survey in which theyassessed their ability to nurse clients with a history of sexual abuse when cultural differences are present. Thirty-nine percent worked at a facility having a significant number of clients from a different culture. Only 4.6% rated themselves as “very competent.” Four themes emerged from nurses’ assessment of their ability: culture is not the problem, culture is not an issue, culture influences perspective and responses, and culturally specific competence. Only one cultural group, First Nations, was identified by sufficient numbers of nurses to generate themes concerning the challenge of working with clients from a particular culture. These themes (abuse as a cultural norm, concurrent and related health and social problems, reluctance to talk about problems, a need to learn about First Nations culture, and developing culturally competent caregivers), critical areas of concern, and possible solutions suggested by the nurses are discussed.

Compulsory community treatment (CCT) of people with serious mental health problems is analysed using the bioethical principles of autonomy and beneficence. Feminist ethical theory is then used to clarify these principles as they relate to community commitment of the severely and persistently mentally ill. Finally, a model of practice is proposed as an alternative to CCT in which both autonomy and beneficence are better served.

Background : There is strong evidence that a history of sexual abuse can have serious psychologic sequelae. Objective : The purpose of the study was to assess the comfort, attitudes, identified competencies, and educational needs of psychiatric nurses who work with these clients. Study Design : Surveys were mailed to a random sample of 3542 nursing personnel in four Canadian provinces. Measures were used to assess comfort, sexual attitudes, competencies, and educational needs. Results : A response rate of 48% (1701 responses) was achieved. Comfort and competency regarding working with clients varied according to educational preparation, gender of the nurse, and a personal history of abuse ( p Conclusion : The surveys showed that significant numbers of nurses are working with clients who report a history of sexual abuse. However, most participants do not believe they have adequate knowledge or therapeutic skills to work with these clients. Information from this study should provide direction for content of sexual abuse education programs.

BACKGROUND: There is strong evidence that a history of sexual abuse can have serious psychologic sequelae.OBJECTIVE: The purpose of the study was to assess the comfort, attitudes, identif ed competencies, and educational needs ofpsychiatric nurses who work with these clients.STUDY DESIGN: Surveys were mailed to a random sample of 3542 nursing personnel in four Canadian provinces. Measures were used to assess comfort, sexual attitudes, competencies, and educational needs.RESULTS: A response rate of 48% (1 701 responses) was achieved. Comfort and competency regarding working with clients varied according to educational preparation, gender of the nurse, and a personal history of abuse (p CONCLUSION: The surveys showed that significant numbers of nurses are working with clients who report a history of sexual abuse. However, most participants do not believe they have adequate knowledge or therapeutic skills to work with these clients. Information from this study should provide directionfor content of sexual abuse education programs.

The purpose of the present study was to further contribute to the psychometric evaluation of the Sexual Abuse Comfort Scale (SACS) in order to provide a standardized measure that would assess the impact of educational programmes on nurses' comfort to intervene with psychiatric clients regarding sexual abuse. This study was part of a larger multisite study conducted in four Canadian provinces, designed to assess the attitudes, beliefs, competencies and educational needs of psychiatric nurses who may work with clients who have been sexually abused. As part of the larger study, a self-administered survey was sent to 3532 psychiatric nurses employed in Alberta, Saskatchewan, Ontario and Nova Scotia. The SACS, the Sexual Attitudes Scale (SAS), the Questionnaire Measure of Emotional Empathy (QMEE) and the Marlowe-Crowne Social Desirability Scale (M-CDS) were included in the survey. The SACS was submitted for item analysis, factor analysis, hypothesis testing regarding construct validity and assessment of concurrent validity. Item analysis of the SACS resulted in a 30-item scale with a coefficient of 0.91, indicating an excellent level of reliability. Empirical evidence indicates that the SACS is a reliable and valid instrument that may be used for the effective evaluation of intervention programmes directed towards increasing clinical knowledge and competence related to sexual abuse.

Preschool children, aged 2 to 5 years, were given a memory task that required them to repeat a list of animal names and a sentence imitation task. A sample of their spontaneous speech was also recorded. Word span was found to predict sentence imitation scores across the whole preschool age range. Word span and chronological age (CA), together, also predicted the mean length of utterance in spontaneous speech in younger preschool children. In a replication with children aged 2 to 3 years, word span predicted mean length or utterance (MLU) better than both CA and mental age (MA). These results extend previous findings regarding the relationship between word span and language imitation to younger preschool children. They also support the notion of a memory constraint on early spontaneous language. Increasing mastery of linguistic rules appears to obviate a memory constraint on spontaneous language, at least with these measures.

This paper explores mental health professionals' experiences working with correctional staff--one aspect of an interdisciplinary phenomenological study of ethical practice in forensic psychiatry. Professionals describe this relationship as coexisting within the system, despite their often conflicting roles. In correctional officers' overt concern for custody and control, practitioners can perceive a "paramilitary mentality" with which they struggle to work. Conversely, practitioners can experience conflict with security personnel for appearing "too caring" or "too sympathetic" to offenders--being "con-lovers." The balance practitioners establish between working with inmates and working alongside facility security is one of walking a fine line.

When nurses have active and untreated addictions, patient safety may be compromised and nurse-health endangered. Genuine responses are required to fulfil nurses' moral obligations to their patients as well as to their nurse-colleagues. Guided by core elements of relational ethics, the influences of nursing organizational responses along with the practice environment in shaping the situation are contemplated. This approach identifies the importance of consistency with nursing values, acknowledges nurses interdependence, and addresses the role of nursing organization as moral agent. By examining the relational space, the tension between what appears to be opposing moral responsibilities may be healed. Ongoing discourse to identify authentic actions for the professional practice issue of nursing under the influence is called upon.

The curative focus of critical care and the advanced technology may overshadow the fact that critically ill patients die. Research investigating critical care nurses involvement with death has predominately focused on experienced nurses, but these findings may not be applicable to novice nurses. Increasingly, novice nurses are beginning their careers in critical care and there is minimal research describing their experiences with death.To explore the experiences of novice nurses with their first patient death in critical care.Approval was received by the University of Alberta Health Research Ethics Board and the health region's Nursing Division Administration to conduct a qualitative research study. Five nurses, employed in a medical-surgical intensive care unit, participated in the study. Data collection involved an unstructured interview with each participant.Analysis of the data revealed five themes: anticipating death, transition from life to death, the moment of death, being with the family, and carrying on. These findings are discussed with implications for academic and clinical settings and suggestions for future nursing research.

AIDS stigma has serious consequences. This study explored those practices within health-care organizations that persons with HIV perceive as stigmatizing. It used an exploratory, descriptive design using a participatory action research approach. Interviews and focus groups were conducted with 16 Aboriginal and 17 non-Aboriginal persons living with HIV as well as with 27 health-care providers. The AIDS stigma perceived by many participants often intersected with other forms of stigma, related to behaviour, culture, gender, sexual orientation, or social class. In addition, policies at the organizational level contributed to AIDS stigma and at times intersected with stigma at the individual level. Participants' experiences of stigma and discrimination were shaped by the organizational policies (universal precautions, models of care) and design (physical layout) under which care was provided. Several paradoxes associated with secrecy, health-care settings, and the layering of stigma emerged in the reported experiences.

In times of contagion, the key role of nurses brings fears, dangers, and unique demands. The ethics of such challenges need to be explored and understood. Using Callahan's framework for thinking ethically and Taylor's "worries" of modern life, the author elucidates some of the challenges and then argues that the current approach to pandemic ethics, with its reliance on moral reasoning, is insufficient to guide nurses' ethical actions. Relational ethics, which explicitly situates ethics within relationships and our commitment to one another, and which recognizes that context matters in ethical decision-making, is offered as a viable alternative for nurses in considering how to respond.

Human rights may be the most globalized political value of our times. The rights paradigm has been criticized, however, for being theoretically unsound, legalistic, individualistic and based on the assumption that there is a given and universal humanness. Its use in the area of health is relatively new. Proponents point to its power to frame health as an entitlement rather than a commodity. The problems and the possibilities of a rights approach in addressing health ethics issues are explored in this article.

This was the first research study in Canada to explore intimacy boundary violations and sexual misconduct between nurses (both RNs and registered psychiatric nurses) and patients. Using a researcher-generated survey, a total of 923 mental health nurses commented on their sexual attraction to patients, and dating and sexual intercourse patterns with patients. The findings indicated that very few nurses had dated or engaged in sexual intercourse with discharged patients, and the few nurses who had done so tended to be younger men prepared at the registered psychiatric nursing diploma level. A small number of nurses believed it was permissible to have a sexual relationship with a patient while the patient was hospitalized, but none reported having a current relationship. Given the severity of this intimacy boundary violation, nurses need to be educated regarding the serious and dangerous psychiatric effects that can result for patients from engaging in a sexual relationship with nurses. The Code of Ethics of the Canadian Nurses Association and nurses' obligation to follow it needs to be reinforced. Nurses engaging in intimacy boundary violations are vulnerable to patient-initiated lawsuits.