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Biomedical subjects

M E Wurzbach

Publications and source records attributed to M E Wurzbach.

13 recordsLinked to original sources
PubMed1999

The moral metaphors of nursing.

The essence of metaphor is understanding and experiencing one thing in terms of another. Metaphorical concepts structure and reflect what we perceive, how we act, and how we relate to other people. In nursing ethics, several metaphors have emerged which have had a great impact on nursing practice. These metaphors include the military metaphor which exemplified nursing during the 1800s, the advocacy and academic metaphors which became a philosophical basis for nursing during the 1960s, and the individualist and community as caring metaphors which have emerged more recently. Although beneficial in some ways, these metaphors may be obscuring the complex moral reality of nursing practice. This article defines a moral metaphor, critiques nursing's moral metaphors, and provides an historical overview of their development with examples of how they have and do affect nursing practice.

Ethics, Nursing↗
PubMed1999

Acute care nurses' experiences of moral certainty.

Moral certainty is a common, vivid experience for many nurses, but it may be a mixed blessing. From one perspective moral certainty provides comfort for the ethical decision-maker and may prompt necessary action which would have been impossible without it. From another perspective, moral certainty stifles dialogue and in-depth discussion of moral issues. Despite the fact that moral certainty is ubiquitous in health care, few research studies have explored both the positive and negative aspects of this complex and sometimes troubling concept. A qualitative design was used to describe the experiences of 20 acute care nurses with moral certainty. They were interviewed and the interviews analysed using Colaizzi's method for qualitative data analysis. These nurses' primary responses to moral certainty were 'speaking up', 'standing up' and 'refusing to participate'. Their experiences with moral certainty, responses to it, reasons for responding as they did, and clinical prompts are described. The author concluded that moral certainty may have positive and negative aspects. Making an effort to hear alternative views is suggested.

Adult↗
PubMed1996

Comfort and nurses' moral choices.

Caring has been advocated as integral to nursing ethics, and much theorizing has suggested that it may be a partial or the entire foundation for nursing's ethic. Yet few research studies have examined the practical expression of caring in the clinical setting. The author describes the concept of comfort as an aspect of care experienced by long-term care nurses in their daily practice related to moral choices. The design of the study was descriptive and qualitative. The sample consisted of 15 registered nurses who were participants in the author's previous study of moral certainty and uncertainty. Their responses to interview questions during the previous study suggested the topic for the present study. A semi-structured interview consisting of eight neutral open-ended questions was conducted with each participant. The findings suggest that long-term-care nurses function in the roles of mediator and communicator. In these roles, they try to meet a mental ideal of "good nursing practice'. They use multiple criteria on which to base their moral choices including comfort, their own and their residents. The author examines the providing and feeling of comfort as related to the nurses' moral choices.

Adult↗
PubMed1996

Long-term care nurses' ethical convictions about tube feeding.

Moral certainty, uncertainty, or both have an impact on every ethical decision confronted by the nurse. This article describes a qualitative study of the moral certainty and uncertainty experienced by long-term care nurses who are faced with the issue of withholding or withdrawing artificial nutrition and hydration from elders in the end stages of life. Moral certainty and uncertainty are analyzed as universal concepts, and the analysis is supported by the words of the study participants. Morally certain participants view tube feeding negatively and are likely to take some action when confronted with elders being tube-fed. The most common action is to educate families about tube feeding. Morally uncertain participants see the tube feeding as neutral or benign and are likely to take no action, but to maintain a strong belief that the elder should not suffer. Moral certainty and uncertainty are compared and contrasted and the findings discussed.

Adult↗
PubMed1995

Long-term care nurses' moral convictions.

Moral certainty and uncertainty have a profound impact on nurses' ethical choices. In order to describe these concepts, the author examined long-term care nurses' convictions about the issue of withholding or withdrawing artificial nutrition and hydration from elders. A convenience sample of 25 BSN and MSN-prepared long-term care nurses were interviewed and asked to describe their experiences with this issue. A qualitative analysis utilizing Colaizzi's (1978) methodology was performed. Five categories of conviction emerged from the data. These five categories included absolute moral conviction, strong moral conviction, moderate moral conviction, moral uncertainty with conviction and moral uncertainty. Eighty-four per cent of the sample was convinced that tube feeding was not always in the resident's best interest. Sixteen per cent of the sample were uncertain, but were convinced that the resident should not suffer. A pattern emerged from the interview results and the answers to three additional questions. The pattern suggests that the more experience a nurse has with nontreatment the more likely she or he is to agree with it. In this paper, the five categories of conviction are compared and contrasted, the pattern of conviction described, and the implications of the findings for nursing discussed.

Adult↗
PubMed1991

Judgment under conditions of uncertainty.

Judgment is an important aspect of nursing practice. This author provides an historical overview of judgment theory, research evidence of the heuristics and biases used by decision makers in their judgments, and a discussion of the fallibility of inferred knowledge--with an emphasis on overconfidence as a primary bias in judgment. The content includes also suggestions for improving judgments, and the implications of normative and non-normative judgment models for nursing.

Choice Behavior↗
PubMed1990

The dilemma of withholding or withdrawing nutrition.

Recently, societal concerns have developed about the artificial prolongation of dying. Life extension is not always viewed as humanitarian. Artificial nutrition and hydration are seen frequently as necessary comfort measures and not merely life extenders. Now debate is rising about whether or not even these basic life support measures are not merely prolonging dying. In this paper, the issue of withholding or withdrawing nutrition and hydration from certain patients is discussed, including the competing ethical arguments, the nursing perspective and the implications of this dilemma for nursing, health care and society.

Beneficence↗
PubMedDate not supplied

Assessment and intervention for certainty and uncertainty.

Research suggests that high degrees of uncertainty and absolute certainty can be very stressful for nursing's clients. Yet, research also suggests that a moderate degree of unexpectedness, unpredictability, and uncertainty may actually produce positive effects--pleasure, hope, information pattern search, and a sense of well-being. The author discusses the research related to psychological certainty and uncertainty, provides suggestions for assessing clients' degree of certainty and uncertainty, and delineates interventions for dealing with detrimental levels of certainty and uncertainty. Precautions for instituting interventions are also stressed.

Adaptation, Psychological↗