Dignita' professionale infermieristica: una metasintesi (2012)

Aim and Objective

This meta-synthesis analyze qualitative and theoretical studies regarding nursing professional dignity. 

Nursing professional dignity should be maintained in practice every day, especially in relations with health care recipients and other professionals. The first facet of dignity (patients’ dignity) is an intrinsic value demonstrated by health professionals, especially nurses. Nursing scholars declare that ‘respect for human dignity is our sea, our common community…’¹ and that it resides in the empathic encounter with patients. Patients’ dignity has been studied extensively by different professions in the health care sector, as underlined by empirical research in palliative care and dignity in dying,^2-6 and in older adults and vulnerable people.^7-9 The second facet of dignity, that of a self-regarding professional right, remains underexplored¹⁰ and an unclear concept in nursing¹¹. Nursing professional dignity as a distinct concept does not have a clear definition in the literature, but nursing research, labour studies, organisational and related health research has provided descriptions of the elements that have an influence on nursing professional dignity.

Background

The first facet of dignity (patients’ dignity) is an intrinsic value demonstrated by health professionals, especially nurses. Patients’ dignity, has been studied extensively by different professions in the health care sector. The second facet of dignity, that of a self-regarding professional right, it is underexplored and an unclear concept in nursing and for nurses and is still in need of a better clarification.

Design

Meta-synthesis of qualitative and theoretical studies.

Method

Several electronic databases have to be searched to identify studies published between January 1995 and December 2010. Additional searches will be conducted by hand searching relevant ethics journals (Journal of Medical Ethics, Nursing Philosophy, Nursing Ethics, Bioethics) and contact with relevant authors.

Results

It’s expected to get a better comprehensive understanding of the concept of nursing professional dignity and to have a better clarification of the different factors involved in the phenomenon to add new knowledge to this tenet

General aims

- The present study will aim to explore nursing professional dignity as a complex, multivalent concept, composed of social elements¹² and intrinsic characteristics of the person¹³ and to add theoretical knowledge on this concept. These elements are inextricably interconnected. The main factors of these two concepts overlap and are constituted of: personal characteristics of every person,¹⁴  intra- and inter-professional relations,¹⁵ workplace characteristics,¹⁰ teamworking,¹⁶ professional competence and experience of nurses,¹⁷ social recognition by the general public, and professional autonomy.^18,19

A tentative theoretical framework on nursing professional dignity will be developed as a further development of this review.

Specific aims

Some indicators of nursing professional dignity such as: satisfaction/non-satisfaction, respect/no respect, are broadly referenced in the literature and concern interrelated organizational and human conditions,²⁰ organizational justice in its interactional dimension,^21,22 were already underlined and have a strong impact on satisfaction in work settings^.23,24 Other factors to comprehend deeply this particular concept can be discovered by the interpretation of different researches and theoretical studies on this topic.

Data Collection

We will try to identify qualitative studies including phenomenologies, ethnographies, grounded theories, and other integrated and coherent descriptions or explanations of nursing professional dignity. Studies will be identified through searches of the electronic data-bases: Medline, CINAHL, PsycINFO, Sociological Abstracts and Scopus, by combining keywords of nursing professional dignity, respect, nurses dignity, professional respect; these terms, used singly and/or in combination, will include case studies, qualitative studies and the truncated terms. The five databases will be chosen because they include a nursing focus, encompass nursing and health-related research or indexed international literature. In particular, CINAHL is known to use methodological indexing terms that accurately capture qualitative research design²⁵.

The time interval for the database searches will be from 01/01/1995 through 2010. A 15 years period was chosen deliberately to create a manageable sample for analysis. Besides, a hand searching of key qualitative research and ethics journals will be performed (Nursing Ethics, Journal of Medical Ethics, Nursing Philosophy, Bioethics).

Two experienced health sciences librarian will assist with the searches to help ensure that all pertinent studies will be retrieved. Results will not be limited to English language publications.

Qualitative studies conducted from a variety of epistemological and methodological orientations will be included for synthesis because the complementary nature of findings from this particular concept.

There will be two criteria for inclusion into the meta-synthesis: (a) The focus of the study on nursing professional dignity (b) the studies accepted will have to be qualitative or with a philosophical framework. No specifications regarding type of qualitative design will limit inclusion.

Data Analysis

Meta-synthesis research in nursing signals a new era in nursing theory and method and evokes ontological, epistemological, and methodological questions related to doing research on research.

The analysis of data in this study will be inspired by the meta-ethnographic method developed by Noblit and Hare.²⁶ This method is a process of re-conceptualisation of themes across qualitative and theoretical studies. This task involves the transfer of ideas, concepts and metaphors across different researches. Interpretations and explanations in the original studies undergo a process of deconstruction, translation and reconstruction. This process is a means to grasp the particular within the whole. A distinguish characteristic of this method is that translations are not literal but are concerned with the preservation of meaning across studies. The basic data that will derive from the reading of the papers selected and will consist of the main concepts or metaphors found in each of the individual works. These concepts will be related to each other and then translated into one another. The synthesis of these findings will make a new whole, and the results of this synthesis could be seen as a basis of an explanatory framework concerning nursing professional dignity. This type of literature review is integrative cause of the particular field of the research and the different types of research designs and multiple qualitative and theoretical studies included.

The results of the research project will be published in both national and international scientific journals. The knowledge produced by the research project will have scientific, societal and educational significance. Nursing, as a profession, can be understood more deeply and fruitfully than before exploring the different factors that constitute nursing professional dignity and this could have a beneficial effect for society and health professionals. Furthermore, this meta-synthesis will shed a light on nursing professional dignity that involves analyses and theory generating syntheses that will remain faithful to the interpretive rendering in each study²⁷. The aim of meta-synthesis is to interpret and integrate, beyond aggregating, the research in the field of the particular phenomenon that has been chosen and to recognize variation and alternative perspectives.

¹Jacobs BB. Respect for human dignity: a central phenomenon to philosophically unite nursing theory and practice through consilience of knowledge. Adv Nurs Sci 2001; 24:17-35.

²Chochinov HM. Dignity-conserving care. A new model for palliative care. JAMA 2002; 287: 2253–60.

³Chochinov HM. Defending dignity. Palliat Support Care 2003; 1: 307–8.

⁴Chochinov HM. Dignity and the eye of the beholder. J Clin Oncol 2004; 22: 1336–40.

⁵Chochinov HM., Hack T, Hassard T, Kristjanson L, McClement S and Harlos M. Dignity in the terminally ill: A cross-sectional, cohort study. Lancet 2002; 360: 2026–30.

⁶Chochinov HM., Hack T, McClement S, Kristjanson L and Harlos M. Dignity in the terminally ill: A developing empirical model. Soc Sci Med 2002; 54: 433–43.

⁷ Lothian K, Philp I. Maintaining the dignity and autonomy of older people in healthcare setting. Brit Med J 2001; 322: 668-70.

⁸Jacelon CS. The dignity of elders in an acute care hospital. Qual Health Res 2003; 13: 543-56.

⁹Jacelon CS, Connelly TW, Brown R, Proulx K, Vo T. A concept analysis of dignity for older adults. J Adv Nurs2004; 48: 76-83.

¹⁰Lawless J, Moss C. Exploring the value of dignity in the work-life of nurses. Contemp Nurse2007; 24: 225-36.

¹¹Gallagher A. Dignity and respect for dignity; two key health professional values: implications for nursing practice.  Nurs Ethics 2004, 11: 587-599.

¹² Jacobson  N. Dignity and health: a review, Soc Sci Med2007; 64: 292–302.

¹³Armstrong A. Towards a strong virtue ethics for nursing practice. Nurs Philos 2006; 7: 110-24.

¹⁴Begley AM. Practising virtue: a challenge to the view that a virtue centred approach to ethics lacks practical content. Nurs Ethics 2005; 12: 622-37.

¹⁵Duddle M, Boughton M. Intraprofessional relations in nursing. J Adv Nurs2007; 59: 29-37.

¹⁶Molyneux J. Inter-professional teamworking: what makes teams work well?  J Interprof Care2005; 15: 29-35.

¹⁷ Pullon S. Competence, respect and trust: key features of successful inter-professional nurse-doctor relationships. J Interprof Care 2008; 22: 133-47.

¹⁸ Varjus SL, Leino-Kilpi H, Suominen T. Professional autonomy of nurses in hospital settings; a review of the literature.  Scand J Caring Sci 2011; 25: 201-7.

¹⁹ Iliopoulou KK, While AE. Professional autonomy and job satisfaction: survey of critical care nurses in mainland Greece. J Adv Nurs2010; 66: 2520-31.

²⁰ Seedhouse D, Gallagher A. Undignifying institution. J Med Ethics 2002; 28: 368–72.

²¹Van Yperen N, Hagedoorn M, Zweers M, Postma S. Injustice and employees’ destructive responses: the mediating role of state negative affect. Soc Justice Res 2000; 13: 291-312.

²²Colquitt JA, Conlon DE, Wesson MJ, Porter COLH, Ng KY. Justice at the millennium: a meta-analytic review of 25 years of organizational justice research. J Appl Psychol 2001; 86: 425-45.

²³Kramer M, Hafner LP. Shared values: impact on staff nurse job satisfaction and perceived productivity. Nurs Res 1989; 38: 172-77.

²⁴Flynn L, Carryer J, Budge C. Organizational attributes valued by hospital, home care, and district nurses in the United States and New Zealand. J Nurs Scholarship 2005; 37: 67-72.

25. Flemming K., Briggs M (2006).Electronic searching to locate qualitative research: evaluation of three strategies. Journal of Advanced Nursing, 57 (1): 95-100.

26 Noblit G and Hare R.Metaethnography: Synthesizing Qualitative Studies, Vol. 11. London: SAGE, 1988.

27 Barroso, J., Gollop, C. J., Sandelowski, M., Meynell, J., Pearce, P. F., & Collonis, L. J. (2003).The challenges of searching for and retrieving qualitative studies. Western Journal of Nursing Research, 25, 153-178.