Ethics is a hot topic these days. Home health care providers need not be ethicists, however they do need to be able to identify problems quickly, and know how to address them. This paper explores the ethical issues arising from a narrative analysis involving an advanced cancer patient receiving Total Parenteral Nutrition (TPN) at home. It shows how complicated it is today to make nutrition support decisions that would have been customary less than 30 years ago. For and against arguments of TPN for advanced cancer patients are reviewed. Ethical positions adopted by the medical and nursing professions are explored and contrasted. The importance of patient autonomy, within a holistic notion of care, including decisions incorporating quality of life, are affirmed, providing a challenge to monitoring the status quo in approaches to decision making.

OBJECTIVES: Substance abuse is nowadays a recurrent theme in the daily practice of occupational physicians (OP), mainly owing to recent legislation prescribing mandatory assessments for workers performing job tasks involving danger to third parties. While some degree of bureaucracy is inevitable and legislation seems to be inclined towards deterrence, it is recommended to take advantage of the opportunities offered for practical interventions which, in accordance with science and ethics, the OP can carry out in the workplace. Risk assessment, health surveillance, fitness for work, health promotion and cooperation in management issues are the areas of intervention required for the OP to fully accomplish his role in the practice of modern occupational health. CONCLUSIONS: We propose specific activities for the OP so as to highlight roles and obligations, based on available scientific evidence and established codes of ethics. Lastly, we wish to emphasize the overall role of the OP in taking on responsibilities shared jointly with all the parties and in the approach to the substance abuse problem in all workplaces with the ultimate goal of acting for the benefit of workers, enterprises and society in general.

Aim. This paper is a report of a study to explore the way in which Registered Nurses relate to and interact with each other in the workplace, and to identify factors that influence nurses' interactions with each other. Background. Intraprofessional relations are an important topic both for nurses and nursing as we face the ongoing challenges of nurse shortages. Poor colleague relationships, together with workplace conflict, cause job dissatisfaction. As a consequence, some nurses leave the profession while others continue working but remain chronically unhappy. Method. An explanatory multiple case study design was adopted. Data were collected from multiple sources on three different wards within one hospital in Australia between July 2005 and January 2006. Findings. The workplace can be a difficult place for both very experienced and less experienced nurses, regardless of the clinical environment. Nurses navigate their way in the workplace through a series of complex negotiations with each other and develop skills to assess the potential success of an interaction before approaching another nurse. Some also develop a resilience to conflict in their workplace, accepting it as part of working life. Conclusion. Creation of a more positive work environment requires increased understanding of the way nurses relate to each other and appreciation of the factors in the environment that contribute to conflict and a negative atmosphere. This appreciation is a necessary prerequisite to developing a more satisfying and productive workplace enhancing the recruitment of new nurses and the retention of experienced nurses.

Aim. This paper is a report of a study to (1) ascertain the relationship among self-nurturance, perceived Magnet features and life satisfaction and (2) evaluate the predictive effects of self-nurturance and Magnet features on life satisfaction. Background. Promoting health is a global priority for nurses and for the public who depend upon them to provide quality care. Health gains can be realized by modifying the work environment and by modifying lifestyle choices (self-nurturance). A study of nurses that examined perceptions of workplace features that enable nurses' professional practice (Magnet features), self-nurturance and healthy outcomes (life satisfaction) was not found in the literature. Methods. Survey data collected in May 2003 from a convenience sample of 310 Registered Nurses were used for this descriptive, correlational study. Findings. Self-nurturing nurses were more satisfied with life and perceived that more Magnet features were present in the workplace. Nurses with a master's degree were more self-nurturing than nurses without a baccalaureate degree. The synergistic effect of both self-nurturance and workplace factors predicted 29% of variance in nurses' life satisfaction. Conclusion. Higher levels of perceived Magnet features and frequent self-nurturance choices are important health influences on nurses' life satisfaction. Greater life satisfaction is known to reduce job dissatisfaction while improving retention. Approaches that incorporate both self-nurturance and workplace Magnet features are suggested to improve the health and retention of experienced nurses.

Limited research exists on the workplace and personal factors that might be associated with the physical and mental health of nurses working in China. Therefore, the purposes of this study were to examine, in Chinese hospital nurses, the most frequently occurring workplace stressor, the most often used coping strategy, and the relationships that exist among workplace stressors, coping strategies, psychological hardiness, demographic characteristics, and physical and mental health. Four-hundred-and-eighty hospital nurses from five hospitals in three major Chinese cities were administered five self-report questionnaires. The findings indicated the most frequently cited workplace stressor was workload, while the most commonly used coping strategy was positive reappraisal. Numerous positive and negative correlations were found, suggesting the importance that workplace stress, coping strategies, psychological hardiness, and demographic characteristics play in relationship to each other, as well as to both the physical and mental health of Chinese nurses.

Concerns about pending retirement of nurses working in the operating room (OR) are undeniable. The nurses' work environment and level of perceived support is part of the equation of why a nurse may choose to retire or stay in the workforce. This study compares nurses' perceptions of the work environment between OR nurses and nurses who work in other type units; and compares the work environment perceptions of OR nurses between institutions of two sizes (<300 beds and >300 beds). Findings include: OR nurses have better perceptions of their work environment than nurses in other type units and OR nurses in smaller hospitals are more satisfied with their work environment, workload and perceptions of organisational support. Implications for OR work environments are discussed.