Professor Ann Gallagher

Ann Gallagher


Professor of Ethics and Care, Lead for Ethics in Integrated Healthcare, Director of the International Care Ethics (ICE) Observatory

Biography

Biography

Ann has extensive experience as a healthcare ethicist, nurse, educator, researcher and editor (of the international journal 'Nursing Ethics'). She is Co-Chair of Princess Alice Hospice Clinical Ethics Committee working with practitioners to resolve ethical challenges in everyday practice. She is also a member of the Nuffield Council on Bioethics.

Ann is currently on sabbatical exploring 'Cross-cultural perspectives on ethics and elder care;. She has been Fulbright Scholar-in-Residence at the National Center for Bioethics in Research and Healthcare at the University of Tuskegee in Alabama, USA. Her sabbatical blog can be accessed at https://blogs.surrey.ac.uk/ethics-in-care/

Research interests

Current projects

  • RIPE - Researching Interventions that Promote Ethics in Social Care
  • HCPC - Understanding the Prevalence of Fitness to Practice; Cases about paramedics and social workers in England
  • PSA - Scoping the Fitness to Practice Databases; Identification of Research Questions
  • PSA - Developing a typology of dishonesty

The current focus of research relates to understanding and responding to deficits in care, dignity in care, professionalism, end of life ethics and research ethics. Ann has published on a wide range of topics in healthcare ethics, for example, on restraint, whistleblowing and conflicts of interest. Ann is co-author of 'Nursing and Human Rights' (with Jean McHale) and 'Ethics in Professional Life: Virtues for Health and Social Care' (with Sarah Banks). Ann is co-editor of 'Ethical, Legal and Professional Aspects of Healthcare: A practice-based approach' (with Sue Hodge 2012).

Recent publications

Gallagher A. (2013) Patients, Not Politics, Are Nurses' Concern New York Times (see: http://www.nytimes.com/roomfordebate/2013/05/01/the-ethics-of-force-feeding-inmates/patients-not-politics-are-nurses-concern)

Gallagher A. (2013) Slow ethics will tackle moral winter Times Higher Education 10th January

Gallagher A. (2012) The key to improving nursing lies with nurses themselves The Times 04/05/12 p.61 (Public Sector section)

Gallagher A. (2012) How nursing should tackle its image problem The Guardian 10/05/2012 (See http://www.guardian.co.uk/healthcare-network/2012/may/10/nursing-should-tackle-image-problem#start-of-comments)

Gallagher A. (2011) If the culture is unethical, acts of heroic staff may be futile Nursing Times 107 (36) p.7 ('In my view' section)

Gallagher A., Wainwright P., Tompsett H. & Atkins C.(2012) Findings from a Delphi Study regarding Conflicts of Interest, General Practice and Safeguarding Children: Listen Carefully, Judge Slowly Journal of Medical Ethics Vol. 38 pp. 87-92

Gallagher A. (2011) Moral Distress and Moral Courage in everyday Nursing Practice Online Journal of Issues in Nursing Vol.16, No.2

Gallagher A. & Gannon C. (2011) Difficult Decisions in Cancer Care - Conducting an Ethics Case Analysis European Oncology & Haematology 7 (2) pp.101-105

Gallagher A. (2011) Ethical issues in patient restraint Nursing Times Vol. 107, No. 9. pp, 18-20

Gallagher A. (2010) Whistleblowing: what influences nurses on whether to report poor practice? Nursing Times 106 (4), pp.22-25

Gallagher A. (2010) Have you thought about assisted suicide? NMC News Issue 31, pp. 12-13

Research collaborations

Research Reports

Evaluation of the RCN Dignity Campaign - 'The Little Things Make a Difference' (2009) - co-authored with Lesley Baillie.

'Receiving bad news about your mental health' pilot research project (2008) - A collaborative project with Anne Arber, University of Surrey and Rob Chaplin and Alan Quirke, Royal College of Psychiatrists.

'The Good Nurse: UK Pilot Study' (2008) - A replication of the Far East Good Nurse Project with Khim Horton, Verena Tschudin and Sara Lister.

'Defending Dignity - Challenges and Opportunities' (2008) - commissioned to develop e-survey, analyse data, write report and contribute to the development of educational materials with Professor Paul Wainwright and Dr Lesley Baillie.

Conflicts of Interests, General Practitioners and Safeguarding Children research project report (Tompsett et al 2008) - funded by the Department for Education and Skills and Department Health 'Safeguarding Children Research Initiative' - Co-researcher with social work and health colleagues at Kingston University and St George's University of London - member of project management team and lead on designing, implementing and analysing Delphi Expert panel component.

'Arts for Life' report (2007) - patients' and carers' perceptions of the value of the arts in palliative care - Commissioned by St Christopher's Hospice. Awaiting publication in Nursing Standard.

'Complementing the Community Project' report (2007) relating to the perceived benefits of complementary therapies by those with non -malignant conditions - Commissioned by St Christopher's Hospice.

Dignity in Practice Pilot Project Report (2001) with Professor David Seedhouse at Middlesex University.

Teaching

Ann is module leader for post-graduate module 'Professional Ethics in a Global Context' - this provides opportunities for UK and international professionals and students to enhance their understanding of professional ethics and to share experiences of working in complex and ever-changing cultural, political and policy contexts.

She teaches ethics to undergraduate health processionals (nurses, midwives, paramedics, and operating department attendants).

Departmental duties

  • Developing research proposals, applying for funding and conducting empirical research relating to healthcare ethics
  • Writing and publishing in peer-reviewed and professional journals
  • Leading staff development in relation to teaching healthcare ethics
  • Lead on nursing research collaboration with University of Sao Paulo, Brazil
  • Developing international research and scholarship collaborations through the International Care Ethics (ICE) Observatory
  • Editor of international journal Nursing Ethics
  • Teaching ethics to undergraduate and post-graduate students
  • Supervising MSc, DCP and PhD students undertaking ethics-related research

Supervision of PhD students

PhD Students

Wendy Grosvenor - Students' experience of a Time for Dementia project - Year 2

Cajetan Ndukwe - Dignity and spirituality in mental health practice - Year 2 (Integrated PhD programme)

Olivia Luijnenburg - Ethics, spirituality and care - Year 1

Completed PhDs

Andrew McKie, University of Aberdeen - Exploring the relationship between the expressive arts and ethical nursing practice - External supervisor - Completed 2010

Iris Gault, Kingston University and St George's University of London - Therapeutic coercion and supervised community orders - Co-supervisor - Completed in 2012

Julia Woods, Kingston University and St George's University of London - Decision-making and dementia care - Completed in 2012

Ruth Jackson, University of Surrey - Midwives' experience of obstetric emergencies - completed May 2014

Kit Tapson - The perspectives of counsellors and of young people who bully on the counselling process - completed in 2015

Maggie Davies - The perspectives of Directors of Nursing on UK care practices - completed in 2015

Vince Mitchell - An Ethical Framework for Dementia Care - Completed January 2016

Davis Mpavaenda - Investigating the impact of a new intervention for Obsessive Compulsive Disorder - Co-supervisor - Completed 2016

Tiziana Sala Defilippis - Moral resilience in healthcare practice - Completed 2017

External examiner of PhD theses:

2016 - University of Salford - Julie Winifred Morton - Mapping Ethical Regulation: The Work of Research Ethics Committees

2012 - University of Dundee - Gordon McLaren - Ethical decision making in the NHS: a theoretical analysis of clinical negligence with reference to the existentialist writings of Kierkegaard, Levinas and Sartre

2011 - University of Sao Paulo, Brazil - Maria Cristina Paganini - Professional autonomy of nurses in the intensive care unit

2010 - University of Hertfordshire - Jennifer Susan Beckwith - Uncovering complexity in everyday practice: A post-modern study of community nursing assessment

Examples of media opinion pieces

Gallagher A. (2017) Blog: Learning from the case of Charlie Gard: How a hard case can make bad ethics (see https://blogs.surrey.ac.uk/health-sciences/2017/07/28/learning-from-the-case-of-charlie-gard-how-a-hard-case-can-make-bad-ethics/ )

Gallagher A. (2017) Let's tackle 'careism' and give workers the respect they deserve The Guardian 22/02/2017 (See https://www.theguardian.com/social-care-network/social-life-blog/2017/feb/22/lets-tackle-careism-and-give-workers-the-respect-they-deserve )

Gallagher A. (2015) Ethical Responses to Child Sexual Exploitation and Abuse Inquiries - Why We Need a Slow Approach The Huffington Post (see http://www.huffingtonpost.co.uk/ann-gallagher/child-abuse-inquiry_b_6156554.html)

Gallagher A. (2013) 'Proposal for hidden cameras in care homes is misguided' The Conversation 15th October (See http://theconversation.com/proposal-for-hidden-cameras-in-care-homes-is-misguided-19216 )

Gallagher A. (2013) 'Dignitas case raises tough questions over right to die and duty to protect' The Conversation 20th August (see http://theconversation.com/dignitas-case-raises-tough-questions-over-right-to-die-and-duty-to-protect-17238)

Gallagher A (2013) 'Should Brady be kept alive? The ethics of force feeding' The Conversation 19th June (see http://theconversation.com/should-brady-be-kept-alive-the-ethics-of-force-feeding-15266)

Gallagher A. (2013) The Ethics of Force-Feeding Inmates New York Times 1st May (see http://www.nytimes.com/roomfordebate/2013/05/01/the-ethics-of-force-feeding-inmates)

Gallagher A. (2013) 'Care: A higher calling' Times Higher Education 28th February (see http://www.timeshighereducation.co.uk/comment/opinion/care-a-higher-calling/2002098.article)

Gallagher A. (2013) 'Slow ethics will tackle moral winter' Times Higher Education 10th January (see http://www.timeshighereducation.co.uk/422322.article)

Gallagher A. (2012) The key to improving nursing lies with nurses themselves The Times 04/05/12 p.61 (Public Sector section)

Gallagher A. (2012) How nursing should tackle its image problem The Guardian 10/05/2012 (See http://www.guardian.co.uk/healthcare-network/2012/may/10/nursing-should-tackle-image-problem#start-of-comments)

Death on Prescription?

The Commission on Assisted Dying provides an impetus for reflection and critical debate

If you or a family member were terminally ill, would you like your GP to have the option of prescribing a lethal dose of medication? What if your diagnosis or prognosis was incorrect? Might you be concerned that a disabled or elderly person might feel pressurised to opt for assisted dying should it become available? Perhaps you think it abysmal that some UK citizens have to travel to Dignitas in Switzerland to avail of assisted death? Or, perhaps, you think that we should not allocate scarce healthcare resources to those who are terminally ill….? The recent report from the Commission on Assisted Dying requires that we engage with, and consider our responses to, these and other challenging questions relating to end of life choices. (See http://www.demos.co.uk/publications/thecommissiononassisteddying).

The Commission considered 'that the current legal status of assisted suicide is inadequate and incoherent'. It concludes that there is 'a strong case for providing the choice of assisted dying for terminally ill people.' Following an extensive consultation process and visits to regions that permit assisted dying (Oregon, the Netherlands, Belgium and Switzerland) the Commission proposed a framework that would, should assisted dying be legalised, provide 'safeguarded access to assisted dying for eligible people'.

People considered eligible must be: over 18 years old; have a diagnosis of a terminal illness; make a voluntary choice; and have the mental capacity required to make such a choice. Safeguards include a decision-making model involving the independent judgements of two doctors (with support from other health and social care professionals) and processes to ensure the person is fully informed of treatment and care options, that he/she has capacity, that the lethal medication is transported and stored safely and that the assisted death is properly supported and recorded.

The ethical arguments for and against assisted suicide are discussed in some detail in Chapter 2 of the report and supported by data from evidence submitted to the Commission. These arguments relate to individual autonomy, the value and sanctity of life, compassion, the protection of vulnerable people, the balance of harms, non-discrimination in law and policy and, what is referred to as, medical ethics. Under the latter heading, the report discusses 'the prohibition on doctors ending life' and 'the doctor's role in relieving suffering' (p.85).

The report has, understandably, generated a lot of controversy and debate. It urges us to consider questions we would probably rather ignore. Death and dying continue to be taboo topics and few people are willing or able to discuss them openly. The Commission's report offers the opportunity to engage with these topics critically and constructively. Adopting an ostrich-like approach is not an option in educational programmes for health professionals and we need to consider additional and crucial questions. These would relate to, for example, the role of nurses and allied professionals should assisted dying be legalised, how conscientious objection would be operationalised; and what would constitute adequate educational preparation for nurses and other professionals should assisted dying be legalised? Professional education is directed not only towards the prevention of ill-health and the promotion of health but also towards helping people live well until they die. The School of Health and Social Care at the University of Surrey, in collaboration with our local hospices and hospitals, already offers an exemplary range of palliative care educational provision.

The debate about assisted dying is not, in my view, going to subside and we need to consider the very real possibility that in the years to come it will be legalised in the UK. Health professionals currently have to give a good deal of thought to how they balance respect for patient autonomy with the values of not doing harm, of doing good and treating people fairly. Should assisted dying be legalised in the future, the most pressing imperative for health professionals must be to protect, and advocate for, the most vulnerable individuals and groups. Professionals must also have the resources required to continue to deliver dignifying end of life care and the opportunity to opt out of assisted dying should this conflict with their personal and professional values.

Dr Ann GallagherReader in Nursing Ethics

Editorials in Nursing Ethics

  • Gallagher A. (2017) Forthcoming: What can we learn from the case of Charlie Gard (24)7:
  • Gallagher A. & Tschudin V. (2017) Celebrating exemplary ethical care: The Human Rights and Nursing Awards 24(6): 637-639
  • Gallagher A. (2017) Ethical leadership revisited: The value of sharing diverse perspective 24(5): 515-516
  • Gallagher A. & Christie I. (2017) Towards a Sustainable Care Utopia Nursing Ethics 24(4): 389-391
  • Gallagher A. (2017) The Good Enough Doctor Nursing Ethics 24(2): 123-4
  • Gallagher A, (2016) Highlights from the 2016 Conference Nursing Ethics 23 (7): 727-728
  • Gallagher A. (2016) Mindfulness, Moral Distress and Dementia Care Nursing Ethics 23 (6): 599-600
  • Gallagher A., Naden D. & Karterud D. (2016) Ethical aspects of Robots in Care Nursing Ethics 23 (4) 369-371
  • Gallagher A. (2016) The 'good' professional regulator: Superhero or adversary? Nursing Ethics 23 (3) 251-153
  • Gallagher A. (2016) What counts as 'ethics education?' Nursing Ethics 23 (2) 131
  • Gallagher A. (2016) The Nursing Ethics Heritage Project Nursing Ethics 23 (1) 3

News

Media Contacts

Contact the press team

Email:

mediarelations@surrey.ac.uk

Phone: +44 (0)1483 684380 / 688914 / 684378
Out-of-hours: +44 (0)7773 479911
Senate House, University of Surrey
Guildford, Surrey GU2 7XH

My publications

Publications

Gallagher A (2011) Ethical issues in patient restraint., Nurs Times 107 (9) pp. 18-20
This article examines the ethical issues that arise in relation to restraint in mental health, dementia care and stroke care. The themes can, however, be applied to all areas of healthcare. The article also discusses how "four quadrants" of practice situations--medical indications, patient preferences, quality of life and contextual features--can be used to analyse three different restraint situations.
Arber A, Gallagher A (2003) Breaking bad news revisited: the push for negotiated disclosure and changing practice implications., Int J Palliat Nurs 9 (4) pp. 166-172
This article revisits the ethical, legal, professional and emotional issues involved with disclosing bad news. The authors examine the push for disclosure that has come from a number of quarters in the UK, including ethical and legal challenges, in particular the Bristol Royal Inquiry Report, professional codes of conduct, health policy and the expectations of the public. The contribution of nurses to breaking bad news is not widely discussed in the literature. With the development of new nursing roles and evidence-based practice it is timely to consider the role of nurses in this process. The article highlights some limitations with current guidelines for breaking bad news, in particular, that these guidelines tend to be constructed from a professional standpoint and lack patient-centred evidence. The issue of emotional labour and how it relates to giving bad news is discussed with respect to professional staff and patients. The article concludes by raising some practice implications, including: the importance of context and continuity; the significance of information and support; the desirable qualities of the professional; and issues to consider in determining patient preferences.
Gallagher A, Zaboli ELCP, Ventura C (2012) Dignity in care: Where next for nursing ethics scholarship and research?, Revista da Escola de Enfermagem 46 (SPL. ISS.) pp. 51-57
Dignity is recognised as both a central and also a contested value in bioethics discourse. The aim of this manuscript is to examine some of the key strands of the extensive body of dignity scholarship and research literature as it relates to nursing ethics and practice. The method is a critical appraisal of selected articles published in Nursing Ethics and other key manuscripts and texts identified by researchers in the UK and Brazil as influential. The results suggest a wide and rather confusing range of perspectives and findings albeit with some overall themes relating to objective and subjective features of dignity. In conclusion, the authors point to the need for more sustained philosophical engagement contextualising human dignity within a plurality of professional values. Future empirical work should explore what matters to patients, families, professionals and citizens in different cultural contexts rather than foregrounding qualitative research with such a contested concept.
Gallagher A, Hodge S, Gallagher A (2012) Ethics, Law and Professional Issues, Palgrave Macmillan
Taking a practice-based approach, this book explores the daily dilemmas faced by modern health care practitioners, using engaging clinical scenarios drawn from across the fields of health care.
Gallagher A (2013) Twentieth anniversary of nursing ethics., Nurs Ethics 20 (2) pp. 121-122
Baillie L, Gallagher A (2011) Respecting dignity in care in diverse care settings: strategies of UK nurses., Int J Nurs Pract 17 (4) pp. 336-341
This paper presents nurses' views of dignity issues in diverse UK health-care settings. A qualitative multisite case study was conducted at seven organizations: four National Health Service hospitals, two independent care providers and one mental health-care provider. The paper reports on the data from qualitative semistructured interviews (n = 51); the participants worked in a wide variety of care contexts. The data were analysed thematically and this paper reports on the theme 'strategies to respect dignity in care'. The subthemes were: recognizing vulnerability to dignity loss; enhancing privacy; improving communication between staff and patients/families and building relationships; improving the care environment; and addressing issues that matter to individuals. The findings indicate core elements to promoting dignity that apply across all care settings but suggest that nurses should identify and address dignity issues specific to their own practice areas.
McHale JV, Gallagher A, RGN AG (2003) Nursing and human rights, Butterworth-Heinemann
" This book focuses on the relationship between human rights and nursing in these changing times.
Olsen DP, Gallagher A (2014) Ethical issues for nurses in force-feeding guantánamo bay detainees:Military nurses face conflicting ethical imperatives, American Journal of Nursing 114 (11) pp. 47-50
Ventura C, Gallagher A, Jago R, Mendes I (2013) Assisted Dying: The View from Solidarity, Journal of Medicine and Law Michigan State University College of Law
Gallagher A (2013) The ethics of reviewing, Nursing Ethics 20 (7) pp. 735-736
Gallagher A (2013) Learning from family and nurse narratives, Nursing Times 109 (19)
Now the initial flurry of media attention relating to this year's Francis report has subsided, it is a good time to take stock and ask what implications the 2010 and 2013 reports and their recommendations will have on nurses and nursing. This article discusses two areas that have significant potential to contribute to sustainable caring practices: leadership in practice and education; and organisational culture informed by research and scholarship. It also discusses the findings of both Francis reports and provides a summary of the stories of two witnesses.
Gallagher A (2011) We need to talk about dying., Nurs Ethics 18 (5) pp. 623-625
Urwin S, Stanley R, Jones M, Gallagher A, Wainwright P, Perkins A (2010) Understanding student nurse attrition: Learning from the literature, NURSE EDUCATION TODAY 30 (2) pp. 202-207 CHURCHILL LIVINGSTONE
Gallagher A (2012) Acknowledging small acts of kindness., Nurs Ethics 19 (3) pp. 311-312
Gallagher M (2010) Editorial, Nursing Ethics 17 (4) pp. 419-420
At the time of writing, UK nurses are responding to the screening of the American television series Nurse
Jackie. Reviews are polarized, with some arguing that: ?Jackie is no advert for nursing. She is a drugs
misuser, steals from patients, forges documents, challenges doctors and has inappropriate sexual relationships?.
1 Another view is that the series is ?entertaining and shows empathy and real caring of patients and
their families. Nurse Jackie Peyton depicts professional autonomy when she challenges medical staff and
is treated as an equal by the medical director, whom she also befriends. This nurse is an example to us all.?
This debate takes place in the UK where there is ongoing media attention to unethical practices and ?shocking
care? in UK health care. Recent work in the UK on evaluating dignity in care supported the view that
there is also much innovative and ethical practice. Conversations I have had recently with practitioners suggest
that our views of ethical and unethical practices, individuals and organizations should not be oversimplified.
These suggest that there may be different perspectives on the quality of patient care, even within the
same family, and this may be related to different expectations and understanding of the health service.
Gallagher A, Wainwright P (2007) Terminal sedation: promoting ethical nursing practice., Nurs Stand 21 (34) pp. 42-46
This article discusses ethical aspects of 'terminal sedation' in relation to end-of-life care. An examination of the literature reveals there are different definitions and explanations of terminal sedation. Some definitions appear compatible with the values of palliative care and nursing, whereas others could arguably be perceived as deserving of the term 'euthanasia in disguise'. The authors suggest that 'palliative sedation' is a more helpful term and argue that, when defined and understood appropriately, it is a defensible and ethical practice. Nurses should be clear about the purpose of their profession, honest about their intentions and respect the autonomy and dignity of the patients for whom they provide care. The doctrine or principle of 'double effect' has been put forward to support the practice of terminal sedation. The authors examine this doctrine and caution that nurses and other professions need to approach it critically in relation to terminal sedation. Vignettes are used to illustrate aspects of the discussion.
Banks S, Gallagher A, RGN AG (2008) Ethics in professional life, Palgrave MacMillan
This much-needed text articulates the issues surrounding professional ethics using a unique virtue-based framework.
Gallagher A (2010) Untitled, NURSING ETHICS 17 (2) pp. 155-156 SAGE PUBLICATIONS LTD
Wainwright P, Gallagher A (2007) Ethical aspects of withdrawing and withholding treatment., Nurs Stand 21 (33) pp. 46-50
Decisions about withdrawing and withholding treatment are common in health care. During almost every encounter between health professionals and patients a decision needs to be made about treatment options. In most cases these choices do not pose any difficulty, for example, starting antibiotics when a patient has an infection. However, decisions not to treat, or to stop treating, raise fundamental questions about the nature and purpose of nursing and the ethics of end-of-life care. This article argues that nurses need to be proactive in deciding what is nursing care and what is treatment. An ethical distinction is drawn between acts and omissions. How this distinction relates to withdrawing and withholding treatment will be considered. Further ethical issues discussed relate to judgements about the futility of treatment, patient autonomy and nurses' duty of care to patients at the end of life.
Gallagher A (2015) Ethical dilemmas., Nurs Stand 29 (29)
Kohlen H, McCarthy J, Buosso RS, Gallagher A, Andrews T (2015) Decision-making processes in nursing and activities at the end of life in intensive care - An international comparative study, PFLEGE 28 (6) pp. 329-338 VERLAG HANS HUBER
Gallagher A (2012) Four countries, four views of nursing ... the best of times, the worst of times?, NURSING ETHICS 19 (2) pp. 181-182 SAGE PUBLICATIONS LTD
Gault I, Gallagher A, Chambers M (2013) Perspectives on medicine adherence in service users and carers with experience of legally sanctioned detention and medication: a qualitative study, PATIENT PREFERENCE AND ADHERENCE 7 pp. 787-799 DOVE MEDICAL PRESS LTD
Gallagher A (2010) Whistleblowing: what influences nurses' decisions on whether to report poor practice?, Nurs Times 106 (4) pp. 22-25
Several recent high profile examples demonstrate that nurses fear and have reason to fear the consequences of reporting poor practice. This article examines the ethical issues surrounding whistleblowing, discussing in detail the reasons for and against reporting concerns about poor practice, and how nurses can be supported to do this.
Wong HS, Santhakumaran S, Statnikov Y, Gray D, Watkinson M, Modi N, Kadalraja R, Kefas J, Srinnel S, Ramesh C, Rackham O, Brearey S, Thirumurugan A, Losa I, McBride T, Zipitis C, Amegavie L, Moise J, Zipitis C, Yadan M, Maddock N, Moise J, Edi-Osagie N, Heal C, Birch J, Al-Zidgali F, Hasib A, Kisat H, Soe A, Long D, Fedee J, Lama M, Gupta R, Rawlingson, De Boer RC, Rao P, Blake K, Bhaduri AK, Halahakoon C, Deshpande, Mohite A, Tewary KK, Palmer K, Gallagher A, Nycyk J, Simmons P, Morgen I, Underhill HC, Mahesh Babu RN, Dalton S, Dixon H, James M, Jayalal V, Dyke M, Babiker S, Soe T, Rubin S, Ogilvy-Stuart A, Evans I, Wickham T, Van Someren V, Watkin S, Blumberg R, Sharief N, Aladangady N, Sharma B, Sullivan C, Alsford L, Sharma B, Khan A, Hamdan S, Ahmed JS, Foo A, Talekar R, Adiotomre P, Gibson A, Thomas M, Mathur R, Cruwys M, Mannix P, Ariff H, Garbasa M, Lal M, Bosman D, Fenton A, Bolton AR, Abu-Harb M, Verber I, Olivier J, Larson J, Cherinet Y, Munyard P, Osbourne N, Raman M, Watts T, Hannam S, Walter S (2014) Retinopathy of prematurity in English neonatal units: A national population-based analysis using NHS operational data, Archives of Disease in Childhood: Fetal and Neonatal Edition 99 (3)
Objectives: To report on retinopathy of prematurity (ROP) screening compliance against a national guideline, factors associated with non-compliance and effect on ROP treatment. Design: National cohort study using operational NHS data from the National Neonatal Research Database (NNRD) for the period 2009-2011. Setting: 161 (94%) neonatal units in England. Population: Infants born below 32 weeks' gestation and/or with a birth weight below 1501 g. Main outcome measures: ROP screening status ('on-time', 'early', 'late', 'unknown') and associated infant and neonatal unit characteristics, ROP treatment. Results: The proportion of infants screened on-time increased over the study period (p
Gallagher A, Sasso L, Bagnasco A, Aleo G (2014) Professing nursing research: the Italian experience., Nurs Ethics 21 (8) pp. 857-858
Arber A, Gallagher A (2009) GENEROSITY AND THE MORAL IMAGINATION IN THE PRACTICE OF TEAMWORK, NURSING ETHICS 16 (6) pp. 775-785 SAGE PUBLICATIONS LTD
Gallagher A (2013) Values for contemporary nursing practice: waving or drowning?, Nurs Ethics 20 (6) pp. 615-616
Gallagher A (2011) Keeping research ethics under review., Nurs Ethics 18 (6) pp. 751-752
Gallagher A, Jago R, Ventura C, Mendes I (2013) Transcultural Research Ethics: Impossibility or Panacea, Salute E Società FrancoAngeli
Chambers M, Gallagher A, Borschmann R, Gillard S, Turner K, Kantaris X (2014) The experiences of detained mental health service users: Issues of dignity in care, BMC Medical Ethics 15 (1)
Background: When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for healthcare professionals. Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored. Methods. This paper reports on the experiences of 19 adult service users who were, at the time of interview, detained under a Section of the MHA. These service users had experienced coercive interventions and they gave their account of how they considered their dignity to be protected (or not), and their sense of self respected (or not). Results: The service users considered their dignity and respect compromised by 1) not being 'heard' by staff members, 2) a lack of involvement in decision-making regarding their care, 3) a lack of information about their treatment plans particularly medication, 4) lack of access to more talking therapies and therapeutic engagement, and 5) the physical setting/environment and lack of daily activities to alleviate their boredom. Conclusions: Dignity and respect are important values in recovery and practitioners need time to engage with service user narratives and to reflect on the ethics of their practice. © 2014 Chambers et al.; licensee BioMed Central Ltd.
Gallagher A (2013) Justice for Older People, AGEING & SOCIETY 33 pp. 1287-1288 CAMBRIDGE UNIV PRESS
Marsh W, Shawe J, Gallagher A, Robinson A (2014) Babies' Removed at Birth: Narratives of Mothers' and Midwives, JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY 32 (3) pp. E20-E21 ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD
Gallagher A, Arber A, Chaplin R, Quirk A (2010) Service users' experience of receiving bad news about their mental health, JOURNAL OF MENTAL HEALTH 19 (1) pp. 34-42 INFORMA HEALTHCARE
Gallagher A (2013) Challenging care deficits: showing, telling and teaching., Nurs Ethics 20 (1) pp. 3-4
Gallagher A (2015) The future of ethics in care: Some reflections, NURSING ETHICS 22 (6) pp. 629-630 SAGE PUBLICATIONS LTD
Gallagher A (2012) Four countries, four views of nursing ... the best of times, the worst of times?, Nurs Ethics 19 (2) pp. 181-182
Gallagher A (2012) Slow ethics for nursing practice., Nurs Ethics 19 (6) pp. 711-713
Wainwright P, Gallagher A (2010) Understanding general practitioners' conflicts of interests and the paramountcy principle in safeguarding children, JOURNAL OF MEDICAL ETHICS 36 (5) pp. 302-305 B M J PUBLISHING GROUP
Gallagher A (2016) What counts as "ethics education'?, NURSING ETHICS 23 (2) pp. 131-131 SAGE PUBLICATIONS LTD
Gallagher A (2014) Ethics education: do we need compassion boot camps?, Nurs Ethics 21 (6) pp. 635-636
Gallagher A (2013) Compassion conundrums., Nurs Ethics 20 (8) pp. 849-850
Dunn E, Arber A, Gallagher A (2016) The Immediacy of Illness and Existential Crisis: Patients' lived experience of under-going allogeneic-stem cell transplantation for haematological malignancy. A phenomenological study, EUROPEAN JOURNAL OF ONCOLOGY NURSING 21 pp. 90-96 ELSEVIER SCI LTD
Gallagher A (2015) Indefensible incentives, Journal of Dementia Care 23 (1)
Gallagher A (2015) Ethical dilemmas., Nurs Stand 29 (34)
I have been a nurse for 20 years and for the first time I am feeling that I have had enough. There is too little time to spend with distressed patients and their families, and it is impossible to provide the care I want to give with the resources available. Should I look for another position?
Gallagher A (2015) Among politicians, patients and nurse leaders: what can a nurse ethicist contribute?, Nurs Ethics 22 (3) pp. 285-286
Hunt G, Gannon C, Gallagher A (2012) Elements of an engaged clinical ethics: A qualitative analysis of hospice clinical ethics committee discussions, Clinical Ethics 7 (4) pp. 175-182
Social, legal and health-care changes have created an increasing need for ethical review within end-of-life care. Multiprofessional clinical ethics committees (CECs) are increasingly supporting decision-making in hospitals and hospices. This paper reports findings from an analysis of formal summaries from CEC meetings, of one UK hospice, spanning four years. Using qualitative content analysis, five themes were identified: timeliness of decision-making, holistic care, contextual openness, values diversity and consensual understanding. The elements of an engaged clinical ethics in a hospice context is not generally acknowledged nor its elements articulated. Findings from this study have the potential to explain some of the most challenging ethical problems and to contribute to their resolution. It may also guide future deliberation and raise CEC members' awareness of the recurrent issues and values of their CEC practice.
Wainwright P, Gallagher A, Tompsett H, Atkins C (2010) The use of vignettes within a Delphi exercise: a useful approach in empirical ethics?, JOURNAL OF MEDICAL ETHICS 36 (11) pp. 656-660 B M J PUBLISHING GROUP
Gallagher A (2015) Authors, editors and ethical ways of working, Nursing Ethics 22 (4) pp. 397-398
Gallagher A (2007) The respectful nurse., Nurs Ethics 14 (3) pp. 360-371
Respect is much referred to in professional codes, in health policy documents and in everyday conversation. What respect means and what it requires in everyday contemporary nursing practice is less than clear. Prescriptions in professional codes are insufficient, given the complexity and ambiguity of everyday nursing practice. This article explores the meaning and requirements of respect in relation to nursing practice. Fundamentally, respect is concerned with value: where ethical value or worth is present, respect is indicated. Raz has argued that the two ways of encountering value are to respect and to engage with it. The former requires acknowledgement and preservation. Respect in nursing practice necessarily requires also engagement. Respect is an active value and can be conceptualized within the context of virtue ethics as a hybrid virtue having both intellectual and ethical components. Examples from the literature are provided to illustrate situations where the respectful nurse requires these components or capabilities.
Davies A, Waghorn M, Boyle J, Gallagher A, Johnsen S (2015) Alternative forms of hydration in patients with cancer in the last days of life: study protocol for a randomised controlled trial, TRIALS 16 ARTN 464 BIOMED CENTRAL LTD
Cox AC (2015) Negotiated reorienting: A grounded theory of nurses' end-of-life decision-making in the intensive care unit, International Journal of Nursing Studies
BACKGROUND: Intensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nurses' end-of-life (EoL) decision-making practice across cultures.
OBJECTIVES: To understand nurses' EoL decision-making practices in ICUs in different cultural contexts.
DESIGN: We collected and analysed qualitative data using Grounded Theory.
SETTINGS: Interviews were conducted with experienced ICU nurses in university or hospital premises in five countries: Brazil, England, Germany, Ireland and Palestine.
PARTICIPANTS: Semi-structured interviews were conducted with 51 nurses (10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine). They were purposefully and theoretically selected to include nurses having a variety of characteristics and experiences concerning end-of-life (EoL) decision-making.
METHODS: The study used grounded theory to inform data collection and analysis. Interviews were facilitated by using key questions. The comparative analysis of the data within and across data generated by the different research teams enabled researchers to develop a deeper understanding of EoL decision-making practices in the ICU. Ethical approval was granted in each of the participating countries and voluntary informed consent obtained from each participant.
RESULTS: The core category that emerged was 'negotiated reorienting'. Whilst nurses do not make the 'ultimate' EoL decisions, they engage in two core practices: consensus seeking (involving coaxing, information cuing and voice enabling); and emotional holding (creating time-space and comfort giving).
CONCLUSIONS: There was consensus regarding the core concept and core practices employed by nurses in the ICUs in the five countries. However, there were some discernible differences regarding the power dynamics in nurse-doctor relationships, particularly in relation to the cultural perspectives on death and dying and in the development of palliative care. The research suggests the need for culturally sensitive ethics education and bereavement support in different cultural contexts.
Gallagher A (2011) The ethics of impact factors., Nurs Ethics 18 (1) pp. 3-5
Gallagher A (2015) Ethics and research culture., Nurs Ethics 22 (2) pp. 161-162
Gallagher A, Wainwright P, Baillie L, Ford P (2009) The RCN dignity survey: implications for leaders., Nurs Manag (Harrow) 16 (4) pp. 12-16
In response to concerns about a lack of dignity in care raised in the media and several studies, the RCN launched last year its dignity campaign, Dignity: At the heart of everything we do. A major part of this campaign was a dignity survey of more than 2000 nurses, nursing students and healthcare assistants, making it the largest dignity survey of the U.K. nursing workforce ever undertaken. This article outlines what some of the survey findings mean for nurse managers and leaders, and discusses the relationship between dignity and nursing.
Gallagher A (2011) Editorial: What do we know about dignity in care?, Nurs Ethics 18 (4) pp. 471-473
Gallagher A (2008) A pilot evaluation of the Arts for Life project in end-of-life care., Nurs Stand 22 (50) pp. 42-46
To explore and evaluate the experience of the 'Arts for Life' project among patients or residents with terminal illness in nursing homes and the community, their relatives and practitioners.
Gallagher A (2010) The ethics of research ethics committees., Nurs Ethics 17 (6) pp. 683-684
Baillie L, Gallagher A (2010) Evaluation of the Royal College of Nursing's 'Dignity: At the heart of everything we do' campaign: Exploring challenges and enablers, Journal of Research in Nursing 15 (1) pp. 15-28
Dignity in care has become a key policy, practice and political priority. This development has become more pressing as media, anecdotal and research reports have highlighted dignity deficits in care. In response to such reports and to concerns of the membership and general public, the Royal College of Nursing initiated a high-profile campaign (Dignity: at the heart of everything we do) involving engagement with stakeholders, a survey of members and the development and dissemination of educational and practice development materials. This article details findings from part of the evaluation of the Royal College of Nursing dignity campaign, which used a qualitative case study design across seven UK sites. The study used interviews with 51 staff members, direct observation of the physical care environment and document analysis, and data were analysed using thematic analysis. The article focuses on two areas: enablers (staff receptivity and creativity; organisational support and leadership; and campaign educational materials) and challenges (time constraints; and staff attitudes and insight). © The Author(s) 2009.
Gallagher A (2015) Research in Nursing Ethics - Looking Back & Looking Forward, PFLEGE 28 (6) pp. 319-320 VERLAG HANS HUBER
Gallagher A (2014) Learning from Tuskegee: from moral outrage to integrative ethics., Nurs Ethics 21 (2) pp. 125-126
Gallagher A (2016) The Nursing Ethics Heritage Project, NURSING ETHICS 23 (1) pp. 3-3 SAGE PUBLICATIONS LTD
Gallagher A (2011) Editorial: all you need is love?, Nurs Ethics 18 (3) pp. 283-284
Gallagher A, Horton K, Tschudin V, Lister S (2009) Exploring the views of patients with cancer on what makes a good nurse--a pilot study., Nurs Times 105 (23) pp. 24-27
This article presents and discusses findings from a qualitative pilot study that surveyed patients with cancer to discover their views on what makes a good nurse. Ten outpatients at a U.K. specialist cancer hospital, who had received inpatient treatment for cancer, were interviewed. The interview data was analysed thematically and four themes identified: good nurse virtues; knowledge; skill; and, organisational culture.
Gallagher A (2012) Ethics and compromised consciousness., Nurs Ethics 19 (4) pp. 449-450
Grob C, Leng J, Gallagher A (2012) Educational responses to unethical healthcare practice., Nurs Stand 26 (41) pp. 35-41
The aim of this article is to explore explanations for unethical healthcare practice and identify educational responses. The meaning of unethical practice is outlined and causes of it are suggested, primarily relating to individual perpetrators and organisational culture or climate. Empirical and theoretical literature is reviewed and research findings are discussed. Individual resilience and the ethical climate of healthcare organisations are considered as responses to unethical practice. Role modelling is explored, acknowledging the role of effective leadership.
Wainwright P, Gallagher A (2008) On different types of dignity in nursing care: a critique of Nordenfelt, NURS PHILOS 9 (1) pp. 46-54 BLACKWELL PUBLISHING
Olsen DP, Gallagher A (2014) Ethical issues for nurses in force-feeding Guantánamo Bay detainees., Am J Nurs 114 (11) pp. 47-50
Military nurses face conflicting ethical imperatives.
Gallagher A (2015) The ethics of migration and what moves us to care, NURSING ETHICS 22 (7) pp. 741-742 SAGE PUBLICATIONS LTD
Gallagher A, Wainwright P, Tompsett H, Atkins C (2012) Findings from a Delphi exercise regarding conflicts of interests, general practitioners and safeguarding children: 'Listen carefully, judge slowly'., J Med Ethics 38 (2) pp. 87-92
General practitioners (GPs) have to negotiate a range of challenges when they suspect child abuse or neglect. This article details findings from a Delphi exercise that was part of a larger study exploring the conflicts of interest that arise for UK GPs in safeguarding children. The specific objectives of the Delphi exercise were to understand how these conflicts of interest are seen from the perspectives of an expert panel, and to identify best practice for GPs. The Delphi exercise involved four iterative rounds with questionnaires completed by an expert panel. Results from each round were distilled and findings sent to panel members until consensus was reached. Panel members shared insights regarding their understanding of conflicts of interest in relation to GPs and safeguarding children and responses when conflicts of interests arise. Findings suggested a broader understanding of conflicts of interest (intrapersonal, interpersonal, interprofessional and interagency), the importance of professional judgement in uncertain situations when both action and inaction have potentially negative consequences and the importance of trust. The Delphi exercise was an effective means to bring together a wide range of professional and disciplinary perspectives on a complex topic. Findings caution against the oversimplification of the conceptual and practical issues, emphasise the importance of professional judgement, and support the development of open and trusting relationships with families and among professionals in health and social care agencies.
Gallagher A (2014) What difference should International Nurses Day make?, Nurs Ethics 21 (5) pp. 503-504
Gallagher A, Tschudin V (2010) Educating for ethical leadership, NURSE EDUCATION TODAY 30 (3) pp. 224-227 CHURCHILL LIVINGSTONE
Gallagher A, Jago R, Ventura CAA, Mendes IAC (2013) Ethics of cross-cultural research in health care: Panacea or Utopia?, Salute e Societa (3) pp. 67-82
The scope and activities that constitute healthcare research are broad and everchanging given new research questions and methodologies. There is also an increasing range of international health research activities. Many of these activities raise significant ethical issues. In this article, healthcare researchers from the UK and Brazil examine some of the challenges that may arise in cross-cultural research and consider the most appropriate ethical frameworks that may be applied. It is concluded that an amalgam of key features of human rights discourse and virtue ethics, in a context of cultural safety, provide the most robust framework for research ethics in a global context. Indeed, this is also the best candidate for a transcultural research ethics. Copyright © FrancoAngeli.
Allan HT, Odelius AC, Hunter BJ, Bryan K, Knibb W, Shawe J, Gallagher A (2015) Supporting staff to respond effectively to informal complaints: findings from an action research study, JOURNAL OF CLINICAL NURSING 24 (15-16) pp. 2106-2114 WILEY-BLACKWELL
Gallagher MA (2013) Slow ethics: a sustainable approach to ethical care practices?, Clinical Ethics 8 (4) pp. 99-104 Sage
Gallagher A (2015) Reflections on compassion in care, NURSING ETHICS 22 (8) pp. 843-844 SAGE PUBLICATIONS LTD
Gallagher A (2012) The demise of nursing?, Nurs Ethics 19 (1) pp. 3-4
Gallagher A (2014) Launch of International Care Ethics (ICE) Observatory., Nurs Ethics 21 (3) pp. 263-264
Gallagher A (2015) Conversations about care, NURSING ETHICS 22 (5) pp. 515-516 SAGE PUBLICATIONS LTD
Dunn L, Arber A, Gallagher A (2015) Safe in the bubble, out into the unknown: Returning home following allogeneic stem cell transplantation: A phenomenological study, EUROPEAN JOURNAL OF CANCER 51 pp. S660-S660 ELSEVIER SCI LTD
Gallagher A (2013) Solidarity and moral perception., Nurs Ethics 20 (5) pp. 499-500
Ventura CA, Gallagher A, Jago R, Mendes IA (2013) Rethinking ethical and legal issues at the end of life in the U.K. and Brazil: a role for solidarity?, Med Law 32 (4) pp. 481-496
There are currently high profile debates about legal and ethical aspects of end of life care and treatment in the U.K. and Brazil. Unlike some other jurisdictions, neither country has legalised assisted dying or euthanasia. We argue that it is timely to consider the issues from the perspectives of an evolving concept in bioethics, that of solidarity.
Gallagher A (2013) The good death., Nurs Ethics 20 (3) pp. 243-244 Sage
International Nurses? End-of-Life Decision-Making in Intensive Care Research Group, Gallagher A, Bousso RS, McCarthy J, Kohlen H, Andrews T, Paganini MC, Abu-El-Noor NI, Cox A, Haas M, Arber A, Abu-El-Noor MK, Baliza MF, Padilha KG (2015) Negotiated reorienting: a grounded theory of nurses' end-of-life decision-making in the intensive care unit., Int J Nurs Stud 52 (4) pp. 794-803
BACKGROUND: Intensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nurses' end-of-life (EoL) decision-making practice across cultures. OBJECTIVES: To understand nurses' EoL decision-making practices in ICUs in different cultural contexts. DESIGN: We collected and analysed qualitative data using Grounded Theory. SETTINGS: Interviews were conducted with experienced ICU nurses in university or hospital premises in five countries: Brazil, England, Germany, Ireland and Palestine. PARTICIPANTS: Semi-structured interviews were conducted with 51 nurses (10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine). They were purposefully and theoretically selected to include nurses having a variety of characteristics and experiences concerning end-of-life (EoL) decision-making. METHODS: The study used grounded theory to inform data collection and analysis. Interviews were facilitated by using key questions. The comparative analysis of the data within and across data generated by the different research teams enabled researchers to develop a deeper understanding of EoL decision-making practices in the ICU. Ethical approval was granted in each of the participating countries and voluntary informed consent obtained from each participant. RESULTS: The core category that emerged was 'negotiated reorienting'. Whilst nurses do not make the 'ultimate' EoL decisions, they engage in two core practices: consensus seeking (involving coaxing, information cuing and voice enabling); and emotional holding (creating time-space and comfort giving). CONCLUSIONS: There was consensus regarding the core concept and core practices employed by nurses in the ICUs in the five countries. However, there were some discernible differences regarding the power dynamics in nurse-doctor relationships, particularly in relation to the cultural perspectives on death and dying and in the development of palliative care. The research suggests the need for culturally sensitive ethics education and bereavement support in different cultural contexts.
Marsh W, Robinson A, Gallagher A, Shawe JA (2014) Removing babies from mothers at birth: Midwives' experiences, British Journal of Midwifery 22 (9) pp. 620-624
It is evident from a review of the literature that looking after the psychological and emotional needs of women who have their baby removed at birth is a vital part of midwifery care in the childbirth continuum. This review reports on the experiences of midwives who have provided care and emotional support to mothers who have had their baby removed at birth and the challenges they have encountered from doing so. BNI, CINAHL, EMBASE, Google Scholar, Maternity and Infant Care and PsycInfo were searched for articles published until January 2014 and findings suggest that providing care and emotional support to women who have had their babies removed at birth remains one of the most challenging aspects of contemporary midwifery practice. It is anticipated that this study will raise awareness of the challenges associated with providing care and emotional support for women whose babies have been removed at birth and contribute to the evidence base for best practice.
Gallagher A (2011) Moral distress and moral courage in everyday nursing practice, Online Journal of Issues in Nursing 16 (2)
In this article the author examines the concepts of moral distress and moral courage within the context of nursing practice. Examples of challenging healthcare situations from the United Kingdom and Ireland are discussed in the light of the examination of these two concepts. The examples illuminate features of healthcare situations that need to be considered in relation to different organisational and cultural contexts. This requires an understanding of the complexity of clinical contexts and an appreciation of the fallibility and vulnerability of nurses and other practitioners. The goal of this article is to encourage healthcare organisations to create supportive structures and sensitive leadership that will enhance moral courage in the work setting.
Gallagher M (2011) Editorial, Nursing Ethics 18 (1) pp. 3-5
In a country renowned for its contribution to the establishment of nursing as a profession, we are reeling from
yet another report of poor care. TheUK Health Service Ombudsman report ?Care and compassion?? detailed
10 investigations into the care of older people in the National Health Service (NHS). The report discussed the
absence of the most fundamental aspects of care for older people. The journalist, Jenni Russell, recently
shared her experiences of the NHS in a Sunday newspaper. She described how a friend?s father had moved
?from an environment where staff were rude and mean to a micro civilisation where the ethos was kindness.
??Honestly, he genuinely felt loved there???. Russell described the activities that contributed to this elderly
gentleman feeling loved. She wrote ?The nurses mushed up his food so that he could eat despite his mouth
cancer; they were cheerful and tactful about his need for bedpans and bed baths; they talked to him with
affection, took messages and rang his family with bulletins whenever they were asked to, even in the middle
of the night. Even though he died from a hospital infection, the family has no regrets.?
Gallagher M (2010) Editorial, Nursing Ethics 17 (3) pp. 283-284
It has been a year since my first two editorials as the new Editor of Nursing Ethics. One of these editorials
focused on ?The good editor?, suggesting that an editor assumes a number of roles, and requires a range of
qualities and also the support and expertise of reviewers and the editorial team.1 A year on, and now not so
new, I can better appreciate the importance of good reviewers. Throughout the year I have relied on the wisdom
and guidance of experienced reviewers. I have also had the pleasure of working with new reviewers,
some of whom ask me for feedback. Such requests require some consideration of what it is that makes a good
review and, related to this, a good reviewer.
Gallagher M (2010) Editorial, Nursing Ethics 17 (5) pp. 539-540
At the time of writing I was attending the 4th Congress of the Croatian Nurses Association in Zagreb, the
theme of which was ?Nursing: the scope of differences?. A congress provides an opportunity for nurses and
others to come together to debate and discuss areas of common concern and interest as well as areas of difference.
Their congress offered some new perspectives and provided opportunities for critical discussion and
reflection. Different perspectives on nursing practice, policy, leadership, education and research were shared
by colleagues from Croatia, other parts of Europe and the USA. We learnt that there are 27 different languages,
over 4 million nurses and many differences in approaches to nurse education in Europe. Any assumptions
we might have had that Europe is homogeneous, with a common culture, politics and history, and
perhaps ethics, were challenged. Conversations with nurses in Croatia confirmed that they are highly motivated
to overcome challenges as they develop the profession. The courage and commitment of Croatian
nurses is illustrated by the achievements of Branka Rimac, President of the Croatian Nurses Association.
Branka continues to overcome past divisions and differences by bringing together nurses in Croatia and elsewhere
to work towards a common goal. Readers may remember that she was one of the recipients of the 2009
Nursing and Human Rights Awards.
Gallagher M (2010) Editorial, Nursing Ethics 17 (1) pp. 3-4
The Japanese Buddhist Great Master and artist, Shinjo Ito, wrote: ?Examine the present and learn from the
past to see how the future will unfold. Too often we just look at the present and base our actions solely on
that?. This insight is very pertinent as I reflect on the recent 10th anniversary International Centre for
Nursing Ethics (ICNE) conference ?Looking back, moving forward? and the first meeting of the new
Editorial Board.
Sala Defilippis T (2017) Moral resilience in intensive care nurses in Switzerland :
a grounded theory study.,
BACKGROUND
Nursing is a moral practice that aims at the good of patients, families and communities (Gastmans, de Casterlé and Schotsmans, 1998). However, applying ethical principles in practice is not a problem-free enterprise (Lützén et al., 2003; Schluter et al., 2008; Epstein and Hamric, 2009; Epstein and Delgado, 2010) due to the particular position that nurses have within healthcare systems, institutions and care teams. Nevertheless, the majority of nurses continue to work ethically despite moral tensions and moral distress. One possibility is that the events that follow a morally distressing situation constitute a process of moral resilience.

OBJECTIVES
This study aimed to examine the main concerns among intensive care nurses in respect of ethical practice, and to investigate how nurses continue to practise in an ethical way despite pressures, tensions and conflicts. Furthermore, this study aimed at developing an explanatory theory of the moral resilience process, understood as a basic social process, which follows a morally challenging situation.

DESIGN
This is a qualitative study drawing on Glaser and Strauss? (1967) version of grounded theory. The data for this study consisted in field notes and interviews from 16 nurses working in intensive care. In-depth interviews were carried out with open-ended questions. Data analysis followed the method suggested by Glaser and Strauss (1967) and Glaser (1978; 2005; 2011) using the constant comparative method.

ETHICAL CONSIDERATIONS
The study was approved by the University Ethics Committee of the University of Surrey, UK, and by the Cantonal Ethics Committee and the Hospital Research Committee of the Southern Switzerland Hospital Organisation. Each participant signed an informed consent form.

FINDINGS
This study breaks new ground in addressing intensive care nurses? main concern regarding moral practice. Harmonising connectedness is both: nurses? main concern and the patterns that characterise moral resilience

CONCLUSIONS AND RECOMMENDATIONS
This study offers new insight into intensive care nurses? moral life, moral wellbeing and strategies nurses put in place in order to achieve moral wellbeing. This study offers new perspectives that should be taken into consideration in nurses? education and in demonstrating measures that aim to increase nurses? moral resilience and their professional retention.

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