Conscientious object in nursing: Regulations and practice in two European countries

Abstract

Background: The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery. Aim: To present (a) the arguments for and against conscientious objection in nursing practice, (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice. Design: Discussion paper. Ethical considerations: Ethical guidelines has been followed at each stage of this study. Findings: Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient’s rights. Discussion and conclusion: Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice.

Supervised internship in undergraduate nursing courses in the State of São Paulo, Brazil

“…In the initial years of the course, the student is instrumentalized through theoretical classes, simulated practices and clinical practices and there is no clear definition of the hours that should be allocated to this type of education (5) . What has been observed in the state of to influencing students' confidence, their sense of belonging and respect for the user (4,16) .…”

“…Regarding the hours of nursing courses developed in Europe, it is observed that, although there is a diversity of curricula, in most of the higher nursing schools, the student, in order to complete the first training cycle (degree), takes three to four years of formal education, and the minimum hours must not be less than 4,600 hours. It should be noted that 50% of this hours should be devoted to clinical teaching, that is, clinical practice in health units (4,(15)(16) , more than double the ECS hours required in Brazil (5) . However, the offer of clinical practices is also a challenge for the European countries, because the number of hours devoted to the clinical practice has varied between 30 and 60% of the total course load, showing the non-compliance with European legislation (16) .…”

“…It should be noted that 50% of this hours should be devoted to clinical teaching, that is, clinical practice in health units (4,(15)(16) , more than double the ECS hours required in Brazil (5) . However, the offer of clinical practices is also a challenge for the European countries, because the number of hours devoted to the clinical practice has varied between 30 and 60% of the total course load, showing the non-compliance with European legislation (16) . proportional to the improvement in the quality of patient care and the reduction of adverse events (17)(18) .…”

“…primary and hospital care. In European countries, to be recognized as a field of clinical learning, health institutions must demonstrate specific criteria related to facilities, including equipment and human resources, the quality of the educational environment determined through audits and positive feedback received from independent accreditation bodies, which monitor the entire nursing education process (16) . that can guarantee the resolution of common healthdisease processes (14,19) .…”

The inequity of conscientious objection: Refusal of emergency contraception

“…As a general practice and policy, it is also found to be pertinent as one of the basic aspects of freedom in a democratic society. 13 Similar to the United States, the issue of conscientious objection is widely debated in Europe, and many individual practitioners have strong beliefs both for and against a provider's or pharmacist's right to use conscientious objection when it comes to dispensing emergency contraception. One study conducted with Norwegian medical students found that most of the support for conserving the right to use conscientious objection was in regard to the abortion procedure, not in regard to dispensing emergency contraception.…”