Letters to the Editor.

This article contains Letters from the Readears.

Guidance for Ethical Leadership in Nursing Codes of Ethics: An Integrative Review.

There has been limited attention to ethical leadership for formal nurse leaders around the world. Assuming that codes of ethics provide meaningful standards of what is expected of health professionals, what specific guidance for ethical leadership is available to formal nurse leaders in national nursing codes of ethics? We conducted an integrative review of national nursing codes of ethics for 131 member countries of the International Council of Nurses (ICN). In the ICN Code, nurse managers/leaders are highlighted for their role in ethical practice.

"Stop the noise!" From voice to silence.

Nurses are frequently portrayed in the literature as being silent about ethical concerns that arise in their practice. This silence is often represented as a lack of voice. However, in our study, we found that nurses who responded to questions about moral distress were not so much silent as silenced.

Navigating towards a moral horizon: a multisite qualitative study of ethical practice in nursing.

This paper reports the results of a qualitative study of nurses' ethical decision-making. Focus groups of nurses in diverse practice contexts were used as a means to explore the meaning of ethics and the enactment of ethical practice. The findings centre on the metaphor ofa moral horizon--the horizon representing "the good" towards which the nurses were navigating.

Shared moral work of nurses and physicians.

Physicians and nurses need to sustain their unique strengths and work in true collaboration, recognizing their interdependence and the complementarity of their knowledge, skills and perspectives, as well as their common moral commitments. In this article, challenges often faced by both nurses and physicians in working collaboratively are explored with a focus on the ways in which each profession's preparation for practice has differed over time, including shifts in knowledge development and codes of ethics guiding their practice. A call for envisioning their practice as shared moral work as well as practical strategies to begin that work are offered as a basis for reflection towards enhanced nurse-physician relationships.

Patient safety: is it just another bandwagon?

In this paper, the author questions the focus of the patient safety movement, speculating that it might be just another "bandwagon" that health executives and some health professionals are eager to join. The history of this current emphasis on patient safety is briefly sketched, including current activities in Canada, and questions are raised about whether the movement aids or avoids pressing healthcare issues, many of which are supported by good evidence. These include the relationship between nursing staffing and patient outcomes, the way in which a "cult of efficiency" has operated to make errors more likely and how the silencing of nurses and other staff leads to error.

Ethical practice in nursing: working the in-betweens.

Background: While contemporary ethical theory is of tremendous value to nursing, the extent to which such theory has been informed by the concerns and practices of nurses has been limited.

Purpose: With a view to complementing extant ethical theory, a study was undertaken to explore, from the perspective of nurses, the meaning of ethics and the enactment of ethical practice in nursing.

Design And Methods: Located in the interpretive/constructivist paradigm, using an emergent design, this inquiry employed focus groups to collect the data.

Keeping codes current. An ethics program to support nursing practice.

In this article, we focus our attention on the Canadian Nurses Association's Code of Ethics (Code) for Registered Nurses (1997) and the background against which it was developed. In doing so, we highlight the participation of nurses in its development and the strategies designed to keep the Code "alive," useful, and current.

Navigating towards a moral horizon: a multisite qualitative study of ethical practice in nursing.

This paper reports the results of a qualitative study of nurses' ethical decision-making. Focus groups of nurses in diverse practice contexts were used as a means to explore the meaning of ethics and the enactment of ethical practice. The findings centre on the metaphor of a moral horizon--the horizon representing "the good" towards which the nurses were navigating.