Ethical conflicts in nursing: An interview study

Abstract

Background: A growing body of evidence about nurses’ ethical conflicts has been added to nursing science in recent decades, but no research has been done in Estonia. Ethical conflicts are a cultural and context sensitive phenomenon, so the historical, legal, social, economic and political backgrounds and position of nursing have had an impact on ethical conflict experiences. Aim: Describe nurses’ experiences of ethical conflicts. Method: A qualitative, descriptive study was conducted among nurses (n = 21) in May-October 2018 in Estonia. The data were collected in the form of semi-structured individual interviews and analysed using the inductive content analysis method. Ethical considerations: Due to the sensitive nature of the research topic, only individual interviews were carried out. Findings: Nurses’ ethical conflicts were related to situations that violated the rights, safety or well-being of the patient or relatives, caused them suffering, were against their will or threatened nurses’ dignity and professionalism through a variety of practices, attitudes and relationships. The insufficiency of patient care and professional collaboration emerged as important sources of nurses’ ethical conflicts and were connected to historical and societal factors. Conclusions: In order to achieve good quality of care, nurses need to have appropriate education and organisational support to carry out ethical daily care. More research is needed to understand the multidimensional cultural and contextual knowledge of ethics and nurses’ ethical conflicts.

School nurses’ engagement and care ethics in promoting adolescent health

“…1,6,7 In agreement with the present findings, an excessive workload with stipulated screenings has been found to prevent school nurses from realizing their ideals and performing health-promoting activities. 21,34,35 Many early interventions may be missed out and symptoms may develop into severe problems that affect health and well-being before the school nurse is contacted. The school nurses believe that they would be able to help adolescents via early interventions if they are contacted in time.…”

“…21,23,37 However, a non-supportive work environment where some teachers are not interested in health issues or disorganization of work can cause ethical conflicts. 21,34,35…”

The Medical Futility Experience of Nursing Professionals in Greece

“…Nursing professionals are the main caregivers who spend most time near the patient, being in close physical and narrative proximity to them, thereby encountering their particularities [6]. However, the literature reports under-representation of nursing professionals in end-of-life decisions [7,22,23].…”

“…Nursing professionals arguably are motivated by a rigid desire that attending physicians should listen to them [22]. More generally, nursing professionals highlight the need for better inter-professional relationships when it comes to end-of-life decisions [23]. Note, however, that it is argued that physicians often recognize the role of senior and experienced nursing professionals and include them in end-of-life decision making processes [24].…”

“…The concept of a good death is highly individual, where the patient's preferences should take precedence [23,31,32] and patient's integrity should be protected [32]. Dignity is perceived by nurses as a multidimensional entity [33].…”