Ethical conflicts in patient relationships: Experiences of ambulance nursing students

Abstract

Background Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts. Aim To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies. Research design An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses. Participants The 69 participants attended a 1-year educational programme for ambulance nurses at a Swedish university. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study. Findings The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care. Discussion Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation. Conclusion The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability.

Ambulance clinicians’ attitudes to older patients’ self‐determination when the patient has impaired decision‐making ability: A Delphi study

“…However, ethical conflicts have been found to be related to self-determination when patients refuse the care offered by the ACs (Sandman & Nordmark, 2006). In a recent study from the AS context, Bremer and Holmberg (2020) found that a number of ethical conflicts originated from problems related to the patient's self-determination. Ethical conflicts arose because of the ACs' inadequate access to the patient's narrative, uncertainty regarding the patient's decision-making ability and conflicting assessments of the patient's best interest.…”

“…Shared decision-making was rarely seen, and an ethical dilemma occurred when the next of kin consented to hospitalisation against the wishes of the patient. based on the signs of illness and available medical history (Bremer et al, 2012;Bremer & Holmberg, 2020;Hagiwara et al, 2013;Holmberg et al, 2016).…”

“…In urgent situations, older patients may have impaired decision-making ability or reduced ability to participate in decisions concerning their own care, making it more difficult for the ACs to understand and respect the patient's autonomy, as there is uncertainty about the patient's authentic wishes and own values. Hence, the risk of value conflicts is significant (Bremer & Holmberg, 2020). Older, acutely ill persons with impaired decision-making abilities also risk negative discrimination resulting from conscious or unconscious bias among ACs or the patient's needs are assessed based on the ACs' own values (Bremer et al, 2015).…”

Ethics education to support ethical competence learning in healthcare: an integrative systematic review

“…Addressing these problems requires ethical competencies that involve the ethical dimensions of sensitivity, knowledge, reflection, decision making, action, and behaviour [ 3 ]. As the future workforce, students need training to effectively deal with ethically problematic situations [ 4 ], and experienced professionals need to develop ways to manage ethical problems [ 5 ]. Therefore, it is essential for ethics education to support the learning and development of ethical competencies among healthcare professionals and students undergoing training to work in healthcare.…”

Nurses’ experiences of encountering patients with mental illness in prehospital emergency care – a qualitative interview study

“…A trusting nurse–patient encounter is also a core part of ‘PEC’ [ 12 ], and these encounters can be understood as a caring relationship. However, nurses have been found to dichotomize medical care and a caring relationship, with their primary focus being on medical care and treatment [ 13 ]. This attitude can affect their encounters with patients with mental illness who do not manifest explicit emergency somatic symptoms.…”