Everyday ethical challenges of nurse-physician collaboration

Abstract

Background: Collaboration between physicians and nurses is key to improving patient care. We know very little about collaboration and interdisciplinary practice in African healthcare settings. Research question/aim: The purpose of this study was to explore the ethical challenges of interdisciplinary collaboration in clinical practice and education in Botswana Participants and research context: This qualitative descriptive study was conducted with 39 participants (20 physicians and 19 nurses) who participated in semi-structured interviews at public hospitals purposely selected to represent the three levels of hospitals in Botswana (referral, district, and primary). Ethical considerations: Following Institutional Review Board Approval at the University of Pennsylvania and the Ministry of Health in Botswana, participants’ written informed consent was obtained. Findings: Respondents’ ages ranged from 23 to 60 years, and their duration of work experience ranged from 0.5 to 32 years. Major qualitative themes that emerged from the data centered on the nature of the work environment, values regarding nurse–doctor collaboration, the nature of such collaboration, resources available for supporting collaboration and the smooth flow of work, and participants’ views about how their work experiences could be improved. Discussion: Participants expressed concerns that their work environment compromised their ability to provide high-quality and safe care to their patients. The physician staffing structure was described as consisting of a few specialists at the top, a vacuum in the middle that should be occupied by senior doctors, and junior doctors at the bottom—and not a sufficient number of nursing staff. Conclusion: Collaboration between physicians and nurses is critical to optimizing patients’ health outcomes. This is true not only in the United States but also in developing countries, such as Botswana, where health care professionals reported that their ethical challenges arose from resource shortages, differing professional attitudes, and a stressful work environment.

An examination of the moral habitability of resource-constrained obstetrical settings

“…Curricular documents, reviewed as part of this study, showed that the ethics training of the nurses and midwives did not provide knowledge and skills for addressing conflicts relating to treatment decisions and how to respond when moral values conflict. When morality is viewed as a set of “codifiable, impersonally action-guiding within an agent or as a compact set of law-like propositions that explains the behavior of a well-formed moral agent” (p. 8), 23 it fails to acknowledge the social environment in which the agent is situated. Such code-like assumptions (respect for autonomy, beneficence, nonmaleficence, and justice) are the main concepts found in the revised nursing and midwifery curriculum of the Nursing and Midwifery Council of Ghana and the professional Code of Ethics documents without consideration of the context of practice which include gender and socio-economic inequities.…”

“…Under these circumstances, interprofessional collaboration became impossible since it damaged their identity and eroded their sense of responsibility. Similarly, Sabone et al 23 found that physician domination and lack of recognition of nurses' role hindered interprofessional collaboration among nurses and doctors in Botswana.…”

“…[15][16][17] These challenges impact the provision of quality care to childbearing women, contribute to preventable maternal deaths, and serve as a constant threat to the moral identity and ability of nurses and midwives to practice safely and ethically. Although several studies have described the nursing and midwifery work environments in resource-constrained settings, such as Ghana, as precarious with dire consequences for the personal and professional lives of midwives and nurses, [18][19][20][21][22][23] they have not identified the ethical implications for those working in such environments. The purpose of this study, therefore, was to explore the moral habitability of obstetric settings in Ghana and how this influences the moral agency of nurses and midwives.…”

Defining ethical challenge(s) in healthcare research: a rapid review

“…7/56 empirical studies, all qualitative interview studies, recruited participants internationally with no specific location stated [ 40 , 54 , 55 , 58 , 60 , 63 , 73 ]. Of the remaining studies, all but one were single-country studies: Botswana [ 75 ], Canada [ 41 , 65 ], China [ 57 ], Denmark [ 39 , 43 ], Dominican Republic [ 44 ], Germany [ 51 , 84 ], India [ 61 ], Iran [ 38 , 46 , 49 , 68 , 70 – 72 , 78 , 82 , 98 ], Italy [ 45 ], Mexico [ 87 ], the Netherlands [ 76 ], New Zealand [ 47 ], Norway [ 42 , 52 , 56 , 64 , 80 , 81 , 83 ], Saudi Arabia [ 34 – 37 ], Tanzania [ 69 , 74 ], Uganda [ 67 ], UK [ 86 ], and USA [ 50 , 53 , 59 , 62 , 66 , 77 , 79 , 85 , 85 ]. The remaining study was undertaken in both Sierra Leone and the UK [ 48 ].…”

Inter-professional physician-nurse collaboration in Lebanon

“…This was also documented in other studies (Sandelowski, 1986;Manning, 2006). A study found that work environment, resources and values regarding a physician-nurse collaboration played a major role in this relationship (Sabone et al, 2019).…”