Exploring Ethical Dilemmas in Perioperative Nursing Practice Through Critical Incidents

Abstract

This article describes the nature of ethical dilemmas in perioperative nursing practice. Using the Critical Incident Technique, common ethical dilemmas experienced by perioperative nurses are explored. The aim of the study was to elicit the ethical dilemmas that arise in perioperative nurses' practice. The study has a descriptive design and the data are critical incidents described by 48 anaesthetic nurses and 76 operating theatre nurses. An analysis of the critical incidents gave four domains of ethical dilemmas: those arising as value conflicts in the intraoperative phase of surgery; those emanating from the patient's right of self-determination; those arising in caring for patients; and those resulting from the allocation of scarce resources and the demands of increased effectiveness.

Inconsistent use of the critical incident technique in nursing research

“…In terms of data analysis, there is general agreement that CIT analysis is an inductive process (Flanagan 1954, Cox et al. 1993, von Post 1996, Kemppainen et al. 1998, Kemppainen 2000, Arvidsson & Fridlund 2005, Aveyard & Woolliams 2006, Persson & Martensson 2006, Bradbury‐Jones 2007, Hensing et al.…”

“…Some nurse researchers have explicitly rejected certain critical incidents from their studies either because they were too vague and general (Dachelet et al. 1981, Kemppainen 2000) or because they were incomplete (von Post 1996). This fits with the original stance of Flanagan (1954), who suggested that if full and precise details are given it can usually be assumed that the information is accurate, but vague reports suggest that the incident is not well‐remembered and some of the data may be incorrect.…”

“…In relation to terminology, as discussed earlier some researchers have moved away from using the term ‘critical’ because of its connotations in health care. In her study involving nurse participants, von Post (1996) provided a definition for participants on how the term ‘critical’ was to be interpreted: ‘critical means that the incident must have a discernible impact on some outcome; it must make either a positive or a negative contribution to the accomplishment of some activity of interest’ (p. 238). In our CIT studies we used an opening prompt, for example: tell me about an incident in which you have felt empowered (Bradbury‐Jones et al.…”

“…However, although sample size does not reflect the volume of data generated, the extremes in sample size are nevertheless interesting. For example, some studies have fewer than 10 participants (Care 1996, Jay 1996 while others have over 100 (Bailey 1956, von Post 1996, Kemppainen et al 1998, Narayanasamy & Owens 2001, and some sample sizes have consisted of over 1000 participants (Cormack 1983). To illustrate variations in the number of incidents generated from different sample sizes, Kemppainen et al's (1998) Persson and Martensson (2006) reported that their sample of 27 yielded 143 'situations'.…”

Nursing Priorities, Actions, and Regrets for Ethical Situations in Clinical Practice

“…The critical incident technique (CIT) framed our research approach. First developed by Flanagan (1954) to investigate critical pilot behaviors, CIT has been adopted by researchers to study quality care indicators (Kemppainen, 2000), student nurse empowerment (Bradbury‐Jones, Sambrook, & Irvine, 2007), perioperative ethical dilemmas (von Post, 1996), communication failures (Arora, Johnson, Lovinger, Humphrey, & Meltzer (2005), and family caregivers' home experiences (Munck, Fridlund, & Mårtensson, 2008). CIT researchers seek specific, real‐life narrations of events critical to the topic of their investigation (Pavlish et al, 2011; Schluter, Seaton, & Chaboyer, 2008).…”