How Community Nurses Manage Ethical Conflicts: A Grounded Theory Study

Abstract

Research is limited on how nurses in community settings manage ethical conflicts. To address this gap, we conducted a study to uncover the process of behaviors enacted by community nurses when experiencing ethical conflicts. Guided by Glaserian grounded theory, we developed a theoretical model (Moral Compassing) that enables us to explain the process how 24 community nurses managed challenging ethical situations. We discovered that the main concern with which nurses wrestle is moral uncertainty (“Should I be addressing what I think is a moral problem?”). Moral Compassing comprises processes that resolve this main concern by providing community nurses with the means to attain the moral agency necessary to decide to act or to decide not to act. The processes are undergoing a visceral reaction, self-talk, seeking validation, and mobilizing support for action or inaction. We also discovered that community nurses may experience continuing distress that we labeled moral residue.

Ethical Problems and Moral Distress in Primary Care: A Scoping Review

“…The most productive country was Brazil, with seven studies included [ 20 , 21 , 25 , 26 , 29 , 30 , 32 ]. Two studies were conducted in Canada [ 24 , 33 ]; two in Sweden [ 22 , 23 ]; one each in Germany [ 19 ], the Netherlands [ 28 ], Turkey [ 27 ], and Australia [ 31 ]. The total number of nurses involved in quantitative studies was 1137 (range: 36–433); the total number of nurses involved in qualitative studies was 144 (range: 7–73).…”

“…Porr et al [ 24 ] developed a theoretical model (Moral Compassing) to explain how community nurses manage challenging ethical situations. Using a qualitative approach, the authors interviewed 24 community nurses, namely, home care and public health nurses.…”

“…Based on their story-telling method, Porr et al [ 24 ] described the sequential process that community nurses used when they were faced with an ethical conflict. Firstly, community nurses underwent a visceral reaction when they were aware that “something is not right”: “an instinctive feeling, an uneasiness that nurses describe as a ‘gut feeling’, arises that causes them to pause and consequently their work is disrupted” [ 24 ]. This visceral reaction led to the process of self-talk, in which nurses reflected why they “feel a certain way”.…”

“…This choice helped to increase their confidence in dealing with ethical conflicts and prepared them to manage similar situations through action or inaction. Porr et al, [ 24 ] emphasized the importance of coworkers and manager support in helping nurses managing ethical conflicts and/or ethical uncertainty. Several emotions were described by participants during ethical conflict management, such as “angst and upset” that have not “really quite gone away”.…”

“…Several emotions were described by participants during ethical conflict management, such as “angst and upset” that have not “really quite gone away”. Porr et al [ 24 ] described this continuing distress experience as “moral residue”.…”