Nurses’ contributions to the resolution of ethical dilemmas

Abstract
New nursing roles and advances in care and treatments have resulted in nurses facing increasingly complex ethical dilemmas in practice, nurses are therefore required to engage effectively in ethical decision-making (Storch et al., 2004). Prior to commencing this empirical study a literature review was undertaken, the databases CINAHL, Science Direct, Medline, Web of Science and British Nursing Index were searched. Peer reviewed papers were systematically reviewed. Emerging themes were moral distress, codes of ethics, conflict within ethical decision-making and policy. The literature included international studies and indicated that ethical decision making is a concern amongst nurses globally.

Aim: To identify how nurses contribute to the resolution of ethical dilemmas in practice.

Method: Following National Research Ethics Committee approval, an interpretive qualitative study (Denzin and Lincoln, 2008) was undertaken between March and December 2012. Eleven registered nurses were interviewed using semi structured interview focusing on how participants addressed ethical dilemmas in practice. In-depth thematic and content analysis of the data was
undertaken (Holloway and Freshwater, 2007).

Results: Whilst the relatively small, single site sample may not account for the effects of organisational culture on the results, four major themes emerged: ‘Best for the patient’, ‘Accountability’, ‘collaboration’ and ‘others’. Professional relationships were clearly key to resolving ethical dilemmas and the data further illuminated the role moral distress played in managing them.

Discussion: Support is required for nurses to acquire the skills to develop and maintain professional relationships for addressing ethical dilemmas in practice. In addition these findings add to our understanding of the phenomenon of moral distress and the strategies that might address its negative impact.

Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas. Research is required to explore this phenomenon in other geographical areas and professional settings.