Nurses contribution to the resolution of ethical dilemmas in context

Background: 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.
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: An Interpretive Qualitative study was undertaken, between March and December 2012, using a flexible approach to analysis. The National Research Ethics Committee provided Ethical approval. 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. The relatively small, single site sample may not account for the affects of organisational culture on the results.
Results: Four major themes emerged: ‘Best for the patient’, ‘Accountability’, ‘collaboration’ and ‘policy’. In addition professional relationships were identified as key to resolving ethical dilemmas. Moral distress was evident in the data as identified in the literature, and reflects the emotional labour nurses’ experience.
Discussion: Support is required for nurses to acquire the skills to develop and maintain professional relationships for addressing ethical dilemmas in practice. Nurses require strategies to address the negative impact of moral distress.
Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas.
Recommendations: Research is required to explore this phenomenon in other geographical areas and professional settings. Nurses need to engage with political and organisational macro and micro decision making. Further research is required to establish how nurses can manage moral residue and minimise the negative impact of moral distress.