Ethical conflicts experienced by certified pediatric nurse practitioners in ambulatory settings

Moral problems and distress among nurse practitioners in primary care

“…However, because 30 of the returned surveys indicated they were not in primary care and thus not eligible for inclusion, the usable response rate was reduced to 37%. This compares favorably to a 21% response rate obtained by Butz et al (1998), in which a survey questionnaire was mailed to 559 pediatric NPs asking them to describe an ethical conflict in their practice.…”

“…The theoretical framework was based upon the experience component of Wilkinson's Moral Distress Equation (1987/1988, 1989), in which a moral situation (ethical issue) + the moral decision about the right action to take in regard to that moral situation (moral problem) + perceived inability to act (in order to resolve the moral problem) = painful feelings and psychological disequilibrium (distress). The types of moral problems in this study are those described above by Jameton (1984) (moral distress, moral dilemma, moral uncertainty) and Wilkinson (1987/1988) (moral outrage), and the ethical issues are those described in the literature as commonly encountered in primary care among NPs (Beidler, 2002; Butz et al, 1998; Turner et al, 1996; Viens, 1995) and physicians (Felder, 2002; Junkerman & Schiedermayer, 1998; Sugarman, 2000).…”

Ethical Dilemma and Moral Distress: Proposed New NANDA Diagnoses

“…The Nursing Interventions Classification (NIC) (Dochterman & Bulechek, 2004) includes many interventions that nurses can apply to ethical dilemma and moral distress diagnoses. For example, the nurse may directly assist the patient in evaluating the situation using “values clarification” (Butz, Redman & Fry, 1998). The nurse may consult with other healthcare providers using “multidisciplinary care conference” that may include the family (Butz et al, 1998; Redman & Donovan, 1999; Redman & Fry, 1998b).…”

Moral conflict and collaborative mode as moral conflict resolution in health care

“…With distributive justice as an ethical principle, health care providers usually encounter moral conflict when they cannot conduct equality of health care. For example, certain managed care and health insurance policies have contributed to the ethical conflicts experienced by certified pediatric nurse practitioners when institutions give preferential services to insured children or provide substandard care to uninsured children (Butz et al ., 1998).…”

“…The study by Butz et al . (1998) regarding moral conflicts experienced by nurses, indicated that nearly one fifth of the moral conflicts were addressed by discussion or collaborative action with other providers, the patients and their families.…”