Ethical Dilemmas Experienced By Hospital and Community Nurses: an Israeli Survey

Abstract

The objective of this survey was to assess the extent to which nurses encounter and identify dilemma-generating situations in the light of the publication and circulation of the Israeli code of ethics for nurses in 1994. The results are being used as a basis for a programme aimed at promoting nurses' decision-making skills in coping with ethical dilemmas. In this era of major advances in medicine, the nurse's role as the protector of patient rights may bring about conflicts with physicians' orders, with institutional policies, or with patients' families. Nurses will then become confronted with ethical and moral dilemmas. A nationwide survey was carried out to identify and describe the ethical conflicts with which nurses in Israel are confronted in the course of their work. A third of the enumerated dilemmas were encountered by more than 50% of the nurses. The major determinant influencing encounters with dilemmas, as perceived by the participating nurses, was their work setting, namely, the hospital versus the community. It was shown that nurses seek support mainly among their peers, they are barely familiar with the Israeli Code, and they consider their own families as the predominant factor in shaping their ethical attitudes.

Nurses’ views on ethical codes: a focus group study

“…(2004) that, in order to empower individual professionals in their daily practice, the moral objective of ethical codes should be emphasized. However, this finding does not correspond with those of quantitative studies (Davis 1991, King & Miskovic 1996, Wagner & Ronen 1996, Whyte & Gajos 1996, Wilmot et al. 2002) showing that nurses are not inclined to use ethical codes to inform their ethical decision‐making, but rather rely on other resources, such as protocols, personal values and nursing education.…”

“…1992) over 68% (Edwards & Haddad 1988) to 75·5% (King & Miskovic 1996). Furthermore, these studies indicate that the ethical code plays a minimal role in influencing nurses’ ethical decision‐making and that they seem to rely less on the ethical code than on other resources, such as protocols (Wagner & Ronen 1996), personal values (Davis 1991), nursing education and religious, political or other normative influences (King & Miskovic 1996). These findings have been confirmed by other studies which have revealed that, although ethical codes are recognized, nurses do not use them proactively to inform decision‐making (Whyte & Gajos 1996), but cite personal experience and the culture of the healthcare setting as roots of moral commitment in their work (Wilmot et al.…”

Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care

“…The EDN is a questionnaire developed by Wagner and Ronen (1996). The title of the questionnaire (EDN) implies that the tool was composed only of ethical dilemmas.…”

“…Wagner and Ronen (1996) have divided ethical dilemmas into three categories: (a) clinical situations such as inappropriate care. Some examples of this type of dilemma are participation in patient interventions that are against the nurse’s principles; providing futile treatment or reporting medical errors, (b) administrative situations such as delay in treatment due to strikes or inability of the patient to pay and (c) interpersonal situations such as inappropriate behaviour of a patient or family member; aggressive, inappropriate behaviour of a staff member to a patient or family member; or conflicts between patients and their families.…”

Ethical dilemmas experienced by nurses presented in nursing publications

“…Brazilian studies, in agreement with foreign studies, identified that health professionals pointed out ethical problems regarding the members of the working team as more important than those from the relationship with users and their families, both in primary, secondary, and tertiary care (7)(8) .…”