Ethical theory, ethnography, and differences between doctors and nurses in approaches to patient care.

Abstract

Objectives-To study empirically whether ethical theory (from the mainstream principles-based, virtue-based, andfeminist schools) usefully describes the approaches doctors and nurses take in everyday patient care. Design-Ethnographic methods: participant observation and interviews, the transcripts of which were analysed to identify themes in ethical approaches. Setting-A British old-age psychiatry ward. Participants-The more than 20 doctors and nurses on the ward. Results-Doctors and nurses on the ward differed in their conceptions of the principles of beneficence and respect for patient autonomy. Nurses shared with doctors a commitment to liberal and utilitarian conceptions of these principles, but also placed much greater weight on relationships and character virtues when expressing the same principles. Nurses also emphasised patient autonomy, while doctors were more likely to adovate beneficence, when the two principles conflicted. Conclusion-The study indicates that ethical theory can, contrary to the charges of certain critics, be relevant to everyday health care -if it (a) attends to social context and (b) is flexible enough to draw on various schools of theory.

Enriching Our Views on Clinical Ethics: Results of a Qualitative Study of the Moral Psychology of Healthcare Ethics Committee Members

“…In the literature, there is evidence that nurses seem to feel or experience more frustration) regarding difficult patients compared to physicians who work at a distance and do not feel ethical problems as strongly [23]. Part of the explanation lies in the fact that nurses have more sustained relationships with patients than physicians do and our data suggests something akin is happening here within HECs [23,24]. Proximity to the clinical context and to patient sufferance shapes moral perspectives.…”

“…We suggest that the affective experience associated to the very nature of the work being conducted by members inside the healthcare system, and primarily the proximity, i.e., the fact of seeing patient sufferance (and also patient improvement), explains in part these differences. In the literature, there is evidence that nurses seem to feel or experience more frustration) regarding difficult patients compared to physicians who work at a distance and do not feel ethical problems as strongly [23]. Part of the explanation lies in the fact that nurses have more sustained relationships with patients than physicians do and our data suggests something akin is happening here within HECs [23,24].…”

Factors Impacting Ethical Behavior in Hospitals

“…In addition, nearly four out of five nurses reported a stress level of 6 or more on a scale of 0-10. Robertson (1996), in a study of an old-age psychiatry ward, found that doctors and nurses differed on respect for patient autonomy. In addition, they also valued relationships and character virtues more than doctors in everyday patient relationships.…”

A Study of Ethical Decision Making by Physicians and Nurses in Hospitals

“…De Casterle et al (2008) in a metaanalysis of nine studies from four countries found that conformist practices are a major barrier for nurses to take appropriate ethical action. Robertson (1996) in a study of an old-age psychiatry ward found that nurses are also likely to face more serious consequences of their decisions than physicians when faced with an ethical problem. Deshpande et al (2006) found that nurses were more ethical than other hospital employees.…”