Retired Registered Nurses’ Stories About Being in Ethically Difficult Care Situations

Abstract

Twelve retired nurses were asked to narrate a care situation in which it had been difficult for them as nurses to know what was the right and good thing to do. The transcribed interviews were examined by content analyses. Physicians were the central coactors in the nurses' stories. Colleagues were seldom mentioned. Other ward staff were mainly called "the girls". The patient was central and referred to with respect. All the nurses focused on experiential learning. Guiding ethical principles are listed.

Ethical competence as a coping resource for moral distress in nursing

“…13,26 This category also covers situations resulting from interpersonal relationships 11 and from disagreement regarding the clinical decisions. 13,17,26 It is also possible to perceive some ethical questions which permeate the patient and professional categories, related to information 13,26,[30][31] and conflicts of values. 17 In the ethical questions related to the health system, emphasis is placed on the lack of human and material resources, [10][11]13,20,26,[28][29][30] when the professional does not act as she would like to, as a result of lack of resources and time.…”

“…13,26 Another topic present in this category is the conflict experienced between professionals and health managers. 11,31 It is possible to perceive that many works reveal ethical questions related to the individual characteristics of the professional who works with a lack of responsibility, 13 lack of commitment, 30 lack of confidence, 26 difficulty communicating 11,13 and, sometimes, ignorance of what the right thing to do is. [17][18]31 One study emphasizes the professional autonomy which seems to be correlated with the different categories, as it appears because the nurses need to respect the patient's rights, follow medical prescriptions, and comply with organizational regulations at the same time.…”

“…11,31 It is possible to perceive that many works reveal ethical questions related to the individual characteristics of the professional who works with a lack of responsibility, 13 lack of commitment, 30 lack of confidence, 26 difficulty communicating 11,13 and, sometimes, ignorance of what the right thing to do is. [17][18]31 One study emphasizes the professional autonomy which seems to be correlated with the different categories, as it appears because the nurses need to respect the patient's rights, follow medical prescriptions, and comply with organizational regulations at the same time. 15 On the topic of coping resources, studies were included in initiatives for coping with the ethical demands experienced, which were undertaken by the professionals themselves or applied by researchers as part of their studies.…”

“…29 Also included are changes in protocols, creativity, and collective actions. 12 On the other hand, the professionals sometimes responded negatively, when they avoided becoming involved in ethically difficult situations and the resolving of these, 12,28 when they did not discuss or reflect on the case 13,31 or when they opted to change job. 28 Characteristics of acceptance, conformism, desisting and individualism can also be observed.…”

“…28 Characteristics of acceptance, conformism, desisting and individualism can also be observed. 12 Many professionals reported wishing to place greater emphasis on the teaching of ethics, 11,31 that there were more courses in the work environment, 10 discussions on the ethical questions experienced 16 and the creation of ethics committees; 10 they did not present, however, any initiatives for achieving any of these objectives.…”