Ethical decision-making : the experience of nurses in selected clinical settings

Abstract

The qualitative study was designed to study how ethical decision-making realises in difficult care situation in nursing. A hermeneutic phenomenological approach was used. Data collection was done through writing of critical incidents by registered nurses and midwives in two hospitals in Gauteng Province. The critical incident technique was developed by Flanagan (1954:327). Narratives/stories were analysed by: naïve reading, structural analysis and comprehensive understanding (Sorlie 2000:52). The study population was 30 registered nurses and midwives, who held in-charge positions, and have dealt with ethical problems themselves. The methodology was about understanding and interpreting lived experiences in clinical practice about ethically difficult care situations in nursing. Guba's model was used for truth value, which was obtained through human experience as was lived and perceived by narrators, who then described/narrated their stories, this was true of critical incidents. The credibility of the findings depends on accurate documentation of the experience as was narrated, so that the participants would recognise their stories. The participants could not validate the findings due to sensitivity of the critical incidents. Applicability was not relevant, as it was description of a particular experience that could not be generalised. Because of the contextual nature of the study, I could not guarantee consistency, as interpretation is based on shared values, norms and beliefs in a particular profession, and is recognised by readers sharing the same values. Anonymity and confidentiality was maintained to protect the narrators, due to the sensitive nature of the study. Ethical principles and respect for human dignity was adhered to. Permission was granted by the hospital authorities as well as Research Ethics Committee at the University of Pretoria. Limitations of the study have been noted. Interpretation of the findings of realisation of ethical decision making in difficult care situations as well as guidelines for teaching ethics to nursing learners has been done Findings of the study indicate that the context and impact of realisation of ethical decision-making in difficult care situations was different to different narrators and completely dependent on the ethical problem that had to be dealt with and be realised or failed to be achieved.