Ethical conflicts with hospitals: The perspective of nurses and physicians
ABSTRACT Nurses and physicians may experience ethical conflict when there is a difference between their own values, their professional values or the values of their organization. The distribution of limited health care resources can be a major source of ethical conflict. Relatively few studies have examined nurses' and physicians' ethical conflict with organizations. This study examined the research question 'What are the organizational ethical conflicts that hospital nurses and physicians experience in their practice?' We interviewed 34 registered nurses, 10 nurse managers, and 31 physicians as part of a larger study, and asked them to describe their ethical conflicts with organizations. Through content analysis, we identified themes of nurses' and physicians' ethical conflict with organizations and compared the themes for nurses with those for physicians.
SourceAvailable from: Dragana Radovanovic[Show abstract] [Hide abstract]
ABSTRACT: The starting point of the interdisciplinary project "Assessing the impact of diagnosis related groups (DRGs) on patient care and professional practice" (IDoC) was the lack of a systematic ethical assessment for the introduction of cost containment measures in healthcare. Our aim was to contribute to the methodological and empirical basis of such an assessment. Five sub-groups conducted separate but related research within the fields of biomedical ethics, law, nursing sciences and health services, applying a number of complementary methodological approaches. The individual research projects were framed within an overall ethical matrix. Workshops and bilateral meetings were held to identify and elaborate joint research themes. Four common, ethically relevant themes emerged in the results of the studies across sub-groups: (1.) the quality and safety of patient care, (2.) the state of professional practice of physicians and nurses, (3.) changes in incentives structure, (4.) vulnerable groups and access to healthcare services. Furthermore, much-needed data for future comparative research has been collected and some early insights into the potential impact of DRGs are outlined. Based on the joint results we developed preliminary recommendations related to conceptual analysis, methodological refinement, monitoring and implementation.Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology 03/2015; 145:w14034. DOI:10.4414/smw.2015.14034 · 1.88 Impact Factor
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ABSTRACT: The major focus of this thesis is the role of feelings and emotions in moral thinking/knowing, ethical conduct and, in particular, moral distress in nursing. Research has consistently found that the moral decisions nurses must make can sometimes lead to distress. However, such experiences are overly individualised in the literature. An alternative view of the person, drawing on the philosophy of Alfred North Whitehead (e.g. 1927-8/1978) and the recent work of Paul Stenner (e.g. 2008), sees human subjectivity or mind as processual and always embodied and in-the-world. The emphasis upon the body draws attention to the role of felt experiences – this thesis views feelings as integral to both sense-making – knowing and thinking – and sensibility or emotionality. The emphasis ‘inthe- world’ highlights that subjectivity is embedded within social contexts, which include relations of power and organisations of material and symbolic capital aligned with those relations. Influenced by ‘deep empiricism’ (e.g. Stenner, 2011a), this thesis develops a novel bricolage methodology based on a metaphor of ‘diffraction’ to explore nurses’ experiences of moral distress. Nurses’ feelings of discomfort, a particular form of ‘feelings of knowing’, appear to be the seeds of moral distress. Various situations seem to be important antecedents for these seeds to bloom into full moral distress, including certain clinical issues, ethical conflict with colleagues, and issues of competency. Nurses also experience some aspects of their job as systemic barriers to high standards of care, which can also be morally distressing. Such distress sometimes affects nurses’ relationships, their physical health, and their mental health. Participants have found several strategies useful in coping with their distress. It is argued that these strategies are about altering one’s feelings through changing one’s activities and/or environment. Additionally, past distress may remain a dormant part of a person’s subjectivity and re-emerge or become (re)enacted in the narrations of those past distressing experiences. It is suggested that subjectivity entails an organisation of past experiences in the present, for present purposes and in anticipation of the future. Six dominant thematic patternings, which recurred throughout the analyses, are discussed: (i) the centrality of feelings; (ii) the relationality of felt experiences; (iii) the complexity of morality, moral conduct, and moral distress – moral/ethical issues become entangled with identity, power, professional competency, and social relations; (iv) the prominence of power and interest; (v) nurses lives as afflicted by moral distress; and (vi) life-as-process. Discussion of these motifs leads to a rethinking of moral distress. Implications for nursing practice, moral distress research and the study of feelings, emotions, and affect are discussed.01/2015, Degree: PhD, Supervisor: John Cromby
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ABSTRACT: Nurse managers have responsibilities relating to the quality of care, the welfare of the staff and running of the organization. Ethics plays significant role in these responsibilities. Ethical problems are part of daily management, but research in this area is limited. The aim of this study was to identify and describe ethical problems nurse managers encounter in their work to get more detailed and extensive view of these problems. The data consisted of nine interviews with nurse managers at different management levels in primary healthcare and specialized healthcare organizations, and it was analysed by inductive content analysis. Permission to conduct the interviews including ethical approval was given at all participating organizations according to national standards. The respondents were informed about the aim of the study, and voluntary participation, anonymous response and confidentiality were explained to them. Four main categories were found: conflicts in practical situations, lack of appreciation, disregard of problems and experienced inadequacy. Problems could also be divided to patient-related, staff-related, organization-related and other problems. The findings correspond with results from earlier studies but add knowledge of the nature and details of nurse managers' ethical problems. New information is produced related to the ethical problems with nurse managers' own courage, motivation and values. Nurse managers identified a variety of different ethical problems in their work. This information is useful in the development of ethics in nursing management. Further research about the frequency and intensity of nurse managers' ethical problems is needed as well as possible differences in different levels of management. © The Author(s) 2015.Nursing Ethics 04/2015; DOI:10.1177/0969733015579309 · 1.09 Impact Factor