Staff nurses\u27 perceptions of ethical dilemmas and their resolution: A multiple case study

The purpose of this study was to identify themes about ethical dilemmas of staff nurses across a variety of work settings and to further identify how nurses resolve ethical dilemmas. This qualitative research study used multiple case study procedures and techniques to identify the themes regarding ethical dilemmas. Twenty-one nurses who had been or were currently working as staff nurses were interviewed. The participants were purposefully selected for the study by network sampling and the participants represented both genders, varying years of nursing experience, and differing educational preparation. The nurses were currently working in eleven different work settings in five different communities in a midwestern state. Semi-structured tape-recorded interviews were conducted. The nurses discussed fifty-six different ethical problems, thirty-nine in detail. Internal and external validity checks were used. The study identified twelve themes about ethical dilemmas of staff nurses. Three of the themes were related to describing the dilemma, six themes were about the dilemma, two themes related to doing the right thing and one theme was about the impact of the dilemma. Topical descriptions of the twelve themes are: (1) the lasting impressions of ethical dilemmas, (2) ethical dilemmas are sensory experiences, (3) ethical dilemmas are intertwined with clinical dilemmas, (4) there are more players in the dilemmas than the patient and the nurse, (5) limitations to influencing decision-making, (6) lack of closure, (7) nursing roles during the dilemmas, (8) complexities caused by legalities, (9) the role of the internal conscious in resolution, (10) risking doing the right thing, (11) the influence of religious beliefs, (12) ethical dilemmas are growth experiences for the nurse. The study further identified eight roles of staff nurses during ethical dilemmas. Those roles were (1) use of self, (2) quality assurance reviewer, (3) therapeutic communicator, (4) patient advocate, (5) support to patients and families, (6) patient educator, (7) referral source, and (8) care giver