Ethical aspects in community nursing in Croatia

The philosophy of public health nursing is based on the belief that care directed towards the individual, his family and different social groups, contributes to the protection of overall population health. Nurses’ care for health is not limited only to age or different disease groups, but it refers to all other activities which contribute to health improvement – prevention, rehabilitation, concern for social justice, reducing disparities in providing health care services, and advocating the interests of community members. It is an unavoidable fact that every health situation includes a set of value judgements or norms, therefore every decision that is made has in itself a moral component as well. There is a small number of research dealing with examining the capacity for cognition of moral dilemmas, moral deliberation, decision-making and implementing those decisions in nursing practice, especially in public health nursing. Since almost one third of the nurses (about ten thousand) in the Croatian health system work in community health care the aim of the authors was to determine how well the nurses were informed about the formal bodies that deal with ethical questions in their institutions (ethical committees) and wider community, and the number of nurses who are members of these committees; whether they know who to refer to for help in identifying and solving their ethical problem (formal bodies, health and other institutions) and how they perceive their capability in identifying and solving an ethical problem. Another aim was to determine which moral dilemmas nurses encounter in their everyday practice. The results of the research would be used for the advancement of nursing practice in public health nursing in the Republic of Croatia. The sample consisted of 300 nurses, out of which 200 finished secondary level of education, 100 finished undergraduate and graduate study programme. A questionnaire on how well the nurses are informed and how they perceive their knowledge and skills in the field of nursing ethics. The questionnaire consisted of 16 questions and one open-ended question where nurses could write about most often encountered moral dilemmas in their practice. The results of the research have shown that nurses who work in community are not sufficiently informed about the existence and formal structure of the bodies that deal with ethical questions in their institutions and wider community, and that they do not perceive their knowledge and skills as being sufficient for dealing with moral dilemmas in practical situations. Furthermore, it can be noted that, during stating ethical dilemmas they encounter in everyday practice, they are a lot more oriented towards themselves, mutual relations in the team and moral dilemmas which come within the competence of a doctor, while not mentioning the issues of social justice, disparity in providing health services, as well as issues of being informed, dignity and mistanasia of community members. The reasons for that are to be found in a deficient theoretical education in the field of their professional ethics, especially when considering nurses with a secondary level education. Even though the nurses with higher education demonstrate more theoretical knowledge and understanding, they have not demonstrated sufficient confidence in three questions that are essential for practical application of knowledge and skills