Nurses' reflections on ethical decision-making

Carmelita Louise Blake, Fordham University


Historically, nurses have engaged in moral conduct and adherence to various codes of ethics which specify expected behaviors and a covenant with society. However, advances in technology, complexity in health care delivery, and the changing environment in the health care industry present nurses with recurring situations in which basic human values and needs pose ethical problems. This requires nurses to exercise ongoing moral judgment in decision making. Because each situation is unique, the task of decision making is further complicated by the changing values and expectations of other health care professionals, patients and their families, and society. This study described and documented nurses' reflections on ethical decision making. The study also attempted to identify the type of ethical dilemmas encountered and the personal and external factors associated with ethical decision making by nurses. Interviews were used to document the stories of 11 nurses, 10 females and 1 male, working in acute care hospitals in New York City. Through the process of recalling past experiences, the nurses were able to explain cause and effect in terms of ethical decision making. The dilemmas encountered focused on patients' rights versus institution policy, care versus pain and suffering, and truth telling versus silence about professional misconduct. Factors affecting decision making included the ethical principles of veracity, autonomy, and beneficence; ethical decision models; caring; personal and professional values and interpersonal relationships. Nurses also identified feelings of powerlessness, anger, and the silence that accompanies some decisions. The results of this study indicate that schools of nursing must reach out to students and hospitals must reach out to nurses to help them clarify and understand the ethical standards of the nursing profession in a changing health care environment; to seek and develop insights into personal values and beliefs; to develop sensitivity to diversity; and to maintain a caring attitude toward peers and patients.

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Recommended Citation

Blake, Carmelita Louise, "Nurses' reflections on ethical decision-making" (1996). ETD Collection for Fordham University. AAI9631022.