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Glenna Knutson, RN, MScN, EdD Why study hospital nurses ethical - - PowerPoint PPT Presentation
Glenna Knutson, RN, MScN, EdD Why study hospital nurses ethical - - PowerPoint PPT Presentation
Glenna Knutson, RN, MScN, EdD Why study hospital nurses ethical decision making? Literature: Nurses depicted as disempowered professionals Deteriorating ethical climate for nurses in 1990s and 2000s Power and the origin of
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Definitions can be positive or negative Positive definition: “the ability (or potential) to exert actions that either directly or indirectly cause change in the behaviour and/or attitudes of another individual or group”
(Alexander & Morlock, 2000)
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Power differences can be seen as a means to social
- rder, or bringing about inequality between groups
Power of position (also called legitimate power) and
coercive power (sanction) are currently aspects of hierarchical organizations
Power of expertise sometimes unacknowledged in nurses
(e.g. St. Boniface baby deaths)
Diversity in modern organizations can lead to conflict and
power struggles (Gaudine & Lamb, 2015)
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Over time, nurses have tended to view:
themselves as relatively powerless in health
care organizations
leaders (administrators and physicians) as
fostering rigidly hierarchical and patriarchal
- rganizational cultures
(Sieloff, 2004)
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Purpose: explore nurses’ perceptions of how their own qualities and hospital environment contributed to their ethical problem solving Methodology: Interviews with 10 experienced nurses who defined selves as ethically‐active, working in two different types of hospitals, Ethical protections Analysis: Data transcribed, coded, analysed using Constant comparison method: themes emerged
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- 1. Nurses’ qualities and ethical problem solving
- 2. Ethical problems described by participants
- 3. The two organizational contexts
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The nurses in this study depicted selves as being characterized by:
- Concern for the patient
- Focus on the patient’s best interest
- Willingness to advocate
- Recognition of the complexity of the
interpersonal context
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The nurses in this study depicted selves as being characterized by:
- Respect and concern for
▪ families ▪coworkers ▪other health care providers
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The nurses in this study depicted selves as being characterized by:
- professional motivations:
▪ professional values ▪clinical experience ▪previous experiences with ethical problems
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A wide range of ethical problems including issues around end of life, decisional conflict, caregiver competence . . . . . . which could be distilled as decisions of others which violated or threatened the patients’ rights, wishes, best interests, best outcomes
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Ethical problem solving emerged as being intensely interpersonal within a complex relational context of ethical problems and solutions Nurses’ ethical action varied from doing nothing to actions that risked their own employment and/or careers
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Similarities:
Key role of the manager
Relational matrix of others on nursing unit: could assist or hinder
Coworkers as supports and sources of problems, caution in speaking with coworkers about care lapses
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Similarities:
Hierarchy, including legal staff and physicians,
allowing patient slow and difficult death
Hospital policies could be support Lack of space for discussion with families
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Differences:
Clinical ethicist
Medical hierarchy
Complexity
Nurse‐physician relationships
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Relational Ethics Lens Quality of Relationships and Ethical Problem Solving How Organization Matters
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- a. Mutual Respect
- b. Relational Engagement
- c. Embodiment
- d. Ethical Environment
(Bergum & Dossetor, 2005)
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Mutual respect: reciprocal valuing Respect for patient’s wishes when different from own Disrespectful physician behaviour and nurses’ attempts to maintain mutual respect Negative impact on nurses’ ethical problem Solving
(Bergum & Dossetor, 2005)
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Relating to patients in a meaningful way as whole persons Understanding of patient contributed to nurse’s ethical problem solving Extended relational engagement to family, coworkers, others Disrespectful behaviour of some physicians made relational engagement unlikely
(Bergum & Dossetor, 2005)
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Postmodern reconnection of mind and body Made possible by engagement with the
- ther
Honouring feelings as well as thoughts Attentiveness to the other person’s life as it is lived
(Bergum & Dossetor, 2005)
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People are the ethical environment People acted as both supports or barriers to ethical problem solving Risk arose from hierarchy and traditional roles, nurses risked or even “crossed the line” to resolve ethical problems Nurses experienced moral distress when unable to resolve ethical problems
(Bergum & Dossetor, 2005)
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These nurses valued good relationships Complex and layered interpersonal context Power differentials, rigid hierarchy and poor
nurse‐physician relationships
Varied ethical action The “fine line” End of life: “bad death” Coworkers and risk
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Organization disempowered nurses Nurses’ multiple role obligations Organizational culture: norms Hospital climate: tense, conflict laden Policy changes limiting disruptive behaviour Changing role of patient, family
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Nurses’ clinical experience Nurses’ varied interpersonal risks Patients’ families Coworkers, interpersonal risk analysis Nurses’ social situational analysis
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Alexander, J.A. & Morlock, L.L. (2000). Power and politics in health service organizations. In S.M. Shortell & A.D.
- Kaluzny. Health care management. Organization design
and behaviour. 4th Ed. (244‐269). Albany, NY: Delmar. Bergum, V. & Dossetor, J. (2005). Relational ethics: the full meaning of respect. Hagerstown, MD: University Publishing Group. Gaudine, A. & Lamb, M. (2015). Nursing leadership and management: working in Canadian health care
- rganizations. Toronto: Pearson.
Seiloff, C.L. (2004). Leadership behaviours that foster nursing group power. Journal of Nursing Management, 12, 246‐251.
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