A qualitative exploratory, descriptive and contextual research design was used to describe professional nurses' experiences with ethical dilemmas in nursing practice. In this study, experiences refer to professional nurses' experiences with ethical dilemmas in nursing practice.
CHAPTER1
Overview of the Study
- Introduction and Background
- Problem Statement
- Research Question
- Purpose of the Study
- Objectives of the Study
- Theoretical Framework
- Level 1: Pre-Conventional Morality
- Level 2: Conventional Morality
- Level 3: Post-Conventional Morality
- Summary of the Research Method
- Significance of the study
- Conclusion
The following question guided the study: What are the ethical dilemmas that professional nurses experience in nursing practice. In this study, Kohlberg's theory of moral development was used as a conceptual framework to analyze the experiences of professional nurses with ethical dilemmas in nursing practice.
CHAPTER2
Literature Review
- Introduction
- Nursing Practice
- Nursing Education
- Contribution of Ethics Education
- Contribution of Teaching Methods
- Conclusion
Thus, the inclusion of ethics education in the curriculum will enable nursing students to develop critical thinking skills that will enable them to deal with the ethical dilemmas they may encounter as students and as they enter nursing practice. The literature review captured several ethical dilemmas faced by professional nurses in nursing practice and explained the formative role of ethics education using various teaching methods in the nursing curriculum.
CHAPTER3
Research Methodology
- Introduction
- Research Setting
- Research Design and Methods
- Research Design
- Exploratory Research Design
- Descriptive Research Design
- Contextual Research Design
- Population
- Sampling
- Inclusion Criteria
- Exclusion Criteria
- Data Collection
- Bias
- Data Analysis
- Ethical Considerations
- Permission
- Informed Consent
- Confidentiality and Anonymity
- Measures to Ensure Trustworthiness
- Credibility
- Transferability
- Dependability
- Confirmability
- Conclusion
An exploratory research design was used to describe professional nurses' experiences of ethical dilemmas in nursing practice in a hospital in Nkangala District, Mpumalanga Province. The descriptive research design enabled the researcher to provide a comprehensive and detailed description of professional nurses' experiences of ethical dilemmas in nursing practice at Witbank Hospital. The descriptive research design also facilitated the researcher's process, providing participants with the opportunity to detail their experiences with ethical dilemmas in nursing practice.
The population of the study included 203 professional nurses who worked at Witbank Hospital during the duration of the study. The researcher made an appointment with the unit managers and participants at Witbank Hospital in a written letter and explained the purpose of the study with the aim of building a relationship of trust with the participants. After the co-coder completed independent coding, common themes and subthemes between the independent coder and the researcher were identified.
Informed consent was obtained from the participants after a thorough explanation of the purpose and the objectives of the study. In this study, transferability was ensured by providing a thick description of the methodology and by purposive sampling of participants. In this study, dependability was ensured by a dense description of the research method that was used.
Results and Discussion
- Introduction
- Themes and Sub-Themes Identified
- Theme 1: Death and Dying
- Theme 2: Distribution of Resources
- also added
- Sub-Theme 2.2: Shortage of Human Resources
- concurred
- Sub-Theme 2.3: Provision of Nursing Care at Nurse’s Health Risk
- added
- Theme 3: Respect for Patients’ Autonomy
- added
- concurred
- Sub-Theme 3.2: Patients’ Confidentiality
- Sub-Theme 3.3: Patients’ Cultural Beliefs
- Theme 4: Nurses’ Rights
- added
- Conclusion
When a patient who refused a blood transfusion died, the participants also found themselves in a dilemma because they could not help the patient. I was traumatized because the patient fully understood the consequences of her action, but the patient's right to make an informed decision was not respected. We ultimately lost that patient and there was no way we could help the patient.
Pera and van Tonder (2011) also point out that health professionals should respect patients' autonomy by giving the patient everything. The patients' visitors exposed themselves to cross-infection because they do not know the patient's diagnosis and they also have poor knowledge about HIV/AIDS. Participants also stated that the patient's right to perform his culture sometimes conflicted with the rights of other patients on the ward.
I don't know how far we can take it when you think about the patient's culture and the Human Tissue Act. Twelve (12) participants stated that they were faced with ethical dilemmas when there was a strike at the hospital because as professional nurses they wanted to provide a lot of patient care because they took an oath and promised to serve humanity and that the health of the patient will be their first consideration. When doctors do not come to review the patients' prescriptions on time and for us, it is difficult because as a professional nurse I am supposed to give medication at the right time so that the patient does not develop resistance to the medication.
Summary of the Findings, Limitations, Conclusion and Recommendations
- Introduction
- Purpose of the Study
- Objectives of the Study
- Summary of the Findings of the Study
- Death and Dying
- Distribution of Resources
- Respect of Patients’ Autonomy
- Nurses’ Rights
- Recommendations
- Support for the Nurses’ Code of Ethics
- Provision of Continuing Education
- Inter-Disciplinary Team
- Establishment of Institutional Policies
- Limitations of the Study
- Conclusion
To determine supportive measures to help professional nurses better manage ethical dilemmas in nursing practice. They stated that as nurses they have taken an oath as stated in the Nurses' Pledge that they will save lives. The study showed that professional nurses experienced ethical dilemmas related to a lack of both human and material resources.
Participants indicated that they experienced ethical dilemmas during nurses' strike actions because they have an obligation to provide patient care. They again referred to the nurses' pledge of service, that they have taken an oath to serve humanity, and that the overall health of the patient will be their first consideration. The nurses' promise of service provides nurses with a framework that helps them resolve ethical dilemmas.
Therefore, nurses should be familiar with the Nurses' Service Promise and use it daily. It is recommended that a nationwide survey of professional nurses' experiences with ethical dilemmas in nursing practice be carried out. The study also found that participants used the Nurses' Pledge of Service as a point of reference to resolve ethical dilemmas in nursing practice.
Identifying ethical issues from the perspective of a registered nurse. Nurses' critical thinking about ethical issues such as pregnancy termination. The reality of political conflicts. Nursing research practice: Implementation, critique, and application. Ethical reasoning in baccalaureate nursing students. Retrieved February 2014 from http:www.sagepublication.Co. Ethics in practice: Ethical dilemmas in healthcare settings. Retrieved October 24, 2012, from http://cna.aiic.ca/en/on-the-issues/best-nursing/nursing-ethics-in-practice. The contribution of ethics education to the ethical competence of nursing students: teachers' and students' perceptions. Should passive euthanasia be legal in South Africa? University of Fort Hare, South Africa. She will not "bloodlessly" kill Jehovah's Witnesses. Constitution of the Republic of South Africa Act 108 of 1996. Research Design: Qualitative, Quantitative Approaches. Thousand Oaks, London New Delhi: SAGE Publications. An integrated analysis of nurse staffing and associated variables: Effects on patient outcome. Retrieved May 2014 from http://connection.ebscohost.com/c/articles/16508453/integrated-analysis-nurse-staffin. Ethical dilemmas and nursing practice. Nurses' responses to ethical dilemmas in nursing practice: A meta-analysis. Democratic Nurses Organization of South Africa 1998: Ethical standards for nurse researchers. Letter to University Departments of Nursing, College of Nursing, Technicons and School of Nursing regarding ethical standards for nurse researchers: Pretoria, 5 March. Local level research for the social sciences and social service professions. Bioethics, human rights and health law: principles and practice. Cape Town: Juta & Co. Wanted - nurses: Ethical issues and the shortage of nurses. Challenges posed by HIV/AIDS for nurses in their work environment. Retrieved May 2014 from http://www.nelsonmandela.org/ormalley/cis/omal. A comparative study of ethical dilemmas in nursing for graduate nurses in South Africa and the United States. Poor working conditions and the ability of nurses to provide moral care. Graduate nurses' experiences of ethical issues in nursing. Nursing and Nursing Principles and Practices: Ethos and Professional Practice, Leadership, Staff Development and Research. Living with conflict-ethical dilemmas and moral distress in the health care system. Retrieved April 2014 from www.elserivier.com/locate/socscimed. Kohlberg's theory of moral development. Retrieved November 2013 from http://www.simplypsychology.org/Kohlberg.html. Many doctors in South Africa support mercy killing. Chris Hani Baragwanath Hospital, Ethics Audit, Ethics Institute of South Africa http://wwwethicsa.org/report_chb,html. Nurse managers' experiences of ethical issues in six government hospitals in Malaysia: a cross-sectional study. Kohlberg's stages of moral development. Retrieved November 2013 from http://www.simplypsychology.org/Kohlberg.html. Emergency medical care and do-not-resuscitate orders:. when they can be used. Promoting professional values among female nursing students in the North West Province. ed) 2011 Medical Ethics, Law and Human Rights: A South African Perspective. In your experience, kindly describe the ethical dilemmas you encountered during your years as a professional nurse. How experiences with ethical dilemmas affect your professional practice over the years.
What resources do you think are needed to help professional nurses (at this hospital) deal with ethical dilemmas in nursing practice?
Appendix B: Consent Form
I agree to answer any future questions about the study to the best of my ability.
Appendix C: Ethical
Clearance - MREC
Appendix D: Ethical
Clearance-Mpumalanga Provincial
Government
Independent Coder
APPENDIX F: SEMI – STRUCTURED INTERVIEW
- Good morning how are you?
- I’m fine thank you
- Yes I am
- Ok I hear you very well sister, anything else maybe you left?
- Ethical dilemmas under the shortage of resources you are expected according to our scope of practise- remember we are guided under the legal framework of our
- Ok with regards to the BI 1663 what are your legal requirements in terms of filling is it within your scope of practice or what?
- It is a right
- Not yet
- So do you mean to tell me that the patient was transfused despite her saying I am a Jehovah's Witness – so it was against the patients will to receive blood? How was
- And the dilemma to me, the patient said she understands fully what can happen to her when she refuses transfusion and she refuses to be transfused. You know it was
- Anything else you would like to add on ethical dilemmas/
- Eish the list is so long but I think these are the few in my mind
- We can move on to the next question which is also related to the ethical dilemmas that you just described. Now that you have described the ethical dilemmas you have
- No except that I wish to know the objective of this interview, how will you address these issues?
- No no no - this is experiences, it has to do with experiences so emotions are part and parcel of those experiences because I should assume your experiences are
The patient can be restless and the patient can fall out of the stretcher because while you are pushing, that patient would fall you account and there are so many duties that we do that are not nursing duties. Jehovah's witnesses - you know that Jehovah's witnesses do not accept blood or blood products, you know this experience that I have without mentioning my own religion, and the patient said. Their tone of voice was not around the issue of supporting the patient, but their tone of voice actually told this patient, they threatened this poor patient "you're going to die", the patient actually said I know I'm going To die.
I remember the patient - you are there and you are the patient advocate, you explain the benefits and you explain what transfusion is for the patient, the reasons and indications, why it would help and the risks, but the patient came in and said, "Sister, I completely understand and I'm sorry that you don't think it's right to be a Jehovah's Witness – but I say please, I don't need a transfusion." Patients' rights – the patient said that even if I die, I can die in peace without transfusion. Here they are trying to convince the patient and here I say something different.
I ended up freezing and the dilemma for me is that I failed to advocate for the patient and that was her belief. Rituals performed when a patient dies to retrieve the patient's spirit. It should be a challenge for the patient, but not for yourself, because these things are exhausting.
Appendix G: Letter from Language Editor
