J Korean Acad Nurs Adm.  2013 Dec;19(5):668-678.

Case Development on Nurses' Ethical Dilemmas with Physicians' and Nurses' Decision Making

• Jeong JM
• Park JH
• Jeong SH

Abstract

PURPOSE
This study was done to develop a realistic clinical case and investigate nurses' decision-making about nurses' ethical dilemmas with physicians in the fields of nursing practice.
METHODS
Case development and a hypothetical case study were used. Participants were 52 nurses. Data were collected in 2012 and 2013 using an open-ended questionnaire and interviews and analyzed using content analysis and descriptive statistics.
RESULTS
Various dilemma situations between nurses and physicians, such as violence, deathbed, medication-prescription, and physicians' incapacity-unfairness, were suggested. A clinical dilemma case about medication-prescription was developed based on nurses' experiences. Nurses' responses to the developed case situation and responses were classified into five types. Various reasons were given for making the decisions and about 56% of the nurses decided to notify their supervisor without deleting nursing records.
CONCLUSION
In this study, a realistic clinical dilemma case was developed, and nurses' ethical decision making was identified. These findings can be used in developing effective strategies for nurses to solve ethical dilemmas and to improve ethical decision-making abilities.

Keyword

Nursing ethics; Ethical dilemma; Decision making; Nurses

MeSH Terms

Decision Making*
Ethics, Nursing
Nursing
Nursing Records
Surveys and Questionnaires
Violence

Reference

1. Ahn S. Quantitative analysis of ethics research within the Korean nursing community. Korean J Med Ethics. 2009; 12:262–274.

2. Ahn S, Kim Y, Cho KC, Um YR, Lee SH. Nurses' experiences of ethical issues and needs of ethical guidelines. 2004. Retrieved July 15, 2013. from http://webzine.koreanurse.or.kr/Webzine/read_article.php?webzine_id=12&sub_cat_id=129&is_sub_no=234&article_id=401.

3. Buiting HM, van der Heide A, Onwuteaka-Philipsen BD, Rurup ML, Rietjens JA, Borsboom G, et al. Physicians' labelling of end-of-life practices: A hypothetical case study. J Med Ethics. 2010; 36(1):24–29. http://dx.doi.org/10.1136/jme.2009.030155.

4. Cameron ME, Schaffer M, Park H. Nursing students' experience of ethical problems and use of ethical decision-making models. Nurs Ethics. 2001; 8:432–447. http://dx.doi.org/10.1177/096973300100800507.

5. Cho NO, Hong QS, Kim HS. Study of nurses's interpersonal conflict and communication. J Korean Acad Soc Nurs Educ. 2001; 7:369–378.

6. Choi J. A study on the problem design principle for problem-based learning through the case analysis. J Educ Technol. 2004; 20:37–61.

7. Dekeyser Ganz F, Berkovitz K. Surgical nurses' perceptions of ethical dilemmas, moral distress and quality of care. J Adv Nurs. 2012; 68:1516–1525. http://dx.doi.org/10.1111/j.1365-2648.2011.05897.x.

8. Dierckx de Casterle B, Izumi S, Godferey NS, Denhaerynck K. Nurses' responses to ethical dilemmas in nursing practice: Meta-analysis. J Adv Nurs. 2008; 63:540–549. http://dx.doi.org/10.1111/j.1365-2648.2008.04702.x.

9. Downe-Wamboldt B. Content analysis: Method, applications, and issues. Health Care Women Int. 1992; 13(3):313–321.

10. HanSS. The nature of ethical dilemmas and decision making in hospital nursing practice. Unpublished doctoral dissertation. Seoul, Korea: Seoul National University;1992.

11. Han SS, Ahn S. Concept analysis of nursing ethical dilemma. Korean Jungang Med J. 1992; 57:55–68.

12. Harrison R, Birks Y, Hall J, Bosanquet K, Harden M, Iedema R. The contribution of nurses to incident disclosure: A narrative review. Int J Nurs Stud. (in press). http://dx.doi.org/10.1016/j.ijnurstu.2013.07.001.

13. Jang KS, Lee MH, Kim IS, Hong YM, Ha NS, Kong BH, et al. Ethics & profession of nursing. Seoul: Hyunmoonsa;2011.

14. Jo KH. Nurses' conflict experience toward end-of-life medical decision-making. J Korean Acad Adult Nurs. 2010; 22:488–498.

15. Kim HG. Analysis of decision-making in ethical dilemma cases among clinical nurses. J Korean Acad Nurs Adm. 2003; 9:450–480.

16. Kim JH, Ahn SY, Kim JY, Chung JH, Kim JM, Choi SH, et al. A study on attitude ethical dilemmas in clinical nurses. J Nurs Acad Soc. 1995; 25:496–509.

17. Kim KK. Development of a web-based diagnostic evaluation program for the prevention of nurses' malpractice liability. J Korean Acad Nurs Adm. 2011; 17:33–43.

18. Kim KK, Song MS, Rhee KS, Hur HK. Study on factors affecting nurses' experience of non-reporting incidents. J Korean Acad Nurs Adm. 2006; 12:454–463.

19. Kim SD. A study on an ethical relationship between nurse and physician. Korean J Med Ethics. 2002; 5:55–69.

20. Kim YM, You MS, Cho YH, Park SH, Nam SN, Park MO, et al. Development and evaluation of patient safety-focused inservice education program for surgical nurses. J Korean Acad Nurs Adm. 2010; 16:152–161.

21. Kim Y, Park J, Yoo M, Hyun M, Kim G. Nurses' moral judgement on ethical dilemmas. Korean J Med Ethics. 1999; 2:159–176.

22. Lee KJ, Yoo SY. Relationships between nurses' ethical dilemma, coping types, job satisfaction and turnover intention in Korea. J Korean Clin Nurs Res. 2011; 17:1–15.

23. Lee Y, Lee YH, Lee MJ, Park J, Lim K, Choi C, et al. Residents's perspectives on ethical conflicts and professional boundaries: A vignette-based survey. Korean J Med Ethics. 2010; 13:153–174.

24. McCarthy J, Deady R. Moral distress reconsidered. Nurs Ethics. 2008; 15:254–262. http://dx.doi.org/10.1177/0969733007086023.

25. National Health Personnel Licensing Examination Board. Workshop for improving item development ability in nurse licensing examination. Seoul: Author;2013.

26. Park H. Ethical dilemma of nurses. J Korean Acad Nurs Adm. 2009; 15:128–135.

27. Park HJ, Kim MY. Ethical dilemma and coping types in nurses. J Korean Acad Soc Nurs Educ. 2004; 10:75–83.

28. Park M, Jeon SH, Hong HJ, Cho S. Ethical issues in nursing practice: Comparisons of nursing units. Gwangju, Korea: Paper presented at the spring meeting of the Korean Academy of Nursing Administration;2013. 05.

29. Pavlish C, Brown-Saltzman K, Hersh M, Shirk M, Nudelman O. Early indicators and risk factors for ethical issues in clinical practice. J Nurs Scholarsh. 2011; 43:13–21. http://dx.doi.org/10.1111/j.1547-5069.2010.01380.x.

30. Perrin KO, McGhee J. Quick look nursing: Ethics and conflict. 2nd ed. Sudbury, MA: Jones and Bartlett Publishers;2008.

31. Redman B, Fry ST. Nurses' ethical conflicts: What is really known about them? Nurs Ethics. 2000; 7:360–366. http://dx.doi.org/10.1177/096973300000700409.

32. Ulrich CM, Taylor C, Soeken K, O'Donnell P, Farrar A, Danis M, et al. Everyday ethics: Ethical issues and stress in nursing practice. J Adv Nurs. 2010; 66:2510–2519. http://dx.doi.org/10.1111/j.1365-2648.2010.05425.x.

33. Um YR, Kang SY, Noh WJ. Changing to positive ethics in hospital nurses through 'theatre of situations'. J Korean Clin Nurs Res. 2012; 18(1):1–12.

34. Westbrook JI, Li L, Georgiou A, Paoloni R, Cullen J. Impact of an electronic medication management system on hospital doctors' and nurses' work: A controlled pre-post, time and motion study. J Am Med Inform Assoc. 2013; 20:1150–1158. http://dx.doi.org/10.1136/amiajnl-2012-001414.

35. Winland-Brown J, Dobrin A. Medical repatriation: Physicians' and nurses' responses to a dilemma. South Online J Nurs Res. 2009; 9(4):Retrieved December 7, 2013, from http://www.resourcenter.net/images/SNRS/Files/SOJNR_articles2/Vol09Num04Art01.html.