The Feelings Nurses and Patients/Families Experience When Faced with the Need to Make Bioethical Decisions - Brief Article

AORN Journal,  July, 2002  by Michelle Byrne

• E-mail
• Print
• Link

G L Husted Nursing Administration Quarterly Vol 25 no 3 (2001) 46-54

This qualitative research study investigated the experiences and feelings of being involved in a bioethical dilemma from the perspective of nurses, patients, and patients' family members. A philosophical assumption for this study was that people know more than they can tell. People have focal or acute awareness of issues, as well as subsidiary awareness. Subsidiary awareness is constituted of those things that people may not be acutely aware of but that make up the background or context for their actions. For comprehensive understanding, it is important to have focal and subsidiary awareness of ethical dilemmas. In this study, a bioethical dilemma was defined as

   a health care situation where choices are difficult and involve a potential
   for harm, the difficulty of choosing the right thing to do, and the
   difficulty of selecting what is and what is not beneficial in the
   situation.

Method and sample. This phenomenological study, which used an inductive and descriptive approach, sought to describe the experience of nurses, patients, and patients' family members involved in bioethical dilemmas. Fifteen nurses, five patients, and 11 family members were interviewed. All nurses were female, with ages ranging from 20s to 60s. Seven had BSN degrees, five had diploma degrees, one had an associate's degree, and two had master's degrees. Of the five patients, four were male, and one was female. All family members were female. Family members were interviewed because many patients were at a stage that did not allow them to participate in decision making. Interview transcripts were analyzed, and clusters were collapsed into themes. Multiple people analyzed the data to support credibility of the findings.

Findings. There were 10 themes for each group, with five common for nurses, patients, and patients' family members. These terms were presented as a dichotomy, whereas in reality, they presented along a continuum. Themes were used as the basis of the development of a visual analog scale for a future study.

The five common themes were

* absence of frustration/ frustration,

* no guilt/guilt,

* no anger/anger,

* sufficient knowledge/insufficient knowledge, and

* power/powerlessness.

The additional themes for nurses were

* no sadness/sadness,

* confidence/no confidence, * support from colleagues/no support from colleagues,

* ability to be an advocate/ inability to be an advocate, and

* content with outcome/discontent with outcome.

Additional themes for patients and their family members were

* hope/no hope,

* ability to make decisions/no ability to make decisions,

* support from staff members/no support from staff members,

* control/no control, and

* agreement with decisions/disagreement with decisions.

Discussion. Although this study did not focus on perioperative bioethical dilemmas, the results provide a framework to analyze issues perioperative nurses face. The perioperative environment produces many ethical dilemmas, and nurses often do not have support to address and communicate concerns. Administrators need to monitor and support ethical decisions made at the organizational, staff member, and patient levels. This study may help nurses and managers identify common bioethical dilemmas. This identification may facilitate provision of resources that can be used to provide a just and caring atmosphere to reduce the burden on nurses, patients, and patients' family members.

MICHELLE BYRNE
RN, MS, PHD, CNOR
NURSING RESEARCH COMMITTEE

COPYRIGHT 2002 Association of Operating Room Nurses, Inc.
COPYRIGHT 2002 Gale Group