Ethical Environment Reports Of Practicing Nurses

AORN Journal, March, 1999 by Kathryn Schroeter

ETHICAL ENVIRONMENT REPORTS OF PRACTICING NURSES C McDaniel Nursing Clinics of North America Vol 33 (June 1998) 363-372

Nursing comprises the largest membership of health care professionals. Nurses also spend more time in direct contact with patient care than any other group of health care professionals. As such, nurses provide care in a variety of clinical settings, and they often are the first to detect ethical conflict situations in practice. Recent developments in health care delivery systems have prompted concern with the ethical context of providing care. Ethical issues such as resource allocation, justice, autonomy, advance directives, and end-of-life decisions have come to the forefront of the current managed care environment.

This article discusses the results of several studies using one tool, the Ethics Environment Questionnaire (EEQ). The author highlights the findings regarding RNs who practice in the clinical setting.

The purpose of this study analysis was to determine an ethical health care environment and identify its related dimensions. An ancillary focus was to explore measures that complement other examinations of the health care setting.

Theoretical framework. The author used the principle approach to ethics as a theoretical framework for her analysis. The author used this theory to address the concept of an "ethical environment." The author notes that the environment of health care implies the values that the system emphasizes. The focus is on beneficence (ie, to do good) and nonmaleficence (ie, to do no harm) as principles applied to the health care milieu. She establishes these two principles as a criterion supported by both physicians in the medical model and by nurses.

Operationalization of the concept. The author provides a general definition of ethics as "what one should do given certain circumstances," further defining that it pertains to the moral nature of activity and behavior of relationships between and among health care practitioners. In describing the ethical environment of health care, the author notes that the ethics environment, in a generic way, is an individual's perception of his or her surrounding in terms of what that individual would do and what others (eg, managers, supervisors, administrators) would do in the environment of health care delivery. According to the author, the ethics environment includes priorities implied through caregivers' ethical treatment of patients.

The author goes on to clarify that an organizational code of ethics should be more than just on paper. It should pervade the organization. Ultimately, the issue is whether this type of ethical ambiance--the understood acceptable behavior--permeates the system.

Specific measure used. This author uses a type of meta-analysis design to discuss the results of several previous studies using the EEQ. The instrument was designed to examine the ethical environment of health care services. Follow-up interviews also were conducted with the respondents.

Content, construct, and criterion validity had been established and were identified in a previous publication as well. The EEQ survey instrument is a self-administered survey using a five-point Likert-type response, with strongly agree (ie, five) being high. The internal consistency reliability and test-retest reliability on Cronbach's alpha are 0.92 and 0.88 respectively.

It was noted that while these findings pertain primarily to nurses, the instrument could be applicable to interdisciplinary populations and across diverse health care and corporate environs.

Description of the sample. The respondents were 450 RNs employed full time in acute care inpatient settings ranging from medical-surgical and pediatrics to transplant and intensive care units. They were from two regions in the United States in noncontiguous states.

The ages of the respondents ranged from 21 through 64, with a mean age of 33 years. The nurses in the study predominantly were female (ie, 90%), married (ie, 55%), and white (ie, 83%). Most respondents had diploma and associate degrees, with a minority of respondents obtaining baccalaureates later.

Results. The mean scores for the nurses ranged across the subsamples from 2.4 to 3.3 out of 5, with an overall mean of 3.1. A mean score of 3.5 suggests a relatively positive ethical environment. Three general concerns of the RN respondents emerged from this study. These concerns were

* the ability to engage in deliberations regarding their practice as it pertained to ethics,

* the presence of an administrator who supported them in their practice, and

* the presence of policies and procedures regarding the care given in that organization that were consistent with their care practice.

Nurses who reported the ability to use avenues for discussions of their patient care as they pertained to ethics were nurses who liked their jobs. Conversely, nurses without any avenue for discussion of their ethical concerns typically scored low on the survey items and did not like their jobs. Nurses who scored low also reported looking for other jobs.