Adult ; Clinical Competence ; Ethics, Nursing* ; Female ; Focus Groups ; Health Services Needs and Demand* ; Hospital Units ; Humans ; Male ; Nursing Staff, Hospital/psychology* ; Nursing Staff, Hospital/statistics & numerical data ; Qualitative Research ; Social Support*
Keywords
Content analysis ; clinical ethics support ; ethical competency ; focus group
Abstract
BACKGROUND: As nurses' ethical competence in their own fields is essential, clinical ethics support services help nurses improve ethical competence.
OBJECTIVES: The purpose of this study was to identify the unmet needs of ethical support for nurses in clinical settings and explore the differences by nursing units.
RESEARCH DESIGN: Focus group interview design was applied. Participants and research context: Data were collected via four rounds of focus group interviews with 37 nurses at intensive care units, medical-surgical units, emergency departments and oncology units. Major questions were as follows: 'What is nurses' experience of ethical difficulties while working as a clinical nurse?' and 'What kinds of clinical ethics support services do nurses require in different clinical settings?' Inductive content analysis was performed to analyse the data. Ethical considerations: Ethical approval was obtained from the institutional review of board at the College of Nursing.
FINDINGS: Five categories (with 14 subcategories) were identified: difficulty providing evidence-based care, lack of support in maintaining patients' and family members' dignity, insufficient education regarding clinical ethics, loss of professional self-esteem and expectations concerning organizational support. Nurses' desire for ethical support varied according to department.
CONCLUSION: Nurses face both practical and existential ethical issues that require rapid solution each day. There is a need for ethical counselling to prevent compassion fatigue and identify means via which nurses reflect on their daily lives in their own fields. In-house training should be provided for each unit, to improve ethical competence and facilitate the development of pragmatic, sensible solutions.