| Learning Objective #1: Identify the types of ethical issues experienced by primary care nurse practitioners when caring for vulnerable patients in nursing centers | |||
| Learning Objective #2: Articulate the shift to a post-modern relational narrative ethic contributing to nursing epistemology |
Objectives: Explore ethical issues and manner in which handled. Design: Multiple naturalistic case studies with cross-case analysis. Population, Sample, Setting, Years: Eleven primary care NPs. Ten nursing centers - majority small (n=4) and in urban settings (n=6). Half affiliated with university. Study conducted 2001-2002. Concepts: Primary care NPs, ethical issues, vulnerable patients, nursing centers. Methods: In-depth audiotaped interviews and documents. Constant comparative method. Findings: Ethical issues were commonplace. NPs utilized some ethical terminology. Infrequent references to principles or codes. Issues occurred at different levels within sociopolitical context of health care delivery. Ability for NP to change circumstances of issues depended upon level at which they occurred. Nurse Practitioners handled ethical issues with stance akin to ethical principles and theories. None identified method of ethical decision making or theoretical framework. Conclusions: Issues identified clearly represented NPs’ understanding and interest in upholding both ethical and legal practice of nursing. Whenever issue described (in which action might potentially be labeled illegal, never with blatant disregard for law. Nurse Practitioners explained rationale as attempt to act responsibly and on behalf of patients. Preliminary typology of ethical issues induced and Level of Ethical Issues Framework inductively derived. Ethical knowledge possibly transitioning from universalistic principle-based approach to postmodern relational narrative ethic, consistent with emphasis of patient-nurse relationship as foundation of ethical knowing. Implications: Further development and utilization of typology and framework could assist NPs and NP students in articulating ethical issues. Enhanced understanding has potential of maximizing NPs’ ability to prevent issues or minimize patient and practitioner distress over those impossible to prevent. Further understanding will help NPs develop strategies toward development of socially just health care delivery system.
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Back to 14th International Nursing Research Congress
Sigma Theta Tau International
10-12 July 2003