Caught in the middle: Ethical dilemmas identified by medical and surgical registered nurses.

摘要

The purpose of this study was to describe the perceptions of and responses to ethical dilemmas reported by non-critical care medical and surgical staff nurses. The major theme "caught in the middle" was identified following analysis of the interviews using the "naturalistic" process of data management recommended by Lincoln & Guba (1985). Convenience sampling was used to recruit the 23 registered nurses, aged 23-55, who participated in this study. Twenty-two participants were female. Fourteen participants were surgical nurses and about half were Baccalaureate prepared.;Four distinct but interconnected themes derived from this study. The primary theme "Caught in the Middle" represented, for all participants, a sense of being "trapped" between two other persons in the primary health care relationship and resulted from a violation represented by one or both of two other themes: the nurse's "sense of professional self" and her/his connection to the patient. The final theme addressed the personal and professional consequences for the nurse as a result of this dilemma. The sense of feeling "caught in the middle," was, for all participants, provoked by an event in the trajectory of care for their patient. Although the specific event differed for each nurse, the event itself represented an ethical dilemma for the nurse when either her/his perceived connection to the patient/family or "sense of professional self" or both would be violated by the required action. This violation of connection or of professional self resulted in feelings of powerlessness, anger, frustration, and fear of getting in trouble. At some point in the dilemma, each nurse reached a decision point and chose action or inaction. Regardless of the choice to act or not act in their ethical dilemmas, many of the nurses felt so strongly about the situation that they endured severe personal and professional consequences after the situation ended. For some, the stress was so intense that it affected their personal and professional lives. Most of the participants, however, indicated that their participation in the ethical dilemma they discussed contributed to their growth as individuals and as nurses. Implications for nurse educators and administrators and recommendations for future study were explored.