Abstract:
During end-of-life care, nurses face ethical dilemmas on a daily basis with minimal operative scholastic preparation and professional expertise. The diverse source of ethical quandaries includes patient care issues related to legalities, inappropriate medical interventions, social roles, and professional and personal values. Ethical discourse in end-of-life care occurs within institutions where policies, professional relationships, and economic factors constrain ethical reflection. Thus, it is imperative that ethics education take into account the professional and social context of nursing, in addition to traditional teachings focused on many principles and theories, codes of conduct, and legal ramifications. The purpose of this research was to explore how experienced nurses' successfully resolved day-to-day ethical dilemmas during end-of-life care. This study utilized narrative analysis to analyze data generated from one-on-one interviews with six hospice nurses. The semi-structured interviews were conducted in two phases. Using core story creation, several different ethical dilemmas were identified divulging struggles with key stakeholders. Thematic analysis was then used to create three main themes: Ethics within Practice, Ethical Knowledge, and Ethical Solutions discussed within the framework of situational context, deliberations, and ethical actions. The results gained from this research provide information on how to improve nursing ethics education through the use of narratives of experienced nurses. The nurses used in this research told their stories depicting a keen awareness of ethical conflicts situated by contextual factors including social, political, and personal issues. Their deliberations were informed through formal, experiential, and intuitive knowledge creating a sense of phronesis as they negotiated the right course of actions. The nurses solved ethical predicaments by either following rules or choosing acts of resistance. It is my contention that the results of this study will empower practicing nurses and nurse educators to appreciate and incorporate context and different forms of knowledge to inform ethical discourse. We can utilize the experienced nurses' wisdom to improve nursing ethics education which ultimately translates to providing better deaths for patients.
