Abstract
BackgroundDNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas. Ethics is considered a basic competence in health care and can be understood as a capacity to handle a task that involves an ethical dilemma in an adequate, ethically responsible manner. One model of ethical competence for healthcare staff includes three main aspects: being, doing and knowing, suggesting that ethical competence requires abilities of character, action and knowledge. Ethical competence can be developed through experience, communication and education, and a supportive environment is necessary for maintaining a high ethical competence. The aim of the present study was to investigate how nurses and physicians in oncology and hematology care understand the concept of ethical competence in order to make, or be involved in, DNR decisions and how such skills can be learned and developed. A further aim was to investigate the role of guidelines in relation to the development of ethical competence in DNR decisions.MethodsIndividual interviews were conducted with fifteen nurses and sixteen physicians. The interviews were analyzed using thematic content analysis.ResultsPhysicians and nurses in the study reflected on their ethical competence in relation to DNR decisions, on what it should comprise and how it could be developed. The ethical competence described by the respondents related to the concepts being, doing and knowing.ConclusionsIn order to make ethically sound DNR decisions in oncology and hematology care, physicians and nurses need to develop appropriate virtues, improve their knowledge of ethical theories and relevant clinical guidelines. Ethical competence also includes the ability to act upon ethical judgements. Continued ethical education and discussions for further development of a common ethical language and a good ethical working climate can improve ethical competence and help nurses and physicians cooperate better with regard to patients in relation to DNR decisions, in their efforts to act in the best interest of the patient.
Highlights
DNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas
Aim The aim of the present study was to investigate how nurses and physicians in oncology and hematology care understand the concept of ethical competence in order to make, or be involved in, DNR decisions and how such skills can be learned and developed
The analysis resulted in an overall theme, related to the aim and the interview questions: Ethical competence in relation to DNR decisions
Summary
DNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas. The aim of the present study was to investigate how nurses and physicians in oncology and hematology care understand the concept of ethical competence in order to make, or be involved in, DNR decisions and how such skills can be learned and developed. On the other hand, a patient can be severely and life-threateningly ill due to treatment, but remain in the curable phase until all available treatments have been given In those cases the palliative phase can be short, sometimes only a few days. Often stigmatization, of a cancer diagnosis, and the occasionally long curative treatment periods, patients and their families might be vulnerable in these situations This imposes major ethical demands on making decisions regarding DNR, and the information given must be clear and adapted to the situation at hand
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