"It Is Difficult to Always Be an Antagonist": Ethical, Professional, and Moral Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada.

Rosemary Ricciardelli,Matthew S Johnston,Brittany Bennett,R Nicholas Carleton,Andrea M Stelnicki

doi:10.3390/ijerph19031454

Abstract

Aims: We explore social and relational dynamics tied to an unexplored potentially psychologically traumatic event (PPTE) that can impact nurses’ well-being and sense of their occupational responsibilities: namely, the moral, ethical, or professional dilemmas encountered in their occupational work. Design: We used a semi-constructed grounded theory approach to reveal prevalent emergent themes from the qualitative, open-ended component of our survey response data as part of a larger mixed-methods study. Methods: We administered a national Canadian survey on nurses’ experiences of occupational stressors and their health and well-being between May and September 2019. In the current study, we analyzed data from four open text fields in the PPTE section of the survey. Results: In total, at least 109 participants noted that their most impactful PPTE exposure was a moral, professional, and/or ethical dilemma. These participants volunteered the theme as a spontaneous addition to the list of possible PPTE exposures. Conclusions: Emergent theme analytic results suggest that physicians, other nurses, staff, and/or the decision-making power of patients’ families can reduce or eliminate a nurse’s perception of their agency, which directly and negatively impacts their well-being and may cause them to experience moral injury. Nurses also report struggling when left to operationalize patient care instructions with which they disagree. Impact: Nurses are exposed to PPTEs at work, but little is known about factors that can aggravate PPTE exposure in the field, impact the mental wellness of nurses, and even shape patient care. We discuss the implications of PPTE involving moral, professional, and ethical dilemmas (i.e., potentially morally injurious events), and provide recommendations for nursing policy and practice.

Highlights

Introduction iationsIn Canada, there are a limited number of empirical studies documenting Canadian nurses’ possible struggles with mental health and potentially causal factors, such as potentially psychologically traumatic event (PPTE) exposure
Nurses replied candidly that their PPTEs resulted from managing ethical, professional, and moral challenges or “ethical dilemmas” (P2277), which refers to the psychological impact of having to act different from what one feels is morally, ethically, or professionally appropriate
Our findings reveal that nurses who disagree with a course of action prescribed by a physician, requested by family members, or forced by resource limitations, become professionally, ethically, and morally conflicted or injured

Summary

Introduction

Introduction iationsIn Canada, there are a limited number of empirical studies documenting Canadian nurses’ possible struggles with mental health and potentially causal factors, such as potentially psychologically traumatic event (PPTE) exposure. Social Relations of Nursing: Hierarchy, Interaction, Moral Injury By virtue of their medical knowledge and training, physicians hold legitimate and expert power over their patients and, in some cases, over other professionals. With the assistance of other allied health professionals and care workers, nurses are trained to engage in a practical, handson, patient-centered, round-the-clock module of care that eventually builds in them their own medical expertise. Alongside their professional knowledge, nurses are still generally expected to overtly defer to the orders and recommendations of physicians under strict and established divisions of labor [16,17,18,19]. Some research shows that recalcitrance against established medical hierarchies could jeopardize a nurses’ career, especially if the nurse lacked social capital or such insubordination was not socially enacted in an appropriate, subtle, selective, informal, and/or sensitive manner [15,20,21]

Methods

Results

Discussion

Conclusion