Experiences Of Ethical Dilemmas Research Articles

Service Allocators' Experiences of Ethical Dilemmas and Strategies in Long-Term Care: A Qualitative Study.

The provision of long-term care services for older adults is characterised by increasing needs and scarce resources, leading to ethical dilemmas. This qualitative study explored the ethical dilemmas experienced by healthcare professionals when allocating long-term care services to older adults and the strategies used to handle ethical dilemmas. Data from semi-structured individual interviews, focus group interviews, and observations of service allocators assessing needs and assigning long-term care services to older adults were analysed using content analysis. The overarching theme was the struggle for safe and equitable service allocation. The identified dilemmas were: (i) Struggles with A Just Allocation of Services due to Limited Time and Trust, (ii) Pressure on Professional Values Concerning Safety and Dignity, and (iii) Difficulties in Prioritising One Group Over Another. The strategies to deal with ethical dilemmas were: (i) Assessing Needs Across the Entire Municipality, (ii) Ensuring Distance to Service Recipients, (iii) Working as a Team, and (iv) Interprofessional Decision-Making. Scarce resources, organisational limitations, and political expectations drive the ethical dilemmas in long-term care service allocation. An open public discussion regarding the acceptable minimum standard of long-term care is needed to reduce the ethical pressure on service allocators.

“I couldn’t”: A phenomenological exploration of ethical tensions experienced by bereaved family members during the pandemic

ABSTRACT Introduction The COVID-19 pandemic entailed significant changes in accompaniment, end-of-life, and bereavement experiences. In some countries, public health measures prevented or restricted family caregivers from visiting their dying loved ones in residences, long-term care institutions, and hospitals. As a result, family members were faced with critical decisions that could easily lead to ethical dilemmas and moral distress. Aim This study aimed to understand better the experience of ethical dilemmas among family caregivers who lost a loved one. Methds We interviewed twenty bereaved family caregivers and analysed their narratives using Interpretative phenomenological analysis. Results Our analysis suggests that family caregivers struggled with their multiple responsibilities (collective, relational, and personal) and had to deal with the emotional cost of their choices. Results display three emerging themes describing the experience of ethical struggles: (1) Flight or fight: Struggling with collective responsibility; (2) Being torn apart: Assuming relational responsibility and (3) “Choosing” oneself: The cost of personal responsibility. Discussion/Conclusion Results are discussed and interpreted using an ethical, humanistic, and existential conceptual framework.

Ethical Dilemmas Facing Substance Use Counselors During the COVID-19 Pandemic.

During the COVID-19 pandemic, substance use disorder (SUD) treatment settings experienced several abrupt changes, including decreased admissions, reduction in services, and modified requirements for medication for substance use disorder. While these changes were implemented to facilitate the maintenance of important treatment options, the ethical consequences of such changes remained unknown. The current study aimed to explore ethical issues related to COVID-19-related changes reported by counselors in SUD treatment facilities. From May to August 2020, we conducted 60 to 90 minutes in-depth interviews with 18 front-line staff in 1 residential and 1 outpatient treatment program, exploring issues drawn from the ethical principles of the national organization representing SUD counselors. Counselors volunteered to participate via phone or email, and participation was confidential. Interviews were conducted via videoconferencing. Topics included day-to-day experiences of ethical dilemmas in the workplace, particularly during the COVID-19 era. Interviews were recorded, transcribed, and checked for accuracy and a trained team of analysts then coded transcripts using thematic analysis. As a result of the COVID-19 pandemic, SUD treatment programs quickly modified procedures to adhere to public health mandates while also continuing to offer care to clients. SUD counselors reported several ways their programs adapted new and creative procedures to reduce the risk of COVID-19 transmission. SUD counselors also identified several novel ethical dilemmas that occurred during the COVID-19 pandemic, often resulting from the counselor balancing the needs for responding to public health mandates with providing services to clients. There were several ways that COVID-19 related changes resulted in therapeutic challenges for some clients, and the SUD counselors highlighted ways that changes resulted in more flexible services for other clients. This study highlights the quick response to COVID-19 that occurred within SUD treatment. While these changes resulted in novel ethical dilemmas, they also offered more flexible and client-centered approaches to treatment.

Tensions: A Grounded Theory of Ethical Practice

Academic advising is fraught with ethical dilemmas. Advisors' actions are beholden to various and conflicting constituents. Existing literature on ethics in academic advising provides guidance for advisors via normative ethical principles, suggested processes, and statements about how advising ought to be practiced. However, knowledge of advisors' experiences of ethical dilemmas remains limited. This grounded theory study produced a model of how primary-role academic advisors working in large state university systems engage in ethical practice. It includes four cyclical phases: pre-encounter, encounter, discernment, and response. Each phase highlights discrete but interconnected themes grounded in data gleaned from semi-structured interviews with 12 advisors. The grounded theory has implications for advisors, advising administrators, and future research in bolstering ethical practice.

Transitioning to the clinical research nurse role - A qualitative descriptive study.

Studies have reported on the important role of the clinical research nurse in clinical studies. Yet, there is no international consensus about the role's competencies and tasks. Furthermore, the literature offers a little description of the career pathway from a ward-based registered nurse to a clinical research nurse. More knowledge about this specific role could benefit the nursing profession as well as increase the quality of clinical research. The aim of the study was to explore Swedish registered nurses' experiences transitioning into the clinical research nurse role. The study had a qualitative design. Data were collected via semi-structured interviews. Inductive qualitative content analysis was employed. Ten participants (i.e., clinical research nurses) were interviewed in the spring of 2017. A semi-structured interview guide was used to address the transition into the clinical research nurse role, experience working in a new role, experience of ethical dilemmas and experience of organizational and professional issues related to the role. The interviews were analysed inductively using qualitative content analysis. The registered nurses described experiencing reality shock when they became clinical research nurses; that is, it was a challenging and transforming experience. The main theme, a challenging transition, was developed from the four subthemes highlighting that it defied their previous nursing role. They experienced an unclear professional identity, extended professional mandate, increased professional status and growing ethical consciousness in their new role. The results highlight that registered nurses who became clinical research nurses had needs that were both distinct from and overlapped with those of their former professional role as registered nurses. To avoid reality shocks, the development of clear competence pathways for nurses to become clinical research nurses, including introduction, mentorship and continued support, is necessary. Making their professional title more homogeneous, nationally and internationally, would facilitate role identification and comparisons in research.

Experience of ethical dilemmas among professionals working in pediatric transplantation: An international survey.

Professionals working in pediatric transplantation commonly encounter complex ethical dilemmas. Most ethical research in transplantation is related to adult practice. We aimed to gain insight into ethical issues faced by transplant professionals when dealing with pediatric transplant recipients. A two-stage study was designed; the first part was a questionnaire completed by 190 (80%) members of the International Pediatric Transplant Association (IPTA) from over 30 different countries. This was followed by a multidisciplinary focus group that explored the preliminary data of the survey. A total of 38% (56 of 149) respondents of the questionnaire had experienced an ethical issue between 2016 and 2018. Surgeons were more likely to have encountered an ethical issue as compared with physicians (60% vs. 35.7%, p= .035). Clinicians from Europe were more likely to have experienced an ethical issue in living organ donation compared with those from North America (78.9% vs. 52.5%, p= .005), with common ethical concerns being psychosocial evaluation and follow-up care of donors. The focus group highlighted the importance of a multidisciplinary approach to ethical issues. The results of this study can direct future research into pediatric transplantation ethics with the aim of producing educational resources, policies, and ethical guidelines.

Formality or Reality: Student Teachers' Experiences of Ethical Dilemmas and Emotions During the Practicum.

The main purpose of the study was to explore Chinese student teachers’ experience during their practicum and what they reported as ethical dilemmas and how these experiences affected them in terms of professional development as well as emotional well-being. Through the analysis of qualitative data collected from forty-three participants’ interviews, this study identified six most commonly reported ethical dilemmas, including: formal curriculum versus informal and hidden curriculum; family agenda versus educational standards; loyalty to colleagues versus school norms; confidentiality versus school rules; conformism dilemmas and red-envelope dilemmas and found that dilemmas about formal curriculum versus informal and hidden curriculum were the dominant workplace ethical dilemma for student teachers. The results also showed that the majority of the student teachers reported experiencing negative emotions or painful memories, which may hinder their development of professional competencies and overall wellbeing. Thus, the study argues that student teachers’ frequent encounters with ethical dilemmas highlight the challenges faced by teacher educators in transferring knowledge between university and school environments, and student teachers should be equipped with essential emotional regulation strategies that could benefit them in their future work.

Ethical dilemmas in nursing documentation.

Nursing documentation is an essential aspect of ethical nursing care. Lack of awareness of ethical dilemmas in nursing documentation may increase the risk of patient harm. Considering this, ethical dilemmas within nursing documentation need to be explored. To explore ethical dilemmas in nurses' conversations about nursing documentation. The study used a qualitative design. Participants were registered nurses from a Patient Hotel at a Danish University Hospital. Data were collected in three focus groups with a total of 12 participants. Data analysis consisted of qualitative content analysis inspired by Graneheim and Lundman. This study was conducted in accordance with the ethical principles of research and regulations in terms of confidentiality, anonymity and provision of informed consent. Ethical dilemmas were strongly present in nurses' conversations about nursing documentation. These dilemmas were demonstrated in two themes: (1) a dilemma between respecting patients' autonomy and not causing harm, which was visible in nurses' navigation between written documentation and oral tradition, and (2) a dilemma concerning justice and fair distribution of goods, which was visible in nurses' balancing between documenting deviations and proof of nursing practice. Ethical dilemmas in nursing documentation regarding respecting patients' autonomy and not causing harm accentuated discussions on professional responsibility and patient participation in clinical decisions. Dilemmas in justice and fair distribution of goods emphasised discussions on trust in relationships versus trust in electronic health records. Actual tendencies in the healthcare system may increase ethical dilemmas in nursing documentation. Sharing otherwise invisible and individual experiences of ethical dilemmas in nursing documentation among nurses, nurse leaders and decision-makers will enable addressing these in reflections and discussions as well as in considering adjustments of conditions for nursing documentation.

Telling their own stories: Encouraging veterinary students to ethically reflect.

Veterinary practice raises complex and unique professional ethical dilemmas. There is increasing discussion of how best to deliver ethics education to veterinary students, so that they are fully prepared to address ethical conflicts in professional practice. This paper proposes the use of innovative methods to allow students to share and reflect on their own experiences of ethical dilemmas. Two innovations are described. The first is formal and compulsory, and involves a small-group facilitated session for final year students, wholly designed around student dilemmas. The second is informal and voluntary, and constitutes a short-story writing competition. The methods described are conducive to student engagement in ethics and ethical reflection. Veterinary schools should consider adopting student-led techniques, deliberately designed to allow students to tell their own stories. Similar methods could also be adapted for use in clinical practice, thereby creating opportunities for professional dialogue on ethical dilemmas.

Ethical Dilemmas for Nursing Students and Faculty: In Their Own Voices.

The aim of this national study was to explore student and faculty personal experiences of ethical dilemmas in nursing education and clinical practice. Nurses encounter complex ethical dilemmas in practice that can lead to moral distress when they cannot "do the right thing" because of external constraints. A mixed-methods study via online survey was conducted on senior nursing student members and faculty advisors of the National Student Nurses Association. Over 1,600 students and 600 faculty answered a "two-minute survey" with the question: "Please describe an ethical dilemma you have experienced." Descriptive statistics demonstrated a difference in student and faculty reports about the ethics content they received. The qualitative results from constant comparison of open-ended questions also supported differences in themes from student and faculty perspectives. This study supports that students and faculty voice their concerns with different ethical dilemmas in their nursing education experiences.

Nurses experiences of ethical dilemmas: A review.

Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today's hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual's dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses' options to act on the basis of ethical and moral grounds in the individual care situation. The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today. The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas. We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse-patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses. Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses' professional decision-making and forcing them to compromise basic nursing values.

Attitudes towards and experiences of ethical dilemmas in treatment decision-making process among medical oncologists.

This study aimed to evaluate the attitudes towards and experiences of ethical dilemmas in the treatment decision-making process among medical oncologists who are the members of the Turkish Society of Medical Oncology. A questionnaire was developed based on related literature. Between April 1 and May 1, 2016, questionnaires were electronically sent to 412 medical oncologists who were the members of the Turkish Society of Medical Oncology. Overall, 125 of 412 medical oncologists (30.33%) filled the questionnaire. Most medical oncologists encountered dilemmas, such as a lack of comprehension among the patients and family members regarding the information provided, a lack of clarity regarding the identity and role of individuals in the decision-making process, and demands for futile treatment. The most common problem (70.4%) was the lack of available clinical ethics consultancy services to guide medical oncologists when facing an ethical dilemma. Legal concerns regarding withholding or withdrawing futile treatments were high. More than half of the medical oncologists (56.8%) reported the preservation of the quality of life as their primary professional duty. Our results demonstrate that medical oncologists tend to adopt an approach that respects patient autonomy and that adheres to the principle of proportionality rather than a paternalistic approach when facing ethical dilemmas. Within this context, we suggest an increased use of a multidisciplinary team approach, ethics consultancy services, and training programmes as well as the publication of ethical guidelines tailored to the oncology field.

Ethical dilemmas on social media: Swedish secondary teachers’ boundary management on Facebook

With the aim of contributing to the research about the educational use of social media, the paper explores teachers’ experiences of ethical dilemmas on Facebook. The paper draws upon focus group interviews with Swedish secondary teachers. Two main categories of ethical dilemmas, related to the border between private and professional, are detected. The dilemmas concern (1) teachers’ moral responsibility for pupils’ actions and (2) how teachers appear on social media. Different boundary work practices created and used by teachers are identified. The main conclusion is that, by having contact with pupils in a virtual social arena originally intended for private use, teachers’ use of social media brings to fore and intensifies deep-rooted ethical questions about what the teacher role is and should be. Teachers’ participation on social media such as Facebook compels them to reflect upon and position their preferred teacher role in these new social arenas.

Ethical dilemmas during cardiac arrest incidents in the patient's home.

The majority (70%) of cardiac arrests in Sweden are experienced in the patient's home. In these situations, the ambulance nurses may encounter several ethical dilemmas. The aim was to investigate Swedish specialist ambulance nurses' experiences of ethical dilemmas associated with cardiac arrest situations in adult patients' homes. Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis. Ethical principles mandated by the Swedish Research Council were carefully followed during the whole process. Two main themes with six sub-themes were identified: The scene - creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients' integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being's dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human. The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient's dignity and to serve life and health.

The Experience of Ethical Dilemmas, Burnout, and Stress Among Practicing Counselors

The authors reported findings from a correlational investigation examining the relationship between counselors' (N = 140) experiences with ethical dilemmas and their reported levels of burnout and stress. Using structural equation modeling, the authors identified that a higher rate of encountering ethical dilemmas related to an increased level of counselor burnout and stress among the participants. However, higher rates of reflecting on the ethical dilemmas did not have a relationship with participants' burnout and stress. The authors present implications of these findings for counselors, along with future research directions.

Sociodemographic Factors Influencing the Experience of Ethical Dilemmas Among Nurses in Critical Care Unit of Kenyatta National Hospital

Ethical issues have emerged in the recent years as a major component of health care for the critically ill patients, who are vulnerable and totally depend on nurse working in the critical care unit. The perception and magnitude of ethical dilemmas faced by nurses working in critical care unit of Kenyatta National Hospital (KNH) as well as the socio-demographic factors influencing this experience had not been determined. This exploratory survey was conducted on 123 nurses working in three critical care areas of the Kenyatta National Hospital. The research aimed to identify the ethical dilemmas by nurses working in Critical Care Units of the Kenyatta National Hospital in their everyday practice and the socio-demographic factors influencing the experience. Personnel records showed the nurses had varying socio-demographic characteristics which were found to influence the experience of dilemmas. Data were collected using questionnaires which were distributed to the123 nurses working in the critical care areas. The participants were selected using stratified random sampling method. Data was cleaned and analyzed using SPSS. Chi square test was used to assess the relationship between variables. The following were identified as the emerging ethical issues: end-of-life decisions (prolonging the dying process, withholding treatment, DNR orders and patients’ religious values), Patient care issues (unsafe nurse-patient ratios, allocation of scarce medical resources, breaches of patients’ privacy, ignoring patients’ autonomy, dealing with incompetent colleagues, discriminatory treatment of patients, patient/ relatives uninformed about the patient’s prognosis) and human rights issues (advance directives, informed consent, rights of pediatric patients and nursing of critically ill patients posing a risk to nurses). Various factors have been attributed to influencing the way one perceives ethical dilemmas. These include knowledge, age and gender among others. The study focused on the socio-demographic factors that significantly affected the experience of ethical dilemmas which included: age, professional qualification and level of knowledge of ethical issues. In conclusion this study shows that ethical dilemmas are an issue of concern among the nurses working in the critical care units of the KNH. The experience of ethical dilemmas is influenced by various socio-demographic factors.

‘I Don't Even Have Time to be Their Friend!’ Ethical Dilemmas in Ph.D. Supervision in the Hard Sciences

This study focused on exploring students’ and supervisors’ perceptions of ethical problems in doctoral supervision in the natural sciences. Fifteen supervisors and doctoral students in one research community in the natural sciences were interviewed about their practices and experiences in the doctoral process and supervision. We explored to what extent doctoral students and supervisors experienced similar or different ethical challenges in the supervisory relationship and analyzed how the experiences of ethical dilemmas in supervision could be understood in light of the structure and practices of natural science research groups. The data were analyzed by theory-driven content analysis. Five ethical principles, namely non-maleficence, beneficence, autonomy, fidelity and justice, were used as a framework for identifying ethical issues. The results show that one major question that appears to underpin many of the emerging ethical issues is that the supervisors and students have different expectations of the supervisory role. The second important observation is that doctoral students primarily described their own experiences, whereas the supervisors described their activities as embedded in a system and elaborated on the causes and consequences at a system level.

Ethical dilemmas experienced by clinical psychology trainee therapists.

Ethical dilemmas are inevitable during psychotherapeutic interactions, and these complexities and challenges may be magnified during the training phase. The experience of ethical dilemmas in the arena of therapy and the methods of resolving these dilemmas were examined among 35 clinical psychologists in training, through an anonymous and confidential online survey. The trainees' responses to four open-ended questions on any one ethical dilemma encountered during therapy were analysed, using thematic content analysis. The results highlighted that the salient ethical dilemmas related to confidentiality and boundary issues. The trainees also raised ethical questions regarding therapist competence, the beneficence and non-maleficence of therapeutic actions, and client autonomy. Fifty-seven per cent of the trainees reported that the dilemmas were resolved adequately, the prominent methods of resolution being supervision or consultation and guidance from professional ethical guidelines. The trainees felt that the professional codes had certain limitations as far as the effective resolution of ethical dilemmas was concerned. The findings indicate the need to strengthen training and supervision methodologies and professional ethics codes for psychotherapists and counsellors in India.

Bridge over troubled water: Phenomenologizing Filipino college deans' ethical dilemmas in academic administration

This phenomenological study intends to capture and describe Filipino college deans’ lived experiences of ethical dilemmas as they carry out their work as administrators. Using semi-structured in-de...

Dilemas éticos em UTI: contribuições da Teoria dos Valores de Max Scheler

O estudo objetivou refletir, tomando como base o referencial teórico de Max Scheler, sobre os dilemas éticos vivenciados por enfermeiros na UTI, e sobre os valores que norteiam suas atitudes e decisões. Trata-se de pesquisa qualitativa, tendo sido entrevistados dez enfermeiros da UTI de um hospital universitário. Identificou-se a vivência de dilemas éticos referentes à terminalidade relacionada aos limites de intervenções e de utilização dos recursos materiais, além da questão da transfusão de sangue em caso de restrição religiosa. Os valores identificados foram: respeito, dignidade do paciente, conhecimento científico, humildade, paixão pela profissão e amor a Deus. A teoria dos valores constitui importante subsídio para enfermagem por permitir a abordagem de uma ética humanizadora da práxis, especialmente nas situações de dilemas éticos.