[Prevention of harm to patients or to nurses: a major moral conflict for nurses in the context of ethical decision making]

ABSTRACT

Factors such as improved medical technology, resource allocation, increasing costs, the rights of individuals and the changing roles of nurses can result in ethical conflicts that demand the ability of nurses to recognize moral dilemmas and conflicts and to make appropriate ethical decisions. The aim of this article is to explain the concept of patient or nurse harm in the context of ethical decision making in patients care. This study was conducted using the Grounded Theory method. The participants were 17 Iranian nurses, who work in hospitals of universities of medical sciences. The data was gathered using semi-structured, unstructured and in-depth interviews. All interviews were transcribed verbatim and simultaneously and were coded according to the Strauss and Corbin method in open, axial and selective coding. Preventing harm to patients or to nurses is one of the major moral conflicts for nurses in ethical decision making. For nurses, the concept of harm is a process which consists of a prediction, a prevention and an outcome that may be harmful or non-harmful. The outcome may affect either the nurse or the patient or both. It seems that the context of ethical decision making plays a major role in moral conflicts for nurses and the outcome of this process. Participants believed that the context of ethical decision making is a major factor in nurse's moral conflicts and in the prevention of harm to themselves or to the patients. Therefore, it is necessary that nurses consider the context of ethical decision making in their moral decisions and resolutions to conflicts. Also, structures with agents and nursing managers must attempt to reform and improve the context especially for structural conditions so nurses could make better decisions without conflict and moral distress