Conscience, conscientious objection, and nursing: A concept analysis.

BACKGROUND:: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses' ethical care provision. Conscientious objection is one such strategy for addressing nurses' personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. RESEARCH AIM:: To analyze the concepts of conscience and conscientious objection in the context of nurses. DESIGN:: Concept analysis using the method by Walker and Avant. RESEARCH CONTEXT:: Data were retrieved from Philosopher's Index, PubMed, and CINAHL with no date restrictions. ETHICAL CONSIDERATION:: This analysis was carried out per established, scientific guidelines. FINDINGS:: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. DISCUSSION AND CONCLUSION:: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts.

Conscientious objection and nurses: Results of an interpretive phenomenological study.

BACKGROUND: While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession. RESEARCH QUESTION: The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario? RESEARCH DESIGN: Interpretive phenomenological methodology was used to gain an in-depth understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process. PARTICIPANTS AND RESEARCH CONTEXT: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months. ETHICAL CONSIDERATIONS: This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent. FINDINGS: Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support. DISCUSSION: This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed. CONCLUSION: Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses' ethical concerns giving rise to objections. Conscience emerged as an informant to nurses' conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice.