Ethical decision making in a bureaucratic context by senior nursing students

This study examined the priorities reflected in the decisions reported by 775 senior baccalaureate nursing students in 16 Midwestern colleges and universities when presented a case depicting an ethical dilemma in nursing practice. In small groups of five each, the students arrived at a course of action to take in dealing with the dilemma. Categories for classifying responses were derived from the literature in nursing ethics. Categories used in content analysis of responses were: (1) patient-centered responses, (2) physician-centered responses, and (3) bureaucratic-centered responses. The small groups of students made from 3 to 17 decisions trying to resolve the dilemma, with a mean number of 8 decisions per group. Of the 1,163 decisions, 9% were in the patient-centered category, 19% were in the physician-centered category, and 60% were in the bureaucratic-centered category. Select characteristics of participants were examined for relationships to group responses. Group responses did not differ significantly by education, clinical experience, previous experience with a similar dilemma, or RN status of group members. Students agreed on the first steps to take to resolve the dilemma, but achieved no consensus about where the nurse's responsibility ended. Examining the decisions made by nurses in response to an ethical dilemma is important in arriving at a better understanding of the relationship between ethical problems in professional practice and the influence of social organizations or bureaucracies on nursing roles.