Ethical decision making in a bureaucratic context by senior nursing students

Area of Science:

• Nursing Ethics
• Healthcare Decision-Making
• Professional Practice

Background:

• Ethical dilemmas are common in nursing practice.
• Understanding student nurses' decision-making priorities is crucial.
• The influence of organizational structures on ethical choices needs examination.

Purpose of the Study:

• To examine the priorities in decisions made by senior baccalaureate nursing students when presented with an ethical dilemma.
• To classify these decisions into patient-centered, physician-centered, and bureaucratic-centered categories.
• To explore relationships between participant characteristics and group responses.

Main Methods:

• 775 senior baccalaureate nursing students from 16 Midwestern institutions participated.
• Students worked in small groups to resolve a presented ethical dilemma case.
• Decisions were content-analyzed into patient-centered, physician-centered, and bureaucratic-centered categories.

Main Results:

• Students made an average of 8 decisions per group to resolve the dilemma.
• The majority of decisions (60%) were bureaucratic-centered.
• Patient-centered decisions comprised only 9% of the total.
• No significant differences in responses were found based on education, experience, or RN status.

Conclusions:

• Senior nursing students' ethical decision-making is heavily influenced by bureaucratic considerations.
• There is a lack of consensus regarding the extent of a nurse's responsibility in ethical situations.
• Further research is needed to understand the interplay between ethical challenges and organizational influences in nursing roles.