Nurses' skills in managing ethically difficult care situations: interpretation of nurses' narratives

A total of 18 good nurses experienced in the care of cancer patients were asked to describe care situations where it had been difficult to know what was 'the right and good' thing to do for the patient. The purpose of the study was to throw light on how they disclosed themselves in managing ethically difficult care situations; to elucidate the nurse as a part of the concrete care situation. A phenomenological hermeneutic interpretation disclosed the use of paradigm cases, placing in opposition to each other negative and positive outcomes, limiting and liberating maxims, and reserved and open approaches, on the part of nurses with limited versus extensive skills in managing ethically difficult care situations. These patterns were interpreted as revealing psychological defences. The study stresses the importance of recurrent education in nursing and nursing ethics, and of individual support.