The ethical quandaries of acute care nursing practice

This study explored the perceptions of nurses employed in acute care nursing regarding the ethical quandaries in which they find themselves involved on a recurrent basis. Sixty-five female nurses volunteered to participate in the study. Data were collected over a 2-year period at four institutions. Qualitative methods were used to collect and analyze the data. Three categories were derived from the situational conditions described. These were exploitation, ie, nurses' concern with the inhumane treatment of seriously ill patients; exclusion, ie, the lack of attention paid to patient wishes in treatment decisions; and anguish, ie, the powerlessness and frustration felt by nurses involved in ethical situations. It was concluded that in an era of escalating, complex dilemmas, nurses are willing and motivated to engage in ethical decision-making situations, particularly when the comfort or rights of their patients are involved. The environmental barriers to this practice, however, are staggering. The barriers identified included lack of support or poorly defined mechanisms of support, time pressures, personal concerns over security, and hierarchic forces within the institution. Nurses' inability to act on behalf of patients or with regard to their individual conscience may be contributing to high turnover rates and the nursing shortage, particularly in those areas with high use of technology.