Expanding Our Understanding Complex Decision-Making in Emergent, Routine and Urgent Ethically Challenging Clinical Situations

2.50
Hdl Handle:
http://hdl.handle.net/10755/335419
Category:
Full-text
Type:
Presentation
Title:
Expanding Our Understanding Complex Decision-Making in Emergent, Routine and Urgent Ethically Challenging Clinical Situations
Other Titles:
Ethical Issues in Nursing Practice
Author(s):
McLemore, Monica
Lead Author STTI Affiliation:
Alpha Eta
Author Details:
Monica McLemore, PhD, MPH, RN, monica.mclemore@ucsf.edu
Abstract:
Session presented on Thursday, July 24, 2014: Purpose: Nurses routinely provide care to patients in ethically challenging situations. The purpose of this study was to discover and identify the continuum between conscientious objectors and designated staff in the provision of nursing care to women seeking abortions. More specifically, we sought to gain a deeper understanding of processes that nurses use when making clinical decisions in ethically challenging situations in both urgent and routine care provision using abortion as the clinical context. Methods: Constructivist grounded theory method was used. A purposive sample of 24 nurses who currently or previously work in abortion clinics, emergency departments, labor and delivery, operating rooms and post anesthesia care units were interviewed between November, 2012 and August, 2013. Questions were designed to examine and explore the cognitive, emotional, and behavioral processes associated with how nurses make decisions to care for women needing and seeking abortions. Results: Nurses develop and use multifaceted, real-time calculi in several dimensions when making decisions about their participation in emergent, routine, or urgent abortion care provision. Additionally, nurses make a clear distinction between knowing how versus know that, meaning knowing how to take care of women needing abortions doesn't always result in provision of care and knowing that (i.e., the circumstances and back story of why women need this care) is a better predictor of its provision. Parameters of the nurse-patient relationship are different than medicine in the abortion context as nurses make clear distinctions between women and patients and these distinctions impacts the taxing between the personal and professional factors that influence calculus formation. Finally, the role of others, broadly defined in the abortion context creates a complex yet integrated variable to be considered in the decisions impacting care provision. Conclusion: This study provides a grounded theory of calculus formation that further develops the science of real-time ethical decision-making in ethically challenging situations. These data expand our understanding of the multitude of factors that impact and influence nurse decision-making. Effective strategies exist that facilitate tuning of individual nurses' calculus formation particularly infrastructural, institutional and other external factors that are essential components of the environment of care.
Keywords:
ethically challenging clinical situations; nurse decision-making; grounded theory
Repository Posting Date:
17-Nov-2014
Date of Publication:
11 ; 11
Other Identifiers:
INRC14A01
Conference Date:
2014
Conference Name:
25th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Hong Kong
Description:
International Nursing Research Congress, 2014 Theme: Engaging Colleagues: Improving Global Health Outcomes. Held at the Hong Kong Convention and Exhibition Centre, Wanchai, Hong Kong

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.language.isoenen
dc.type.categoryFull-texten
dc.typePresentationen
dc.titleExpanding Our Understanding Complex Decision-Making in Emergent, Routine and Urgent Ethically Challenging Clinical Situationsen
dc.title.alternativeEthical Issues in Nursing Practiceen
dc.contributor.authorMcLemore, Monicaen
dc.contributor.departmentAlpha Etaen
dc.author.detailsMonica McLemore, PhD, MPH, RN, monica.mclemore@ucsf.eduen
dc.identifier.urihttp://hdl.handle.net/10755/335419-
dc.description.abstractSession presented on Thursday, July 24, 2014: Purpose: Nurses routinely provide care to patients in ethically challenging situations. The purpose of this study was to discover and identify the continuum between conscientious objectors and designated staff in the provision of nursing care to women seeking abortions. More specifically, we sought to gain a deeper understanding of processes that nurses use when making clinical decisions in ethically challenging situations in both urgent and routine care provision using abortion as the clinical context. Methods: Constructivist grounded theory method was used. A purposive sample of 24 nurses who currently or previously work in abortion clinics, emergency departments, labor and delivery, operating rooms and post anesthesia care units were interviewed between November, 2012 and August, 2013. Questions were designed to examine and explore the cognitive, emotional, and behavioral processes associated with how nurses make decisions to care for women needing and seeking abortions. Results: Nurses develop and use multifaceted, real-time calculi in several dimensions when making decisions about their participation in emergent, routine, or urgent abortion care provision. Additionally, nurses make a clear distinction between knowing how versus know that, meaning knowing how to take care of women needing abortions doesn't always result in provision of care and knowing that (i.e., the circumstances and back story of why women need this care) is a better predictor of its provision. Parameters of the nurse-patient relationship are different than medicine in the abortion context as nurses make clear distinctions between women and patients and these distinctions impacts the taxing between the personal and professional factors that influence calculus formation. Finally, the role of others, broadly defined in the abortion context creates a complex yet integrated variable to be considered in the decisions impacting care provision. Conclusion: This study provides a grounded theory of calculus formation that further develops the science of real-time ethical decision-making in ethically challenging situations. These data expand our understanding of the multitude of factors that impact and influence nurse decision-making. Effective strategies exist that facilitate tuning of individual nurses' calculus formation particularly infrastructural, institutional and other external factors that are essential components of the environment of care.en
dc.subjectethically challenging clinical situationsen
dc.subjectnurse decision-makingen
dc.subjectgrounded theoryen
dc.date.available2014-11-17T13:52:01Z-
dc.date.issued11/17/2014-
dc.date.issued11/17/2014en
dc.date.accessioned2014-11-17T13:52:01Z-
dc.conference.date2014en
dc.conference.name25th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen
dc.conference.locationHong Kongen
dc.descriptionInternational Nursing Research Congress, 2014 Theme: Engaging Colleagues: Improving Global Health Outcomes. Held at the Hong Kong Convention and Exhibition Centre, Wanchai, Hong Kongen
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