MORAL PROBLEMS AND ETHICAL DECISION-MAKING IN THE NURSING CARE OF ELDERS: REPORTED EXPERIENCES OF REGISTERED NURSES IN SELECTED TEXAS CRITICAL CARE UNITS AND NURSING HOMES.
Contributors: Texas A & M University.
Published: 1990
Number of pages: 293
Subjects: Health Sciences, Nursing.; Education, Adult and Continuing.; Gerontology.
Description: Nurses' ethical practice in caring for elders in selected Texas critical care units (CCUs) and nursing homes (NHs) was examined. Descriptive data were collected by mail survey from a nonrandom sample of professional nurses (N = 117). A conceptual model for ethical decisions was developed, in which nurses' moral actions were supported or constrained by environmental factors. The ethical decision process was delineated into two phases (moral reasoning and judgment) and four functional activities (assessing, planning, implementing, and evaluating).

The original instrument focused on experience with selected moral problems (informed consent, behavior control, resuscitation, and withholding treatment). Content validity was established through use of an expert panel, field interviews, and tool testing. Alpha reliability coefficients for instrument indices raged from.66 to.92.

Problem frequency was highest for informed consent and lowest for withholding treatment. The opposite was found for problem difficulty. Respondent's most difficult moral problems in their current practice were prolonging life (74%) and assuring elders' autonomy (22%).

Respondents expressed low satisfaction with moral problem resolution, with NH subjects significantly more satisfied. Powerlessness and discouragement were the most frequent feelings of moral distress.

Respondents reported average competency for, and moderate involvement in, ethical decision making, participating most in implementing and least in planning. NH subjects reported more involvement in all decision steps. Increased involvement was desired by 45% of respondents.

Environmental supports for ethical practice were rated inadequate by 55% of respondents. Constraining factors were moderately limiting, with lack of time and lack of administrative support most common. CCU subjects reported fewer supports and more constraints.

Examination of relationships among the eight indices revealed nine significant correlations ($p$ $<$.05 or better), providing support for the model. Problem difficulty correlated positively with moral distress. Level of involvement correlated positively with level of preparation, supporting factors, and ethical decision making resources; but negatively with constraints. Supports correlated positively with ethical decision making resources and negatively with constraints.

Although additional refinement is recommended, this instrument may be useful for examining nurses' experience with moral problems and environmental factors that affect ethical practice.
Notes: Source: Dissertation Abstracts International, Volume: 51-05, Section: B, page: 2287.

Thesis (PH.D.)--TEXAS A&M UNIVERSITY, 1990.

School code: 0803.