JULY 2002, VOL 76, NO I It I< \ I I.: \\ s

RESEARCH REVIEW

THE FEELINGS NURSES AND PA TlENTS/FAMILIES EXPERIENCE WHEN FACED WITH THE NEED TO MAKE BlOETHlCAL DECISIONS G I, Hirsted Nursing Administration Quarterly K d 2.5 no 3 (2001) 46-54

his qualitative research study investigated the experiences T and feelings of being involved

in a bioethical dilcmma from the perspective of nurses, patients, and patients’ family members. A philosophical assumption for this study was that people know more than they can tell. People have focal or acute awareness ofissues, as well as subsidiary awareness. Subsidiary awareness is constitut- ed of those things that people may not be acutely aware of but that make up the background or con- text for their actions. For compre- hensive understanding, it is important to have focal and sub- sidiary awareness of ethical dilemmas. In this study, a bioethi- cal dilemma was detined as

Method and sample. This phe- nomenological study, which used

an inductive and descriptive approach, sought to describe the experience of nurses, patients, and patients’ family members involved in bioethical dilemmas. Fifteen nurses, five patients, and 11 family members were interviewed. All nurses were female, with ages ranging from 20s to 60s. Seven had BSN degrees, five had diplo- ma degrees, one had an associate’s degree, and two had master’s degrees. Of the five patients, four were male, and one was female. All family members were female. Family members were interviewed because many patients were at a stage that did not allow them to participate in decision making. Interview transcripts were ana- lyzed, and clusters were collapsed into themes. Multiple people ana- lyzed the data to support credibili- ty of the findings.

Findings. There were 10 themes for each group, with five common for nurses, patients, and patients’ family members. These terms were presented as a dichotomy, whereas in reality, they presented along a continuum. Themes were used as the basis of the development o f a visual ana- log scale for a future study.

The five common themes were a absence of frustration/

frustration, .’ no guilt/guilt, .i no angerianger, i, sufficient knowledgelinsuffi-

cient knowledge, and vt powerlpowerlessness. The additional themes for nurses were

a no sadness!sadness, au confidenceino confidence, I support from colleagueslno

support from colleagues, L’+ ability to be an advocate1

inability to be an advocate, and !w content with outcomeldiscon-

tent with outcome. Additional themes for patients and their family members were 4 hopelno hope, s+ ability to make decisionsho

ability to make decisions, w support from s t a r membersino

support from staff members, $3 controlho control, and a agreement with decisionsidis-

agreement with decisions. Discussion. Although this

study did not focus on periopera- tive bioethical dilemmas, the results provide a framework to analyze issues perioperative nurses face. The perioperative environment produces many ethical dilemmas, and nurses often do not have support to address and communicate con- cerns. Administrators need to monitor and support ethical deci- sions made at the organizational, staff member, and patient levels. This study may help nurses and managers identify common bioethical dilemmas. This identi- fication may facilitate provision of resources that can be used to provide a just and caring atmos- phere to reduce the burden on nurses, patients, and patients’ family members.

MICHELLE BYRNE RN, MS, PHD, CNOR

NURSING RESEARCH COMMIITEE

185 A O K N JOURNAL.