Nurses' negotiation processes in facilitating ethical decision-making in patient care

Abstract

<p>The literature on ethical decision-making by nurses presents both prescriptive and descriptive decision-making models. The processes nurses use to move through the step-wise models has not been described. An atheoretical approach was taken using naturalistic inquiry methodology to explore the processes further. Eighteen nurses working in a midwest, urban academic medical center were interviewed. The major themes focused on the moral agency of nurses and the processes by which nurses accomplish their objectives for their patients. Physician-nurse relationships and their interactions were critical in the expression of moral agency of the nurses. The main finding in the study was that nurses' moral work is invisible. Their clinical decision-making, their negotiation with others to meet their patients' needs, and their investment in their patients' welfare virtually goes unrecognized and unacknowledged. Implications for nursing practice are that the nurses must decide if they want to change the system in which they practice. They would need to be willing to accept visibility and the accompanying accountability. Nursing education should prepare nurses for "visible", accountable practice. Future research is needed to explore this aspect of ethical decision-making by nurses and their role in ethical decision-making in patient care.</p>