Ethically difficult situations in hemodialysis care – Nurses' narratives

Background:Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dile...

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Authors: Fischer Grönlund, Catarina EC (Author) ; Söderberg, Anna IS (Author) ; Zingmark, Karin M (Author) ; Sandlund, S Mikael (Author) ; Dahlqvist, Vera (Author)
Format: Electronic Article
Language:English
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Published: Sage 2015
In: Nursing ethics
Year: 2015, Volume: 22, Issue: 6, Pages: 711-722
Further subjects:B Ethics
B Dialogue
B Nursing
B Narratives
B troubled conscience
B dialysis care
Online Access: Volltext (lizenzpflichtig)
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Summary:Background:Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose.Research question:This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses’ experiences of being in ethically difficult situations that give rise to a troubled conscience.Research design:This study has a phenomenological hermeneutic approach.Participants:Narrative interviews were carried out with 10 registered nurses working in dialysis care.Ethical considerations:The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University.Results:One theme, ‘Calling for a deliberative dialogue’, and six sub-themes emerged: ‘Dealing with patients’ ambiguity’, ‘Responding to patients’ reluctance’, ‘Acting against patients’ will’, ‘Acting against one’s moral convictions’, ‘Lacking involvement with patients and relatives’ and ‘Being trapped in feelings of guilt’.Discussion:In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience.Conclusion:In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.
ISSN:1477-0989
Contains:Enthalten in: Nursing ethics
Persistent identifiers:DOI: 10.1177/0969733014542677