Ethics in Health Care Research Research in Nursing Ethics
In recent decades, the rapid advancement of technology in healthcare has heightened awareness of the ethical dimensions of high-tech care. As technology evolves, it often introduces complex ethical issues that challenge existing norms and practices. While technological advancements offer numerous benefits, they also pose ethical dilemmas that can outpace our ability to address them effectively. This disparity underscores the need for ongoing research and discussion in nursing ethics to ensure that ethical considerations keep pace with technological innovations.
Nursing ethics, as a field of study, has evolved significantly from its early days when it was primarily concerned with etiquette and conduct. Today, nursing ethics encompasses a broader analysis of moral phenomena in nursing practice, the ethical foundations of nursing, and the ethical judgments made by nurses. This evolution reflects a shift from prescriptive rules to a more nuanced understanding of moral and ethical issues in nursing.
Why Ethics Are Needed
Ethics in nursing are essential for several reasons. They provide a framework for making decisions that align with the values and principles of the profession, ensuring that patient care is both compassionate and just. Ethics help navigate complex situations where clinical decisions may not be straightforward, offering guidance on how to balance competing interests and values.
Historically, nursing ethics was often guided by a set of rules or codes of conduct. However, the field has increasingly recognized the need for a more comprehensive approach that includes philosophical and empirical analyses of moral issues. This shift acknowledges that ethical decision-making in nursing involves not just adhering to established rules but also engaging in thoughtful reflection about the moral implications of various actions.
Fry (1995) highlighted three key areas in nursing ethics: the moral phenomena found in nursing practice, the moral language and ethical foundations of nursing, and the ethical judgments made by nurses. These areas emphasize the importance of understanding the ethical dimensions of nursing work and the need for ongoing ethical inquiry to address emerging challenges.
Ethical Inquiry in Nursing
Over the past two decades, there has been a notable increase in ethical inquiry within nursing research. Earlier studies in this area were primarily philosophical and normative, focusing on abstract ethical principles and theories. More recent research has shifted towards empirical and descriptive approaches, utilizing both qualitative and quantitative methods to explore nurses’ ethical decision-making processes.
Empirical studies in nursing ethics aim to understand how nurses make ethical decisions and how they respond to ethical dilemmas. These studies investigate various factors that influence ethical practice, including the context in which ethical decisions are made, the personal and professional values of nurses, and the impact of organizational and systemic factors.
Recent research has also explored moral reasoning, which is the process by which individuals interpret and respond to ethical issues. Understanding how nurses reason about moral choices and what conditions promote high-quality reasoning is crucial for improving ethical practice in nursing.
Moral Reasoning
Moral reasoning involves a cognitive and developmental process that reflects how individuals interpret social arrangements and ethical problems. According to Kohlberg (1978), moral reasoning progresses through a series of stages, each more complex and differentiated than the previous one. These stages represent different ways of understanding and addressing moral issues, with each stage reflecting a higher level of cognitive development.
Kohlberg’s theory is based on notions of rights, obligations, and justice, which some critics argue reflect a male-oriented perspective. Gilligan (1982) challenged this perspective by proposing the ethic of care, which emphasizes the importance of relationships and contextual factors in moral reasoning. According to Gilligan, moral conflicts and choices are shaped by the context of the situation and the relationships involved, rather than by abstract ethical principles.
Research on care-oriented reasoning has shown that both justice and care perspectives can be used by the same person, and both offer valuable insights into moral judgments. Studies using instruments like the Ethic of Care Interview have found relationships between age, ego identity, and care orientation among women, highlighting the complexity of moral reasoning.
Nursing Research on Ethical and Moral Reasoning
Nursing research on ethical and moral reasoning has explored various factors influencing nurses’ decision-making processes. Ketefian (1989) conducted an integrative review of empirical studies on ethical practice and moral reasoning, updating the information with a literature search conducted in 1996. This research has focused on understanding how different educational, cognitive, environmental, and personal variables affect moral reasoning and ethical behavior in nursing.
Recent studies have examined qualitative descriptions of nurses’ reasoning, including whether they use care or justice conceptions of morality. Despite these efforts, no clear direction has emerged regarding the dominance of one moral perspective over the other.
Ethical practice in nursing involves making decisions and taking actions that reflect high ethical standards. Various indices of ethical behavior have been proposed, but comparisons across studies are challenging due to differences in measurement tools. The most commonly used tool is Judgments about Nursing Decisions (Ketefian, 1989), although other measures have been developed by different investigators.
Educational, moral reasoning, and organizational variables have been studied as predictors of ethical practice, but results have been inconsistent. This highlights the need for further research to clarify the factors influencing ethical behavior and to develop more reliable measures of ethical practice.
Ethical and Moral Practice in Health Care
Caring behaviors in nursing are essential for providing compassionate and effective care. These behaviors include empathetic communication, competence, continuity of care, and respect for patients. Several descriptive studies have identified these aspects of caring behaviors and their impact on patient satisfaction and outcomes.
Research on the effects of nurses’ caring behaviors on patient satisfaction has provided valuable insights into how these behaviors contribute to positive patient experiences. Further research is needed to explore the relationship between caring behaviors and patient outcomes in different clinical settings.
Ethical Values and Attributes in Health Care
Studies have explored various aspects of ethical values and attributes in health care, including nurses’ attitudes towards ethical issues, their understanding of ethical dilemmas, and their perceptions of ethical problems. Research has examined how nurses address ethical concerns in their practice, their experiences of powerlessness in influencing ethical decisions, and the ethical issues related to pain management and long-term tube feedings.
Other studies have investigated nurses’ roles in end-of-life decisions, practices related to assisted suicide and euthanasia, and differences between nurses and physicians in ethical decision-making. These studies provide valuable insights into the ethical challenges faced by health care professionals and the factors influencing their decision-making processes.
A promising area of research involves examining how organizational variables impact the quality of nurses’ reasoning, behavior, and judgments. Understanding the role of organizational factors in ethical decision-making can help identify ways to improve ethical practice in health care settings.
Moving Forward in Nursing Ethics Research
Despite the progress made in nursing ethics research, there is a need for a more programmatic and cumulative approach to studying ethical issues. Many studies in this field are isolated projects or dissertations, and there is a lack of published research that contributes to a meaningful body of knowledge.
To advance the field, researchers should focus on developing comprehensive research programs that build on existing knowledge and address gaps in the literature. Replication studies and meta-analyses can help establish a more reliable and robust understanding of ethical practice in nursing.
In conclusion, nursing ethics is a critical area of research that addresses the moral dimensions of nursing practice and the ethical challenges posed by technological advancements. By continuing to explore ethical inquiry, moral reasoning, and ethical practices, researchers can contribute to improving the quality of care and ensuring that ethical considerations are integrated into all cts of health care.