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Ethical decision making by nurses and doctors: Communication, professional and contextual influences

Perry, Shirley J. (2001) Ethical decision making by nurses and doctors: Communication, professional and contextual influences. PhD thesis, Murdoch University.

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There are many decisions made in health that have an ethical dimension, and there is a growing realisation of this by health care professionals and by society. Understanding the factors that influence the processes employed in reaching an ethical decision is likely to be crucial in providing effective patient care. This study explores the communication patterns between health professionals when engaged in ethical decision making, and examines the way in which ethical decision making in health care practice is influenced by three factors- communication processes, professional background (as exhibited by professional values and the role perceptions of health professionals involved), and the context (represented by two specific types of health care settings). Existing literature has tended to focus on one or two aspects considered important in ethical decision making, but not how they are linked together, and may influence each other. A conceptual framework was developed to demonstrate the way in which the four factors affect ethical decision making in health care practice and to articulate the different theoretical perspectives used to explore them. The study used a combination of qualitative and quantitative methodologies to investigate the different aspects, using two in-depth interviews with each participant together with rating scales. The study included an analysis of qualitative interview data, and comparative analysis of responses on particular sets of questions. For the qualitative analysis. Coding Categories were developed from the data and from the literature, for ethical decision making. communication, professional values, and professional roles. The Participants were 12 nurses and 12 doctors (representing two professional health groups), from intensive care and palliative care-two specific contexts in health care where ethical issues arise and ethical decisions are made. Findings from the study indicate differences amongst participants in relation to crucial elements of the ethical decision making process, and a lack of clarity in their perceptions about their roles, values, and effectiveness in communication when decisions of an ethical nature are to be made. Differences due to professional education and socialisation processes, and the context, were of pivotal significance. There were differences between the two professional groups, doctors and nurses, and between members of the two speciality areas, intensive care and palliative care. Nurses and doctors operated at different levels of effectiveness in relation to ethical matters, had difficulty identifying ethical dilemmas, and identified different priorities when ethical decisions were to be made, i here were differences in relation to communication in ideal and actual situations in clinical practice. Nurses and doctors generally found collaboration (postulated to be the highest form of communication) difficult to define, and not often in evidence in their workplaces. Participants gave a variety of responses in relation to the priority of personal and professional values in professional behaviour. They also gave many examples of value conflict, but few examples of effective strategies used to deal with conflict. Most participants had difficulty defining their roles and each other’s, and had differing views about doctors’ and nurses’ roles in decision making. The findings of this study, which are relevant to almost all aspects of patient care, will facilitate a greater understanding of the complex factors which influence ethical decision making by doctors and nurses, and have implications for both practice and theory. Recommendations are made in regard to clinical and generic education, workplace practices and the potential for further research.

Item Type: Thesis (PhD)
Murdoch Affiliation(s): Division of Social Sciences, Humanities and Education
Notes: Note to the author: If you would like to make your thesis openly available on Murdoch University Library's Research Repository, please contact: Thank you.
Supervisor(s): Styles, Irene and MacCallum, Judith
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