Living with ethical dilemmas : the ethical reasoning of surgeons and nurses in surgical units

Abstract

Papers number 3 and 4 of the thesis are not available in Munin due to publishers' restrictions:
 <br>3. Torjuul K, Sørlie V (2006): «Nursing is different than medicine: ethical difficulties in the process of care in surgical units», Journal of Advanced Nursing 56 (4):404-413 (Blackwell). Available at <a href=http://dx.doi.org/10.1111/j.1365-2648.2006.04013.x>http://dx.doi.org/10.1111/j.1365-2648.2006.04013.x</a>
 <br>4. Torjuul K, Elstad I, Sørlie V (2007): «Compassion and responsibility in surgical care», Nursing Ethics 14(4):522-534 (Sage). Available at <a href=http://dx.doi.org/10.1177/0969733007077886>http://dx.doi.org/10.1177/0969733007077886</a>

The aim of this thesis is to illuminate surgeons’ and nurses’ experiences of living with ethical dilemmas in their work. The thesis comprises the kinds of ethical dilemmas experienced from the practitioners’ own point of view, and explores their way of reasoning, deliberating and acting in ethically difficult situations, including the meaning they assign to their experiences.
 The data collection consists of open-ended narrative interviews with ten surgeons and ten registered nurses at a university hospital in Norway. The transcribed interview texts were subjected to a phenomenological hermeneutical interpretation.
 <br>The main ethical dilemmas experienced by surgeons and nurses concerned the respecting
 patients’ right to decide their own treatment and care, and act accordingly. Taking appropriate actions to rescue and sustain patients’ lives, and maintain patients’ hopes and efforts to fight
 the disease were important concerns for surgeons and nurses. Being responsible for particular patients in life threatening and decisive circumstances made profound impressions on surgeons and nurses and challenged their outlook on life as well as their professional conduct.
 <br>Situations when ethical dilemmas occur are characterized by complexity, uncertainty and ambiguity about the correct and best thing to do and what constitutes an ethically satisfying solution to the problem. Surgeons and nurses emphasized the importance of collegial recognition and support in order to live with the responsibility and emotional burden of
 experiencing ethical dilemmas. Discussing and resolving ethical problems in the team, and sharing thoughts and feelings with their peers was experienced as a relief. Social
 confirmation and recognition by the patients, relatives, colleagues, and their knowledge that the needs of patients and relatives were attended to in a morally and professionally satisfying manner increased the surgeons’ and nurses’ confidence and satisfaction in their work, and their courage to live with the responsibility for being and acting in ethically difficult
 situations.
 <br>Experiencing the continuous abundance of ethical difficulties in the unit provided surgeons and nurses with opportunities of learning. The kind of ethical knowledge acquired included the acceptance of ethical dilemmas as an inseparable and unavoidable feature of practice, and coming to terms both with the contingencies of human life, and their own limitations and fallibility when trying to provide high quality professional treatment. Acceptance of personal and professional limitations did not mean that surgeons and nurses had abandoned their ethical and professional commitment of trying to maintain and improve the quality of treatment and care to the patients in the unit.

Å leve med etiske dilemma – intervjuer med kirurger og sykepleiere i kirurgiske avdelinger.
 <br>Hensikten med undersøkelsen er å belyse hvordan erfarne kirurger og sykepleiere på
 kirurgiske avdelinger opplever etiske vanskelige situasjoner.
 <br>Bakgrunn: Undersøkelser viser at leger og sykepleiere ofte er i tvil om hva som er det rette og beste å gjøre for pasienten i konkrete situasjoner. Leger og sykepleiere opplever flere og mer kompliserte etiske dilemma enn tidligere pga. økt vitenskapelig kunnskap, økt tilgang til- og mer effektiv medisinsk teknologi, et mer likeverdig forhold til pasienten og organisatoriske
 endringer i helsevesenet.
 <br>Ti kirurger og ti sykepleiere ble bedt om å fortelle fritt om situasjoner de hadde opplevd som etisk vanskelige. Resultatene viser at kirurger og sykepleiere ønsker å gjøre det som er rett og godt for pasienten. Avgjørelsen om å starte, fortsette eller avslutte medisinsk behandling er spesielt
 vanskelig. Samtaler med pasienter og pårørende og diskusjoner i behandlingsteamet er viktig for å oppnå enighet og løse etiske dilemmaer. Å få bekreftelse fra pasienter, pårørende, kollegaer og egen samvittighet om at pasientens behov er ivaretatt på en etisk og profesjonell god måte øker kirurgenes og sykepleiernes trygghet og tilfredsstillelse i arbeidet.
 <br>Etiske dilemma oppleves både som en belastning og en mulighet til å lære av erfaringen. Kirurgene og sykepleierne betrakter etiske dilemma som en uunngåelig og uadskillelig del av yrkesutøvelsen. De erkjenner at livet er skjørt og uforutsigbart, noe som gir muligheter og
 setter grenser for yrkesutøvelsen. Kirurgene og sykepleierne aksepterer egen usikkerhet,
 sårbarhet og feilbarlighet i etisk vanskelige situasjoner, samtidig som de arbeider kontinuerlig for å forbedre kvaliteten på behandlings og pleietilbudet til pasienten.