Professional Documents
Culture Documents
Significance of research problem and purpose of the study: A growing concern about
the capacity of nurses to perform ethically in daily practice can be observed.
Nurses tend to reason and behave in a conformist or conventional manner when
faced with ethical conflicts. Not what the patient really needs but contextual fac-
tors seem to determine nurses’ ethical decision making and ethical practice. A
conformist approach to ethical dilemmas in nursing practice affects the quality of
patient care and, in the long term, the well-being of nurses themselves.
There is a strong belief that the work environment might exert a significant
influence on nurses’ ethical behaviour, but empirical support for this presumed
relationship is scant at best. The purpose of this study is to explore the ethical
behaviour of nurses and, more specifically, the influence of the work environment
on their ethical performance.
Research methods: An adapted version of the cognitive theory of moral develop-
ment of Kohlberg has been used as a framework. The cognitive structural char-
acteristics of Kohlberg’s conceptualization of moral stages have been used.
However, Kohlberg’s definition of morality as justice – in term of duties and
rights, fairness and impartiality – has been refined by adding a care perspective.
This change is believed to relate to the postconventional stages of Kohlberg’s
theory and focus on nurses’ commitment to promote patients well-being.
The Ethical Behaviour Test has been used in this study to measure nurses’
response in five nursing dilemmas. Two components of ethical behaviour were
discerned: ethical reasoning and its associated decisions; and the actual imple-
mentation of ethical decisions. Thus, ethical behaviour not only refers to nurses’
ethical reasoning but also to the relationship between this reasoning and their
actual conduct. Both components are operationalized in terms of the refined ver-
sion of Kohlberg’s theory. Reliability and validity were thoroughly evaluated in
previous research and found to be adequate for the purpose of this study.
The sample consisted of 513 staff nurses and was obtained through a random
selection of 23 nursing units in an academic hospital in Belgium. The study
examined the ethical behaviour of nurses, as measured by the Ethical Behaviour
Test, and the relationship between ethical behaviour and personal variables (age,
gender, level of education, experience, etc.) as well as environmental variables
(field of nursing, ward climate, hospital climate, support of head nurse, ethical
committees or rounds, training in nursing ethics).
Results and implications: The data have been collected and were analysed in
February and March 1998. The results will permit us to describe how nurses rea-
son, decide and practice when confronted with daily ethical dilemmas and to
identify characteristics of the work environment that promote nurses’ ethical
development. The implications for the practice of caring and for the nursing work
environment will be discussed.
Purpose and objectives: As part of a larger research project that attempts to describe
the specificity and efficacy of palliative care in an inpatient palliative care unit,
this qualitative study examined two questions: (1) Which interaction, care and
decision processes take place?; and (2) How do patients, relatives and members
of the palliative care team go through these processes?
Significance of the research question: The recent development of palliative care has
led to several concerns. First, a growing number and variety of initiators and orga-
nizations attempt to provide palliative care. This structural diversity could
enhance the already existing vagueness about the specificity of palliative care.
Secondly, the development of palliative care in Belgium is mostly based on vol-
untary initiatives. Palliative care is reproached as a discipline for lack of profes-
sionality. Frequently, it is reduced to ‘holding the patient’s hand’. Moreover, a
review of the available literature about palliative care shows that research mainly
directs attention to the control of symptoms or to other separate aspects of pal-
liative care. For these purposes, quantitative methods are frequently used. Most
studies employ the method of outcome measurement and only report incidentally
on processes occurring within palliative care. These are a few of the reasons why
a research-based description of the specificity of palliative care is needed. This
description is important to obtain professional appreciation in order for palliative
care to be treated as a valuable part of health care.
Methods: A qualitative approach was used to explore the processes that take place
on an inpatient palliative care unit, and the experiences of patients, relatives and
palliative care team members. This study was conducted in 12-bed palliative care
units in two cities. Ten patients, 10 relatives, 20 caregivers and three volunteers
participated. Patients participated when the physician considered that it would
not harm them. Family members were approached during their visits to the hos-
pital. Staff members were approached by the researcher. Selected staff members
were nurses, two doctors, the social work assistant, the pastor’s assistant and
volunteers. In-depth interviews were conducted with patients, relatives, care-