PSYCHOLOGICAL VARIABLES IN NURSES' ETHICAL DECISION-MAKING: THE RELATIONSHIPS AMONG MORAL REASONING, COPING STYLE AND ETHICS STRESS.

Description

Stress related to decision-making is a serious consequence of encounters with ethical dilemmas for nurses. This study explored relationships among exposure to ethical issues, moral reasoning, coping style and ethical stress. A nationwide sample of 229 oncology nurses was surveyed. Respondents reported experiencing major ethical issues nearly every day with an average 31.7 different types of dilemmas within the past year. Pain management issues were the most frequently reported followed by cost containment, making decisions in the best interest of the patient and quality of life decisions. About 80% rated their stress level at 6 or higher (moderate to high) on a 0-10 scale. Forty-six percent indicated they used an independent ("sovereign") style of moral reasoning, 22.4% accommodated to the opinions of others, and 31.6% used characteristics of both styles. Stress level did not vary with type of ethical dilemma; stress level did correlate with moral reasoning style for sovereign reasoners. As predicted, the more types of ethical dilemmas a nurse experienced within the past year, the more types of coping strategies were used. Respondents reported other nurses were most helpful in coping with ethics stress. Clinical nurse specialists, social workers, spouses and nurse managers were next most helpful. Legal counsel and hospital administrators were least helpful. Most respondents (87.6%) used positive, adaptive coping strategies; planful problem-solving and support-seeking were used most. Emotion-focused strategies, such as distancing, escape-avoidance and accepting blame, were used least. Ethics stress scores related to single dilemmas were positively correlated with adaptive coping strategies and satisfaction with resources. Cumulative ethics stress scores were negatively correlated with these variables. Findings suggest nurses cope well with individual ethical dilemmas, but with cumulative stress they tend to use less adaptive coping. Understanding these relationships among ethics stress, moral reasoning and coping can be useful to nurses, as well as their support systems, as they strive to deal with high levels of moral distress in today's healthcare settings. This study provides quantitative data to support earlier theory-building, qualitative studies. Future research should incorporate cross-sectional and longitudinal methodology, including repeated measures of stress and coping, in nurses practicing in other clinical specialties.

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