Exploring the Challenges Encountered and Strategies Employed by Nurses when Confronted with Moral Decisions: Implication on Moral Competence
DOI:
https://doi.org/10.31674/mjn.2023.v15i02.014Abstract
Background: The public perceived negative attitudes and poor performance by some nurses, implying low moral competence levels. To determine how nurses handle moral issues in nursing practice, this study explored the challenges encountered and strategies employed by nurses when confronted with moral decisions. Methods: This study employed a qualitative research design utilizing in-depth interviews conducted by twenty nurse informants from hospitals in Iligan City, Philippines, recruited through a purposive sampling technique. A researcher-made interview guide with open-ended questions was utilized. The interviews were recorded, transcribed, and thematically analyzed. Results: The emergent themes are “predicaments toward patient and family issues” with two sub-themes (patient/family non-conforming decisions and dealing with emotionally burdened family members), “recognition of own weaknesses and shortcomings” with four sub-themes (infrequent performance of emotional care, insufficient provision of comfort, interference with the patient’s privacy, and delays in care due to prioritization), and “conflict with superiors”. Several strategies were employed to effectively address the moral challenges encountered. Conclusion: Moral competence is inherent in nurses, as they exhibit moral judgment and skills in overcoming the moral challenges encountered. However, there are moral issues beyond control in patient care. Therefore, hospital administrators may conduct a program to enhance the nurses’ competence to handle moral challenges and prevent moral distress, which will improve nursing practice.
Keywords:
Moral Competence, Moral Challenges, Nurses, PhilippinesDownloads
References
Ahmed, A. R., Zaghlol, M., & Tawfik, L. (2018). Effect of educational guideline on intern nurses’decisionmaking skills during first stage of labor. The Malaysian Journal of Nursing (MJN), 9(4), 114-122. https://ejournal.lucp.net/index.php/mjn/article/view/358 .
Aller, T. (2019). What is a nurse’s role in patient pain management? https://www.nursechoice.com/blog/profiles-and-features/what-is-a-nurses-role-in-patient-pain-management/ . Accessed on 17th August 2022.
Becker, C. A., Wright, G., & Schmit, K. (2017). Perceptions of dying well and distressing death by acute care nurses. Applied Nursing Research, 33, 149-154. https://doi.org/10.1016/j.apnr.2016.11.006
Berhie, A. Y., Tezera, Z. B., & Azagew, A. W. (2020). Moral distress and its associated factors among nurses in northwest amhara regional state referral hospitals, Northwest Ethiopia. Psychology Research and Behavior Management, 161-167. https://doi.org/10.2147/PRBM.S234446
Bradshaw, J., Siddiqui, N., Greenfield, D., & Sharma, A. (2022). Kindness, listening, and connection: patient and clinician key requirements for emotional support in chronic and complex care. Journal of Patient Experience, 9, 23743735221092627. https://doi.org/10.1177/23743735221092627
Bronikowska, M., Korcz, A., Krzysztoszek, J., & Bronikowski, M. (2019). How years of sport training influence the level of moral competences of physical education and sport students. BioMed Research International, 2019. https://doi.org/10.1155/2019/4313451
Demirsoy, N., & Kirimlioglu, N. (2016). Protection of privacy and confidentiality as a patient right: physicians’ and nurses’ viewpoints. Biomedical Research, 27(4), 1437-1448. https://efaidnbmnnnibpcajpcglclefindmkaj/https://www.alliedacademies.org/articles/protection-of-privacy-and-confidentiality-as-a-patient-right-physicians-and-nurses-viewpoints.pdf
Garces-Cabanas, C. T., & Dano, J. C. (2022). The experiences of nurse’s frustrations in clinical settings. The Malaysian Journal of Nursing (MJN), 13(3), 77-84. https://doi.org/10.31674/mjn.2022.v13i03.0
Germossa, G. N., Hellesø, R., & Sjetne, I. S. (2019). Hospitalized patients’ pain experience before and after the introduction of a nurse-based pain management programme: a separate sample pre and post study. BMC Nursing, 18(1), 1-9.
Godfrey, K. (2016). Patients have a Right to be Rude. https://www.nursingtimes.net/opinion/patients-have-a-right-to-be-rude-18-01-2016/ . Accessed on 18th August 2022.
Haghighat, S., Borhani, F. & Ranjbar, H. (2020). Is there a relationship between moral competencies and the formation of professional identity among nursing students? BMC Nursing 19, 49. https://doi.org/10.1186/s12912-020-00440-y
Johnstone, M. J. (2015). Moral competence in nursing. Australian Nursing and Midwifery Journal, 22(10), 33. https://search.informit.org/doi/abs/10.3316/informit.132055997722594. Accessed on 10th August, 2022.
Kim, K., Han, Y., & Kim, J. S. (2017). Nurses’ and patients’ perceptions of privacy protection behaviours and information provision. Nursing Ethics, 24(5), 598-611. https://doi.org/10.1177/0969733015622059
Kunjukunju, A., & Ahmad, A. (2019). Effective communication among doctors and nurses: barriers as perceived by doctors. The Malaysian Journal of Nursing (MJN), 11(2), 3-11. https://doi.org/10.31674/mjn.2019.v11i02.001
Labrague, L. J., Al Hamdan, Z., & McEnroe‐Petitte, D. M. (2018). An integrative review on conflict management styles among nursing professionals: implications for nursing management. Journal of Nursing Management, 26(8), 902-917. https://doi.org/10.1111/jonm.12626
Lamar University (2020). How Nurses Can Provide Emotional Support to Patients. https://degree.lamar.edu/online-programs/healthcare/rn-to-bsn/patient-emotional-support/. Accessed on 22nd August 2022.
Ma, H. K. (2012). Moral competence as a positive youth development construct: a conceptual review. The Scientific World Journal, 2012. https://doi.org/10.1100/2012/590163
Maluwa, V. M., Gwaza, E., Sakala, B., Kapito, E., Mwale, R., Haruzivishe, C., & Chirwa, E. (2019). Moral competence among nurses in Malawi: a concept analysis approach. Nursing Ethics, 26(5), 1361-1372. https://doi.org/10.1177/0969733018766569
Maluwa, V. M., Maluwa, A. O., Mwalabu, G., & Msiska, G. (2022). Assessment of ethical competence among clinical nurses in health facilities. Nursing Ethics, 29(1), 181-193. https://doi.org/10.1177/09697330211010259
Markey, K. (2021). Moral reasoning as a catalyst for cultural competence and culturally responsive care. Nursing Philosophy, 22(1), e12337. https://doi.org/10.1111/nup.12337
McConnell, D. (2020). Balancing the duty to treat with the duty to family in the context of the COVID-19 pandemic. Journal of Medical Ethics, 46(6), 360-363. https://doi.org/10.1136/medethics-2020-106250
McCutcheon, A. (2022). 6 Tips for Dealing with a Patient's Difficult Family Members. https://nurse.org/articles/how-to-deal-with-difficult-patient-family/. Accessed on 17th September, 2022.
Murcia, S. E. A., & Lopez, L. (2016). The Experience of Nurses in Care for Culturally Diverse Families: A Qualitative Meta-Synthesis. Revista Latino-Americana de Enfermagem, 24. https://doi.org/10.1590/1518-8345.1052.2718
National Institutes of Health (n.d.). Cultural Respect. https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/cultural-respect . Accessed on 13th September 2022.
Ramsey, S. D., Bansal, A., Fedorenko, C. R., Blough, D. K., Overstreet, K. A., Shankaran, V., & Newcomb, P. (2016). Financial Insolvency as a Risk Factor for Early Mortality Among Patients with Cancer. Journal of Clinical Oncology, 34(9), 980. https://doi.org/10.1200/jco.2015.64.6620
Sillero Sillero, A., Ayuso Margañon, R., Gil Poisa, M., Buil, N., Padrosa, E., Insa Calderón, E., ... & Alcover Van de Walle, C. (2023, July). Moral Breakdowns and Ethical Dilemmas of Perioperative Nurses during COVID-19: COREQ-Compliant Study. In Healthcare (Vol. 11, No. 13, p. 1937). MDPI. https://doi.org/10.3390/healthcare11131937
Tegegne, M. D., Melaku, M. S., Shimie, A. W., Hunegnaw, D. D., Legese, M. G., Ejigu, T. A., ... & Chanie, A. F. (2022). Health Professionals' Knowledge and Attitude towards Patient Confidentiality and Associated Factors in a Resource-limited Setting: a cross-sectional study. BMC Medical Ethics, 23(1), 26. https://doi.org/10.1186/s12910-022-00765-0
Torrey, T. (2022). Why People Are Noncompliant with Treatment. https://www.verywellhealth.com/adhering-to-treatment-recommendations-2614978. Accessed on 15th August 2022.
Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content Analysis and Thematic Analysis: Implications for Conducting a Qualitative Descriptive Study. Nursing & Health Sciences, 15(3), 398-405. https://doi.org/10.1111/nhs.12048
Wiley, K. (2016). Help Your Patients Navigate the Financial Challenges of Cancer. https://voice.ons.org/news-and-views/help-your-patients-navigate-the-financial-challenges-of-cancer . Accessed on 10th July 2022.
Winters, R., & Neville, S. (2012). Registered nurse perspectives on delayed or missed nursing cares in a New Zealand Hospital. Nursing Praxis in New Zealand, 28(1). https://go.gale.com/ps/i.do?id=GALE%7CA288689507&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=01127438&p=AONE&sw=w&userGroupName=anon%7Ee6951e45&aty=open-web-entry. Accessed on 10th August 2022.
Wolters Kluwer (2017). Five Strategies for Providing Effective Patient Education. https://www.wolterskluwer.com/en/expert-insights/5-strategies-for-providing-effective-patient-education . Accessed on 11th July 2022.
Zafarnia, N., Abbaszadeh, A., Borhani, F., Ebadi, A., & Nakhaee, N. (2017). Moral competency: meta-competence of Nursing Care. Electronic Physician, 9(6), 4553. https://doi.org/10.19082/4553 . Accessed on 12th August, 2022.
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 The Malaysian Journal of Nursing (MJN)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
