Ethical conflict situations of nursing staff development educators

Abstract

Nursing Staff Development Educators (NSDEs) teach, mentor, consult with health care staff, and conduct educational research in varied health care settings. These role functions demand professional ethical conduct and skill in ethical decision-making. No available data exist concerning the ethical conflict situations these nursing professionals encounter in their practice. Hence, the major purposes of this study were to: (1) identify and categorize the themes in the ethical conflict situations reported by a sample of nursing staff development educators; (2) categorize the types of ethical conflict situations using Jameton's (1984) categories of moral conflict; (3) identify and categorize the modes of moral reasoning used by the NSDEs; (4) measure "how often" NSDEs are directly involved in and "how troubled" they are by the reported ethical conflict situations; and (5) describe the sample in terms of selected demographic variables, type and level of academic preparation (including ethics education), work history, and time spent in NSDE roles in their practice. The theoretical framework guiding this study was ethical theory and an adaptation of Rest's (1979) Four-Component Model Of Morality. Component 1 is the identification of the salient ethical aspects of an ethical conflict. Principled and care ethics modes of reasoning were proposed in Component 2 followed by moral intent (Component 3) and moral behavior or action as Component 4. The sample consisted of 102 NSDEs who represent a 35% return rate for the mailed survey of 300 randomly selected from the mailing list of the major professional organization for NSDEs. The NSDEs responded to a three-part questionnaire which asked for a description of an ethical conflict situation they were "directly involved in", how they responded, and demographic/background information. For coding of open-ended material, evidence of intrarater and interrater reliability was obtained, with percentages of agreement in the 80s and 90s. Thematic content analysis, a qualitative methodology, was used to code the responses to the open-ended questions provided by the 79 participants. (The remaining 23 NSDEs were unable to describe an ethical conflict situation, although they completed the rest of the questionnaire. The modified Zablow (1984) coding scheme revealed nine categories of ethical conflict situations which are: competence testing of staff and educators (14); resource allocation vs. quality (14); the triangle: manager/NSDE/staff (14); professional values (10); educator role functions (8); business/legal issues (8); patient care issues (7) confidentiality (4); and no stated conflict (23). Use of Jameton's typology of moral conflicts (1984) to categorize the described situations yielded an almost bimodal distribution, with 48% involving moral distress and 41% involving moral dilemma. In terms of Lyon's (1984) coding scheme for modes of moral reasoning, the 79 NSDEs predominantly (60%) used principled ethics moral reasoning, with 13% using care ethics moral reasoning. Study results provide evidence that NSDEs are directly involved in ethical conflict situations specific to their practice of adult education and staff development. The majority of the NSDEs (89%) perceived these situations as either a moral dilemma or distress. NSDEs predominantly (60%) use principled ethics mode of moral reasoning to resolve the conflicts. Implications for staff development, ethics education for NSDEs, and future research are explored.