Cultural aspects of moral actions and moral choices in nursing

Abstract

Health care in America occurs in many different contexts including the use of nurses from a variety of cultural backgrounds and experience. With ever increasing complexities in health care occurring at rapid rates, nurses are frequently involved in moral dilemmas that provide additional challenges to the practicing nurse. The role of culture in the resolution of moral dilemmas in nursing is unclear. The presumption that foreign born nurses, licensed to practice in the United States, respond similarly to nurses who are native to America, when both are faced with a moral dilemma, has not been adequately explored. This descriptive study explored the responses of foreign-educated and domestic nurses on hypothetical ethical dilemmas in an instrument that purports to measure knowledge of the American Nurses' Association Code of Ethics. Using the Judgments About Nursing Decisions (JAND) developed by Ketefian (1982), 33 European American, 26 African American and 17 Filipino nurses completed the instrument. Moral choice was operationally defined as the responses to Column A of the JAND; moral action was operationally defined as responses to Column B of the JAND. Demographic and cultural data were obtained in an instrument developed by the author. The data were analyzed using one-way ANOVAs with ethno-cultural group as the independent variable, and post-hoc comparisons of significant differences using the Student-Newman-Keuls procedure. Significant differences were found among the groups in Column A (moral choice) responses (F(2,73) = 6.56; p =.002), with European Americans scoring significantly higher than Filipino nurses. No significant differences were found among the groups in Column B (moral action) responses. Seven subjects agreed to be interviewed after completing the questionnaire to determine additional cultural factors that might have influenced their responses to the JAND. Professional and personal value systems influenced the ways in which nurses attempted to resolve the dilemmas within each story. Professional value systems related to issues of trust, accountability and confidentiality while personal value systems related to the influence of ethnocultural heritage (e.g. Irish Catholic), ethnocultural traits (e.g. stoicism and pride) and ethnocultural ethics (e.g. influence of German truth).