Head nurses’ decision-making when managing ethical dilemmas

Ethical dilemmas experienced by midwives working in the delivery room

BACKGROUND

Midwives frequently encounter ethical dilemmas in a critical unit such as a delivery room. Determining these ethical dilemmas is very important to prevent ethical problems and develop an ethical approach.

AIM

This study aims to identify the ethical dilemma experiences of midwives working in delivery rooms in Turkey.

RESEARCH DESIGN

This study follows a qualitative phenomenological research design.

PARTICIPANTS AND RESEARCH CONTEXT

The sample comprised 13 midwives with at least two years working experience in delivery rooms, having completed the midwifery program of Manisa Celal Bayar University Health Sciences Institute in the 2017-2018 academic year. Data were collected through audio-recorded semi-structured interviews to reveal their experiences. Content analysis was done using the Nvivo software package program. All interviews were digitally recorded, transcribed verbatim, and transferred into NVivo for analysis.

ETHICAL CONSIDERATIONS

Ethical approval was granted by Manisa Celal Bayar University University Health Sciences Ethics Committee (Date: 16.12.2016 No: 372). Participation in this study was voluntary. Written and verbal consent was gained. These consents include protecting midwives' privacy, keeping information confidential, and/or allowing the participant to remain anonymous.

FINDINGS

Four themes were identified: differences of approach to the birth process, hospital management, communication, and differences in ethical approach. Several factors explained these ethical dilemmas while the midwives adopted different approaches to ethical decision making.

DISCUSSION

These midwives experienced various dilemmas while working in the delivery room and are aware of most of them. They also took responsibility in the decision-making process and experienced many intense emotions that they had to cope with.

CONCLUSION

The ethical dilemmas faced by these midwives while working in delivery rooms were mainly caused by hierarchy. Future studies could investigate clarifying job descriptions of midwives, who are authorized to manage normal births under their own responsibility, within the hospital management and the health care team.

Narrativity and its application in business ethics research

Purpose

The purpose of this paper is to develop a narrative framework for doing empirical research into business ethics and shows, through two examples, how the framework can be applied in practice in this context. The focus is on interview-based research.

Design/methodology/approach

A theoretical research based on literature review was conducted.

Findings

In the developed narrative framework, two main kinds of analysis are distinguished: an analysis of the narrative and a narrative analysis. An analysis of the narrative is a matter of classifying and producing taxonomies out of the data. The purpose of a narrative analysis is to construct a story or stories based on the data. Narrative analysis differs from the analysis of narratives in that the story does not exist prior to the analysis, but is created during the analysis.

Research limitations/implications

The proposed narrative framework helps those doing empirical research into business ethics avoid simplistic “black and white” interpretations of their material, and helps them to show that ethical realities in the business world are often complex, various and multiple.

Practical implications

The paper offers a methodological framework for those doing qualitative research into business ethics which will increase the quality and rigor of their studies.

Originality/value

A value of the narrative approach is that the stories offer researchers an entry point to understanding the complexity of ethics and how people make sense of this complexity. The paper shows in detail how the methods presented can be used in practice in empirical research.

Brazilian nursing professionals: leadership to generate positive attitudes and behaviours

PURPOSE

This paper aims to identify the kind of work environment that should be offered by hospital leaders to their nursing staff in Brazil to generate job satisfaction, organizational commitment and organizational citizenship behaviour within their field of expertise.

DESIGN/METHODOLOGY/APPROACH

A survey was applied to 171 nurses and 274 nursing technicians who work at five private hospitals in Brazil. Both factor analysis and regression analysis were used to analyse the study model.

FINDINGS

The results indicate that to stimulate positive behaviours and attitudes among nursing staff, managers should mainly be concerned about establishing a clear and effective communication with their professionals to ensure role clarity, promote a good working environment and encourage relationships based on trust.

RESEARCH LIMITATIONS/IMPLICATIONS

The limitations of the study are absence of the researcher while the questionnaires were filled out and the fact that the sample comprised respondents who made themselves available to participate in the research.

PRACTICAL IMPLICATIONS

This study contributes to elucidate the factors that can promote a good internal climate for nursing staff, assisting hospital leaders to face the huge managerial challenges of managing, retaining and advancing these professionals.

ORIGINALITY/VALUE

The findings contribute to the body of knowledge in leadership among nursing professionals in developing countries. Hospital leaders in Brazil should encourage trusting relationships with nursing professionals through clear, effective and respectful communications, besides investing in team development and promoting a good working environment.

The role of the psychological contract in the motivation of nurses

Purpose Although private health care is regarded as providing a premium quality experience for both patients and staff alike, it is not without its daily challenges for health professionals. This study aims to explore the psychological contract of nurses to develop a greater understanding of how employee-employer interaction impacts motivation levels. Design/methodology/approach Data were gathered through semi-structured interviews with thirteen nurses at a private hospital in South Africa. Five nursing managers were interviewed to provide a management perspective. Thematic analysis was used to identify the salient elements of the psychological contract and to establish connections with motivational features. Findings The psychological contract of nurses was balanced in nature, contained predominantly relational elements and was characterized by the need for manager support, leadership and autonomy. Motivation was a by-product of fulfilment and was enhanced by a combination of tangible and intangible rewards. Practical implications Nursing managers should recognize their role in caring for the wellbeing of their staff and should be trained accordingly. Equipping nurses with the necessary tools to work autonomously, as well as acknowledging their skills, will stimulate confidence and improve motivation. Originality/value This study makes an important contribution to the existing literature on the psychological contract of nurses within the health-care system. It provides insight into relationship-based mechanisms that can be used to improve the motivation of nurses and thus impact the overall quality of patient care.