요양병원 간호사의 윤리적 갈등 경험

Abstract

The purpose of this study was to understand the experience of ethical conflicts which nurses of long-term care hospitals encounter in clinical practice and to clarify the essential meaning structure of the phenomenon. This research was a phenomenological qualitative study. The research question was 'what kind of ethical conflict nurses experience while working in a long-term care hospital' and Colaizzi's(1978) analysis method was applied. The participants were a total of nine nurses working in long-term care hospitals located in G Province, and they included only the nurses who had worked in long-term care hospitals for one year or longer. The data were collected by conducting an in-depth one-on-one interview with each of the participants two times or more, the recorded materials of the interviews were transcribed and field notes were used. The data collection period was from July, 2015 to January, 2016 after the approval of the Institutional Review Board of C University. In this study, 19 themes, 7 theme groups, and 3 categories were derived through the data analysis using Colaizzi’s six step analysis method. The first category was 'the confusion between nurses’ values,' and the related theme groups included 'the conflicts between good nursing care and values' and 'apathy toward the value of human life and nursing care.' The second category is ‘conflicts in the relationship of nursing work’, and the related two themes were ‘dissatisfaction with unfaithful and irresponsible medical personnel’ and ‘conflicts in the relationship of care.’ The final category was the difficulties stemming from the institutional environment of the hospital, and related themes were classified into three groups, such as ‘the situations in which the truth must be hidden,’ ‘conflicts between the characteristics of the long-term care hospital and values,’ and ‘confrontation with the policies and values pursued by the organization.’ The nurses of long-term care hospitals try to protect the dignity of geriatric patients, and help elderly people make autonomous decisions. In addition, they think that they should make the best choice for elderly care and provide active care for the elderly. However, the nurses experience confusion in their values due to moral uncertainty, experience ethical conflicts in the relationships of nursing work, and go through ethical difficulties caused by the systems and policies that impede good nursing care. This is the ethical suffering of the nurses and it is the essential structure of the phenomenon of the ethical conflict experience of nurses of long-term care hospitals. A meaningful aspect of this study is that it attempted to elucidate and describe the phenomenon of ethical conflicts and the nature of conflict experience by long-term care hospital nurses that have been overlooked or hidden so far by phenomenological methods. Therefore, this study is thought to contribute to providing an important basic data for nursing research, nursing education, and improvement of institutional systems to resolve conflicts by identifying the factors of ethical conflicts on the basis of the study results. In particular, this study showed the limitations of long-term care hospital nurses’ ethical decision-making ability to cope with the ethical conflict situation and revealed the problems of the systems and policies of long-term care hospitals which may be obstacles to good nursing care. In this respect, this study showed the necessity for ethics education to enhance the nurses’ ethical sensitivity and ethical decision-making ability in ethical conflict situations, and also presented the need for the improvement of institutional systems for ethical nursing care.