Cultural issues in the understanding of ethics in the nursing profession : implications for practice.

Abstract

The study explored moral and ethical dilemmas experienced by Black nurses in a local community clinic. In particular, it examined the influences of the concept of self or personhood in nurses' ethical and moral decision-making. Influences of culture and family on morality were also investigated. Using the interview methodology developed by Gilligan (1982), nurses were asked to tell stories involving moral dilemmas in their work. Interviews were analysed using the voicecentred relational method. This method involves reading the interview narratives a number of times, each reading focusing on a particular aspect of a respondent's narrative. Results show that nurses often find themselves caught between two opposing moral and ethical viewpoints in their practices. On the one hand are hospital procedures, which are informed by universalist approaches to the person and the moral. From these are derived ethical principles emphasizing individual autonomy and choice. On the other hand, the majority of patients subscribe to a communal view . ofpersonhood. From this perspective, to be moral entails knowing one's position and responsibilities within family and community. Dilemmas arose from nurses' identification with patients' moral perspectives while realizing that this could lead to "unethical" conduct, (given , their training and current codes of ethics). It is recommended that moral and ethical deiiberations should dialogue with alternative, marginalised, viewpoints, in order to be culturally responsive. It is further recommended that ethics be conceptualised as a practical-moral engagement, rather than a detached application of knowledge.