Influences on Ethical Decision-Making by Nurses Employed in Federal Health Care Facilities
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Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Influences on Ethical Decision-Making yb Nurses Employed in Federal Health Care Facilities Cecil Dean Blount Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Bioethics and Medical Ethics Commons, and the Social and Behavioral Sciences Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Cecil D. Blount has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Eliesh Lane, Committee Chairperson, Public Policy and Administration Faculty Dr. Mi Young Lee, Committee Member, Public Policy and Administration Faculty Dr. Tanya Settles, University Reviewer, Public Policy and Administration Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University May 2020 Abstract Influences on Ethical Decision-Making by Nurses Employed in Federal Health Care Facilities by Cecil D. Blount Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University April 2020 Abstract Healthcare professionals are tasked with making key decisions involving new and controversial approaches such as organ transplantation and life-prolonging technologies and treatments that raise various ethical issues. Suboptimal ethical choices by nurses can lead to negative patient outcomes and lower the quality of life in federal healthcare facilities. The purpose of this nonexperimental quantitative correlational study was to identify the factors that influence nurses’ ethical decision-making processes in U.S. federal healthcare facilities. The theoretical framework was based on Beauchamp and Childress’ ethical system of principlism. Three research questions addressed the nature and extent of the relationship between nurses’ Ethical Behavior Test (EBT) scores and personal experiences, professional experiences, and professional ethics training. A quantitative correlational design using the EBT questionnaire to collect data from a convenience sample of 381 nurses. Data analysis included descriptive statistics and multiple linear regression at the 0.05 significance level. Findings indicated a significant relationship between EBT scores and personal experiences (p < 0.0001), professional experiences (p < 0.0001), and professional ethics training (p < 0.015). In conclusion, professional ethics training and personal and professional experiences significantly predicted nurses’ ethical behaviors. Professional training for nurses in ethical decision- making is recommended to allow them to effectively apply ethics in clinical practice. Implications for social change include informing nursing educators and public health policymakers of these influences so they can design interventions. Influences on Ethical Decision-Making by Nurses Employed in Federal Health Care Facilities by Cecil D. Blount Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University April 2020 Dedication To my daughters Melanie and Nicole Blount To the living and deceased who have inspired me A very special thanks to Marcellus N. Hughes and Sylvia Hughes I thank you deeply for the Faith, Love, and Hope over the years we were together. A special thanks to Brigitte L. Greissl-Blount who made it all possible. Acknowledgments To my committee, Dr. Lane, Dr. Lee, and Dr. Settles To Walden, Columbia Southern, and Northcentral Universities for the educational opportunities you provided. A very special thanks to Ms. Koosed for her long years of support and advice A very special thanks to Mr. Paul Wilkens and Mr. Felix Vazquez, for the Programming support. “Education is the only way, into the glorious light” (Forest Whitaker, 2015). Table of Contents List of Tables .......................................................................................................................v List of Figures .................................................................................................................... vi Chapter 1: Introduction to the Study ....................................................................................1 Background of Study .....................................................................................................1 Problem Statement .........................................................................................................4 Purpose of the Study ......................................................................................................5 Significance of the Study ...............................................................................................6 Significance to Practice..................................................................................................6 Significance to Theory ...................................................................................................7 Significance to Social Change .......................................................................................7 Research Questions ........................................................................................................8 Research Design Summary ............................................................................................9 Theoretical Framework ................................................................................................10 Nature of the Study ......................................................................................................13 Dependent and Control Variables ................................................................................15 Assumptions .................................................................................................................15 Limitations ...................................................................................................................15 Researcher Bias ............................................................................................................16 Delimitations ................................................................................................................16 Definition of Terms......................................................................................................17 Summary ......................................................................................................................19 i Chapter 2: Literature Review .............................................................................................21 Literature Search Strategy............................................................................................21 Theoretical Foundation ................................................................................................22 Literature Review Related to Key Concepts and Variable ..........................................24 Ethical Dilemmas in Nursing .................................................................................28 Medical Education Ethics ......................................................................................30 Trust .......................................................................................................................31 Breaking Bad News ...............................................................................................33 Bureaucratic Ethics—Commitment to the Group ..................................................37 Group Influence on Ethics .....................................................................................40 Ethical Competence ...............................................................................................43 Nursing Leadership ................................................................................................46 Influence of Gender on Ethical Decision-Making .................................................49 Influence of Education Level on Ethical Decision-Making ..................................52 Influence of Generational Factors Among Nurses on Ethical Decision-making ...57 Length of Employment Influence on Decision-making.........................................61 Summary and Conclusions ..........................................................................................64 Chapter 3: Research Method ..............................................................................................66 Setting ..........................................................................................................................66 Research Design and Rationale ...................................................................................67 Variables ................................................................................................................67 Research Design.....................................................................................................67 ii Methodology ................................................................................................................69