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Abstract
Purpose
This study was aimed at identifying the types of perceptions of ethical issues among perioperative nurses.
Methods
Q-methodology focusing on individual subjectivity was used with data collected in November 2016. Thirty-four Q-statements were selected and scored by the 35 participants on a 9-point scale with normal distribution. Participants were perioperative nurses working in advanced general hospitals and general hospitals. The data were analyzed using the PC-QUANL program.
Results
A total of 35 perioperative nurses were classified into 4 factors based on the following viewpoints: self-centered (type 1), onlooking and avoiding (type 2), patient-centered (type 3), and problem-centered (type 4). The 4 factors accounted for 57.84% of the total variance. Individual contributions of factors 1, 2, 3, and 4 were 41.80%, 7.18%, 5.20%, and 3.66%, respectively.
Conclusion
The major contribution of this study is the clarification of perioperative nurses’ subjective perceptions of ethical issues. These findings can be used in formulating effective strategies for nursing educators, professional nurses, and nursing administrators to improve ethical decision-making abilities and to perform ethical nursing care by the appropriate management of ethical issues in everyday nursing practice.
References
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Table 1
. Eigen Value, Variance, Factor Weights, and Characteristics of Participants
Table 2.
Q Statements and Z-Scores according to Types
| No | Q statements | Z-scores | |||
|---|---|---|---|---|---|
| Type 1 | Type 2 | Type 3 | Type 4 | ||
| (n=9) | (n=12) | (n=6) | (n=8) | ||
| 1 | Even if I need to participate in the operation of patients who can threaten my health (patients with HIV, tuberculosis, etc.), I actively nurse them. | -0.08 | -0.93 | 0.27 | -0.19 |
| 2 | Ethical issues such as special treatment for VIP patients should be put to an end. | 0.18 | 0.09 | 1.74 | -0.02 |
| 3 | I feel guilty and skeptical when ethical issues arise in the surgery in which I participated. | 1.96 | 0.50 | 0.28 | 1.68 |
| 4 | I talk to the physician about it after the surgery because it is likely to interfere with the operation if the physician uses abusive language with me. | -1.05 | -1.37 | -1.33 | 0.78 |
| 5 | It is advantageous to have someone I know in hospitals when ethical issues occur. | -1.13 | -1.04 | -0.22 | -0.30 |
| 6 | It is not hard to confront the physician and say that it is wrong when he/she exerts his/her authority and gives unethical instructions. | -1.69 | -2.00 | -0.83 | -1.70 |
| 7 | Generally, ethical issues related to physicians go unmentioned in many cases. | -0.14 | 0.68 | 0.10 | -0.23 |
| 8 | When I come to be directly involved in ethical issues, it is better that my colleagues profess ignorance. | -0.60 | -0.66 | -0.85 | -1.57 |
| 9 | If ethical issues occur in the operation in which I participated, I do not mention it and let it pass unless the operating surgeon points out the issue out of concern that it may ruin the flow of the operation. | -0.89 | 0.40 | -1.49 | -0.80 |
| 10† | Even when ethical issues are covered, nurses in the operating room share information about it. | 1.30 | 0.66 | 1.09 | 1.14 |
| 11 | I am anxious as I feel that the ethical issues that once occurred are going to occur repeatedly. | 1.58 | -0.27 | -1.20 | -0.46 |
| 12 | Regarding the ethical issues related to physicians, I can point it out as a nurse but I do not expect the physicians to change their behavior considerably. | 0.33 | 1.02 | 1.00 | 1.05 |
| 13† | In the context of ethical issues, I think it is right to act in accordance with the physician’s decision. | -1.60 | -1.25 | -1.74 | -1.30 |
| 14 | When ethical issues related to count error occur, the medical staffs who participated in the operation together seem to want to shift the responsibility to nurses. | -0.09 | 1.10 | -0.31 | 0.76 |
| 15 | When ethical issues occur, the reaction varies depending on whether the subject is a physician or a nurse. | 0.36 | 0.58 | 1.09 | -0.29 |
| 16 | Regarding the physician who often uses abusive language during the operation, I think “that’s just how he (or she) is” and do not focus much on it. | -0.39 | 0.30 | -1.09 | -1.19 |
| 17† | I think most of the responsibility for the problems related to ethical issues that occur during operation lies with physicians. | -1.33 | -1.18 | -0.78 | -1.00 |
| 18 | When ethical issues occur, I think that colleagues will not change even if I try to point out the faults and fix the problem. | -1.17 | -0.42 | -1.26 | -0.94 |
| 19† | It is easy to tell the facts to the patient or caregiver if the operating surgeon does not participate in the operation or only participates in the important parts of the operation. | -1.98 | -2.01 | -1.96 | -2.06 |
| 20 | When ethical issues occur, it should be handled in accordance with the procedures prescribed by the hospital, such as reporting to the manager and writing a report. | 0.91 | 0.65 | 1.05 | 1.12 |
| 21 | When ethical issues occur, an atmosphere exists where nurses cannot tell about the issues to a physician because of being a nurse. | -0.22 | 1.11 | 0.22 | 0.23 |
| 22 | When ethical issues occur, I pay attention to it even if I am not involved. | 1.37 | 0.23 | 0.19 | 0.59 |
| 23 | Measures and plans should be prepared at the medical community level in order to solve ethical issues. | 1.04 | 0.30 | 0.50 | 1.68 |
| 24 | Physicians who make a medical accidents, use of abusive language, or assault should be disclosed to others. | 0.26 | 1.53 | 2.06 | 1.13 |
| 25 | Looking at my colleagues who behave unethically with regard to the boundary between disinfection and non-disinfection occurring during the operation preparation or operation procedure, I reflect on myself and promise myself to maintain the principles. | 1.35 | 0.58 | 0.68 | 0.62 |
| 26 | When ethical issues occur, it should be disclosed to the patient or caregiver as it is and compensation for the victim needs to be made. | -0.42 | -0.40 | 1.16 | 0.90 |
| 27 | When witnessing the physician’s ethical issues, it is hard to point it out in many cases. | 0.51 | 1.09 | 0.55 | 0.14 |
| 28 | If the operating surgeon does not participate in the operation or participates only in the important parts of the operation and leaves, it is rare to connive at it. | -1.21 | -1.80 | -0.58 | -1.45 |
| 29 | When a physician uses abusive language with me during the operation, I want to get out of the way as I feel uncomfortable and it wounds my self-respect. | 0.78 | 0.68 | 0.93 | -0.77 |
| 30 | Medical staffs are desensitized to their own ethical issues and tend to turn a blind eye to other medical staffs like them. | 0.14 | 0.85 | 0.37 | 0.03 |
| 31 | I think the authority of nurses is too weak for them to actively play a role as the patient’s advocate when ethical issues occur. | 0.29 | 1.14 | 0.44 | 0.70 |
| 32 | When ethical issues occur, they are settled quietly within the hospital in many cases. | 0.61 | 1.13 | -0.52 | -0.03 |
| 33 | When ethical issues occur, I check the professional medical staff’s advice, experience, and various data and think about solutions. | 0.17 | -1.32 | -0.30 | 0.52 |
| 34 | For the prevention of ethical issues, I think managers should educate medical staffs regarding this matter and present plans. | 0.86 | 0.03 | 0.74 | 1.24 |
Table 3.
Z-Score Differences by Types
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