The process of ethical decision making in psychiatric nursing practice.

The process by which nurses make ethical decisions in clinical practice has significance for the practitioners, educators, and administrators concerned with professional standards and quality of care. Twenty nurses participated in semistructured interviews during which they discussed ethical problems of their choice that had occurred in their clinical practice. Content analysis of interview transcripts revealed a 10-stage process used in ethical decision making. The process begins with an emotional response on hearing of an event that affects clinical practice and ends in an aftermath that includes feelings, talking with others, reconsiderations, and change or vows to change. The study identifies both affective and cognitive components of the decision-making process. The importance of the emotional aspect of ethical decision making, absent from previous studies, is recognized and evaluated. Implications based on the study suggest that the problems of ethical decision making may be a significant part of the stress in nursing. In addition, there is evidence that the process of ethical decision making affects nurses' views of self and of the profession and may have direct bearing on their leaving nursing for another professional career.