| Summary: | Nurses and other community health care professionals are often challenged by the
ethical problems of clients who are living at risk, that is, clients who choose to make
autonomous decisions related to personal situations that have the potential for negative
outcomes. Although these encounters may cause some of the highest levels of stress in
health care professionals, there is a noted lack of research in this area. This exploratory
study, conducted using a constructivist qualitative methodology describes the experiences
of nurses and other community health care professionals who are participating in ethical
decision-making with clients who are living at risk. Constructivism was chosen in
recognition that community health care professionals may describe their experiences
with ethical decision-making in diverse ways and may experience a number of different
realities of these experiences.
Participants, purposively sampled via one-on-one interviews, described the
intensity of complex client situations that they cope with. Four main themes emerged
from their descriptions: "Our clients who are living at risk", "Worrying about our
clients", "Finding a better way-how we cope", and "Frustrated by the system-hitting the
brick wall". Powerful emotions including anxiety, frustration, anger, fear, guilt and
helplessness- emotions that sound like moral distress- were part of the experiences.
Concepts associated with the four themes included: personal and professional values and
beliefs, client capability, use of legislation, resource allocation, ethical climates in
organizations, client-directed care delivery, and collaborative practice within
interdisciplinary teams. The findings of this study suggest significant implications for
clinical practice, leadership, research, and education. Overall, there is a critical need to
ensure that professionals have opportunities to deal with their emotions and concerns
when coping with all ethical problems. Strategies that will assist this process include the
establishment of supportive systems such as highly functioning interdisciplinary teams,
reflective practice, and flexible transformational leadership approaches.
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