Mapping the ethical journey of experienced nurses now practising in rural and remote hospitals in central and south-west Queensland and in domiciliary services in Brisbane : a grounded theory approach

The aim of this thesis has been to map the ethical journey of experienced nurses now practising in rural and remote hospitals in central and south-west Queensland and in domiciliary services in Brisbane. One group of the experienced nurses in the study were Directors of Nursing in rural and remote hospitals. These nurses were “hands on”, “multi-skilled “ nurses who also had the task of managing the hospital. Also there were two Directors of Nursing from domiciliary services in Brisbane. A grounded theory method was used. The nurses were interviewed and the data retrieved from the interviews was coded, categorised and from these categories a conceptual framework was generated. The literature which dealt with the subject of ethical decision making and nurses also became part of the data. The study revealed that all these nurses experienced moral distress as they made ethical decisions. The decision making categories revealed in the data were: the area of financial management; issues as end of life approaches; allowing to die with dignity; emergency decisions; experience of unexpected death; the dilemma of providing care in very difficult circumstances. These categories were divided into two chapters: the category related to administrative and financial constraints and categories dealing with ethical issues in clinical settings. A further chapter discussed the overarching category of coping with moral distress. These experienced nurses suffered moral distress as they made ethical decisions, confirming many instances of moral distress in ethical decision making documented in the literature to date. Significantly, the nurses in their interviews never mentioned the ethical principles used in bioethics as an influence in their decision making. Only one referred to lectures on ethics as being an influence in her thinking. As they described their ethical problems and how they worked through them, they drew on their own previous experience rather than any knowledge of ethics gained from nursing education. They were concerned for their patients, they spoke from a caring responsibility towards their patients, but they were also concerned for justice for their patients. This study demonstrates that these nurses operated from the ethic of care, tempered with the ethic of responsibility as well as a concern for justice for their patients. Reflection on professional experience, rather than formal ethics education and training, was the primary influence on their ethical decision making.

Doing collaborative reflection in the professional experience

Despite the importance of the school-based practicum experience in teacher education programs, only limited research has investigated how supervising and pre-service teacher roles and relationships are interactively achieved in situ. Using conversation analysis, we interrogate extracts of practicum talk between supervising teachers (STs) and their pre-service teachers (PTs), revealing that asymmetrical relationships are talked into being within and through their conversations about classroom practice. We compare the different structural conversational arrangements that are employed when STs provide either positive feedback or raise issues of potential difficulty in relation to their PTs’ observed classroom activities. Analysis reveals that STs tend to make evaluative statements when providing positive feedback, in contrast to initiating a process of critical reflection when talking about the need for improvements in PTs’ pedagogic practices. We conclude by arguing the need for STs to instigate sustained critical and collaborative professional conversations with their PTs during the practicum experience, enabling them to engage in reflective practice and providing them with opportunities to extend their professional knowledge and skills, thereby potentially improving their future classroom practices.