DAI LY ACTI VI TI ES OF NURSI NG AUXI LI ARI ES AND TECHNI CI ANS I N
RELATI ON TO ETHI CAL EVENTS
Geniv al Fer nandes de Fr eit as1
Fr eit as GF. Daily act iv it ies of nur sing aux iliar ies and t echnicians in r elat ion t o et hical ev ent s. Rev Lat ino- am Enfer m agem 2 0 0 9 j ulho- agost o; 1 7 ( 4 ) : 4 4 9 - 5 4 .
This st udy aim ed t o k now and under st and t he act ions of nur sing aux iliar ies and t echnicians w ho w or k in t he int ensive care unit of t he school hospit al at t he Universit y of São Paulo in relat ion t o et hical event s. Dat a were collect ed t hrough int erview s w it h eight nursing auxiliaries and t echnicians ( NAs and NTs) , w it h experience w it h et hical event s, and w ere analyzed according t o sociological phenom enology. Part icipant s’ experiences perm it t ed t o uncover t he follow ing concret e cat egories of m eaning: m inim izat ion of t he risk in t hese event s for pat ient s, openness/ dialog w it hin t he nur sing t eam , nur ses’ guidance and super vision of act ivit ies per for m ed by NAs and NTs, v aluing j ust ice in int er per sonal r elat ionships, and r espect ing t he r ight of pat ient s t o be infor m ed about such ev ent s. The act ions of NAs and NTs in et hical ev ent s r ev ealed t heir int ent ion t o ensur e deliv er y of safe car e t o pat ient s.
DESCRI PTORS: et hics; nur sing car e; m alpr act ice; im pr udence
ACTI VI DADES COTI DI ANAS DE AUXI LI ARES Y TÉCNI COS DE ENFERMERÍ A
FRENTE A ACONTECI MI ENTOS ÉTI COS
El est udio t uv o com o obj et iv o conocer y com pr ender las acciones de aux iliar es y t écnicos de enfer m er ía, que t r abaj an en la Unidad de Ter apia I nt ensiva del Hospit al Univer sit ar io de la Univer sidad de San Pablo, fr ent e a acont ecim ient os ét icos. Los dat os fuer on obt enidos por m edio de ent r evist as con ocho auxiliar es y t écnicos de en f er m er ía ( AEs y TEs) q u e ex p er im en t ar on el f en óm en o, sien d o an alizad os b aj o el m ar co t eór ico d e la fenom enología sociológica. Las ex per iencias de los colabor ador es per m it ier on r ev elar las siguient es cat egor ías concr et as del significado ex per im ent ado, m inim izar los r iesgos al pacient e en esas sit uaciones; m ant ener el diálogo ent r e los m iem br os del equipo de enfer m er ía; or ient ación y super v isión de las act iv idades de los AEs y TEs por los enfer m er os; v alor ización de la j ust icia en las r elaciones int er per sonales, así com o el r espet o al d e r e ch o d e l p a ci e n t e a se r i n f o r m a d o so b r e t a l e s si t u a ci o n e s. La s a cci o n e s d e l o s AEs y TEs, e n l o s acont ecim ient os ét icos, r ev elar on la int ención de asegur ar una asist encia que ofr ezca segur idad al pacient e.
DESCRI PTORES: ét ica; at ención de enfer m er ía; m ala pr ax is; im pr udencia
ATI VI DADES COTI DI ANAS DE AUXI LI ARES E TÉCNI COS DE ENFERMAGEM
FACE ÀS OCORRÊNCI AS ÉTI CAS
O est udo obj et ivou conhecer e com pr eender as ações de aux iliar es e t écnicos de enfer m agem , que t r abalham na Unidade de Ter apia I nt ensiva do Hospit al Univer sit ár io da Univer sidade de São Paulo, fr ent e às ocor r ências ét icas. Os dados for am obt idos por m eio de ent r ev ist a com oit o aux iliar es e t écnicos de enfer m agem ( AEs e TEs) que v iv enciar am o fenôm eno, sendo analisados segundo o r efer encial da fenom enologia sociológica. As ex per iên cias dos colabor ador es per m it ir am desv elar as segu in t es cat egor ias con cr et as de sign ificado v iv ido, pois eles bu scam a m in im ização dos r iscos dessas ocor r ên cias ao pacien t e, a aber t u r a e diálogo en t r e os m em br os da equipe de enfer m agem , or ient ação e super visão das at ividades dos AEs e TEs pelos enfer m eir os, v alor ização da j ust iça nas r elações int er pessoais, bem com o r espeit o ao dir eit o do pacient e de ser infor m ado sobr e t ais ocor r ên cias. As ações dos AEs e TEs, n as ocor r ên cias ét icas, r ev elar am a in t en ção de assegu r ar assist ência segur a ao pacient e.
DESCRI TORES: ét ica; cuidados de enfer m agem ; im per ícia; im pr udência
1RN, Facult y, Escola de Enferm agem da Universidade de São Paulo, Brazil, e- m ail: [email protected].
I NI TI AL CONSI DERATI ONS
B
e c a u s e p a t i e n t s / c l i e n t s s h o u l d h a v e g u a r a n t e e d d e l i v e r y o f n u r s i n g f r e e o f w o r r y con cer n in g r isk s or h ar m s cau sed b y m alp r act ice, n eg lig en ce, im p r u d en ce or in ex p er ien ce com m it t ed b y n u r sin g p r of ession als, w e sh ou ld aim t o b et t er u n der st an d t h e act ion s of t h ese pr ofessionals so as t o underst and t he phenom enon of et hical event s from t he experiences of nursing auxiliaries and t echnicians in an I nt ensiv e Car e Unit ( I CU) .We also n eed t o con sider t h at an I CU is a com plex and dy nam ic unit t hat gat her s pr ofessionals and is also a place w her e decision- m aking has t o be r ead y an d p r eci se, t h u s, ad eq u at e p er so n n el an d m at er ial st r u ct u r es f or t h e deliv er y of saf e car e t o crit ical pat ient s( 1- 2) are expect ed. Hence, t his st udy helps t o under st and t he act ions of nur sing pr ofessionals in r e l a t i o n t o e t h i ca l e v e n t s a n d co n t r i b u t e s t o t h e im provem ent of nursing care t hrough t he m inim izat ion of r isk s t o pat ien t s, h ealt h in st it u t ion s an d n u r sin g pr ofessionals inv olv ed in t he pr ocess.
Et hical ev ent s ar e har m ful ev ent s caused by nur sing pr ofessionals dur ing t heir pr act ice and w hich are relat ed t o inadequat e behavior t oward co- workers, clien t s or t h e in st it u t ion s w h er e t h ey w or k . Th ese ev en t s can cau se in j u r y or dam age t o clien t s or t o t he involved professionals t hem selves whet her by lack of at t ent ion, abilit y, knowledge or zeal. They can also be cau sed by om ission , t h at is, w h en pr of ession als do not act or do som et hing t hey w er e supposed t o, t hus, inj uring or posing risk t o ot hers( 3).
Wh en er r or s in v olv in g n u r sin g pr ofession als occu r, gr eat er em ph asis is placed on pu n ish in g t h e g u i l t y t h a n o n t h e a n a l y si s a n d i m p r o v e m e n t o f p r o c e s s e s t h a t i n c l u d e s u c h e v e n t s . Th u s , pr ofessionals becom e afr aid of com m unicat ing er r or s f o r f e a r o f p u n i s h m e n t a n d , c o n s e q u e n t l y, opport unit ies t o learn from one’s own failure are lost( 4). The phenom enon of nursing et hical event s is t h e o b j e ct o f t h i s st u d y, w h i ch i s b a se d o n t h e ex p er i en ce o f n u r si n g a u x i l i a r i es a n d t ech n i ci a n s w o r k i n g a t t h e I CU o f t h e sch o o l h o sp i t a l a t t h e Univ er sit y of São Paulo. The obj ect iv es of t his st udy were defined as: t o know and underst and t he m eaning of act ions of nursing auxiliaries ( NAs) and t echnicians ( NTs) in relat ion t o et hical event s at t he I CU m ent ioned a b o v e.
The problem at izat ion of t he st udy obj ect leads t o t he quest ion: How do NAs and NTs working at t he
school hospit al at t he Univ er sit y of São Paulo act in view of et hical event s in t he I CU? What do t hey expect f r o m t h e n u r si n g t ea m a n d p r o f essi o n a l s d i r ect l y inv olv ed w it h such ev ent s?
THEORETI CAL PHI LOSOPHI CAL APPROACH
I N THE STUDY CONTEXT
The sociological phenom enology fram ew ork( 4) w as chosen t o br oaden t he under st anding of et hical event s involving NAs and NTs because it perm it s one t o k n o w a n d u n d e r st a n d t h e m ea n i n g o f n u r si n g p r o f e s s i o n a l s ’ a c t i o n s r e g a r d i n g t h e s t u d i e d phenom enon in t he cont ex t of t heir daily ex per ience at an I CU.
Sociological ph en om en ology does n ot f ocu s on single act s or individual behavior cent ered in one’s self, b u t r at h er p er m it s t h e u n d er st an d in g of w h at con st it u t es a g iv en social g r ou p liv in g in a t y p ical sit uat ion. Hence, daily life is not an individual universe; it is an int ersubj ect ive w orld com m on t o everyone in w hich people shar e w it h t heir equals( 5).
I n t e r s u b j e c t i v i t y u n d e r t h e s o c i o l o g i c a l p h en o m en o l o g y p er sp ect i v e al so r ef er s t o h u m an a ct i o n, w h i ch can b e p u r el y i n t er i o r ( t h o u g h t ) o r ext er nalized t hr ough body m ovem ent s, i.e., changing som et hing in t he w or ld. Hum an behav ior is focused on a pr oj ect people pr opose t o achiev e( 6- 8).
Pe o p l e a ct b a se d o n m o t i v e s d i r e ct e d t o goals t hat w ould shape t he fut ur e. Mot iv es consist of a d esir ed st at e of t h in g s, t h e g oal on e in t en d s t o ach iev e w it h act ion . Wh en on e t ak es act ion , t h er e a r e m o t i v e s f o r su ch a ct i o n s. Th e se m o t i v e s a r e r o o t e d i n e x p e r i e n c e s , i n t h e p e r s o n a l i t y o n e dev elops ov er lif e( 6 ).
We considered t he hypot hesis t hat when NAs and NTs t ake act ion in relat ion t o et hical event s, t hey cause changes in pr act ice. These changes per m eat e int erpersonal relat ions and act ions relat ed t o pat ient s’ car e, influencing or guiding new act ions( 9).
METHODOLOGI CAL TRAJECTORY
The set t ing chosen t o carry out t he st udy was t h e sch ool h osp it al at t h e Un iv er sit y of São Pau lo, w h i ch i s a n i n st i t u t i o n t h a t f o cu se s o n t e a ch i n g , r esear ch an d com m u n it y ser v ices. Th e ch oice of an I CU i s j u st i f i e d b y t h e f a ct t h i s i s a u n i t w h e r e procedures of high t echnical com plexit y are perform ed on pat ient s who are, in general, m ore vulnerable and are oft ent im es subj ect t o a series of risks arising from professionals act ions, which can lead t o harm ful et hical event s. The choice of NAs and NTs is j ust ified by t he fact t hat m ost of t im e t hey are t hose who deliver care and are also t hose who are charged for failures in t he car e p r ocess.
The st udy w as init iat ed aft er perm ission w as o b t a i n e d f r o m t h e i n s t i t u t i o n ’ s Et h i c s Re s e a r c h Com m it t ee and part icipant s were provided a free and i n f o r m e d c o n s e n t a g r e e m e n t . Th e n , a c l o s e r relat ionship was est ablished wit h each part icipant . The num ber of par t icipant s w as not pr e- det er m ined and int erviews ceased when reasons t hat led NAs and NTs t o a c t i n r e l a t i o n t o e t h i c a l e v e n t s t h e y h a v e experienced in t he I CU were underst ood. I n t his way, d at a collect ion w as car r ied ou t w it h t h e v olu n t ar y p a r t i ci p a t i o n o f e i g h t i n d i v i d u a l s a m o n g n u r si n g aux iliar ies and t echnicians.
I t is wort h m ent ioning t hat t he area of st udy w as n ot lim it ed t o t h e I CU ph y sical space becau se according t o phenom enology scholars, t he idea of area of inquiry is m uch m ore broad and is focused on t he r e se a r ch e r s’ u n i v e r se o f i n q u i r i e s o r q u e st i o n i n g r egar ding t he phenom enon under st udy( 10- 11).
To est ablish rapport wit h t he part icipant s, t he follow in g qu est ion s w er e ask ed: t ell m e abou t y ou r pr ofession al act iv it y at t h e I n t en siv e Car e Un it ; t ell
m e abou t y ou r act ion s in r elat ion t o et h ical ev en t s
inv olv ing nur sing pr ofessionals at t he I nt ensiv e Car e
Unit ; w hat do you expect fr om your act ions?
Par t i ci p an t s ar e n o t i d en t i f i ed i n o r d er t o e n s u r e t h e i r a n o n y m i t y , t h u s , i n i t i a l s o f t h e i r f u n ct ion f ollow ed by t h e in t er v iew n u m ber ar e u sed ( NA1 , NT1 . . . ) .
EMERGEN T CON CRETE CATEGORI ES AN D
THE EXPERI ENCED TYPE
T h e o r g a n i z a t i o n a n d c a t e g o r i z a t i o n o f r e su l t s a l l o w e d t h e co n st r u ct i o n o f t h e co n ce p t
e x p e r i e n c e d t y p e, w h i c h c o n s t i t u t e s a t y p i c a l c h a r a c t e r i s t i c o f a g i v e n s o c i a l g r o u p , w h i c h i s
e x p e r i e n c e d g i v e n t h e s o c i a l s i t u a t i o n o f e x p e r i e n ce d b e h av i o r( 7 ). To o r g a n i ze a n d d i scu ss r esu l t s, t h e r esea r ch er f o l l o w ed m o d el s a ssu m ed by ot h er n u r sin g r esear ch er s w h o h av e u sed Alf r ed S c h ü t z ’ s S o c i o l o g i c a l Ph e n o m e n o l o g y a s t h e t h eor et ical f r am ew or k in t h eir r esear ch( 1 2 - 1 3 ).
The following st eps were followed: a) reading of discourse t o com prehend t he individuals’ m ot ivat ed experience b) ident ificat ion of concret e cat egories t hat include indiv iduals’ act s in r elat ion t o nur sing et hical event s; c) grouping excerpt s of report s, t hat is, relat ed aspect s t hat ar e significant for act ions in r elat ion t o t he phenom enon of et hical ev ent s inv olv ing nur sing pr ofessionals; d) est ablishm ent of m eanings of social a ct s i n r e l a t i o n t o t h e se e v e n t s f r o m t h e t y p i ca l d iscou r se t o d ev elop t h e t y p ol og y of p ar t icip an t s’ ex p er i en ces.
NAs’ a n d NTs’ “ m o t i v es t o ” i n r el a t i o n t o e t h i c a l e v e n t s a t t h e I CU r e v e a l e d e m e r g e n t p r o p o si t i o n s a n d co n cr e t e ca t e g o r i e s f r o m t h e i r ex per ien ces in r elat ion t o t h e st u died ph en om en on , p r e se n t e d b e l o w :
Proposit ion: t o deliver nursing care wit h m inim um risk t o pat ient s – Cat egor y : m inim izat ion of r isk
Th e st u d y p ar t icip an t s r ev ealed t h at t h eir concern t o ensure t he delivery of care wit h m inim um risk or harm t o pat ient s originat ed from professionals’ m alpr act ice or lack of at t en t ion or pr u den ce in t h e I CU , t a k i n g i n t o a c c o u n t t h e p a t i e n t s ’ g r e a t e r v ulner abilit y and sev er it y of t he pat ient condit ion as not ed in t he follow ing r epor t s.
I hope not hing happens t o pat ient s, t hat not hing has changed…I hope t hat not hing worsens t he sit uat ion due t o a failure of nursing. I hope t hat people pay m ore at t ent ion t o what t hey ar e going t o do, t hough t his is a highly st r essful place
[ referring t o t he I CU] ), you can never be t oo careful.
We m ake m ist akes, but when you assum e you’d m ade a m ist ake, you have t he opport unit y t o learn wit h t hat . You can im prove yourself so as not t o m ake any m ore m ist akes. Dealing wit h lives is som et hing very com plicat ed, because t he ideal is never t o m ake m ist akes ( NA) .
Regar ding “ m ot ives t o” act ion of par t icipant s in relat ion t o et hical event s at t he I CU, t he cat egories
o p e n n e ss a n d d i a l o g, g u i d a n ce a n d su p e r v i si o n,
Pr o p o si t i o n : t o a l l o w t h e p a r t i ci p a t i o n o f n u r si n g au x iliar ies/ t ech n ician s in act ion s r elat ed t o et h ical ev ent s – Cat egor y : openness and dialog
Wh at w e ex p ect is t h at t h e n u r se w h o is p r esen t d u r i n g an ev en t , an er r o r , i s a b al an ced p r o f essi o n al , a b alan ced p er son , w h o t alk s, n ot as if p u n ish in g , b ecau se it cau ses y ou n ot t o com m u n icat e t h e er r or , w h ich m ak es t h in gs ex t r em ely g r av e ( NT2 ).
I hope he’s a person open t o dialog, because t his way t he professional him self can t alk t o t he nurse and acknowledge his fault... ( NA2) .
We expect an underst anding behavior from nurses; t hey have t o see t he em ployee’s perspect ive and condit ions of work and t he m om ent of t he event . What happened? Why punish so severely if t here was no inj ury t o t he pat ient or not hing t o harm him ? ( NT3) .
Pr o p o s i t i o n : t h e p r o m o t i o n o f g u i d a n c e a n d su p e r v i si o n , a v o i d i n g p u n i sh i n g t h e p r o f e ssi o n a l inv olv ed in t he et hical ev ent – Cat egor y : guidance/ su p er v ision
Anot her rem arkable aspect in t he part icipant s’ report s is relat ed t o nurses’ guidance and supervision, point ed out by NAs and NTs as im port ant elem ent s so as t o av oid pu n ish in g pr of ession als in v olv ed in t h e e t h i ca l e v e n t . Th e y v a l u e n u r se s’ f o l l o w - u p , t h e g u i d a n ce a n d su p e r v i si o n o f n u r si n g p r o ce d u r e s, suppor t ing and encour aging safe pr act ice in r elat ion t o t he delivery of nursing care t o client s in I CUs.
I expect less punishm ent, even if the professional has made a mistake. But, if there’s a situation where the patient is harmed, in this case, I ’m in favor of punishm ent. The professional him self has to acknowledge his fault, but not to be fired, no (NT3).
I expect nurses, in t he case of such event s, errors, et c., t o have a different perspect ive. I expect t hem t o t alk t o t he em ployee and explain t hings clearly, because I guess t hat nurses and auxiliaries and t echnicians don’t need t o be enem ies… Nurses sh o u l d g u i d e p r o f e ssi o n a l s, b e ca u se t h e p r o f e ssi o n a l s, som et im es, act wit hout t he orient at ion t hey’d need t o do a good j ob and not t o m ake m ist akes ( NA1) .
Pr o p o si t i o n : act w i t h j u st i ce i n r el at i o n t o et h i cal ev en t s i n v o l v i n g n u r si n g a u x i l i a r i es/ t ech n i ci a n s – Cat eg or y : j u st ice
NAs and NTs ex pect and consider j ust ice t o be a sign if ican t elem en t w h en et h ical ev en t s occu r. They expect nurses t o be fair and not t o punish, but
in st ead , g u id e p r of ession als an d t ak e in t o accou n t t heir work condit ions, which can lead professionals t o inv olunt ar ily com m it er r or s har m ful t o pat ient s.
I ex p ect n u r ses t o act w it h j u st ice in r elat ion t o professionals’ m istakes. What nurses have to do is to talk with the patient and professionals when his team m akes m istakes (NA1).
… and j ust ice would be for nurses t o value people who work right and accept crit iques. I t is not about privileging one over anot her in schedules, work shift s, allowing one t o t ake t wo weekends off in a row while ot her people have only one weekend off ( NT1 ) .
I f you who have an adequat e num ber of em ployees and m ist akes st ill occur, t he nurse’s role is t o guide t he professionals because such m ist akes should not occur ( NA2) .
Pr oposit ion: t o infor m t he pat ient and/ or r esponsible people about m ist akes m ade by nursing professionals – Cat egor y : pr ov ide infor m at ion t o pat ient s
Par t icipan t s h igh ligh t ed t h e n eed of n u r ses t o inform pat ient s about et hical event s com m it t ed by n u r sin g p r of ession als in t h e I CU. Th is in f or m at ion should include what m easures will be im plem ent ed t o m in im ize con seq u en ces an d sh ou ld b e p r ov id ed in cl ea r, u n d er st a n d a b l e a n d a ccessi b l e l a n g u a g e t o pat ient s and/ or legally r esponsible people, as show n by t he follow ing r epor t s.
I also expect t hat t he nurse t ake t he init iat ive and inform t he pat ient about what happened when t here are m ist akes involving t he t eam ; inform of t he t ype of nursing error and explain what m easures will be t aken t o correct t he error and t hat he’s going t o do his best for t hat not t o happen again. I f t he pat ient falls off t he bed, for inst ance, t he nurse should orient t he t eam and t he pat ient t o avoid t hat in t he fut ure; expressing t his in a clear and underst andable way for t hose who m at t er: t he pat ient or his responsible part y ( NA1) .
I n case t he event is not very grave, for inst ance, you should have given a Capot en of 12.5 but gave one of 50, t he pat ient hasn’t died, is st able. I n t his case, in m y opinion, you wouldn’t need t o com m unicat e wit h t he fam ily, but t he nurse responsible for t he unit needs t o know. Now, if t he error severely harm s t he pat ient , I guess t he pat ient and fam ily have t o be t old. I guess t hat t he head nurse is t he one who should be responsible for com m unicat ing t he error t o t he pat ient ’s fam ily ( NA2) .
COMPREHENSI VE ANALYSI S
and infor m at ion t o pat ient” gat her ed, m ost of t im e, t he “ m ot ives t o” act ion in relat ion t o et hical event s in t he I CU in t he report s of bot h NAs and NTs.
Th e c a t e g o r y “ i n f o r m a t i o n t o p a t i e n t ” con sist ed of an im por t an t “ m ot iv e t o” f or NAs’ an d NTs’ act ions in r elat ion t o et hical ev ent s in t he I CU. These pr ofessionals r ev ealed t heir desir e t hat client s acq u ir e or m ain t ain t r u st in t h e n u r sin g t eam w h o d eliv er car e t o t h em , j u st if y in g , in t h is w ay, t h eir concern t o inform pat ient s about t he event , especially when it poses a risk t o pat ient s’ safet y or lives.
On t he one hand, professional et hics aim s t o st u d y d u t ies, r ig h t s an d r esp on sib ilit ies of a g iv en pr of ession al cat egor y. On t h e ot h er h an d, pat ien t s/ clien t s sh ou ld be con sider ed su bj ect s of r igh t s an d du t ies. Th u s, t h e r igh t of bein g in f or m ed r egar din g professionals’ act ions, as well as pot ent ial risks, cost s an d b en ef i t s ar e h i g h l i g h t ed so t h at p at i en t s can co n sen t , af t er b ei n g ap p r o p r i at el y i n f o r m ed o f o r r eceiv ing clar ificat ion r egar ding t he ser v ice/ car e t hat w ill b e d eliv er ed( 1 4 - 1 6 ). Hen ce, r ig h t t o in f or m at ion
const it ut es a m easure of j ust ice, revealing it self as a value t hat can be defined and can int egrat e a last ing b el i ef i n a sp eci f i c m o d el o f b eh av i o r o r st at e o f exist ence, which is personally or socially adopt ed and based on pr e- ex ist ent behav ior( 17- 18).
Th e c a t e g o r y “ j u s t i c e ” r e v e a l e d t h e part icipant s’ desire or expect at ion t o face t he fear of punishm ent when errors or failures occur during care delivery, especially when such m ist akes cause physical or m oral harm t o pat ient s. Part icipant s also expressed t heir desir e t o ov er com e fear t hr ough guidance and
super v ision of t he nur sing t eam ’s act ions as par t of t he nur ses’ r ole.
I n t h is p er sp ect iv e, NAs an d NTs r ev ealed t heir ex pect at ion t hat t hese act ions w ould cont r ibut e t o av oid or lessen t h e st igm a of pu n ish m en t w h en errors occur. This expect at ion is consist ent wit h ot her st u d i e s t h a t p o i n t t o t h e f e a r o f p u n i sh m e n t o f p r o f e s s i o n a l s i n v o l v e d i n t h e s e e v e n t s , w h i c h som et im es lead t hem not t o regist er or com m unicat e ev ent s of t his nat ur e and consequent ly, do not t ake t he opport unit y t o learn from t heir own m ist akes( 4,14). Th e ca t e g o r y “ g u i d a n ce a n d su p e r v i si o n ” r e v e a l e d t o b e i n h e r e n t l y i n t e r w o v e n w i t h t h e e d u c a t i o n a l p r o c e s s b e c a u s e t h e N A s a n d N Ts ex p r essed t h eir in t en t ion t o w or k t h r ou g h n u r ses’ or ient at ion so as t o get ev er y one com m it t ed t o t he ed u cat iv e an d p r ev en t iv e ob j ect iv es in r elat ion t o et hical event s. This guidance should be support ed by
c o m m u n i c a t i o n a n d r e f l e c t i o n b y p r o f e s s i o n a l s inv olved in sit u at ion s of failu r e or er r or, w het her in t heir car e giv ing or in int er per sonal dim ensions.
Report s reveal t hat NAs and NTs hold sim ilar perspect ives regarding t heir act ions. Hence, som e NAs and NTs ex pr essed t heir ex pect at ion t hat nur ses be able t o guide and supervise t heir act ions, act ing wit h j u s t i c e a n d i n f o r m i n g p a t i e n t s r e g a r d i n g t h e occurrence of event s wit h language com pat ible t o t heir under st anding. NAs and NTs also ex pect t he nur sing t eam t o be open t o dialog in sit uat ions involving et hical ev ent s, w hich can allow bet t er under st anding of t he set of fact ors leading t o errors such as work condit ions a n d i n d i v i d u a l f a ct o r s. I n t h i s w a y, p a r t i ci p a n t s expr essed t heir int er est in m inim izing t he r isk of t he r eoccu r r en ce of ev en t s of t h is n at u r e in addit ion t o respect ing pat ient s’ right t o be inform ed about nursing p r of ession als’ er r or s.
CON STRUCTI ON OF TH E EXPERI EN CED
TYPE
I n sociological phenom enology, t he idealized “ experienced t ypes” are int erpret at ive schem es of t he social world t hat are part of hum an beings’ collect ion of knowledge regarding t he world, have a significat ion v a l u e a n d t h e i r e l e m e n t s a r e a l w a y s t a k e n i n int er per sonal r elat ionships( 5 , 9 ).
Th e st u d y sh o w s t h at t h er e i s a co m m o n ex per ien ced t y pe, w h ich is u n der st an dable becau se t hese individuals are insert ed in t he sam e social group and hav e ex per ienced sim ilar “ m ot iv es t o” based on t he sam e cont ex t of m eanings of t hese ex per iences. Hence, act ions relat ed t o et hical event s in t he I CU r ev ealed t he par t icipant s’ int ent ion t o m inim ize r i sk s o f et h i ca l ev en t s. Fo r t h a t , t h ey b el i ev ed a r elat ionship t hat fav or ed openness and dialog w it hin t h e n u r sin g t eam as w ell as n u r ses’ g u id an ce an d super v ision of nur sing act iv it ies t o be necessar y.
FI NAL CONSI DERATI ONS
overcom e t he fear of punishm ent t hat involves et hical ev en t s, r ev eal i n g t h e n eed t o p l ace a p r i o r i t y o n edu cat iv e act ion s f ocu sed on gu idan ce/ su per v ision . NAs and NTs expect nur ses t o infor m pat ient s in t he case of f ailu r es d u r in g car e d eliv er y in v olv in g t h e n u r si n g t e a m a n d a l so t o sp e e d u p m e a su r e s t o m inim ize t he r isk of har m ful ev ent s.
Based on t he r esult s, w e can conclude t hat n u r sin g p r of ession als sh ou ld f eel ab le t o d eal w it h et h ical ev en t s in t h eir daily pr act ice in an I CU. For t hat , ongoing t raining is required so t hey can discuss t h e i r o w n d a i l y e x p e r i e n c e s r e l a t e d t o t h i s p h e n o m e n o n . I n t h e a u t h o r ’ s p o i n t o f v i e w , t h i s t r a i n i n g s h o u l d b e i n i t i a t e d d u r i n g p r o f e s s i o n a l ed u cat i o n , r ev eal i n g t h e i m p o r t an ce o f co n t i n u ed
ed u cat ion , u p d at in g an d t r ain in g p r og r am s, w it h a v iew t o m inim ize et hical ev ent s.
I t i s w o r t h h i g h l i g h t i n g t h a t t h e p h e n o m e n o l o g i ca l a p p r o a ch p e r m i t t e d o b t a i n i n g p o si t i v e a n sw er s t o t h e i n i t i a l q u est i o n s b eca u se m e a n i n g s r e g a r d i n g p r o f e s s i o n a l s ’ a c t i o n s w e r e r ev eal ed , n am el y : m i n i m i zat i o n o f r i sk s p o sed t o pat ient s due t o errors or failures; t he need of nurses t o be open, dialog, guide and super v ise t he nur sing t eam ’s act iv it ies in t he I CU. Hence, t he “ m ot iv es t o” act i o n s o f NAs an d NTs ar e co n t ex t u al i zed i n t h e p r a ct i ce o f t h e se p r o f e ssi o n a l s a n d i n d i ca t e t h e im port ant need t o invest in educat ive act ions so as t o g u a r a n t ee t h e d el i v er y o f n u r si n g f r ee o f r i sk o f har m ful ev ent s t o pat ient s.
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