ETHI CAL EVENTS I N NURSI NG: DAI LY ACTI VI TI ES OF NURSE
MANAGERS AND NURSI NG ETHI CS COMMI TTEE MEMBERS
1Geniv al Fer nandes de Fr eit as2 Tak a Ogu isso3 Mir iam Apar ecida Bar bosa Mer ighi4
Freit as GF, Oguisso T, Merighi MAB. Et hical event s in nursing: daily act ivit ies of nurse m anagers and nursing et hics com m it t ee m em bers. Rev Lat ino- am Enferm agem 2006 j ulho- agost o; 14( 4) : 497- 502.
This study aim ed to understand the m eaning of nurses’ actions related to ethical occurrences involving nursing professionals. Dat a were collect ed t hrough int erviews wit h nurse m anagers and m em bers of a Nursing Et h ics Com m it t ee w h o ex p er ien ced t h e p h en om en on . Dat a w er e an aly zed in t h e f r am ew or k of social phenom enology. The nurses’ experiences gave rise to the following categories of m eaning, as these professionals seek: t he hum anizat ion of nursing care; cont inuous im provem ent of t he care process; professional credibilit y; patients’ satisfaction; dem ystification of the fear of punishm ent; partnership in the educational process; respect for ethical secrecy and expectation related to t he event being forwarded to the Nursing Et hics Com m it t ee. The social t ypificat ion was described at t he end. Nurses’ act ions in cases of et hical event s at t ract t he int erest of nursing professionals, who want t o ensure a risk or dam age- free care and t o prom ot e t he valuat ion of t hese pr ofessionals.
DESCRI PTORS: et hics, nursing; organizat ion and adm inist rat ion; educat ion, nursing; et hics
OCURRENCI AS ÉTI CAS DE ENFERMERÍ A: EL COTI DI ANO DE LOS ENFERMEROS
GERENTES Y MI EMBROS DE LA COMI SI ÓN DE ÉTI CA DE ENFERMERÍ A
El obj et iv o de est e est udio fue com pr ender el significado de las ocur r encias ét icas inv olucr ando a profesionales de enferm ería. Los dat os fueron obt enidos por m edio de ent revist as con enferm eros gerent es y enferm eros m iem bros de la Com isión de Ét ica de Enferm ería que pasaron por el fenóm eno. Los dat os fueron analizados según la perspect iva de la fenom enología social. Las experiencias de los enferm eros posibilit aron desvelar las siguient es cat egorías concret as del significado del vivido, pues ellos buscan: la hum anización de la atención; la m ej oría continua del proceso de cuidar, la credibilidad profesional; la satisfacción de la clientela; las dem istificación del m iedo de la punición, el com partir en el proceso educativo; el respeto al sigilo ético y la expect at iva relacionada al posible envío de la ocurrencia a la Com isión de Ét ica. La t ipificación fue descrit a al final. Las acciones de los enfer m er os en las ocur r encias ét icas despier t an int er és de los pr ofesionales de enfer m er ía, que desean gar ant izar una at ención libr e de r iesgos/ daños y pr om ov er la v alor ización de esos pr ofesion ales.
DESCRI PTORES: ét ica de enferm ería; organización y adm inist ración; educación en enferm ería; ét ica
OCORRÊNCI AS ÉTI CAS DE ENFERMAGEM: COTI DI ANO DE ENFERMEI ROS
GERENTES E MEMBROS DA COMI SSÃO DE ÉTI CA DE ENFERMAGEM
O obj etivo deste estudo foi com preender o significado das ações dos enferm eiros frente às ocorrências ét icas env olv endo os pr ofissionais de enfer m agem . Os dados for am obt idos por m eio de ent r ev ist a com en f er m eir os ger en t es e en f er m eir os m em br os da Com issão de Ét ica de En f er m agem qu e v iv en ciar am o fenôm eno. Os dados for am analisados segundo o r efer encial da fenom enologia sociológica. As exper iências dos enferm eiros perm it iram desvelar as seguint es cat egorias concret as de significado vivido, pois eles buscam : a hum anização da assistência, a m elhoria contínua do processo de cuidar, a credibilidade profissional, a satisfação da clientela, a desm istificação do m edo da punição, a parceria no processo educativo, o respeito ao sigilo ético e a expectativa em relação ao encam inham ento da ocorrência à Com issão de Ética. A tipificação foi descrita ao final. As ações dos enferm eiros nas ocorrências éticas despertam o interesse dos profissionais de enferm agem , que querem assegurar um a assistência isenta de riscos ou danos e prom over a valorização desses profissionais.
DESCRI TORES: ét ica de enfer m agem ; or ganização e adm inist r ação; educação em enfer m agem ; ét ica
1 Study extracted from Doctoral Dissertation; 2 RN, PhD, Faculty, e- m ail: genivalf@usp.br; 2 RN, Full Professor, e- m ail: t akaoguisso@usp.br; 3 RN, Associat e Professor, e- m ail: m erighi@usp.br. University of São Paulo at School of Nursing
I NI TI AL CONSI DERATI ONS
W
h e t h e r a s n u r si n g p r o f e ssi o n a l s, m anager s or facult y, ever y day, w e ar e faced w it h et hical ev ent s. I n t hese sit uat ions, w e seek t o get in v olv ed an d d iscu ss t h ese occu r r en ces w it h t h e respective professionals, whether in the Nursing Ethics Com m it t ee or at t he clinic or unit w her e t he event occur r ed, using t he know ledge acquir ed t hr oughout our professional t raining and act ivit ies. Thus, wit h a view to guaranteeing a nursing care free from risk or dam age caused by negligence, lack of ex per t ise or im prudence com m it t ed by nursing professionals, we believe it is fundam ent ally im port ant t o underst and the world of ethical events, as well as ways of seeing and coping with them , based on the daily experience of t hese pr ofessionals as nur se m anager s ( NM) or m em bers of a Nursing Et hics Com m it t ee ( NEC) .Et h i ca l o ccu r r e n ce s a r e h a r m f u l e v e n t s ca u se d b y n u r si n g p r o f e ssi o n a l s d u r i n g t h e i r pr ofessional ex er cise and r elat ed t o an inadequat e at t it ude t ow ar ds a colleague, client or t he place of work. These event s can ent ail som e kind of harm or dam age t o client s or t o t he inv olv ed pr ofessionals t hem selves, whet her due t o a lack of at t ent ion, skill, k n o w l e d g e , ze a l o r t o o m i ssi o n , t h a t i s, w h e n professionals do not act or do not do som ething they should and, t hus, cause r isk or dam age t o anot her person( 1).
Nur sing act ions ar e int r insically link ed w it h professional account abilit y when t hey cause harm or dam age to a patient/ client. On the other hand, m ultiple factors can contribute to risks or dam age in the care pr ocess. I n t his sense, w hen er r or s occur involving nur sing pr ofessionals, gr eat er em phasis is giv en t o blam ing the guilty one than to analyzing and im proving t he processes t hat result ed in t hose harm ful event s. Hence, out of fear of punishm ent , professionals are afraid of com m unicat ing er r or s and, consequent ly, opport unit ies t o learn from t heir own errors m ay not be exploit ed( 2).
Som e researchers have investigated different dim ensions of professionals’ and healt h inst it ut ions’ r esponsibilit y in cases of har m ful ev ent s inv olv ing clients( 1- 2). However, these studies did not respond to
ou r in q u ir ies ab ou t n u r ses’ m ot iv at ion s t o act in r elat ion t o et hical occur r ences in t heir daily r ealit y, thus m aking im possible a better understanding of the m eanings these professionals attribute to their actions in these events. Therefore, this research was j ustified
by t he need we felt t o underst and t he phenom enon of ethical events in nursing, based on the experiences of nurse m anagers ( NM) and nursing m em bers ( NE) of ethics com m ittees, aim ed at getting t o k now and u n d e r st a n d in g t h e m e a n in g of n u r se s’ a ct ion s in vie w of e t h ica l e ve n t s in n u r sin g.
THEORETI CAL-PHI LOSOPHI CAL APPROACH
W i t h a v i e w t o r e a ch i n g a b r o a d e r u n der st an din g of et h ical ev en t s in v olv in g n u r sin g pr of ession als f r om t h e per spect iv e of n u r ses w h o sh a r e a n d u n d e r g o t h e se e x p e r i e n ce s t h r o u g h int er per sonal r elat ions, w e adopt ed t he sociological phenom enology of Alfr ed Schüt z. We believ ed t his r efer en ce fr am ew or k w ou ld allow u s t o u n v eil t h e phenom enon, in view of t he experiences and act ions of NE and NM.
Perceiving the intentionality of NE and NM who experience ethical events, we attem pted to understand how t he experiences of act ing on et hical occurrences are m anifest ed in t heir daily realit y. We did not lim it ourselves t o t he percept ion of t he individual proj ect , but looked at what intentionality reveals to the group of nursing professionals involved in this phenom enon. Social phenom enology is not oriented towards single act s, indiv idual behav ior s, r est r ict ed t o self-co n sci e n ce , b u t t o t h e u n d e r st a n d i n g o f w h a t co n st i t u t e s a d e t e r m i n e d so ci a l g r o u p , w h i ch experiences a t ypical sit uat ion. Thus, t he daily world is not individual but intersubj ective, in which we share with our peers, with one com m on world to all of us( 3). I n t e r su b j e ct i v i t y r e v e a l s i t se l f i n t h e r ecip r ocit y of m ot iv es an d p er sp ect iv es. Thus, t he r eact ion of one indiv idual pr ov ok es t he r eact ion of anot her in v iew of a giv en sit uat ion, in w hich one e x p e r i e n ce s t h e co m m o n si t u a t i o n f r o m t h e p e r sp e ct i v e o f t h e o t h e r a n d v i ce - v e r sa . Th i s constitutes a we- relat ion. I n turn, this is expressed in t he ot her per son’s m ut ual conscience t hr ough each p er so n a n d co n st i t u t es a g en er a l l y sy m p a t h et i c participation in one another’s life, even if only during a certain period of tim e. This we- relat ion em erges by capturing the other person’s existence in face t o face int er act ions( 4).
m odifying som ething in the world. Hum an behavior is focused on based on a pr oj ect m an aim s t o car r y out(5-6).
The m ot ive for consists in a state of things – the obj ective one intends to achieve through the action; t hat is, t he orient at ion t owards t he fut ure act ion and
m o t i v e w h y is r elat ed t o p ast ex p er ien ces, w it h available know ledge( 7).
Ne x t , w e w i l l d i scu ss t h e m e t h o d o l o g y developed t o achieve t his st udy.
D EV ELOPI N G TH E M ETH OD OLOGI CAL
TRAJECTORY
We defined t he follow ing r esear ch inclusion crit eria: part icipat e in t he Nursing Et hics Com m it t ee as a full or substitute m em ber and possess experience i n t h e r ecep t i on an d f ol l ow - u p of et h i cal ev en t s for w ar ded t o t his or gan; hav ing ex per ienced, as a nurse head or m anager, et hical occurrences involving n u r sin g st af f. I n or der t o est ablish “ r appor t ” an d introduce the them e to the study subj ects, we posed t he following quest ions:
- NE: How do you act in relation to ethical events in a NEC? What m akes you act when confronted with ethical event s? What do you expect t hrough t hese act ions? - NM: What is it like for you to act in relation to ethical event s involving nursing st aff ? What m akes you act w hen confr ont ed w it h et hical ev ent s? What do y ou expect t hrough t hese act ions?
St udy par t icipant s w er e NE and NM fr om a privat e hospit al in t he cit y of São Paulo, Brazil. The study was approved by the Research Ethics Com m ittee of the study institution.
We est ablished a r elat ion of closeness and em pat hy wit h each collaborat or. Thus, we explained the reasons why we had contacted them and the study obj ect iv es, and t hen inv it ed t hem t o par t icipat e by m eans of an int erview. Aft er obt aining t heir free and spon t an eou s m an if est at ion , w e ask ed par t icipan t s w h et h er w e cou ld u se a r ecor der. Mor eov er, each part icipant received t im e t o read and w as asked t o sign t he Free and I nform ed Consent Team .
We a t t e m p t e d t o o f f e r a f a v o r a b l e environm ent , allowing each part icipant t o t alk freely abou t t h e pr oposed qu est ion s, clear ly st at in g t h e guiding questions and letting collaborators reflect and declare what t hey were t hinking at t hat t im e.
Th e n u m b e r o f p a r t i ci p a n t s w a s n o t det er m ined. I nt er view s st opped w hen w e per ceived the repetitiveness of the m otives that im pulse subj ects’ actions in relation to ethical occurrences. I n total, ten interviews were held with NM and NE.
CONSTRUCTI NG CONCRETE CATEGORI ES
AND THE EXPERI ENCED TYPE
The or ganizat ion and cat egor izat ion of our r e su l t s a l l o w e d u s t o co n st r u ct a t y p o l o g y o f experiences, in accordance wit h m odels proposed by n u r se r e se a r ch e r s w h o u se d So ci o l o g i ca l Phenom enology( 8- 11). For this purpose, we carried out
t he following st eps:
- r ead in g t h e t est im on ies t o g r asp t h e su b j ect s’ m ot iv at ed ex per ience;
- identifying the concrete categories that covered the subj ects’ actions in relation to ethical nursing events; - grouping discourse ext ract s, t hat is, relat ed act ion a sp ect s t h a t a r e si g n i f i ca n t w i t h r esp ect t o t h e p h en o m en o n o f et h i cal o ccu r r en ces t h at i n v o l v e nur sing pr ofessionals;
- establishing the m eaning of the social act of acting in relation to these events, based on what was typical i n p ar t i ci p an t s’ d i sco u r se, i n o r d er t o r each t h e t ypology of subj ect s’ experiences.
Co n cr e t e ca t e g o r i e s r e l a t e d t o NE’ s a n d NM’ s m ot ivat ion for act ion
NM’s and NE’s m ot ivat ions t o act converged in t he following cat egories:
Hum anizat ion
Par t icipant s consider ed it w as necessar y t o act in relation to ethical events in nursing with a view t o guar ant eeing hum anized car e, t hat is, based on respect and on t he dignit y of hum an beings. This is shown by t he following ext ract s:
By act ing in relat ion t o et hical event s, I at t em pt t o
advise t he involved professional, t hat , if he want s t he pat ient t o
be well t aken care of or if he want s t o be t aken care of well, t here
is no way of not being com m it t ed t o care, t o what he does and
how he act s ( NM4) .
I hope we will learn t o work wit h t he event s so as t o
seek t he hum anizat ion of nursing care, respect for hum an beings’
Client s’ sat isfact ion
NM and NE consider it is im portant to act in relation to ethical events in order to guarantee clients’ sat isfact ion about whet her t heir needs are at t ended t o, as shown by t he following excerpt s:
By working on et hical event s, I hope t o cont ribut e t o
t h e sat isfact ion of n u r sin g clien t s, t h e v alu at ion of n u r sin g
service, t his inst it ut ion ( ...) ( NE1) .
( ...) t hat is what I expect from m y act ions in relat ion t o
et hical occurrences, t hat is, I hope our client is receiving t he
best possible care for his case ( NM3) .
Dem yst ifying t he fear of punishm ent
Subj ect s want t heir act ions t o cont ribut e t o extinguish the fear of punishm ent when som e nursing pr of ession als ar e f or w ar ded t o t h e Nu r sin g Et h ics Com m ission. They st at e t hat :
( ...) I hope t his, t hat people learn from each sit uat ion
and t hat t he event and a punit ive t one are not t oo em phasized
( NM3) .
( . . . ) We al so n eed t o t ak e aw ay t h at st i g m a of
punishm ent , w hich unfor t unat ely st ill exist s. The NEC should
at t r act t h e at t en t ion of n u r se h eads, so t h at den ou n cin g a
professional is not a form of punishm ent , but of guidance ( NE3) .
Cr edibilit y
NM and NE hope their activities in relation to et h ical ev en t s w ill r esu lt in cr edibilit y f or n u r sin g p r o f e ssi o n a l s a m o n g cl i e n t s a n d o t h e r h e a l t h professionals. This is shown by the following discourse ex t r act s:
The pat ient m ust be respect ed and, if som et hing wrong
happens, he needs t o be inform ed, but we first need t o prevent
dam age t o t his pat ient from happening ( NM4) .
I t is com fort ing t o know t hat you are act ing so as t o
v alu e an d dign if y t h e pr of ession , at t em pt in g t o st r en gt h en
nur sing pr ofessionals’ act ions inside t he inst it ut ion because,
when you work in relat ion t o et hical occurrences, t his m akes t he
gr oup of nur sing pr ofessionals be consider ed m or e ser iously
and also guarant ees support t o t he professional if he is being
accused unfairly ( NM3) .
Part nership in t he educat ion process
The nurses believe it is im portant for the NEC, cont inuing educat ion, nursing service m anagers and
n u r sin g pr of ession als t o be par t n er s in edu cat ion act ivit ies relat ed t o et hical event s, as shown by t he follow ing excer pt s:
( ...) I hope our act ion w ill cont r ibut e t o cont inuing
educat ion as well. That is what I t hink: t hat is what we have done
in t he sect or I am in charge of and also when we forward an event
t o t he NEC, because t hat is a way t o m ake t his sit uat ion visible t o
everybody ( NM3) .
I n m y opinion, in daily realit y, each nurse should guide,
indicat e where t he flaw is, accom pany persons and give advice.
I t is really educat ive w ork ( ...) ( NE4) .
Cont inuous im provem ent of t he care process
Var iou s st at em en t s in dicat ed t h e n eed for con t in u ou s im pr ov em en t of t h e car e pr ocess as a fundam entally im portant elem ent to act in relation to et hical event s in nursing:
( ...) When I act in relat ion t o an et hical event , it ’s t o
achieve a change and im provem ent in t he work environm ent and
in people’s relat ions ( NM3) .
( ...) By seeking updat ed knowledge, t hese nurses feel
secure about offering qualit y nursing care t o client s and about
using t he available hum an resources and m at erial t o guarant ee
care qualit y ( NE1) .
COMPREHENSI VE ANALYSI S
The cat egor ies of hum anizat ion, cont inuous i m p r o v e m e n t o f t h e ca r e p r o ce ss, cr e d i b i l i t y, d e m y st i f y i n g t h e f e a r o f p u n i sh m e n t , cl i e n t s’ sat isfact ion and part nership in t he educat ion process j oin m ost m ot iv es int o point s of conv er gence t hat appeared in NE’s and NM’s discourse.
The subj ect s r ev ealed t heir concer n about g u a r a n t e e i n g a h u m a n i ze d ca r e , co n cr e t i ze d i n respect for clients, their dignity and hum an integrality as act iv e su bj ect s in t h e car e pr ocess. Th u s, t h e
hum anizat ion of care represent s a st rong m ot iv e for guaranteeing the right to a dignified nursing care that is safe for client s.
NM and NE also see providing for cont inuous
Credibilit y is an im portant m ot ive why for NE and NM to act in relation to ethical events in nursing. They aim for client s t o hav e confidence in nur sing p r o f e ssi o n a l s a n d , t h u s, t h e y j u st i f y t h e i r p r e o ccu p a t i o n s w i t h o r i e n t i n g t h e m , w h e n e v e r possible, infor m ing client s/ fam ilies and t he m edical t eam about t he et hical ev ent in nur sing. By act ing t his way, t hese nurses hope t hat ot her professionals an d clien t s/ fam ilies v alu e n u r sin g t eam act ion s in relat ion t o t he et hical occurrence and t he m easures t aken t o m inim ize t he negat ive consequences of t he ev en t .
An o t h er cat eg o r y i s cl i e n t s’ sa t i sf a ct i o n, revealed because it drives NE’s and NM’s actions and reveals t hese social subj ect s’ com m it m ent t o achieve t his sat isfact ion, as a goal for nursing professionals. By coping with ethical events in nursing, they attem pt t o get closer t o t his goal of sat isfying t he needs of client s at t ended by t he nursing t eam .
Dem yst ifying t he fear of punishm ent indicates that NE and NM acknowledge that fear of punishm ent exist s, but bot h groups feel t he need t o overcom e it by dissem inat ing t he funct ions of t he NEC and it s guidelines to professionals, in view of the ethical event or it s pr ev ent ion. I n t his per spect iv e, by act ing in relat ion t o et hical occurrences, t hese nurses hope t o p u t an en d t o t h i s st i g m a o f p u n i sh m en t . Th ei r expectation is in line with another study according to which nursing professionals are afraid to notify errors and, consequently, do not exploit opportunities to learn from t heir own m ist akes( 2).
The cat egory of part nership in t he educat ion process highlight s t hat NE and NM also t hink about developing m ovem ent s in part nership wit h cont inuing ed u cat i o n an d w i t h n u r si n g p r o f essi o n al s, n u r se m anagers and t he NEC, wit h a view t o everybody’s com m itm ent to this education and prevention process relat ed t o et hical event s, by sharing t he NEC’s and n u r se h e a d s/ m a n a g e r s’ g u i d e l i n e s, b y su p p o r t , co m m u n i ca t i o n a n d r ef l ect i o n i n r el a t i o n t o t h e professional who com m it t ed an error.
The NE’s and NM’s discour se also cont ains r ecipr ocal per spect ives t ow ar ds t heir act ions. Som e NE ex pect NM t o be t r ained t o decide and for w ar d cert ain et hical event s t o t he NEC. NM, on t he ot her hand, proj ect t heir act ivit ies in relat ion t o forwarding an et h i cal o ccu r r en ce an d ex p ect NE t o r esp ect se cr e t a r y, i n o r d e r t o sa f e g u a r d t h e i n v o l v e d pr ofessional’s im age, av oiding fut ur e discr im inat ion or defam at ion.
CONSTRUCTI ON OF THE EXPERI ENCED TYPE
Accor d in g t o social p h en om en olog y, id eal experienced t ypes are schem es to interpret the social world, which are part of our background of knowledge about t he w or ld and have a m eaningful v alue. We always t ake elem ent s of t hese t ypes in int erpersonal relat ions( 12).
The cat egories t hat em erged from subj ect s’ discourse allowed us to construct the experienced type relat ed t o t heir experiences wit h et hical event s. Our st udy indicat ed one com m on experienced t ype. This is under st andable as t hese subj ect s ar e inser t ed in the sam e social group and have sim ilarly experienced t h e m o t i v e s w h y, b ased on t h e sam e con t ex t of m eanings in t hese experiences.
Th u s, NE an d NM ar e p r of ession als w h o,
t h r o u g h t h e i r a c t i o n s 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 , a i m f o r t h e h u m a n i z a t i o n a n d
co n t i n u o u s i m p r o v e m e n t o f t h e ca r e p r o ce ss.
T h e y w o r k t o w a r d s t h e cr e d i b i l i t y o f n u r si n g
p r of e ssion a ls. Th e y w a n t t o d e m y st if y t h e f e a r
o f p u n i s h m e n t a m o n g n u r s i n g p r o f e s s i o n a l s
i n v o l v e d i n e t h i c a l e v e n t s . T h e y a t t e m p t t o
a c h i e v e c l i e n t s ’ s a t i s f a c t i o n a b o u t c a r e
d e liv e r y . Th e y w a n t t o close p a r t n e r sh ip s w it h
c o n t i n u i n g e d u c a t i o n a n d t h e N E C i n t h e
e d u ca t i o n p r o ce ss.
FI NAL CONSI DERATI ONS
By unveiling the m eanings of typified actions sh a r ed b y t h e st u d y su b j ect s, w e w er e a b l e t o understand that it is essential for the health institution t o b e a p a r t n e r a n d f o r a l l p r o f e ssi o n a l s t o b e com m it t ed t o t his process, wit h a view t o prevent ing ethical events, prim arily those m ost harm ful to clients. I n t his perspect ive, underst anding t he act ions of NE and NM in r elat ion t o et hical occur r ences r ev ealed t h a t t h e y b e l i e v e i n cl o si n g p a r t n e r sh i p s f o r a per m anent and long- t er m educat ion pr ocess about these events, involving NE, nurse m anagers and other nur sing pr ofessionals.
on reflection and responsibility of the professional who com m it t ed an et hical event .
The educat ive and m anagem ent act ions NM and NE pr oposed in r elat ion t o et hical occur r ences a r e m e a n i n g f u l a n d i m p o r t a n t w i t h a v i e w t o hum anized, safe and efficient nursing care that is free from expect able risks. Moreover, t his st udy allow ed us t o under st and t he need for t hese act ions t o be non- punitive, as educative attitudes seem to be wiser and m or e effect ive act ions in m anagem ent pr act ice relat ed t o et hical event s in nursing.
By act ing in relat ion t o et hical occurrences, NE an d NM aim t o con t in u ou sly im pr ov e t h e car e process and clients’ satisfaction. I n their opinion, this m ay be possible through partnerships with continuing educat ion of nur sing pr ofessionals and t he w or k of the NEC by guiding professionals instead of punishing them . Hence, these nurses – who are part of the sam e social gr ou p, h av e con v er gin g ex pect at ion s abou t m ot ivat ions for act ions relat ed t o et hical event s. By t heir com m it m ent t o t he care process, t hey hope t o con t r ibu t e t o t h e ben efit of clien t s an d aim t o be socially recognized and professionally valued.
The NE’s and NM’s experiences also disclosed t hat all nur ses need t o cope w it h et hical ev ent s in d aily r ealit y, m ak e d ecision s, g u id e an d f or w ar d nursing professionals to the NEC whenever necessary. Therefore, t hey expect equit y in deciding on et hical occurrences, so that decisions m ay result in im proved care and, consequent ly, benefit t he social group.
The com prehensive phenom enological branch of social act ion, which guided t his st udy, allowed us to foresee new horizons for ethical events that involve nursing professionals, wit h a view t o awaking t o t he r elev ance of t hese ev ent s, as w ell as t o indiv idual a n d i n st i t u t i o n a l r e sp o n si b i l i t i e s, so t h a t a l l professionals t ake on t he com m it m ent of expanding t heir knowledge in order t o guarant ee a care t hat is free from any risk or dam age t o client s.
I n sum m ary, t his research gave us a closer look at t h e ex per ien ces liv ed an d pict u r ed by t h e subj ect s of t he social act ion. They revealed proj ect s t o const ruct knowledge for a care pract ice based on t he act ions t riggered by et hical event s and involving t he r esponsibilit ies of nur sing pr ofessionals as w ell as healt h care inst it ut ions.
REFERENCES
1 . Fr e i t a s GF. Oco r r ê n ci a s é t i ca s co m o p e sso a l d e e n f e r m a g e m e m u m h o sp i t a l d o Mu n i cíp i o d e Sã o Paulo.[ dissert ação] . São Paulo ( SP) : Escola de Enferm agem / USP; 2 0 0 2 .
2 . Ver m o ch KL. Sh o u l d m ed i ca l l a b o r a t o r i es m i st a k es. [ abst r act ] . Clin Leader ship Rev 2000 Sept em ber - Oct ober ; 1 4 ( 5 ) : 2 1 9 - 2 4 .
3 . Ca p a l b o C. Me t o d o l o g i a d a s ci ê n ci a s so ci a i s: a fenom enologia de Alfred Schüt z. Londrina ( PR) : UEL; 1998. 4. Schüt z A. Fenom enologia del m ondo social. Buenos Aires: Paid os; 1 9 7 2 .
5. Wagner HR, organizador. Fenom enologia e relações sociais: t ex t os escolh idos de Alf r ed Sch ü t z. Rio de Jan eir o ( RJ) : Z ah ar ; 1 9 7 9 .
6. Schüt z A. El problem a de la realidad social. Buenos Aires: Am or r or t u; 1974.
7 . Sch ü t z A. Est u dios sobr e t eor ia social. Bu en os Air es: Am or r or t u; 1974.
8 . To ca n t i n s FR. As n e ce ssi d a d e s n a r e l a çã o cl i e n t e -enferm eiro em um a unidade básica de saúde: um a abordagem na perspect iva de Alfred Schüt z. [ t ese] . Rio de Janeiro ( RJ) : Escola de Enfer m agem Anna Ner y/ UFRJ; 1993.
9. Jesus MCP. A educação sexual na vida cot idiana de pais e adolescent es: um a abordagem com preensiva da ação social. [ t ese] . São Paulo ( SP) : Escola de Enferm agem / USP; 1998.
10. Merighi MAB. Enferm eiras obst ét ricas egressas da Escola de Enferm agem da Universidade de São Paulo: caract erização e t raj et ória profissional.[ t ese de Livre Docência] . São Paulo ( SP) : Escola de Enfer m agem / USP; 2000.
11. Fust inoni SM. As necessidades de cuidado da part urient e: um a per spect iv a com pr eensiv a da ação social. [ t ese] São Paulo ( SP) : Escola de Enferm agem / USP; 2000.
12. Cam poy MA, Mer ighi MAB, St efanelli MC. O ensino de en f er m ag em em saú d e m en t al e p si q u i át r i ca: v i são d o professor e do aluno na perspect iva da fenom enologia social. Rev Lat in o am En fer m agem 2 0 0 5 m ar ço abr il; 1 3 ( 2 ) : 1 6 5 -7 2 .
