Expanding our understanding complex decision-making in emergent, routine and urgent ethically challenging clinical situations

Purpose: The purpose of this study was to gain a deeper understanding of processes that nurses use when making clinical decisions in ethically challenging situations in both urgent and routine care provision using abortion as the clinical context.

Methods: Constructivist grounded theory method was used. A purposive sample of 24 nurses were interviewed using questions designed to examine and explore the cognitive, emotional, and behavioral processes associated with how nurses make decisions to care for women needing and seeking abortions.

Results: Nurses develop and use multifaceted, real-time calculi when making decisions about their participation in emergent, routine, or urgent abortion care provision. Additionally, nurses make clear distinctions between knowing how versus know that, meaning knowing how to take care of women needing abortions doesn't always result in provision of care and knowing that (i.e., the circumstances and back story) of why women need this care is a better predictor of its provision. Parameters of the nurse-patient relationship are different than medicine in the abortion context as nurses make clear distinctions between women and patients and these distinctions impacts the taxing between the personal and professional factors that influence calculus formation. Finally, the role of others, broadly defined in the abortion context creates a complex yet integrated variable to be considered in the decisions impacting provision.

Conclusion: This study provides a grounded theory of calculus formation that further develops the science of real-time ethical decision-making in  challenging situations and expands our understanding of the multitude of factors that influence nurse decision-making.