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UBC Theses and Dissertations

Multiple loyalty conflicts in nursing Lamb, Ruth M.


The International Council of Nurses [ICN] Code for Nurses clearly states that the registered nurse's first obligation is to the patient (ICN, 1973). But, in the clinical setting, multiple loyalties or obligations to the patient, family, physician, employing agency, professional standards, and personal ethical beliefs may conflict. Given the diversity of obligation in nursing practice and the ever expanding array of life sustaining technologies and techniques, a problem arises for nurses when they attempt to employ clinical guidelines offered by the ICN Code. Therefore, in order to ascertain how nurses uphold patient autonomy when responding to conflicts in the empirical setting and to delineate the patterns of reasoning which contribute to the actual response as well as to the preferred response, a qualitative grounded theory methodology was selected. This exploratory approach provided evidence that when conflict occurs, perceptions of relevancy on both a cognitive and affective level, influence the nurses' response. Often nurses with apparently equal cognitive capabilities on a moral developmental level perceived conflict of loyalty situations in vastly different ways and thereby responded with a range of behavior that went from exemplary care, which supported patient autonomy, to unsafe care, which completely denied patients their autonomy. An inductively derived substantive theory outlines this variance in care. The manner in which patient autonomy is upheld in multiple loyalty conflicts can be expressed on a three dimensional categorical basis with perceptions of imposed, bounded and volitional relevance conjoined with three levels of cognitive moral development, including both descriptive and normative explanations of conflict resolution. Principles and their supporting rules for nursing action derived from each category emphasize the little researched but complex relationship between moral cognitions, perceptions and affective valuing.

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