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How is ethical behavior an integral part of the doctorally prepared advanced practice nurse’s role? Why is the doctorally prepared advanced practice nurse considered a role model? How does one display the characteristics of a role model? Does a doctorally prepared advanced practice nurse have a legitimate right and/or ethical foundation to interject their ideas into business practice?

This study was guided by nursing, ethics, and health services theory and literature. Rest’s (1986) four-component model of ethical decision-making identifies the importance of recognizing ethical issues that evolve from the social, cultural, and organizational

DNP 840 Topic 8 Discussion Question One

environment in which one is embedded. The ethical issue or problem needs to be identified by the moral agent before moral decision-making processes can be activated. Thus, individuals may differ not only in their recognition of the moral or ethical issues they encounter but also in how they respond. This could vary by age, gender, ethnicity, years in practice or some other identified factors. Additionally, the intensity in which nurses experience these ethical issues or problems can influence the degree to which they engage in moral behavior (Jones 1991). Thus, it is essential to identify the ethical problems nurses face, the frequency with which they confront them, and the level of stress they produce.

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Many of the studies that focus on ethical problems in nursing practice produce data unique to a particular specialty area. Such study topics include ethical issues in restraint use in mental health (Redman & Fry, 2003); providing care to high risk neonates (van Zuuren & van Manen, 2006; Janvier et al. 2007; Kain, 2007; Epstein, 2008); initiating, withholding, and withdrawing treatment and advance directives in acute and long-term care (Crego & Lipp 1998; Burns et al. 2001; Redman & Fry 2003); conflict resolution in parent-child-provider relationships in pediatric care (Butz et al. 1998); and physician collaboration, autonomy, and insurance constraints in advanced practice (Laabs 2005; Ulrich et al. 2007).

Studies have shown that nurses, more often than their physician colleagues, feel that end-of-life ethical issues are not thoroughly discussed within the care team or with families and significant others (Levi et al. 2004). Preliminary studies (Corley et al. 2005) have explored professionals’ experiences of ethical stress related to their inability to take moral action.

Redman and Fry (2003) published exploratory work on what is known about ethical conflicts among nurse leaders. Fry and Duffy (2001) developed and tested a tool (Ethical Issues Scale) to assess the full range of ethical issues experienced by nurses in current practice and the frequency of their occurrences. Seventy-nine percent of the 934 nurses surveyed by the American Nurses Association Center for Ethics and Human Rights at the ANA Convention in 1994 reported confronting ethical issues in practice daily (43%) or weekly (36%). Over 50% of these nurses identified the following four issues as the most frequent: cost-containment issues that jeopardized patient welfare; end-of-life decisions; breaches of patient confidentiality; and incompetent, unethical or illegal practices of colleagues. Pain management, use of advance directives, informed consent for procedures, access to healthcare, issues in the care of persons with HIV/AIDs, and providing “futile” treatment completed the list of 10 (Scanlon 1994). Previous researchers, however, have not explored the type, frequency, and level of stress that ethical problems engender in nurses across practice specialties.

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