142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

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

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 12:42 PM - 12:54 PM

Monica McLemore, RN, MPH, PhD , Advancing New Standards in Reproductive Health, Oakland, CA
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.

Learning Areas:

Ethics, professional and legal requirements
Provision of health care to the public
Public health or related nursing

Learning Objectives:
Describe a grounded theory of calculus formation which provides a deeper understanding of processes that nurses use when making clinical decisions in ethically challenging situations, particularly emergent, routine and urgent care provision using abortion as the clinical context.

Keyword(s): Abortion, Decision-Making

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctorally prepared research scholar who designed and conducted the study and data analysis with my faculty mentor, Dr. Susan Kools. I conducted this study as completion of a qualitative course series I completed in 2012.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.