Determinants of Nurses' Ethical Decision-Making in Acute Care: A case study of Thika level V hospital

Abstract

BACKGROUND Nurses in acute care settings often face complex ethical challenges, requiring them to make rapid and skilled decisions despite having limited clinical support. Moreover, novice nurses with limited experience frequently adopt linear decision-making approaches, which focus on single tasks and problems. However, in critical care environments, these decisions could significantly affect patient outcomes. Therefore, this study aimed to identify determinants influencing ethical decision-making among nurses working in the intensive care unit, renal unit, and emergency unit of Thika level V hospital, in Kiambu County, Kenya. METHODOLOGY Adopting an analytical cross-sectional design with quantitative and qualitative methods through a census approach, we recruited 36 registered nurses working in critical care settings of Thika Level V hospital. A self-administered questionnaire and a key informant interview guide were instruments used to collect quantitative and qualitative data, respectively. We analysed the quantitative data using SPSS version 26.0 for descriptive and inferential statistics and thematically analysed qualitative data using NVivo version 21.2. The Mantel-Haenszel chi-square test was used in the inferential analysis with P<0.05 considered statistically significant. The confidence interval was set at 95%. RESULTS The majority of nurses (75%) demonstrated low adherence to the ethical decision-making process. Work-related factors did not significantly influence adherence levels. Emerging thematic areas of ethical issues were three namely, resource allocation, paediatric care, and challenges affecting patient care in acute settings. CONCLUSION AND RECOMMENDATIONS Most nurses in Thika Level V Hospital’s acute care settings exhibited low adherence to ethical decision-making processes and work-related factors did not significantly affect their adherence. The ethical dilemmas the nurses faced were: the allocation of resources, handling of paediatric patients and ethical issues affecting care. To address these gaps, healthcare institutions should provide targeted support to nurses for navigating ethical challenges. We also recommend further research, inter-institutional collaborations, and dissemination of best practices to enhance ethical decision-making in critical care environments.