Influence of practice environment and nurse characteristics on perinatal nurses' responses to ethical dilemmas

Background: Previous research on nurses' responses to ethical dilemmas has focused either on nurse characteristics or on practice environment characte ristics, but has not examined both influences concurrently Objective:To explore the relative contributions of practice environment cha racteristics and nurse personal and professional characteristics to perinat al nurses' willingness to be involved in activities to resolve clinical eth ical dilemmas. Methods: A descriptive correlational design and hierarchical multiple regre ssion were used to examine responses of 127 perinatal nurses to three instr uments: the Nursing Ethical Involvement Scales (NEIS), Perinatal Values Que stionnaire (PVQ), and Demographic Data Sheet (DDS). Results: The organizational variable, nursing influence, accounted for the greatest amount of variance in nurses' reported resolution actions, with nu rses' concern about ethics and consequentialist values also contributing si gnificantly. The three predictors together accounted for 31% (24% adjusted) of the variance in actions to resolve clinical ethical dilemmas. Level of nursing education was not a statistically significant influence. Conclusions: These results suggest that nurses are more likely to be involv ed in dilemma resolution activities when they perceive themselves to have h igher levels of influence in their practice environments and higher levels of concern about the ethical aspects of clinical situations. Nurses who emp hasize consideration of morally relevant aspects of individual patient situ ations (consequentialist value orientation) and deemphasize adherence to ab stract standards, rules, and policies also are more likely to be involved i n dilemma resolution.