Ethical decision-making in emergency nursing : managing pain in patients with substance misuse disorder

Abstract

Background: Individuals struggling with substance misuse often seek medical assistance from emergency departments when in pain. Managing their pain is challenging for healthcare professionals, who must balance their duty to alleviate pain with preventing substance misuse and drug diversion. Limited research explores the ethical decision-making processes of emergency department nurses when caring for substance misuse patients in pain, both locally and internationally. Aim of the research: This research aims to explore how emergency nurses navigate ethical-decision-making when caring for substance misuse patients in pain. This exploration starts by assessing whether emergency nurses possess the moral sensitivity required to identify the ethical dilemma presented by this specific issue, have the resolve to determine the correct course of action prioritizing ethical values, and possess and implement their decisions in practice. Setting: The study took place at the emergency departments in Malta and Gozo. Design: A qualitative approach study using a Descriptive Exploratory methodology Participants Nine male and female nurses, who have been working in the Emergency Department for over three years, participated in the study. Methodology: Purposive sampling methods was used to recruit participants for this study. Data was collected through audio-recorded semi-structured interviews transcribed verbatim and analysed to identify codes, themes, and super-ordinate themes. Results: The study identified eight main themes that illustrate the experiences of emergency department nurses when caring for patients with substance misuse disorder and in pain. These themes include vulnerability of the individual, moral awareness, nurses’ moral capacity, organizational factors, moral consultation, affective ethical decision-making approach, moral hypocrisy, and ethics of care. Conclusions: Most healthcare professionals demonstrate moral sensitivity when managing patients with substance misuse who are experiencing pain. They recognize their duty to alleviate suffering while also considering the risks of potential substance dependence and drug diversion. Initially, their decision-making is influenced by emotions and intuitions; however, they strive to control negative impulses, such as stigma, through the application of cognitive strategies aimed at making ethical decisions. Despite these efforts, various obstacles within the emergency department often impede their ability to make these ethical choices. Some healthcare providers resort to moral hypocrisy to avoid taking responsibility, whereas others seek moral consultation from experienced colleagues to achieve better patient outcomes. Furthermore, attributes such as patience, empathy, compassion, and honest communication can significantly enhance the effectiveness of the caregiving relationship with these patients.