Physicians' and nurses' perceptions of ethics problems on general medical services.
OBJECTIVE
To understand the kinds of clinical situations physicians and nurses regard as "ethics problems."


METHODS
The authors prospectively studied physicians' and nurses' perceptions of ethics problems using paired interviews. Individual interviews were conducted with physicians and nurses as they cared for the same patients during a six-week period. Each was asked whether any ethics problems had arisen in the care of his or her patients and, if so, to give a brief description of each problem.


METHODS
Three general medical services in a 497-bed community teaching hospital.


METHODS
13 physicians (mostly family medicine residents) and 42 nurses caring for 142 patients.


RESULTS
The physicians and nurses thought ethics problems were present in 75 of the 142 patients cases. Physicians and nurses identified ethics problems with similar frequencies; however, they often identified ethics problems in different patient cases or identified different ethics problems in the same case. Physicians and nurses described a variety of problem types. Physicians identified more problems related to quality of life, inappropriate hospital admissions, and cost of care; nurses identified more problems related to patient preferences, family wishes, pain management, implementing treatments, and discharge planning. A fourth of the ethics problems identified by physicians and nurses involved interstaff conflicts.


CONCLUSIONS
The physicians and nurses studied considered a broad range of clinical situations to be "ethics problems," and they perceived them to occur frequently. Systematic differences were found between physicians' and nurses' perceptions of ethics problems, and many ethics problems generated interstaff conflicts. Incorporating this kind of information into clinical ethics education programs, and into hospital policies, may represent a useful approach toward improving physician-nurse interaction.
Walker
R M
RM
Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612-4799.
Miles
S H
SH
Stocking
C B
CB
Siegler
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D026688:Bioethical Issues; D026690:Ethics, Clinical; D004992:Ethics, Medical; D004993:Ethics, Nursing; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010817:Physician-Patient Relations