title: Avenues of action in ethically complex situations: a critical incident study.
abstract: OBJECTIVE
  The aims of this study were to explore nurse leaders' experiences with ethically difficult situations, perceptions about risk factors, and specific actions for ethical conflicts.
  
  
  BACKGROUND
  Research indicates that nurses are reluctant to bring ethical concerns to nurse leaders for fear of creating trouble, and yet, nurse leaders are key figures in supporting ethics-minded clinicians and cultures.
  
  
  METHODS
  The critical incident technique was used to collect descriptions from 100 nurse leaders in California. Responses were qualitatively coded, categorized, and counted.
  
  
  RESULTS
  End-of-life situations accounted for the majority of incidents. Most situations had 3 to 4 ethical issues. Healthcare provider and system-level factors were perceived to increase the likelihood of ethical conflicts more often than family and patient factors. Respondents were more likely to identify leader actions that address specific situations rather than specify system-level actions addressing root causes of conflicts.
  
  
  CONCLUSIONS
  Findings can be used to help leaders create ethics competencies, policies, and education.
authors.affiliation: Author Affiliations: Associate Professor (Dr Pavlish) and Student Research Assistants (Mss So, Heers, and Iorillo), UCLA School of Nursing; and Codirector of Ethics Center (Ms Brown-Saltzman) and Quality and Safety Specialist (Ms So), UCLA Health System, Los Angeles, California.
authors.forename: Carol
authors.initials: C
authors.lastname: Pavlish
authors.forename: Katherine
authors.initials: K
authors.lastname: Brown-Saltzman
authors.forename: Loretta
authors.initials: L
authors.lastname: So
authors.forename: Amy
authors.initials: A
authors.lastname: Heers
authors.forename: Nicole
authors.initials: N
authors.lastname: Iorillo
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D005260:Female; D006801:Humans; D007857:Leadership; D008297:Male; D019300:Medical Errors / Q000941:ethics*; D008875:Middle Aged; D017008:Negotiating; D009718:Nurse Administrators; D009732:Nursing Care / Q000941:ethics*; D011361:Professional Competence; D028743:Professional Misconduct / Q000941:ethics*; D013647:Task Performance and Analysis