Ethical reasoning among experienced registered nurses in relation to communication with severely ill patients disclosing personal knowledge

Sammanfattning: Personal knowledge was disclosed amongst a group of experienced registered nurses in relation to feeding severely ill patients with cancer and dementia (I,II,III), communicating with severely demented patients (IV,V), and receiving group supervision (VI). Principled ethics did not seem an adequate model for describing the ethical reasoning of experienced RNs. For the twenty RNs working in oncological care the question of whether or not to accept active euthanasia was the most urgent. The twenty RNs working in dementia care emphasized the difficulty they had in understanding the meaning of communicative cues in severely demented patients. Both groups of nurses saw themselves as advocates for their patients and seemed to reason mainly in accordance with the Golden Rule. Through a phenomenological hermeneutic analysis of video recordings of two RNs' interaction with each of four severely demented patients, it was possible to interpret the patients' vague and unclear communicative cues. But observations based on an assessment of facial muscle movements showed that it was very difficult (the FACS). Group supervision based on a narrative framework was carried out in order to support nurses working in dementia care. Interviews with the fifteen RNs showed that they experienced recognition and reassurance of worth, an increased repertoire of actions, gained new perspectives, an increased awareness of their professional role, and interdependence. It is proposed that the care of severely ill patients can be improved by the use of a narrative approach both as regards understanding patients and encouraging RNs to develop their clinical knowledge through reflecting on their own and their coworkers' narrations about care.