Jmrmd of Advanced Nursmg, 1992,17, 734-738
Greipp's model of ethical decision making Mary Elizabeth Greipp RN EdD FAAN Assoaate Professor, Rutgers, The State University of New Jersey, Camden College of Arts and Saences, Camden, New Jersey, USA
Accepted for publication 28 October 1991
GREIPP M E (1992) Journal of Advanced Nursmg 17, 734-736 Greipp's model of ethical dedsion makii^ Nurses need to become more aware of evoryday ethical deasions and the many factors which mfluence them m order to develop skills in this cognitive process This author's model of ethical deasion makmg has been designed and developed to illustrate an overall conception of the mteraction between nurse and chent withm an ethical framework. This model lends itself to the exammation of all factors which enter into the ethical decision makmg process descnptive, normative and meta-ethics INTRODUCTION The nursmg bterature of tbe 1980s contams a notable increase m atations on the topic of nursmg ethics and etbcal deasion makmg Tbs may refled tbe times — hmes wben systems of bealtb care debvery are drastically cbangmg Tbe amount and complexity of the technology mvolved m that debvery are well beyond the comprehension of the average lay person In addihon to these changes is the pobhcal-^noral issue of access to bealth care Nurses are mvolved m all facets of bealtb care debvery as tbey interact daily witb cbents, families, physiaans and other health care professionals Consequently, nurses are directly mvolved m tbe mulhtude of ethical dilemmas posed by tbe players (dients, nurses, physiaans, fanubes), the play (the parhcular situahon) and tbe stage (tbe pbysical settmg) It IS tbs autbor's bebef tbat most professionals agree on the need for etbcal prachce based on a code of etbcs Tbe queshon t>ecomes one of how to move professionals fi-om this theorehcal stance to assistmg them to apply a theorehcal code m practice How does one make etbcs real and meanmgful m everyday prachce m vanous settmgs and situations? Etbcal decisions should be an mtegral component of all prachce, not just those monumental deasions mvolvmg life and death, donors and transplants
have gone largely unexammed Etbcal behavior is not the display of one's moral reditude m tunes of cnses It is the dayby-day expression of one's commitment to ottier persons and the ways m wbdi human beings relate to one another in their daily mteradions (Levme 1990)
MODELS OF ETHICAL DECISION MAKING
Fry has done extensive work on ethics m nursmg, and m 1987 called for nurses to approach etbcal enquiryfi-omthe perspechves of descnptive ethics, normative ethics and meta-etbcs mstead of nursing's tradihonal paradigm (Fry 1987) Work first pubbsbed on deasion makmg models m nursmg, m the 1970s, mduded Bergman (1973), Murphy & Murphy (1976) and Thompson & Thompson (1985) Husted & Husted first pubbsbed their model m 1991 Most of them are based on Koblberg's theory of moral development and deasion theones and consist of sequences of steps mvolved in cognitive processing — normative ethics All of these models seem to imply nurses' pnor knowledge of etbcal pnnaples and are very useful m problem idenhficahon and working tbrougb to an ethical soluhon There are overlooked ethical diallenges m the mundane, Fry (1989) states tbat etbcalfi-ameworics,wben utibzed everyday rouhne achvities of professional prachce, and tiiese with knowledge and the appbcation of etbcs, can assist m the development of the moral skill needed for dirucal Correspondence M t Gretpp, 229 Carriage Hill, Moortstcum, Nete Jersey 08057, USA practice 734
Model of ethteal decision making Figure 1 Greipp's mcxkl of ethieal cieasion maktng
Leamed potential inhibitors - Personal expenences - Professtonal expenences - Culture - Belief system
Learned potential inhibitors - Personal experiences
- Culture
- Belief system
process Decision making Education
Education
Deontological base Individuals are ends in and of themselves
GREIPPS MODEL Nurses need to beeome more aware of everyday ethieal deetsions and the many faetors wbeh mfluenee them m order to develop the moral skiU discussed by Fry (1989) This autbor's model of etbcal deasion making has been designed and developed to lUushate an overaU conception of the mteraction between nurse and ebent witbn an ethical framework This model lends itself to the exammation of all factors wbch enter mto the ethical deasion makmg process — descnphve, normative and meta-ethics The tmderlymg theory of the mcxiel is general systems theory This model is compatible witb tbe extensive work done by Leinmger and ber theory of hanseultural eanng (Leinmger 1978) Tbs author documents the importance of the dient's culture m addihon to the culture of the nurse as they influence the outcome (deasion) of the mteradion The importance of Greipp's model hes in tbe global presentation of the mteraetions between dients and nurses and those multifadors wbch can enhance or mbbit the ethical deasion making process — descnphve etbcs It lUushates the placement of etbcal knowledge and the professional code of ethics — the normahve component TTie overaU model sets the stage for analyhcal ethics — meta-etbcs
nurse is found to be lacking m knowledge of etbcs, tbs would be a problem ansmg m the eenhal portion of the model Perhaps the nurse is knowledgeable about etbes eontent but comesfroma cultural environment where it is the duty of younger people to 'take care of their elders As a result this nurse has great difficulty applymg the pnnaple of autonomy when worhng v«th elderly dients — bmitmg dients' ehoiees wben planmng and lmplementmg eare on a daily basis This situation would be a problem based m the lefr proporhon of the model under potenhal inhibitors (Figure I) It IS anhapated that tbs model wiU generate and dnve saentifie mquiry by ldentifymg many potential researeb areas for study relahve to deasion makmg as it assists diagramaheaUy m ldentifymg the locahon of difficulties with the decision makmg process MAJOR CONCEPTS AND DEFINITIONS OF GREIPFS MODEL Nurse: biological essence A nurse is an individual with physical and mental charactenshes/eapabibties attnbutable to parentage, growtb and developmental factors, and wbo has been edueated m a professional nursmg programme to plan and dehver bealtb care to individuals, families and commumties
Universality f^ model is considered to be umversal and applicable Client: biological essence m any sethng fllustrahng tbs global perspechve aUows one to identify Iweakdowns or areas of difficulty m nuJang A dient is an mdividuid with physical and mental charaderdeosicms of either a mjqor or mmor nature For exMnple, if a lshcs attnbutable to parentage, growth and development 735
ML Gretpp
fadors and who is tn need of professtonal nursmg health care The dtent's need for nursing health care will be commumcated m physiological expressions, verbal and non-verbal expressions
essenhal ethical pnnciples (autonomy, beneficence, nonmaleficence and jushce), in addihon to the responsibihty and aeeountabihty for eompetenee Autonomy
Leamed potential inhibitors
Autonomy is the ethieal pnnaple which supports selfdetermination by the dient
Leamed potential inhibitors are defined as the nurse's and dient's psychosoctocultural vanables whtch may enhance Beneficence the person's mteradions with others The model is conBeneficence is the ethical pnnaple which directs the nurse cemed with their potential to 'inhibit' the person's mtertoward dotng good for the chent actions with others and potenhally afiFed the quality or 'nghtness' of health care given and received
Non-maleficence Non-maleficence ts the ethtcal pnnciple which guides the Behef system nurse m avoiding aehons which will harm the dtent Basic set of values and assumptions that the person holds to
be true — it may or may not be based on fact (truth) A person's leamed belief system may be contrary to the ethicalframeworkof the model For example a nurse may not be able to accept the tenet that dients should be selfdetermimng by virtue of the ethical pnnaple of autonomy The dient may not believe in his autonomy and may welcome the opportumty to have physiaans and nurses make his deasions for him Culture Leamed and shared set of symbols, meamngs, values and sandions which guides the behaviour of the members of the culture Personal expenences
All of an mdividual's hfe expenences from birth to the present, mdudmg family, educahon and employment Professional expenence Those expenences gained through the professionai role of the nurse and the speaalized knowledge achieved m that role Education General or speafic teachmg/leammg which efFeds a behaviour change In the model, education may be purposeful or lnadental Education is necessary to change psychosoaocultural vanables
Justice Jushce ts the ethical pnnciple which direds the nurse to resf>ect dients' nghts and to seek fair treahnent Responstbiltty/accountabtlity for competence
The ANA Code for Nurses (1985) mandates that professional nurses accept the responsibility and accountability for jjrofessional competence Nurses must keep themselves updated and current m order to make informed and effective judgements and deasions with, and for, dients Deontological base The deontological base is a fundamental behef m, and resped for, one's obhgahons to other human betngs — one's duty A behef that individuals are ends in and of themselves Nursing process TTie nursmg process ts the nursmg professton's 'saenttfic method' The nursing process focuses on the mdependent adions of the nurse as problem solver and mdudes dient collaborahon to the extent that the dient is willmg and able to parhapate Decision making
Deasion makmg is ideally a collaborative process based on sound information, withm therealitiesof the dient's world, The Intemahonal Counal of Nurses' Code for Nurses (1977) where proii^ems mtd conflicts are defined and (klineated, and the Amencan Nurses' Association Profe^umal Code and resohihon is guided by ethical pnnaples whidi respect for Nurses (1985) are the fr'mnework which contams four the mdividual as an end m and of himself Ethical framework
736
Model of ethical decision maktng
UNDERLYING ASSUMPTIONS The underlying assumphons of Greipp's model of ethieal deasion makmg are as foUows 1 2 3 4
aU ebents share a need for basie health eare, nurses aet as 'data analyst/deeision maker' on a daily basis, aU nurses praehse within a eode of ethies, deasion mabng is a eomplex prcKess subjeet to vanations imposed by people, situations and environments
EXPLANATION OF GREIPFS MODEL The model begins on the left side of the diagram with the nurse (Figure 1) The nurse takes leamed potential mbbitors to the etbcal framework as part of self The potential inhibitors as defined may also act to enhanee the proeess The leamed potential inhibitors are eounterbalaneed or modified by edueation The heart of desenptive ethies is embedded in culture and bebef systems When examining existmg moral views and causation, it is neeessary to study psyehosoeioeultural faetors of the individual and related groups For example, it would seem at first glanee that the dilemma for the pro-life, pro-ehoiee groups is rooted m the central portion of Greipp's model, as advoeates for both stdes argue for the nghts of tbe mother or imbom fetus Autonomy and justtee are heard m all of their arguments Upon eloser analysis, it ean be seen that the heart of the dilemma lies not m the etbeal framework but m the individual's belief and value systems An individual's bebef system and value system are mtegral parts of the self and earmot be exased as the nurse approaches the ethical framework Education can assist the individual to see and respeet other perspeehves, or to leam thmgs that may lead the person to change b s beliefs or values
Professional knowledge In order to be able to make professional etbcal decisions the nurse must move through the ethical framework At the eore of the framework is professional knowledge needed for practice, mduding objective situahonal data T b s is surrounded by responsibility and aeeoimtability for eompetenee mandated by tbe professional eode of ethies Struetunng these eomponents are the four general pnnaples of autonomy, benefieence, non-maleficence and jushce which are inherent m the Nursing Code of Ethics The total ethical frameworic rests on a deontological base which necessitates an inherent belief in tbe nurse's
obligations as a prachsmg professional The nurse has to take mto consideration all of this mformation dunng mterachons with the client In a manner of speakmg, t b s framework beeomes an inseparable part of nursing praehee Movmg to the nght side of the diagram, the ebent with needs for health eare also takes leamed potential inhtbttors mto the mteraetion (nursing proeess and deasion makmg) The leamed potential inhibitors are eounterbalaneed or modified by edueation Dunng the appbeahon of the nursmg proeess the nurse collaborates with the cbent (and sigmficant others) m devising the ebent's plan of eare usmg tbs decision makmg model As ean be noted from the model, the nurse is responsible for the appbeation of etbeal pnneiples The results of the deeision revert baek to the elient as tbe reeipient of eare Additionally, the nurse utilizes the model in making day-to-day deasions when pnonhzing care for groups of ebents, for determimng how and when to medieate ebents and how and what to teach
SUMMATION Greipp's model of etbeal deeision making elanfies the e t b eal proeess by defimng etbeal behaviour withm the eenhe of the model, and delineating relevant vanables on both the earegiver's and eare reeipient's sides wbeh ean dramaheaUy alter the outeome of the deasion makmg proeess The value of tbs model for the praetitioner lies m its diagrammahe struettire wbeh wiU keep the nurse focused and aware of the mfluenee that psyehosoeioeultural vanables have on deasion making mteraehons The model also mcikes evident the power of those potential inhibitors (vanables) to violate basie etbcal pnnaples and negate the framework Loeatmg tbe violation is essential in findmg a solution 'Men are not evil Most of the evil gets done without maliee Evil eomes less from maliee and sadism than from good intentions that are stupid and low-level' (Maslow 1972) Eaeh professional nurse eames responsibibty for nght behaviour and ngbt knowledge The seareh and quest for that behaviour and knowledge is a never-endmg proeess fired by a eommitment to personal ideals and professional exeeUence
References Amenean Nurses' Assoeiation (1985) Code for Nurses with Interpretive Statements ANA, Kansas City, Missoun Bergman R (1973) Ethies — eoneepts and praetiee Intemahonal Nurstng Revtew 20,140-141,152 737
ME Grttpp Fry S (1987) Researdi on etbcs m nursing the state of the art Nursing Outlook 35(5), 246 Fry S (1989) Etbcal deasion making Part I Seieding a framework. Nurstng Outlook 37(5), 248 Husted G & Husted I (1991) Bhtcal Deaston Mahng tn Nurstng C V Mosby, St Louis Intemahonal Counal of Nurses (1977) Code for Nurses ICN, Geneva LemmgerM (ed)(1978) TransculturalNt.trstng Concepts, Theones and Practtces John Wiley & Sons, New York
7J8
Levme M (1990) Nursing etbcs and the etbcal nurse In Professional Ethtcs m Nurstng (Thompson) & Thompson H eds), Kneger, Malabar, Flonda, p 41 Maslow B (1972) Abraham H Maslow A Memonal Volume Brooks/Cole, Monterey, California, p 94 Murphy M & Murphy J (1976) Making etbcal decisions systenwtically Nurstng 76 6(5), 13-14 Thompson I & Thompson H (1985) Btoethtcal Deaston Mahng for Nurses Appleton-Century-Crofts, Norwalk, Connedicut, pp 89-99
Greipp's model of ethical decision making Mary Elizabeth Greipp RN EdD FAAN Assoaate Professor, Rutgers, The State University of New Jersey, Camden College of Arts and Saences, Camden, New Jersey, USA
Accepted for publication 28 October 1991
GREIPP M E (1992) Journal of Advanced Nursmg 17, 734-736 Greipp's model of ethical dedsion makii^ Nurses need to become more aware of evoryday ethical deasions and the many factors which mfluence them m order to develop skills in this cognitive process This author's model of ethical deasion makmg has been designed and developed to illustrate an overall conception of the mteraction between nurse and chent withm an ethical framework. This model lends itself to the exammation of all factors which enter into the ethical decision makmg process descnptive, normative and meta-ethics INTRODUCTION The nursmg bterature of tbe 1980s contams a notable increase m atations on the topic of nursmg ethics and etbcal deasion makmg Tbs may refled tbe times — hmes wben systems of bealtb care debvery are drastically cbangmg Tbe amount and complexity of the technology mvolved m that debvery are well beyond the comprehension of the average lay person In addihon to these changes is the pobhcal-^noral issue of access to bealth care Nurses are mvolved m all facets of bealtb care debvery as tbey interact daily witb cbents, families, physiaans and other health care professionals Consequently, nurses are directly mvolved m tbe mulhtude of ethical dilemmas posed by tbe players (dients, nurses, physiaans, fanubes), the play (the parhcular situahon) and tbe stage (tbe pbysical settmg) It IS tbs autbor's bebef tbat most professionals agree on the need for etbcal prachce based on a code of etbcs Tbe queshon t>ecomes one of how to move professionals fi-om this theorehcal stance to assistmg them to apply a theorehcal code m practice How does one make etbcs real and meanmgful m everyday prachce m vanous settmgs and situations? Etbcal decisions should be an mtegral component of all prachce, not just those monumental deasions mvolvmg life and death, donors and transplants
have gone largely unexammed Etbcal behavior is not the display of one's moral reditude m tunes of cnses It is the dayby-day expression of one's commitment to ottier persons and the ways m wbdi human beings relate to one another in their daily mteradions (Levme 1990)
MODELS OF ETHICAL DECISION MAKING
Fry has done extensive work on ethics m nursmg, and m 1987 called for nurses to approach etbcal enquiryfi-omthe perspechves of descnptive ethics, normative ethics and meta-etbcs mstead of nursing's tradihonal paradigm (Fry 1987) Work first pubbsbed on deasion makmg models m nursmg, m the 1970s, mduded Bergman (1973), Murphy & Murphy (1976) and Thompson & Thompson (1985) Husted & Husted first pubbsbed their model m 1991 Most of them are based on Koblberg's theory of moral development and deasion theones and consist of sequences of steps mvolved in cognitive processing — normative ethics All of these models seem to imply nurses' pnor knowledge of etbcal pnnaples and are very useful m problem idenhficahon and working tbrougb to an ethical soluhon There are overlooked ethical diallenges m the mundane, Fry (1989) states tbat etbcalfi-ameworics,wben utibzed everyday rouhne achvities of professional prachce, and tiiese with knowledge and the appbcation of etbcs, can assist m the development of the moral skill needed for dirucal Correspondence M t Gretpp, 229 Carriage Hill, Moortstcum, Nete Jersey 08057, USA practice 734
Model of ethteal decision making Figure 1 Greipp's mcxkl of ethieal cieasion maktng
Leamed potential inhibitors - Personal expenences - Professtonal expenences - Culture - Belief system
Learned potential inhibitors - Personal experiences
- Culture
- Belief system
process Decision making Education
Education
Deontological base Individuals are ends in and of themselves
GREIPPS MODEL Nurses need to beeome more aware of everyday ethieal deetsions and the many faetors wbeh mfluenee them m order to develop the moral skiU discussed by Fry (1989) This autbor's model of etbcal deasion making has been designed and developed to lUushate an overaU conception of the mteraction between nurse and ebent witbn an ethical framework This model lends itself to the exammation of all factors wbch enter mto the ethical deasion makmg process — descnphve, normative and meta-ethics The tmderlymg theory of the mcxiel is general systems theory This model is compatible witb tbe extensive work done by Leinmger and ber theory of hanseultural eanng (Leinmger 1978) Tbs author documents the importance of the dient's culture m addihon to the culture of the nurse as they influence the outcome (deasion) of the mteradion The importance of Greipp's model hes in tbe global presentation of the mteraetions between dients and nurses and those multifadors wbch can enhance or mbbit the ethical deasion making process — descnphve etbcs It lUushates the placement of etbcal knowledge and the professional code of ethics — the normahve component TTie overaU model sets the stage for analyhcal ethics — meta-etbcs
nurse is found to be lacking m knowledge of etbcs, tbs would be a problem ansmg m the eenhal portion of the model Perhaps the nurse is knowledgeable about etbes eontent but comesfroma cultural environment where it is the duty of younger people to 'take care of their elders As a result this nurse has great difficulty applymg the pnnaple of autonomy when worhng v«th elderly dients — bmitmg dients' ehoiees wben planmng and lmplementmg eare on a daily basis This situation would be a problem based m the lefr proporhon of the model under potenhal inhibitors (Figure I) It IS anhapated that tbs model wiU generate and dnve saentifie mquiry by ldentifymg many potential researeb areas for study relahve to deasion makmg as it assists diagramaheaUy m ldentifymg the locahon of difficulties with the decision makmg process MAJOR CONCEPTS AND DEFINITIONS OF GREIPFS MODEL Nurse: biological essence A nurse is an individual with physical and mental charactenshes/eapabibties attnbutable to parentage, growtb and developmental factors, and wbo has been edueated m a professional nursmg programme to plan and dehver bealtb care to individuals, families and commumties
Universality f^ model is considered to be umversal and applicable Client: biological essence m any sethng fllustrahng tbs global perspechve aUows one to identify Iweakdowns or areas of difficulty m nuJang A dient is an mdividuid with physical and mental charaderdeosicms of either a mjqor or mmor nature For exMnple, if a lshcs attnbutable to parentage, growth and development 735
ML Gretpp
fadors and who is tn need of professtonal nursmg health care The dtent's need for nursing health care will be commumcated m physiological expressions, verbal and non-verbal expressions
essenhal ethical pnnciples (autonomy, beneficence, nonmaleficence and jushce), in addihon to the responsibihty and aeeountabihty for eompetenee Autonomy
Leamed potential inhibitors
Autonomy is the ethieal pnnaple which supports selfdetermination by the dient
Leamed potential inhibitors are defined as the nurse's and dient's psychosoctocultural vanables whtch may enhance Beneficence the person's mteradions with others The model is conBeneficence is the ethical pnnaple which directs the nurse cemed with their potential to 'inhibit' the person's mtertoward dotng good for the chent actions with others and potenhally afiFed the quality or 'nghtness' of health care given and received
Non-maleficence Non-maleficence ts the ethtcal pnnciple which guides the Behef system nurse m avoiding aehons which will harm the dtent Basic set of values and assumptions that the person holds to
be true — it may or may not be based on fact (truth) A person's leamed belief system may be contrary to the ethicalframeworkof the model For example a nurse may not be able to accept the tenet that dients should be selfdetermimng by virtue of the ethical pnnaple of autonomy The dient may not believe in his autonomy and may welcome the opportumty to have physiaans and nurses make his deasions for him Culture Leamed and shared set of symbols, meamngs, values and sandions which guides the behaviour of the members of the culture Personal expenences
All of an mdividual's hfe expenences from birth to the present, mdudmg family, educahon and employment Professional expenence Those expenences gained through the professionai role of the nurse and the speaalized knowledge achieved m that role Education General or speafic teachmg/leammg which efFeds a behaviour change In the model, education may be purposeful or lnadental Education is necessary to change psychosoaocultural vanables
Justice Jushce ts the ethical pnnciple which direds the nurse to resf>ect dients' nghts and to seek fair treahnent Responstbiltty/accountabtlity for competence
The ANA Code for Nurses (1985) mandates that professional nurses accept the responsibility and accountability for jjrofessional competence Nurses must keep themselves updated and current m order to make informed and effective judgements and deasions with, and for, dients Deontological base The deontological base is a fundamental behef m, and resped for, one's obhgahons to other human betngs — one's duty A behef that individuals are ends in and of themselves Nursing process TTie nursmg process ts the nursmg professton's 'saenttfic method' The nursing process focuses on the mdependent adions of the nurse as problem solver and mdudes dient collaborahon to the extent that the dient is willmg and able to parhapate Decision making
Deasion makmg is ideally a collaborative process based on sound information, withm therealitiesof the dient's world, The Intemahonal Counal of Nurses' Code for Nurses (1977) where proii^ems mtd conflicts are defined and (klineated, and the Amencan Nurses' Association Profe^umal Code and resohihon is guided by ethical pnnaples whidi respect for Nurses (1985) are the fr'mnework which contams four the mdividual as an end m and of himself Ethical framework
736
Model of ethical decision maktng
UNDERLYING ASSUMPTIONS The underlying assumphons of Greipp's model of ethieal deasion makmg are as foUows 1 2 3 4
aU ebents share a need for basie health eare, nurses aet as 'data analyst/deeision maker' on a daily basis, aU nurses praehse within a eode of ethies, deasion mabng is a eomplex prcKess subjeet to vanations imposed by people, situations and environments
EXPLANATION OF GREIPFS MODEL The model begins on the left side of the diagram with the nurse (Figure 1) The nurse takes leamed potential mbbitors to the etbcal framework as part of self The potential inhibitors as defined may also act to enhanee the proeess The leamed potential inhibitors are eounterbalaneed or modified by edueation The heart of desenptive ethies is embedded in culture and bebef systems When examining existmg moral views and causation, it is neeessary to study psyehosoeioeultural faetors of the individual and related groups For example, it would seem at first glanee that the dilemma for the pro-life, pro-ehoiee groups is rooted m the central portion of Greipp's model, as advoeates for both stdes argue for the nghts of tbe mother or imbom fetus Autonomy and justtee are heard m all of their arguments Upon eloser analysis, it ean be seen that the heart of the dilemma lies not m the etbeal framework but m the individual's belief and value systems An individual's bebef system and value system are mtegral parts of the self and earmot be exased as the nurse approaches the ethical framework Education can assist the individual to see and respeet other perspeehves, or to leam thmgs that may lead the person to change b s beliefs or values
Professional knowledge In order to be able to make professional etbcal decisions the nurse must move through the ethical framework At the eore of the framework is professional knowledge needed for practice, mduding objective situahonal data T b s is surrounded by responsibility and aeeoimtability for eompetenee mandated by tbe professional eode of ethies Struetunng these eomponents are the four general pnnaples of autonomy, benefieence, non-maleficence and jushce which are inherent m the Nursing Code of Ethics The total ethical frameworic rests on a deontological base which necessitates an inherent belief in tbe nurse's
obligations as a prachsmg professional The nurse has to take mto consideration all of this mformation dunng mterachons with the client In a manner of speakmg, t b s framework beeomes an inseparable part of nursing praehee Movmg to the nght side of the diagram, the ebent with needs for health eare also takes leamed potential inhtbttors mto the mteraetion (nursing proeess and deasion makmg) The leamed potential inhibitors are eounterbalaneed or modified by edueation Dunng the appbeahon of the nursmg proeess the nurse collaborates with the cbent (and sigmficant others) m devising the ebent's plan of eare usmg tbs decision makmg model As ean be noted from the model, the nurse is responsible for the appbeation of etbeal pnneiples The results of the deeision revert baek to the elient as tbe reeipient of eare Additionally, the nurse utilizes the model in making day-to-day deasions when pnonhzing care for groups of ebents, for determimng how and when to medieate ebents and how and what to teach
SUMMATION Greipp's model of etbeal deeision making elanfies the e t b eal proeess by defimng etbeal behaviour withm the eenhe of the model, and delineating relevant vanables on both the earegiver's and eare reeipient's sides wbeh ean dramaheaUy alter the outeome of the deasion makmg proeess The value of tbs model for the praetitioner lies m its diagrammahe struettire wbeh wiU keep the nurse focused and aware of the mfluenee that psyehosoeioeultural vanables have on deasion making mteraehons The model also mcikes evident the power of those potential inhibitors (vanables) to violate basie etbcal pnnaples and negate the framework Loeatmg tbe violation is essential in findmg a solution 'Men are not evil Most of the evil gets done without maliee Evil eomes less from maliee and sadism than from good intentions that are stupid and low-level' (Maslow 1972) Eaeh professional nurse eames responsibibty for nght behaviour and ngbt knowledge The seareh and quest for that behaviour and knowledge is a never-endmg proeess fired by a eommitment to personal ideals and professional exeeUence
References Amenean Nurses' Assoeiation (1985) Code for Nurses with Interpretive Statements ANA, Kansas City, Missoun Bergman R (1973) Ethies — eoneepts and praetiee Intemahonal Nurstng Revtew 20,140-141,152 737
ME Grttpp Fry S (1987) Researdi on etbcs m nursing the state of the art Nursing Outlook 35(5), 246 Fry S (1989) Etbcal deasion making Part I Seieding a framework. Nurstng Outlook 37(5), 248 Husted G & Husted I (1991) Bhtcal Deaston Mahng tn Nurstng C V Mosby, St Louis Intemahonal Counal of Nurses (1977) Code for Nurses ICN, Geneva LemmgerM (ed)(1978) TransculturalNt.trstng Concepts, Theones and Practtces John Wiley & Sons, New York
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