Negotiated ethical responsibility: Bruneian nurses' ethical concerns in nursing practice

Background: There has been wide interest shown in the manner in which ethical dimensions in nursing practice are approached and addressed. As a result, a number of ethical decision-making models have been developed to tackle these problems. However, this study argued that the ethical dimensions of nursing practice are still not clearly understood and responded to in Brunei. Research aim: To explore how Bruneian nurses define ethical concerns they meet in everyday practice in the medical surgical wards of three Brunei hospitals. Research design: A qualitative study was employed. Interviews were conducted with 28 practising and administrative nurses of three hospitals. Interview data were analysed via a constant comparative method. Ethical consideration: The study's protocol was reviewed and approved by the Ethical Committee of the School of Health in Social Science at the University of Edinburgh and the Medical Health Research Ethics Committee of the Ministry of Health, Brunei. Findings: The nurses described three ethical dimensions in their practice, namely: 'nurse at work' which illustrates the ethical dimensions within the work environment; 'nurse and doctor' which elucidates the ethical dimensions in the nurse and doctor relationship; and 'nurse and patient' which further examines ethical aspects in patient care. Nurses responded to the ethical dimensions in the ward setting with the aim of avoiding the conflict and maintaining ward harmony. Discussion: The data provide new insights into how nurses respond to ethical dimension in the ward settings where it puts strong emphasis on the nurses' understanding of responsibility placed upon them as professional nurses. Conclusion: With these findings, it is recommended that further support is needed for nurses to be aware of the ethical dimension in their practice and to respond to ethical concerns accordingly.