How rural nurses in Southern New Zealand navigate their ethical landscape—A qualitative study

Objective: To explore rural nurse experiences of ethical issues and their management of these as a first step in a programme of work to address rural nurses' ethical needs. Design: This study was qualitative, using mixed qualitative techniques to gather data, which was analysed using a general inductive approach. Setting: Primary health care in 2 regions of Aotearoa New Zealand. Participants: Eleven nurses working in the West Coast (District Health Board) region and 9 working within the Southern District Health Board region. Intervention: Participants took part in either a focus groups or an interview with members of the research team. Main outcome measures: To document ethical issues that confronted these rural nurses and how they navigated these issues. Results: Three themes were identified: ‘Signals and Silences,’ ‘One and Other’ and ‘Frustrations and Freedoms.’ A continuous thread through these themes was the concept of phronesis, or what is sometimes called practical virtue. This practical virtue largely developed through their own experiences, rather than through educational or health system specific support or resources. Conclusions: We found that rural nurses' deal with specific issues related to the rural setting, such as resourcing and isolation, while maintaining a relationship with the communities they serve and their professional autonomy. Additionally, we discovered the ways in which rural nurses deal with the ethical issues they encounter to be practically focussed. However, rural nurses need supportive leadership not only to sustain the moral agency they demonstrate but also to further develop their ethical decision-making practices. The provision of a clinical ethics tele-service delivering both training opportunities and an on-call consult support service would provide a potential solution.