Ethical Challenges Among Nurses in Samoa: Workplace, Practice and Profession

This research explores and seeks to understand nursing perspectives/interpretations of ethical challenges within Samoan workplaces, and the impact on nurses’ ethical decision making and their nursing practices. It is well known that nurses often encounter ethical challenges in their everyday practice, and researchers from developed countries explore these challenges and generate models and theories about ways to address these issues within the nursing profession. However much less is known about such issues in developing countries, and there has been little, if any, research on the ethical practices of nurses in the Pacific region, such as in Samoa. To perform the research as both theoretically sound and culturally appropriate as it could be, the Ietoga research model (a developing methodology that recognises the nuances of the Samoan context) in association with “Teu o le Va” and “Samoan Philosophy of Nursing” was incorporated during data collection and analysis.

The study is a mixed methods approach that employed a sequential exploratory design (SED). The two-phase design explores the topic by firstly using a qualitative method with twenty-one participant nurse experts, through interview techniques. Thematic analysis was used to extract themes that were later used to develop a survey questionnaire. The quantitative method phase used the purposively made survey questionnaire to collect 221 responses from nurses’ respondents that was analysed by using descriptive analysis. The findings from both analyses of the study were transformed into a conceptual model (called the Sulu Model) that is presented as a symbolic representation of Tuiga, a cultural headdress. The model presents the viewpoints of nurses’ concerning ethical knowledge, ethical challenges and ethical decision making in Samoa by means of five main key findings. First, fa’asamoa (culture) as a foundational and collective perspective of the meanings of ethics as perceived within Samoa, and by Samoan nurses in particular. Second, perspectives of socio-cultural knowledge relating to nursing ethics and education. Third, the attempted integration of western perspectives of nursing ethics in nursing education. Fourth, the experiences of ethical challenges in nursing practice, and lastly, decision making considerations and approaches to these ethical challenges. The study therefore contributes a particularly Samoan approach to the existing knowledge of nursing ethics and methodological approaches to research from socio-cultural, contextual and professional perspectives. The study concludes with implications and recommendations for nursing education and practice, for quality assurance, and also ideas for improvements to quality (ethical) patient care within the Samoan health care organisational culture.