The authors describe significant turning points immanent in “never again” stories that practicing nurses, having participated in previously, vowed not to allow to recur during future, similar situations. Nurses submitted written accounts of critical, “never again” situations. The authors used critical incident technique and employed Colaizzi’s approach to reveal the essential structure. Patient outcomes were fatal, close calls, dehumanizing, or isolating. Never again stories incorporated ethical dilemmas, deficits in nurses’ knowledge, lack of confidence in clinical abilities, and failure to act correctly. Patients’ welfare was the center of accounts. Circumstances threatened patients’ and family members’ trust in nurses and other providers. Patients’ wishes were denied because of haste, providers’ arrogance, or providers’ desire not to be inconvenienced. Nurses’ emotions mirrored a sense of failed responsibility for patients. Regret was tempered by nurses’ pledges. Critical incidents revealed dilemmas in which nurses’ autonomous clinical practice was constrained by feelings of powerlessness.
Allan, H. (2001). A “good enough” nurse: Supporting patients in a fertility unit. Nursing Inquiry, 8, 51-60.
2.
Berger, M., Seversen, A., & Chvatal, R. (1991). Ethical issues in nursing. Western Journal of Nursing Research, 13, 514-521.
3.
Bowman, K. W. (2000). Communication, negotiation, and mediation: Dealing with conflict in end-of-life decisions. Journal of Palliative Care, 16 (Suppl.), S17-S23.
4.
Cassell, J. (2004). Stories, moral judgment, and medical care in an intensive care unit. Qualitative Health Research, 14, 663-674.
5.
Colaizzi, P. F. (1978). Psychological research as the phenomenologist sees it. In R. S. Valle & M. King (Eds.), Existential-phenomenological alternatives for psychology (pp. 48-71). New York: Oxford University Press.
6.
Flanagan, J. C. (1954). The critical incident technique. Psychological Bulletin, 51, 327-358.
7.
Fry, S. T., & Duffy, M. E. (2001). The development and psychometric evaluation of the Ethical Issues Scale. Journal of Nursing Scholarship, 33, 273-277.
8.
Georges, J., & Grypdonck, M. (2002). Moral problems experienced by nurses when caring for terminally ill people: A literature review. Nursing Ethics, 9, 155-178.
9.
Havens, G. A. D. (2000). Individual moral perspectives of professional nurses. International Journal for Human Caring, 4(3), 35-44.
10.
Johns, C. (1999). Unraveling the dilemmas within everyday nursing practice. Nursing Ethics, 6, 287-298.
11.
Keatinge, D. (2002). Versatility and flexibility: Attributes of the critical incident technique in nursing research. Nursing and Health Sciences, 4, 33-39.
12.
Kemppainen, J. K. (2000). The critical incident technique and nursing care quality research. Journal of Advanced Nursing, 32, 1264-1271.
13.
Kuuppelomaki, M. (2002). The decision-making process when starting terminal care as assessed by nursing staff. Nursing Ethics, 9, 20-35.
14.
Lanza, M. L., Carifio, J., Pattison, I., & Hicks, C. (1997). Validation of a vignette simulation of assault on nurses by patients. Image: Journal of Nursing Scholarship, 29, 151-154.
15.
Lipson, J. G. (1989). The use of self in ethnographic research. In J. M. Morse (Ed.), Qualitative nursing research (pp. 61-75). Rockville, MD: Aspen.
16.
Lutzen, K., Cronqvist, A., Magnusson, A., & Andersson, L. (2002). Moral stress: Synthesis of a concept. Nursing Ethics, 10, 312-322.
17.
Morse, J. M., Barrett, M., Mayan, M., Olson, K., & Spiers, J. (2002). Verification strategies for establishing reliability and validity in qualitative research. International Journal of Qualitative Methods, 1(2), Article 2. Retrieved November 1, 2005, from http://www.ualberta.ca/%7Eijqm/
18.
Norman, I. J., Redfern, S. J., Tomalin, D. A., & Oliver, S. (1992). Developing Flanagan’s critical incident technique to elicit indicators of high and low quality nursing care from patients and their nurses. Journal of Advanced Nursing, 17, 590-600.
19.
Penticuff, J. H., & Walden, M. (2000). Influence of practice environment and nurse characteristics on perinatal nurses’ response to ethical dilemmas. Nursing Research, 49(2), 64-72.
20.
Pike, A. W. (1991). Moral outrage and moral discourse in nurse-physician collaboration. Journal of Professional Nursing, 7, 351-363.
21.
Ray, M. (1998). A phenomenological study of the interface of caring and technology in intermediate care: Toward a reflexive ethics for clinical practice. Holistic Nursing Practice, 12(4), 69-74.
22.
Rodney, P., Varcoe, C., Storch, J. I., McPherson, G., Mahoney, K., Brown, H., et al. (2002). Navigating towards a moral horizon: A multisite qualitative study of ethical practice in nursing. Canadian Journal of Nursing Research, 34(3), 75-102.
23.
Rosenal, L. (1995). Exploring the learner’s world: Critical incident methodology. Journal of Continuing Education in Nursing, 26(3), 115-118.
24.
Smith, R., Hiatt, H., & Berwick, D. (1999). A shared statement of ethical principles for those who shape and give healthcare: A working draft from the Tavistock group. JONA, 29(6), 5-8.
25.
Storch, J. L., Rodney, P., Pauly, B., Brown, H., & Starzomski, R. (2002). Listening to nurses’ moral voices: Building a quality health care environment. Canadian Journal of Nursing Leadership, 15(4), 7-16.
26.
Watson, J. (2005). Caring science as sacred science. Philadelphia: F. A. Davis.
27.
Webster, G. C., & Baylis, F. E. (2000). Moral residue. In S. B. Rubin & L. Zoloth (Eds.), Margin of error: The ethics of mistakes in the practice of medicine (pp. 215-230). Hagerstown, MD: University Publications.
28.
Wilkinson, J. M. (1988). Moral distress in nursing practice: Experience and effect. Nursing Forum, 23(1), 16-29.
