ETHICAL EVENTS IN NURSING: DAILY ACTIVITIES OF NURSE MANAGERS AND NURSING ETHICS COMMITTEE MEMBERS

This study aimed to understand the meaning of nurses’ actions related to ethical occurrences involving nursing professionals. Data were collected through interviews with nurse managers and members of a Nursing Ethics Committee who experienced the phenomenon. Data were analyzed in the framework of social phenomenology. The nurses’ experiences gave rise to the following categories of meaning, as these professionals seek: the humanization of nursing care; continuous improvement of the care process; professional credibility; patients’ satisfaction; demystification of the fear of punishment; partnership in the educational process; respect for ethical secrecy and expectation related to the event being forwarded to the Nursing Ethics Committee. The social typification was described at the end. Nurses’ actions in cases of ethical events attract the interest of nursing professionals, who want to ensure a risk or damage-free care and to promote the valuation of these professionals.


INITIAL CONSIDERATIONS
Whether as nursing professionals, managers or faculty, every day, we are faced with ethical events.In these situations, we seek to get involved and discuss these occurrences with the respective professionals, whether in the Nursing Ethics Committee or at the clinic or unit where the event occurred, using the knowledge acquired throughout our professional training and activities.Thus, with a view to guaranteeing a nursing care free from risk or damage caused by negligence, lack of expertise or imprudence committed by nursing professionals, we believe it is fundamentally important to understand the world of ethical events, as well as ways of seeing and coping with them, based on the daily experience of these professionals as nurse managers (NM) or members of a Nursing Ethics Committee (NEC).
Ethical occurrences are harmful events caused by nursing professionals during their professional exercise and related to an inadequate attitude towards a colleague, client or the place of work.These events can entail some kind of harm or damage to clients or to the involved professionals themselves, whether due to a lack of attention, skill, knowledge, zeal or to omission, that is, when professionals do not act or do not do something they should and, thus, cause risk or damage to another person (1) .
Nursing actions are intrinsically linked with professional accountability when they cause harm or damage to a patient/client.On the other hand, multiple factors can contribute to risks or damage in the care process.In this sense, when errors occur involving nursing professionals, greater emphasis is given to blaming the guilty one than to analyzing and improving the processes that resulted in those harmful events.
Hence, out of fear of punishment, professionals are afraid of communicating errors and, consequently, opportunities to learn from their own errors may not be exploited (2) .Some researchers have investigated different dimensions of professionals' and health institutions' responsibility in cases of harmful events involving clients (1)(2) .However, these studies did not respond to our inquiries about nurses' motivations to act in relation to ethical occurrences in their daily reality, thus making impossible a better understanding of the meanings these professionals attribute to their actions in these events.Therefore, this research was justified by the need we felt to understand the phenomenon of ethical events in nursing, based on the experiences of nurse managers (NM) and nursing members (NE) of ethics committees, aimed at getting to know and understanding the meaning of nurses' actions in view of ethical events in nursing.

THEORETICAL-PHILOSOPHICAL APPROACH
With a view to reaching a broader understanding of ethical events involving nursing professionals from the perspective of nurses who share and undergo these experiences through interpersonal relations, we adopted the sociological phenomenology of Alfred Schütz.We believed this reference framework would allow us to unveil the phenomenon, in view of the experiences and actions of NE and NM.
Perceiving the intentionality of NE and NM who experience ethical events, we attempted to understand how the experiences of acting on ethical occurrences are manifested in their daily reality.We did not limit ourselves to the perception of the individual project, but looked at what intentionality reveals to the group of nursing professionals involved in this phenomenon.
Social phenomenology is not oriented towards single acts, individual behaviors, restricted to selfconscience, but to the understanding of what constitutes a determined social group, which experiences a typical situation.Thus, the daily world is not individual but intersubjective, in which we share with our peers, with one common world to all of us (3) .interactions (4) .modifying something in the world.Human behavior is focused on based on a project man aims to carry out (5)(6) .

Intersubjectivity reveals itself in
The motive for consists in a state of thingsthe objective one intends to achieve through the action; that is, the orientation towards the future action and motive why is related to past experiences, with available knowledge (7) .
Next, we will discuss the methodology developed to achieve this study.

DEVELOPING THE METHODOLOGICAL TRAJECTORY
We defined the following research inclusion criteria: participate in the Nursing Ethics Committee as a full or substitute member and possess experience in the reception and follow-up of ethical events forwarded to this organ; having experienced, as a nurse head or manager, ethical occurrences involving nursing staff.In order to establish "rapport" and introduce the theme to the study subjects, we posed the following questions: - The number of participants was not determined.Interviews stopped when we perceived the repetitiveness of the motives that impulse subjects' actions in relation to ethical occurrences.In total, ten interviews were held with NM and NE.

CONSTRUCTING CONCRETE CATEGORIES AND THE EXPERIENCED TYPE
The organization and categorization of our results allowed us to construct a typology of experiences, in accordance with models proposed by nurse researchers who used Sociological Phenomenology (8-11)   .For this purpose, we carried out the following steps: -reading the testimonies to grasp the subjects' I hope we will learn to work with the events so as to seek the humanization of nursing care, respect for human beings' rights and dignity (NE2).
Credibility is an important motive why for NE and NM to act in relation to ethical events in nursing.
They aim for clients to have confidence in nursing professionals and, thus, they justify their preoccupations with orienting them, whenever possible, informing clients/families and the medical team about the ethical event in nursing.By acting this way, these nurses hope that other professionals and clients/families value nursing team actions in relation to the ethical occurrence and the measures taken to minimize the negative consequences of the event.
Another category is clients' satisfaction, revealed because it drives NE's and NM's actions and reveals these social subjects' commitment to achieve this satisfaction, as a goal for nursing professionals.
By coping with ethical events in nursing, they attempt to get closer to this goal of satisfying the needs of clients attended by the nursing team.
Demystifying the fear of punishment indicates that NE and NM acknowledge that fear of punishment exists, but both groups feel the need to overcome it by disseminating the functions of the NEC and its guidelines to professionals, in view of the ethical event or its prevention.In this perspective, by acting in relation to ethical occurrences, these nurses hope to put an end to this stigma of punishment.Their expectation is in line with another study according to which nursing professionals are afraid to notify errors and, consequently, do not exploit opportunities to learn from their own mistakes (2) .
The category of partnership in the education process highlights that NE and NM also think about developing movements in partnership with continuing education and with nursing professionals, nurse managers and the NEC, with a view to everybody's commitment to this education and prevention process related to ethical events, by sharing the NEC's and nurse heads/managers' guidelines, by support,

CONSTRUCTION OF THE EXPERIENCED TYPE
According to social phenomenology, ideal experienced types are schemes to interpret the social world, which are part of our background of knowledge about the world and have a meaningful value.We always take elements of these types in interpersonal relations (12) .
The categories that emerged from subjects' discourse allowed us to construct the experienced type related to their experiences with ethical events.Our

FINAL CONSIDERATIONS
By unveiling the meanings of typified actions shared by the study subjects, we were able to understand that it is essential for the health institution to be a partner and for all professionals to be committed to this process, with a view to preventing ethical events, primarily those most harmful to clients.
In this perspective, understanding the actions of NE and NM in relation to ethical occurrences revealed that they believe in closing partnerships for a permanent and long-term education process about these events, involving NE, nurse managers and other nursing professionals.
This study also indicated the need to take away the fear of punishment in forwarding professionals to the NEC.NE and NM expect and aim for the goals of nursing services and health institutions to contemplate and allow for the construction of a participatory, dialogue and support process, based Ethical events in nursing... Freitas GF, Oguisso T, Merighi MAB.Rev Latino-am Enfermagem 2006 julho-agosto; 14(4):497-502 www.eerp.usp.br/rlae on reflection and responsibility of the professional who committed an ethical event.
The educative and management actions NM and NE proposed in relation to ethical occurrences are meaningful and important with a view to humanized, safe and efficient nursing care that is free from expectable risks.Moreover, this study allowed us to understand the need for these actions to be non-punitive, as educative attitudes seem to be wiser and more effective actions in management practice related to ethical events in nursing.The NE's and NM's experiences also disclosed that all nurses need to cope with ethical events in daily reality, make decisions, guide and forward nursing professionals to the NEC whenever necessary.Therefore, they expect equity in deciding on ethical occurrences, so that decisions may result in improved care and, consequently, benefit the social group.
The comprehensive phenomenological branch of social action, which guided this study, allowed us to foresee new horizons for ethical events that involve nursing professionals, with a view to awaking to the relevance of these events, as well as to individual and institutional responsibilities, so that all professionals take on the commitment of expanding their knowledge in order to guarantee a care that is free from any risk or damage to clients.In summary, this research gave us a closer look at the experiences lived and pictured by the subjects of the social action.They revealed projects to construct knowledge for a care practice based on the actions triggered by ethical events and involving the responsibilities of nursing professionals as well as health care institutions.
the reciprocity of motives and perspectives.Thus, the reaction of one individual provokes the reaction of another in view of a given situation, in which one experiences the common situation from the perspective of the other and vice-versa.This constitutes a we-relation.In turn, this is expressed in the other person's mutual conscience through each person and constitutes a generally sympathetic participation in one another's life, even if only during a certain period of time.This we-relation emerges by capturing the other person's existence in face to face NE: How do you act in relation to ethical events in a NEC?What makes you act when confronted with ethical events?What do you expect through these actions?-NM: What is it like for you to act in relation to ethical events involving nursing staff?What makes you act when confronted with ethical events?What do you expect through these actions?Study participants were NE and NM from a private hospital in the city of São Paulo, Brazil.The study was approved by the Research Ethics Committee of the study institution.We established a relation of closeness and empathy with each collaborator.Thus, we explained the reasons why we had contacted them and the study objectives, and then invited them to participate by means of an interview.After obtaining their free and spontaneous manifestation, we asked participants whether we could use a recorder.Moreover, each participant received time to read and was asked to sign the Free and Informed Consent Team.We attempted to offer a favorable environment, allowing each participant to talk freely about the proposed questions, clearly stating the guiding questions and letting collaborators reflect and declare what they were thinking at that time.
communication and reflection in relation to the professional who committed an error.The NE's and NM's discourse also contains reciprocal perspectives towards their actions.Some NE expect NM to be trained to decide and forward certain ethical events to the NEC.NM, on the other hand, project their activities in relation to forwarding an ethical occurrence and expect NE to respect secretary, in order to safeguard the involved professional's image, avoiding future discrimination or defamation.
study indicated one common experienced type.This is understandable as these subjects are inserted in the same social group and have similarly experienced the motives why, based on the same context of meanings in these experiences.Thus, NE and NM are professionals who, through their actions in relation to ethical events, aim for the humanization and continuous improvement of the care process.They work towards the credibility of nursing professionals.They want to demystify the fear of punishment among nursing professionals involved in ethical events.They attempt to achieve clients' satisfaction about care delivery.They want to close partnerships with continuing education and the NEC in the education process.
By acting in relation to ethical occurrences, NE and NM aim to continuously improve the care process and clients' satisfaction.In their opinion, this may be possible through partnerships with continuing education of nursing professionals and the work of the NEC by guiding professionals instead of punishing them.Hence, these nurses -who are part of the same social group, have converging expectations about motivations for actions related to ethical events.By their commitment to the care process, they hope to contribute to the benefit of clients and aim to be socially recognized and professionally valued.