Martine Kruijtbosch

40 Chap t e r 2 .1 Limitations This study has some limitations. Firstly, the moral dilemmas were reported by ‘early career’ pharmacists. These pharmacists may be more committed to patients’ well-being, because of more advanced training on the patient perspective than earlier generations of pharmacists. Moreover, the training provided might have influenced their sensitivity for moral dilemmas. 57 The themes underlying the moral dilemmas were not less numerous than those in previous studies involving more experienced pharmacists. Exceptions to this are primary business dilemmas. The underreporting of these types of dilemmas might be explained by the fact that the early career pharmacists in our study generally do not own a pharmacy. A second limitation is that saturation of themes was not formally assessed. We did, however, have no clues on additional themes from the excluded narratives. Moreover, screening of an additional stratified random sample of 50 narratives by two authors (MK and MB) neither gave clues on missed themes. Therefore, we are of the opinion that the most important themes for the Dutch context are identified. This does, however, not imply that every individual pharmacist will identify these dilemmas. Furthermore, our results are not completely generalizable to countries with different health systems and a different position of the community pharmacist in healthcare. Lastly, the written narratives contained much richer information than reported in our brief summaries; some narratives were excluded because they were unclear. As we were primarily interested in the themes, we did not analyse the feelings of pharmacists in depth. Implications for practice This study suggests that a short training enables pharmacists to write narratives on moral dilemmas they experience in clinical practice. Reflecting on these dilemmas may help pharmacists to increase their professionalism. Hence, we suggest to integrate such ethical training in experiential learning within both pre- and postgraduate education. This will raise pharmacists’ awareness on moral conflicts and will support the profession’s transition to delivering pharmaceutical care. CONCLUSION Pharmacists experience a number of moral dilemmas in clinical practice. The narrative method enables pharmacists to reflect directly on their feelings at the time these dilemmas occur. Most dilemmas involve the pharmacists’ professional relationships and often arise when the professional autonomy of pharmacists is challenged by patients’ and other health professionals’ behaviour.