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Exploring moral distress – a study of how nurses struggle to do what feels morally right

Gorke, Sonja LU and Bollmann, Simone Carolin LU (2017) BUSN49 20171
Department of Business Administration
Abstract
Moral distress in nursing is a widely-acknowledged phenomenon that has been linked to decreased patient care, burnouts and job turnover. Thereby, it is often described by quantitative studies which lack insights in feelings and perceptions of affected nurses. Our thesis approached the phenomenon differently by interpreting narratives. These were identified through a qualitative study in cooperation with two university hospitals. Thus,
moral distress is illustrated by depicting its multifaceted appearances. For this purpose, we entered lifeworlds of nurses by conducting interviews and observations regarding the theory of symbolic interactionism and interpreted findings in a hermeneutical way.

Consequently, we analyzed our findings by... (More)
Moral distress in nursing is a widely-acknowledged phenomenon that has been linked to decreased patient care, burnouts and job turnover. Thereby, it is often described by quantitative studies which lack insights in feelings and perceptions of affected nurses. Our thesis approached the phenomenon differently by interpreting narratives. These were identified through a qualitative study in cooperation with two university hospitals. Thus,
moral distress is illustrated by depicting its multifaceted appearances. For this purpose, we entered lifeworlds of nurses by conducting interviews and observations regarding the theory of symbolic interactionism and interpreted findings in a hermeneutical way.

Consequently, we analyzed our findings by focusing on nurses’ moral foundations, on explanations for and consequences of moral distress as well as on alleviating factors. Firstly, most nurses seemed to appreciate their work as they aim at improving patients’ situations by listening to their own gut feeling concerning what is ‘right’ for the ones they care for. The
most mentioned reasons for acting immorally were time constraints as well as constraints by colleagues and patients’ parents. Subsequently, nurses often felt stressed, avoided patients and handed their responsibility over to physicians. Moreover, we elaborated on five stories which we assessed as particularly interesting for understanding moral distress: caring for terminally ill patients, experiencing interferences through patients’ parents, assessing the decisions of doctors as immoral, suffering from time constraints and finding oneself amidst requirements of physicians and families. As this thesis’ aim is to enhance the understanding of moral
distress in order to empower nurses to handle it as well as to enable healthcare managers to grasp it, we also elaborate on approaches to tackle moral distress by drawing comparisons to passages from interviews and observations in which moral distress was handled differently.

Subsequently, our discussion explicitly focuses on passionate care in nursing, which comes to light when nurses experience moral distress. Thus, we argue that experiencing moral distress should also be seen positively, since it only arises when nurses have caring moral foundations they want to live up to. Besides, our discussion touches upon the inevitability of fully
preventing moral distress. Thereby, we stress the coherence between communication, especially moral courage, and moral distress by outlining the downside of these seemingly easy ‘solutions’. Therefore, in contrast to many other studies, our research shows the positive aspects of an in itself negative concept like moral distress and expresses clearly, that it is not
evitable, especially not by applying panaceas. Finally, we give a brief recapitulation, accompanied by recommendations for further research. (Less)
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author
Gorke, Sonja LU and Bollmann, Simone Carolin LU
supervisor
organization
course
BUSN49 20171
year
type
H1 - Master's Degree (One Year)
subject
keywords
moral distress, moral residue, moral courage, nursing
language
English
id
8910013
date added to LUP
2017-06-12 12:56:09
date last changed
2017-06-12 12:56:09
@misc{8910013,
  abstract     = {Moral distress in nursing is a widely-acknowledged phenomenon that has been linked to decreased patient care, burnouts and job turnover. Thereby, it is often described by quantitative studies which lack insights in feelings and perceptions of affected nurses. Our thesis approached the phenomenon differently by interpreting narratives. These were identified through a qualitative study in cooperation with two university hospitals. Thus,
moral distress is illustrated by depicting its multifaceted appearances. For this purpose, we entered lifeworlds of nurses by conducting interviews and observations regarding the theory of symbolic interactionism and interpreted findings in a hermeneutical way.

Consequently, we analyzed our findings by focusing on nurses’ moral foundations, on explanations for and consequences of moral distress as well as on alleviating factors. Firstly, most nurses seemed to appreciate their work as they aim at improving patients’ situations by listening to their own gut feeling concerning what is ‘right’ for the ones they care for. The
most mentioned reasons for acting immorally were time constraints as well as constraints by colleagues and patients’ parents. Subsequently, nurses often felt stressed, avoided patients and handed their responsibility over to physicians. Moreover, we elaborated on five stories which we assessed as particularly interesting for understanding moral distress: caring for terminally ill patients, experiencing interferences through patients’ parents, assessing the decisions of doctors as immoral, suffering from time constraints and finding oneself amidst requirements of physicians and families. As this thesis’ aim is to enhance the understanding of moral
distress in order to empower nurses to handle it as well as to enable healthcare managers to grasp it, we also elaborate on approaches to tackle moral distress by drawing comparisons to passages from interviews and observations in which moral distress was handled differently.

Subsequently, our discussion explicitly focuses on passionate care in nursing, which comes to light when nurses experience moral distress. Thus, we argue that experiencing moral distress should also be seen positively, since it only arises when nurses have caring moral foundations they want to live up to. Besides, our discussion touches upon the inevitability of fully
preventing moral distress. Thereby, we stress the coherence between communication, especially moral courage, and moral distress by outlining the downside of these seemingly easy ‘solutions’. Therefore, in contrast to many other studies, our research shows the positive aspects of an in itself negative concept like moral distress and expresses clearly, that it is not
evitable, especially not by applying panaceas. Finally, we give a brief recapitulation, accompanied by recommendations for further research.},
  author       = {Gorke, Sonja and Bollmann, Simone Carolin},
  keyword      = {moral distress,moral residue,moral courage,nursing},
  language     = {eng},
  note         = {Student Paper},
  title        = {Exploring moral distress – a study of how nurses struggle to do what feels morally right},
  year         = {2017},
}