"Being certain": Moral distress in critical care nurses

Abstract

“BEING CERTAIN”: MORAL DISTRESS IN CRITICAL CARE NURSES By: Marian Lynn Baxter, PhD, RN A dissertation submitted in partial fulfillment of the requirement for the degree of Doctor of Philosophy in Nursing at Virginia Commonwealth University. Virginia Commonwealth University, 2012 Major Director: D. Patricia Gray, PhD, RN Associate Professor and Chair, Department of Adult Health and Nursing Systems, Virginia Commonwealth University School of Nursing, Richmond, Virginia Moral distress is the suffering that occurs when one is unable to do what that individual believes to be the right thing, based on personal values and world view. The purpose of this qualitative study was to explore the experience and meaning of becoming certain of the right course of action in the context of moral distress. The study design was an interpretative approach incorporated with narrative analysis as developed by Clandinin and Connelly. A maximum variation sample of 10 critical care nurses from three medical centers included diversity of gender, ethnicity, age, years of practice, and education. Face to face interviews were audio recorded and transcribed verbatim. Analysis focused on constructing and reconstructing a shared narrative. Participants “recognized” or “knew” the right action as they considered the situation within its context and their own personal context, and they determined what was right, from their own perspective of “doing good” and avoiding a sense of failure that would come from “not doing good”. Results highlighted an absence of resources to provide an alternate to individual determinations of the “right course of action”, creating an environment, in which participants had to rely on what they knew for themselves. Moral certitude, an unintended consequence, resulted from a lack of alternate knowing. Recommendations for practice and future research were addressed.