Heidi Newsome and Professor Catherine Coverston and Dr. Beth Luthy, College of Nursing
The purpose of this study is to identify examples of moral courage in nurses at work and to analyze through case studies their traits, processes, and skills that may be related to courageous acts in their work. This research may lead to helping other nurses to develop moral courage and decrease the frequency of moral distress found in nursing practice. The research question this research will answer is “How have nurses developed moral courage?” We anticipate that the research will yield examples, themes, and patterns of how nurses have developed moral courage in the work place to resolve ethical and moral dilemmas.
Background
Many researchers have identified moral distress in nurses stemming from ethical or moral dilemmas in healthcare. Since nurses are frequently confronted with these dilemmas, they need the courage to act in such situation. Without this courage, nurses experience moral distress which contributes to psychological stress and burn out. Research has identified approximately 27% of nurses leave the profession because of a stressful working environment (Wood, 2009). Though these causes of stress have been recognized, research has neglected the solution to this problem: how does a nurse obtain moral courage?
Objective
To identify how nurses have developed moral courage in the healthcare workplace through examples, themes, and patterns.
Methods
The research obtained IRB approval from the BYU IRB board on April 15, 2011. Participants were recruited by flyer during 2011 Association of Women’s Health, Obstetrics and Neonatal Nursing Conference in June of 2011. Informed consent was obtained and a 45 minute individual interview was conducted. Participants were questioned on their experience with ethical dilemmas in the workplace requiring moral courage. A $20 incentive was given for participation in this research. Thirteen nurses were interviewed. All participants were female labor and delivery nurses. Of these, 77% were Caucasian, 8% were African American, 8% were American Indian, and 8% were Hispanic. Forty-six percent possessed Master’s Degree, 46% possessed Bachelor Degree, and 8% possessed Associate Degree. The mean age of the participants was 49 years and average years of employment as a full-time nurse was 19.4.
Results
In this qualitative study, three main themes were identified that contributed to moral conflict and resolution with each main theme having underlining patterns. These themes were verified by each researcher individually resulting in an agreement percentage of 40. Each interviewer offered up suggestions of ways to resolve and continue these main themes to enable other nurses in resolving moral conflict.
1. Common Causes of Moral Conflict
a. Disagreement with physician regarding patient care
b. Guilt for remaining silent during an ethical dilemma
c. Fear of disciplinary action for engaging in a moral conflict situation
2. Factors Empowering Nurses to Exhibit moral courage
a. Years of experience as a nurse
b. Strong support system in work environment
c. Debriefing with other nurses
3. Motivations for Nurses to Remain in the Profession
a. Feeling like a valued member of the healthcare team
b. Having a sense of balance in personal life
c. Versatility of nursing
Implications for individual nurses to develop moral courage include maintain a sense of balance in their personal life, review personal reasons and goals of being a nurse, and seek the counsel of experienced nurses and medical staff. This research also yielded recommendations for general healthcare organizations and interdisciplinary healthcare teams to help combat moral distress in the workplace. For healthcare organization, these included providing a system whereby nurses can verbalize their concerns without being penalized and establishing clear-cut channels by which nurses can report moral conflict situations. For healthcare teams, cultivating healthcare environments where professional communication is expected, setting up a strong and trusted leadership for a supportive work environment, and reviewing case studies or scenarios on resolving moral conflict were common themes for implementation into practice.
Conclusion
During this research, it was identified that a more clear and thorough definition and/or examples of moral courage would have benefited the interviewing process. This is a preliminary study with findings that need verification as well as a more in depth study of what moral courage looks like as this research answered what causes it, what contributed to its development, and suggestions of how to increase it. It may also be beneficial to develop tools to initiate and practice moral courage. These results were presented at the BYU College of Nursing and Sigma Theta Tau – Iota Iota Chapter – International Research Conference on October 10, 2011. A final draft of these results is in the process for publication. After completion of the final draft, these results will be submitted for publication in Nursing Ethics (an international peer-reviewed journal) and may be submitted to other professional journals. Once published, we will send your office a copy.
Source
- Wood, Debra. (2009). Why Have Nurses Left the Profession. Nursezone. Retrieved from http://www.nursezone.com/nursing-news-events/more-news/Why-Have-Nurses- Left-the-Profession_29118.aspx