Original Article

The lived experiences of clinical nurse managers regarding moral distress

Abstract

Ethical management with minimum moral distress is one of the main duties of nurse managers. There is no doubt that a better understanding of the experiences of nurse managers in morally challenging situations could have an effective role in improving health care systems. The present study aimed to investigate the lived experiences of clinical nurse managers regarding moral distress.
This hermeneutic phenomenological qualitative research involved the use of semi-structured interviews with nurse managers. The interviews were transcribed and analyzed by the Diekelman, Allen and Tanner approach. For this purpose, a total of 14 Iranian nurse managers with at least five years of experience in nursing management in hospitals were purposefully selected.
The findings related to nurse managers’ experiences of moral distress contained two main themes (psycho-emotional trauma and professional desperation syndrome) and four sub-themes (shame, emotional dissociation, helplessness, impaired professional identity).
The findings of the study indicated that in order to understand the phenomenon of moral distress among nurse managers, it is essential to investigate the moral distress experienced by them. We also found that although they experience moral distress in their daily decisions repeatedly, they are not fully aware of this phenomenon
According to the results, for clinical nurse managers, moral distress is an ambiguous situation like suspension along with uncertainty, fear and so on. They believed that experiencing this kind of conscious mistake is the reason for the occurrence of professional desperation syndrome and psycho-emotional trauma.

Jameton A. Dilemmas of moral distress: Moral responsibility and nursing practice. AWHONNS Clin Issues Perinat Womens Health Nurs. 1993; 4(4): 542-51.

Austin W. Moral distress and the contemporary plight of health professionals. HEC Forum. 2012; 24(1): 27-38.

Rubin S.B, Zoloth L. Margin of Error: The Ethics of Mistakes in the Practice of Medicine. UK: Univ Pub Group; 2000.

Austin W, Bergum V, Goldberg L. Unable to answer the call of our patients: mental health nurses’ experience of moral distress. Nurs Inq.2003; 10(3):177-83.

Elpern e, Covert B, Kleinpell r. Moral distress of staff nurses in a medical intensive care unit. Am J Crit Care. 2005; 14(6): 523-30.

Nathaniel AK. Moral Reckoning in Nursing. West J Nurs Res. 2006; 28(4):419-38.

Ashley JA. Nurses in American history: Nursing and early feminism. Am J Nur. 1975; 75(9):1465-7

Holsclaw PA. Nursing in high emotional risk areas. Nursing Forum. 1965; 4(4): 36-45.

Kopala B, Burkhart L. Ethical dilemma and moral distress: proposed new NANDA diagnoses. Int J Nurs Terminol Classif. 2005; 16(1): 3-13

Choe K, kang Y, park Y. Moral distress in critical care nurses: a phenomenological study. J Adv Nurs. 2015; 71(7):1684-93.

Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. AJCC. 2005; 14(6): 523-30

Janvier A, Nadeau S, Deschenes M, Couture E, Barrington KJ. Moral distress in the neonatal intensive care unit: Caregivers’ experience. J Perinatol. 2007; 27(4): 203-8.

McLendon H, Buckner H. Distressing situations in the intensive care unit. Dimens Crit Care Nurs. 2007; 26(5):199-206.

Mobley MJ, Rady MY, Verheijde JL, Patel B, Larson J. The relationship between moral distress and perception of futile care in the critical care unit. Intensive Crit Care Nurs. 2007; 23(4):256-63.

Shahriari M, Mohammadi E, Abbaszadeh A, Bahrami M. Nursing ethical values and definitions: a literature review. Iran J Nurs Midwifery Res. 2013; 18(1): 1-8.

Clay-Williams R, Ludlow K, Testa L, Li Z, Braithwaite J. Medical leadership, a systematic narrative review: do hospitals and healthcare organizations perform better when led by doctors? BMJ open. 2017; 7:e014474.

Barzideh M, Choobineh A, Tabatabaee SH. Comparison of job stress dimensions in Iranian nurses with those from other countries based on the demand-control-support model. J Health Sci Surveillance Sys. 2014; 2(2):66-71.

Moradi-Lakeh M, Vosoogh-Moghaddam A. Health sector evolution plan in Iran; equity and sustainability concerns: Int J Health Policy Manag. 2015; 4(10):637-40.

Corley MC, Minick P, Elswick RK, Jacobs M. Nurse moral distress and ethical work environment. Nurs Ethics. 2005; 12(4): 381-90.

Espinoza D, Lopez-Saldana A, Stonestreet J. The pivotal role of the nurse manager in healthy workplaces implications for training and development. Critical Care Nursing Journal. 2008; 32(4): 327-34.

Ganz f, Wagner N, Toren O. Nurse middle manager ethical dilemmas and moral distress. Nurs Ethic. 2015; 22(1):43-51.

Hardingham L. Integrity and moral residue: nurses as participants in a moral community. Nurs Philos. 2004; 5(2):127-34.

Skytt B, Ljunggren B, Carlsson M. Reasons to leave: The motives of first line nurse managers' for leaving their posts. J Nurs Manag. 2007; 15(2): 294-302.

Toren O, Wagner N. Applying an ethical decision-making tool to a nurse management dilemma. Nurse Ethics. 2010; 17(3): 393-402.

Wlody G. Nursing management and organizational ethics in the intensive care unit. Crit Care Med. 2007; 35(2 Suppl): S29-35.

Astbury JL, Gallagher CT, O'neill RC. The issue of moral distress in community pharmacy practice: background and research agenda. IJPP. 2015; 23: 361-6.

Paterson BL, Duflett-Leger L, Cruttenden K. Contextual factors influencing evolution of nurses‘roles in a primary health care clinic. Public Health Nurs. 2009: 29(5): 41-9.

Patrick A, Laschinger HK .The effect of structural empowerment and perceived organizational support on middle level nurse managers' role. J Nurs Manag. 2006; 14(1):13-22.

Begat I, Ellefsen B, Severinsson E. Nurses' satisfaction with their work environment and the outcomes or clinical nursing supervision on nurses' experiences or well-being: a Norwegian study. J Nurs Manag. 2005; 13(3): 221-30.

Cronqvist A, Lutzen K. Nystrom M. Nurses' lived experiences or moral distress support in the intensive care context. J Nurs Manag. 2006; 14(1):405-13.

Gutierrez KM. Critical care nurses’ perceptions of and responses to moral distress. Dimens Crit Care Nurs. 2005; 24(5): 229-41.

Rice EM, Rady MY, Hamrick A, Verheijde JS, Pendergasl DK. Determinants or moral distress in medical and surgical nurses at an acute tertiary care hospital. J Nurs Manag. 2008; 16(l); 360-73.

Wilkinson JM. Moral Distress in Nursing Practice: Experience and Effect. Nurs Forum. 1987-1988; 23(1):16-29.

Ameri M, Mirhashemi B, Hosseini S. Moral distress and the contributing factors among nurses in different work environments. Journal of Nursing and Midwifery Sciences. 2015; 2(3): 44-49.

Diekelmann N, Allen D, Tanner CA. The NLn Criteria for Appraisal of Baccalaureate Programs: A Critical Hermeneutic Analysis. USA: Natl League for Nursing Pr; 1989.

Sandelowski M. Justifying qualitative research. Research in Nursing & Health. 2008; 31:193-5.

Streubert H, Carpenter D.R. Qualitative Research in Nursing: Advancing the Humanistic imperative. USA: Lippincott William &Wilkins; 2011, p. 97-105.

Kelly B. Preserving moral integrity: a follow-up study with new graduate nurses. J Adv Nurs. 1998; 28(5):1134-45.

Hendel T, Fish M, Galon V. Leadership style and choice of strategy in conflict management among Israeli nurse managers in general hospitals. J Nurs Manag. 2005; 13(2):137-46.

Dzeng E, Colaianni A, Roland M, et al. Moral Distress amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study. J Gen Intern Med. 2016; 31(1):93-9.

Henrich NJ, Dodek PM, Gladstone E, et al. Consequences of moral distress in the intensive care unit: a qualitative study. Am J Crit Care. 2017; 26(4):e48-e57.

Christodoulou-Fella M, Middleton N, Papathanassoglou EDE, Karanikola MNK. Exploration of the association between nurses’ moral distress and secondary traumatic stress syndrome: implications for patient safety in mental health services. Biomed Res Int. 2017; 2017:1908712.

Meltzer LS, Huckabay LM. Critical Care Nurses' Perceptions at Futile Care and its Effect on Burnout. Am J Crit Care. 2004; 13(3):202-8.

Maluwa VM, Andre J, Ndebele P, Chilemba E. Moral distress in nursing practice in Malawi. Nurs Ethics. 2012; 19(2):196-207.

Abbaszadeh A, Borhani F, Hoseinabadi Farahani M, Naderi Ravesh N. Moral distress among nurses of Shaheed Beheshti University of medical sciences hospitals in 2013. Medical Ethics. 2013; 8(29):129-43.

Joolaee S, Jalili HR, Rafii F, Hajibabaee F, Haghani H. Relationship between moral distress and job satisfaction among nurses of Tehran University of medical sciences hospitals. Hayat. 2012; 18(1):42-51.

Flinkman M, Isopahkala-Bouret U, Salantera S. Young registered nurses' intention to leave the profession and professional turnover in early career: a qualitative case study. lSRN Nursing. 2013; 2013:916061.

Harrowing JN, Mill J. Moral distress among Ugandan nurses providing HIV care: a critical ethnography. Int J Nurs Stud. 2010; 47(6); 723-31.

Baraz-Pordanjani S, Memarian R, Vanaki Z. Damaged professional identity as a barrier to Iranian nursing students’ clinical learning: a qualitative study. Journal of Clinical Nursing and Midwifery. 2014; 4(3):1-15.

Vaismoradi M, Salsali M, Ahmadi F. Perspectives of Iranian male nursing students regarding the role of nursing education in developing a professional identity: a content analysis study. Jpn J Nurs Sci. 2011; 8(2): 174-83.

Files
IssueVol 11 (2018) QRcode
SectionOriginal Article(s)
Keywords
Nurse manager Lived experience Moral distress Desperation syndrome Psycho-emotional trauma

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Nikbakht Nasrabadi A, Khoobi M, Cheraghi MA, Joolaei S, Hedayat MA. The lived experiences of clinical nurse managers regarding moral distress. J Med Ethics Hist Med. 2018;11.