Development of a Model of Moral Distress in Military Nursing

Abstract

The purpose of this article is to describe the development of a model of moral distress in military nursing. The model evolved through an analysis of the moral distress and military nursing literature, and the analysis of interview data obtained from US Army Nurse Corps officers (n = 13). Stories of moral distress (n = 10) given by the interview participants identified the process of the moral distress experience among military nurses and the dimensions of the military nursing moral distress phenomenon. Models of both the process of military nursing moral distress and the phenomenon itself are proposed. Recommendations are made for the use of the military nursing moral distress models in future research studies and in interventions to ameliorate the experience of moral distress in crisis military deployments.

Work Engagement, Moral Distress, Education Level, and Critical Reflective Practice in Intensive Care Nurses

“…Although there is currently limited evidence to directly link nurses' moral distress to patient satisfaction, quality of care, or patient outcomes, it is perhaps appropriate to suggest distancing (or disengagement) caused by moral distress contributes to the abundance of evidence which suggests "nurses do not always practice in ways persons cared for consider helpful" (Mitchell & Bournes, 2006, p. 118 (Corley, Minick, Elswick & Jacobs, 2005;Cronqvist, Theorell, Burns & Lützén, 2004;Erlen & Frost, 1991;Fry, Harvey, Hurley & Foley, 2002;Georges & Grypdonck, 2002;Hamric & Blackhall, 2007;Hart, 2005;Hefferman & Heilig, 1999;Kälvemark, Höglund, Hansson, Westerholm & Arnetz, 2004;Martin, 1989;Penticuff & Walden, 2000;Redman & Fry, 2000;Storch, Rodney, Pauly, Brown & Starzomski, 2002;Sundin-Huard & Fahy, 1999;Von Post, 1998) and (2) hierarchical work structures, (i.e., distrust of and fear of retribution from hospital leadership) (Erlen & Frost, 1991;Gutierrez, 2005;Hefferman & Heilig, 1999;Martin, 1989;Millette, 1994;Penticuff & Walden, 2000;Redman & Fry, 2000;Storch, et al, 2002;Sundin-Huard & Fahy, 1999, Wilkinson, 1987. Both of these are briefly summarized in the following paragraphs.…”

“…Moreover, in the midst of diminished collaboration within work environments, there is the fact that RNs and MDs operate from different philosophical bases (Redman & Fry, 2000), (e.g., they lack a shared value system) (Cronqvist, et al, 2004;Fry, et al, 2002;Kälvemark, et al 2004, Von Post, 1998. Registered nurses' believe they value "patient autonomy more highly than do physicians" (Redman & Fry, 2000, p. 365) and state deep ethical concern in regards to 38 institutionalized medicines' focus upon cure of "disease" (Liaschenko, 1995, p. 188), versus care of the patient (Cronqvist, et al, 2004), as the most relevant factor for patients.…”

Effectiveness of mindfulness based cognitive therapy on the distress tolerance of nurses and job burnout

“…Some of the evident symptoms of chronic depression include unnecessary crying, insomnia, nightmares, loss of appetite, palpitation, headaches, and changes in physical performance (18). Moreover, nurses who experience turmoil in their work environment tend to talk about wretchedness, futility, and melancholy (12,13).…”

Moral distress and the Australian aged care worker: A mixed methods study

“…Commonly, the initial ideas put forth by Jameton and supported by Wilkinson and/or Corley, have been used as a basis for investigations or discussion of moral distress (Wendy Austin, Vangie Bergum, & L Goldberg, 2003a;Fry, Harvey, Hurley, & Foley, 2002;Green & Jeffers, 2006;Hamric, 2000;Laabs, 2005;Nathaniel, 2006;Redman & Fry, 2000;Silen, Tang, Wadensten, & Ahlstrom, 2008), and continue to exert influence to this day.…”