In search of salience: phenomenological analysis of moral distress

Abstract

The nurse's moral competences in the management of situations which present ethical implications are less investigated in literature than other ethical problems related to clinical nursing. Phenomenology affirms that emotional warmth is the first fundamental attitude as well as the premise of any ethical reasoning. Nevertheless, it is not clear how and when this could be confirmed in situations where the effect of emotions on the nurse's decisional process is undiscovered. To explore the processes through which situations of moral distress are determined for the nurses involved in nursing situations, a phenomenological-hermeneutic analysis of a nurse's report of an experience lived by her as a moral distress situation has been conducted. Nursing emerges as a relational doctrine that requires the nurse to have different degrees of personal involvement, the integration between logical-formal thinking and narrative thinking, the perception of the salience of the given situation also through the interpretation and management of one's own emotions, and the capacity to undergo a process of co-construction of shared meanings that the others might consider adequate for the resolution of her problem. Moral action requires the nurse to think constantly about the important things that are happening in a nursing situation. Commitment towards practical situations is directed to training in order to promote the nurse's reflective ability towards finding salience in nursing situations, but it is also directed to the management of nursing assistance and human resources for the initial impact that this reflexive ability has on patients' and their families' lives and on their need to be heard and assisted. The only case analysed does not allow generalizations. Further research is needed to investigate how feelings generated by emotional acceptance influence ethical decision making and moral distress in nursing situations.

The Evolution of Professional Nursing Culture in Italy

“…Patient-centered care as a core in health care quality is well known and valued globally (Kunyk & Austin, 2012). An exemplar is demonstrated in Latin countries where the juxtaposition of relational dimensions to quality care is manifested through expressive communicative styles that characterize strong relationships between patients and health care teams (Manara, Villa, & Moranda, 2014). In appreciation of this context, Italian nurses expressed concern over the lack of attention to the nurse–patient relationship because of clinical variables such as heavy workloads, scarcity of health care support staff, and the burden of a “fixed list of work tasks.”…”

Les enjeux éthiques de la pratique de l’ergothérapie : perceptions d’ergothérapeutes

“…Tandis que les enjeux éthiques que soulève la pratique de la médecine (Cole, Falcone, Caplan, Timmons-Mitchell, Jares, & Ford, 2014;Messner & Gentili, 2011;Miller, Siegler, & Angelos, 2014;Pellegrini & Ferreres, 2014;Sansom, 2014;Tocker & Salzer, 2012) ou des sciences infirmières (Austin, 2012;Burston & Tuckett, 2012;Dekeyser & Berkovitz, 2012;Eran, 2014;Holm & Severinsson, 2014;Jameton, 2013;Manara, Villa, & Moranda, 2014) sont o 2, pp. 166-196. 168 abondamment documentés, ceux que pose la pratique de l'ergothérapie sont, à ce jour, peu étudiés (Bushby, Chan, Druif, Ho, & Kinsella, 2015).…”

Moral distress in undergraduate nursing students

“…Despite the importance and the implications of moral distress for the quality of healthcare, 9 and despite the difficulties affirmed by nurses and students when they are faced with ethical issues and dilemmas or they are called upon to make ethical decisions, 10 this phenomenon is still a partly unexplored field of research because few studies have explored moral distress in undergraduate nursing students. 11 Moreover, at a conceptual and theoretical level, there remains a knowledge gap that prevents action from being taken on moral distress at the educational, political, organizational, and practical levels. 12 According to Garity, 13 the possible reasons for this phenomenon may lie in the type of training that nurses receive with regard to how to analyze and solve ethical dilemmas in the workplace.…”