Nursing Education: Students’ Narratives of Moral Distress in Clinical Practice

Abstract

Background: Research indicates that newly graduated nurses are often unprepared for meeting challenging situations in clinical practice. This phenomenon is referred to as a “reality shock”. This gap in preparedness may lead to moral distress. The aim of this article is to provide knowledge of moral distress in clinical nursing practice. Methods: Bachelor and further education nursing students were invited to write a story about challenging situations from their own clinical practice, resulting in 36 stories. Analysis was based on hermeneutical reading inspired by a narrative method; therefore, six stories were selected to represent the findings. Results: A finding across the stories is that the students knew the right thing to do but ended up doing nothing. Four themes were related to moral distress: (a) undermining of professional judgement, (b) disagreement concerning treatment and care, (c) undignified care by supervisors, and (d) colliding values and priorities of care. Conclusion: Nursing education should emphasize to a greater extent ethical competency and training for the challenging situations students will encounter in clinical practice.

Moral Distress in Nursing Undergraduates: A Qualitative Study

“…In some situations in which the students felt moral distress, they considered it a positive and perhaps a moral learning experience when it was managed in a professional manner [12]. Likewise, in our study and others, students learned a positive lesson from the moral distress they experienced and the negative attitudes they faced and often used the expression "I will not be like this when I am a nurse" [3,10,24,28].…”

“…There is a disconnect between nursing education and clinical practice. Current nursing training programs do not sufficiently teach students how to identify their feelings of moral distress, much less, how to cope with them [1,10]. In our study, students frequently emphasized that they experienced moral distress because of this issue.…”

“…Moral distress has negative physical, psychological, and sociological effects on nurses [2,4,10,15,16,23]. Similarly, nursing students are affected in different ways by the moral distress they experience.…”

“…Some students stated that they thought of leaving the profession and school because of the moral distress they experienced. Other studies have also pointed out that nursing students may ask to leave school when faced with moral distress [3,10,25]. Hence, student nurses must recognize these situations and learn how to deal with them, as negative experiences and environments can be significant deterrents to their remaining in the nursing profession [8,12,24,32].…”

“…Moral distress concerns nursing students as well as nurses [2]. In the clinical training process, nursing students may experience ethical conflicts and dilemmas that can lead to moral distress at varying levels [6][7][8][9][10][11]. And, as a result, they may suffer physical and psychological health problems [1,3,7].…”