Invisibility of the self: Reaching for the telos of nursing within a context of moral distress

Many studies have examined clinical and institutional moral problems in the practice of nurses that have led to the experience of moral distress. The causes and implications of moral distress in nurses, however, have not been understood in terms of their implications from the perspective of virtue ethics. This paper analyzes how nurses reach for the telos of their practice, within a context of moral distress. A qualitative case study was carried out in a private hospital in Brazil. Observation and semi‐semistructured interviews were conducted with 13 nurse participants. With the aid of ATLAS.ti software, the data were analyzed by using thematic content analysis using virtue ethics to theorize the findings. These nurses experienced a loss of their nursing identity as they encountered an ambiguous telos and the domination of institutional values. In their reach for the telos of their practice, nurses found an environment permeated by ethical challenges, which not only created moral distress but also created professional invisibility, a phenomenon referred to as ‘invisibility of the self’.     

Preparing nurses for practice: a phenomenological study of the new graduate in Australia

Aims. To explore the expectations of final year nursing students before they start employment and to describe the experiences of newly graduated nurses during their first six months of employment as registered nurses. Background. Nursing shortages are at crisis point world wide with registered nurses leaving the profession at a high rate and changing occupations. Thus, there is a need to reflect on new graduate nurses experiences in relation to retention and support. Design. Husserl’s phenomenological approach was used to gain insight and understanding into the lived experiences of new graduate nurses. Methods. Students enrolled in a Bachelor of Nursing programme at an Australian University were interviewed in their final semester and during employment in the hospital setting. Semi‐structured interviews were used to gather data from 13 participants. Data were collected at three intervals: prior to commencing employment, one month and six months postemployment and the results were analysed thematically. Results. As students, the participants held positive perceptions surrounding their impending role as a registered nurse and what it would encompass. However, after one month of employment, it became apparent that nursing comprised of a culture that embraced cliques which excluded them. The graduates were unprepared for ‘bitchiness’ and the limited amount of assistance with unfamiliar tasks they received from registered nurses. Participants also found rotating to different wards recreated the feelings they experienced on commencing employment. Conclusions. Nursing curricula should prepare new graduates for foreseeable stressors and oppressive practices so that graduates can become proactive in preventing and responding to factors such as silence and aggression. Moreover, nursing courses need to ensure that socialisation issues are addressed to assist in the eradication of oppressive practices. Finally, organisations need to address socialisation issues such as hostility within the workplace to address the attrition of new graduates from the profession. Relevance to clinical practice. Individuals in clinical practice settings need to be cognisant of the significant role that experienced registered nurses and nurse unit managers occupy in the socialisation of new graduate nurses. Additionally, there needs to be increased awareness that nursing culture can influence recruitment and retention of new graduates. Further, health care organisations need to evaluate the benefits of new graduates rotating through clinical areas in the first 12 months of employment.     

Preliminary outcomes of a local residency programme for new graduate registered nurses

kowalski s. & cross c.l. (2010) Journal of Nursing Management 18 , 96–104
Preliminary outcomes of a local residency programme for new graduate registered nurses
Aim  The present study reports preliminary findings regarding new graduate nurses participating in a year-long local residency programme at two hospitals in Las Vegas, NV.
Background  Nurse resident programmes are purported to increase the level of clinical competency and professional transition in new graduate registered nurses (RNs) and to decrease first-year turnover rates. The effectiveness of this programme was assessed using data of the first two cohorts participating in this new residency programme.
Method  Clinical competencies, anxiety, stress, professional transition and retention were measured on 55 nurse residents who have participated in the nurse residency programme.
Results  The findings indicate improved clinical competency throughout the programme, a decreased sense of threat, and improved communication and leadership skills. The first-year cohort's employment retention rate was 78%, and the second-year cohort is presently 96%.
Conclusions  The results of this study demonstrate the positive impact of a year-round residency programme for new graduate RNs.
Implications for nursing management  The need for a consistent nurse workforce demands that new graduates be transitioned into competent practitioners as soon as possible. Nurse residency programmes can provide this support and decrease replacement costs involved in high turnover.     

临床护士道德困境的潜在剖面分析及其与道德敏感性的关系研究

目的 调查临床护士道德困境现况,分析临床护士道德困境的潜在剖面及其与道德敏感性的关系并探讨不同剖面的影响因素。方法 采取便利抽样法于2022年5月选取武汉市某三级甲等综合医院1 022名临床护士作为调查对象。采用一般资料调查表、护士道德敏感性量表、护士道德困境量表进行调查,以护士道德困境量表的4个外显指标进行潜在剖面分析,并用单因素分析、二分类Logistic回归分析进行统计分析。结果 1 022名临床护士的道德困境可分为“低道德困境型”（72.7%）和“高道德困境型”（27.3%）2个潜在剖面。道德困境的影响因素包括年龄、职称、道德力量与责任、道德负担感（P<0.05）。结论 临床护士道德困境水平处于轻度水平。护士道德困境可分为2个类别,护理管理者应根据不同剖面的人群特征制定针对性的干预方案,增强护士道德敏感性,降低其道德困境水平。针对“高道德困境型”护士,既要注意培养护士道德决策能力,也要充分营造良好的医院伦理氛围,合理授权,疏导其因道德困境产生的不良情绪;针对“低道德困境型”护士,要强化护士职业道德伦理再教育,提升护理道德修养,规范临床实践中的道德行为,从而改善护理质量。     

Identification of risk factors for moral distress in nurses: basis for the development of a new assessment tool

This article proposes to identify risk factors for moral distress from the literature, validate them through expert analysis and provide the basis for a new tool to assess the risk of moral distress among nurses. Moral distress is related to the psychological, emotional and physiological aspects of nursing. It arises from constraints caused by various circumstances and can lead to significant negative consequences. A scoping review and validation through expert analysis were used. The research question guiding this study was as follows: What is known about risk factors for moral distress in nursing? The research was conducted using multiple sources including electronic databases and lists of references from relevant literature. The final sample consisted of 38 studies. A validation analysis was conducted by experts during December 2014 and June 2015. To exclude a risk factor item, at least 80% of the experts had to agree with the exclusion. In total, 53 risk factors for moral distress were identified, reviewed by the experts and grouped to form a new instrument that may help to identify risk for moral distress and to address its consequences.     

Development and psychometric testing of a new tool for detecting moral distress: the Moral Distress Thermometer

Aim. To report the development and psychometric testing of the Moral Distress Thermometer. The Moral Distress Thermometer is a new screening tool to measure moral distress in nurses who practise in the hospital setting. Background. Moral distress occurs when one knows the ethically correct thing to do, but is prevented from acting on that perceived obligation. It is a well documented phenomenon with negative consequences that may be experienced by nurses. Creating an instrument to effectively and efficiently measure moral distress in a timely way has been identified as a priority for nursing. Design. This study used a cross‐sectional survey design. Methods. Data collection for this research occurred in 2009. Participants simultaneously completed either the adult or pediatric version of the Moral Distress Scale version 2009 and the Moral Distress Thermometer. A total of 529 participants from various clinical areas completed both tools. Results. Coefficients alpha were adequate for both Adult (0·90) and Pediatric (0·92) Moral Distress Scale 2009 scales. Statistically significant Pearson correlations were found for the Moral Distress Thermometer with Adult Moral Distress Scale 2009 and Pediatric Moral Distress Scale 2009 and higher Moral Distress Thermometer, Adult Moral Distress Scale 2009 and Pediatric Moral Distress Scale 2009 means for participants who had left or who considered leaving a position because of moral distress. Conclusion. These findings provide support for the validity of the Moral Distress Thermometer.     

Authentic leadership,empowerment and burnout: a comparison in new graduates and experienced nurses

Aim To examine the effect of authentic leadership and structural empowerment on the emotional exhaustion and cynicism of new graduates and experienced acute-care nurses. Background Employee empowerment is a fundamental component of healthy work environments that promote nurse health and retention, and nursing leadership is key to creating these environments. Method In a secondary analysis of data from two studies we compared the pattern of relationships among study variables in two Ontario groups: 342 new graduates with <2 years of experience and 273 nurses with more than 2 years of experience. Results A multi-group path analysis using Structural Equation Modelling indicated an acceptable fit of the final model (χ² = 17.52, df = 2, P < 0.001, CFI = 0.97, IFI = 0.97 and RMSEA = 0.11). Authentic leadership significantly and negatively influenced emotional exhaustion and cynicism through workplace empowerment in both groups. Conclusions The authentic behaviour of nursing leaders was important to nurses’ perceptions of structurally empowering conditions in their work environments, regardless of experience level, and ultimately contributed to lower levels of emotional exhaustion and cynicism. Implications for nursing management Leadership training for nurse managers may help develop the empowering work environments required in today’s health-care organizations in order to attract and retain nurses.