Kaohsiung Medical University, Taiwan.
Nurs Ethics. 2020 Feb;27(1):67-76. doi: 10.1177/0969733019833126. Epub 2019 Apr 11.
As moral action could help nurses reduce moral distress, it is necessary to carry out qualitative research to present the experiences in which nurses apply moral action.
To describe and analyze the phronesis applied by nurses in the face of moral distress.
The research participants were invited to participate in in-depth interviews. The research materials were based on the stories described by the research participants and recorded by means of first-person narrative. Narrative analysis was applied to interpret the nurses' phronesis.
Twenty-seven nurses from Taiwan.
The Institutional Review Board of the Kaohsiung Medical University Hospital in Taiwan confirmed that this study passed the research ethical review.
According to the narrative analysis results, the phenomenon of moral distress contains difficulty, action, and idea transformation. The difficulty is the source of moral distress, action is the practice of moral courage, and idea transformation is the nurse's emotional movement. Action and idea transformation are collectively called phronesis in this study.
Moral distress refers to a state of suffering caused by situations in which nurses cannot carry out their ethical intentions. Phronesis is the process through which nurses take actions and relocate the subjects and is an ethical way to find relief from moral distress. Starting with empathy and respectful attitudes arising from self-reflection, nurses may be helped to get relief from the suffering of moral distress.
Phronesis can help nurses positively face the emotional strain of moral distress. This article puts forward a narrative method to complete the four steps of phronesis: write about the care experience, identify the difficulties in the stories, seek the possibility of action, and form a new care attitude, which could help nurses learn to reduce their moral distress.
道德行为有助于护士减轻道德困境，因此有必要进行定性研究，以呈现护士运用道德行为的经验。
描述和分析护士在面对道德困境时所应用的实践智慧。
邀请研究参与者参加深入访谈。研究材料基于研究参与者描述并通过第一人称叙述记录的故事。采用叙事分析来解释护士的实践智慧。
来自中国台湾的 27 名护士。
台湾高雄医学大学附属医院的机构审查委员会确认本研究通过了研究伦理审查。
根据叙事分析的结果，道德困境现象包含困难、行动和观念转变。困难是道德困境的根源，行动是道德勇气的实践，观念转变是护士的情感波动。行动和观念转变在本研究中统称为实践智慧。
道德困境是指护士无法践行伦理意愿而导致的痛苦状态。实践智慧是护士采取行动和重新定位主体的过程，是一种从道德困境中寻找解脱的伦理方式。从同理心和自我反思中产生的尊重态度出发，护士可能会从道德困境的痛苦中得到缓解。
实践智慧可以帮助护士积极面对道德困境带来的情绪压力。本文提出了一种叙事方法来完成实践智慧的四个步骤：书写护理经历、识别故事中的困难、寻找行动的可能性、以及形成新的护理态度，这有助于护士学习减轻道德困境。
