School of Nursing & Midwifery, College of Health and Medicine, University of Tasmania, Burnie, Tasmania, Australia.
Nurs Health Sci. 2021 Sep;23(3):658-664. doi: 10.1111/nhs.12827. Epub 2021 Apr 14.
Moral distress results from the threat to professional moral integrity and identity. This phenomenon is well documented in nursing literature. Persistent and unresolved moral distress is frequently linked to high nursing staff turnover and shortages. Engagement in a structured hermeneutic critical reflective process facilitated identification of micro, meso, and macro factors influencing the experience of moral distress. Following this process, a theorized model was developed to illustrate interactions between influences contributing to the experience of moral distress in nurses. The model highlights where opportunities lay to take action to avoid or minimize the negative consequences of this phenomenon. Professional resilience is achieved via the conscientious development of professional identity and practice of critical reflection, as components of enculturation of nurses into the profession. Undergraduate and further nurse education activities must focus on developing the necessary attitude, confidence, and skills to address issues in practice which contribute to the experience moral distress to build resilience.
道德困境源于对专业道德操守和身份的威胁。这种现象在护理文献中有详细记载。持续且未解决的道德困境通常与高护理人员流动率和短缺有关。参与结构化的解释学批判性反思过程有助于确定影响道德困境体验的微观、中观和宏观因素。在这个过程之后，提出了一个理论模型来阐明影响护士道德困境体验的因素之间的相互作用。该模型突出了在采取行动避免或最小化这种现象的负面影响方面的机会。通过认真发展专业身份和批判性反思实践，作为护士职业社会化的组成部分，实现专业弹性。本科和进一步的护士教育活动必须侧重于培养必要的态度、信心和技能，以解决实践中导致道德困境体验的问题，从而建立弹性。
