Nielsby Ulla, Dau Susanne, Bruun Henriette, Christensen Anne-Marie Søndergaard
University College of Northern Denmark and University of Southern Denmark.
University College of Northern Denmark.
Nurs Ethics. 2025 Mar 18:9697330251319373. doi: 10.1177/09697330251319373.
The transition from nursing education to professional practice is a critical period for newly graduated nurses, marked by significant moral challenges that can lead to moral distress and impact the development and application of clinical judgment. Understanding how moral distress affects newly graduated nurses is vital to support their integration into professional roles and ensure the delivery of quality care. Newly graduated nurses may experience moral distress due to conflicts between professional values and institutional constraints, which impact their ability to exercise effective clinical judgment. The purpose of this qualitative meta-ethnographic review is to investigate the phenomenon of moral distress among newly graduated nurses and its implications for clinical judgment. The research question is: How do newly graduated nurses experience moral distress, and how does it affect their clinical judgment? Methodologically, the study is grounded in Ricoeur's three-fold mimesis, which offers a rich interpretative framework for exploring the complexities of moral distress in nursing practice. Guided by the seven steps of meta-ethnography, the analysis reveals significant variations in the conceptualization and experiences of moral distress, thus highlighting inadequacies in existing definitions. The findings from 12 qualitative studies were synthesized into an integrative model of moral challenges. This integrative model presents moral distress as a multifaceted phenomenon that intersects with clinical judgment. The integrative model of moral challenges demonstrates how institutional constraints, moral uncertainty, moral conflict and lack of moral attention can hinder newly graduated nurses' ability to exercise effective clinical judgment and deliver quality care. The integrative model of moral challenges is a crucial contribution to research on moral distress. The review reveals limited research on the way moral distress affects the clinical judgment of newly graduated nurses and highlights the importance of promoting reflective practice and moral deliberation among newly graduated nurses to strengthen their clinical judgment and professional development.
从护理教育过渡到专业实践，对新毕业护士来说是一个关键时期，其特点是面临重大的道德挑战，这些挑战可能导致道德困扰，并影响临床判断的发展与应用。了解道德困扰如何影响新毕业护士，对于支持他们融入专业角色以及确保提供高质量护理至关重要。由于专业价值观与机构限制之间的冲突，新毕业护士可能会经历道德困扰，这会影响他们有效行使临床判断的能力。本定性元民族志综述的目的是调查新毕业护士中的道德困扰现象及其对临床判断的影响。研究问题是：新毕业护士如何经历道德困扰，以及它如何影响他们的临床判断？从方法论上讲，该研究基于利科的三重模仿理论，该理论为探索护理实践中道德困扰的复杂性提供了丰富的解释框架。在元民族志的七个步骤指导下，分析揭示了道德困扰在概念化和经历方面的显著差异，从而凸显了现有定义的不足之处。来自12项定性研究的结果被综合成一个道德挑战的综合模型。这个综合模型将道德困扰呈现为一个与临床判断相交的多方面现象。道德挑战综合模型展示了机构限制、道德不确定性、道德冲突和缺乏道德关注如何阻碍新毕业护士有效行使临床判断和提供高质量护理的能力。道德挑战综合模型是对道德困扰研究的一项重要贡献。该综述揭示了关于道德困扰如何影响新毕业护士临床判断的研究有限，并强调了促进新毕业护士进行反思性实践和道德思考以加强其临床判断和专业发展的重要性。
