As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage it.

The purpose of this study was to determine the development of moral judgement in first-year and senior baccalaureate nursing students. These students were enrolled in three separate nursing programmes, each of which differed significantly in ethical content. The sample totalled 180 students enrolled in three New England programmes. Programme A included an ethics course taught by a professor of ethics. Programme B integrated ethical issues into all nursing theory courses. Programme C did not include ethical content in theory courses. The (...) design was of a developmental cross-sectional study. The dependent variable was the development of moral judgement, as measured by Rest’s Defining Issues Test. The independent variable was the amount of ethics taught in the nursing programmes and the level of academic education. The senior nursing students from programme A scored significantly higher than the other senior groups on the Defining Issues Test. The conclusion is that an ethics course with group participation and a decision-making element significantly facilitated nursing students’ development of moral judgement. (shrink)

The vast majority of research in nursing ethics over the last decade indicates that nurses may not be fully prepared to ‘deliver the good(s)’ for their patients, or to contribute appropriately in the wider current health care climate. When suitable research projects were evaluated for this article, one key question emerged: if nurses are educationally better prepared than ever before to exercise their ethical decision-making skills, why does research still indicate that the expected practice-based improvements remain elusive? Hence, a number (...) of ideas gleaned from recent research about the current nature of nursing ethics, and especially teaching nursing ethics to student nurses, are analysed and critiqued in this article, which concludes with a cluster of ideas and conclusions based on that analysis. It is hoped that such a review may serve as a catalyst for nurse educators to re-examine their teaching practices with a view to enhancing good (i.e. ethical) nursing practice through educational means. (shrink)

Objectives: The objective of this research is to analyse the evolution and nature of published empirical research in the fields of medical ethics and bioethics.Design: Retrospective quantitative study of nine peer reviewed journals in the field of bioethics and medical ethics .Results: In total, 4029 articles published between 1990 and 2003 were retrieved from the journals studied. Over this period, 435 studies used an empirical design. The highest percentage of empirical research articles appeared in Nursing Ethics , followed by the (...) Journal of Medical Ethics and the Journal of Clinical Ethics . These three journals account for 84.1% of all empirical research in bioethics published in this period. The results of the χ2 test for two independent samples for the entire dataset indicate that the period 1997–2003 presented a higher number of empirical studies than did the period 1990–1996 . This increase is statistically significant . Most empirical studies employed a quantitative paradigm . The main topic of research was prolongation of life and euthanasia .Conclusions: We conclude that the proportion of empirical research in the nine journals increased steadily from 5.4% in 1990 to 15.4% in 2003. It is likely that the importance of empirical methods in medical ethics and bioethics will continue to increase. (shrink)

This work examines contemporary views on medical ethics, such as preventing death, defining family relations, and reproductive and disabled issues.

In a Different Voice is the little book that started a revolution, making women's voices heard, in their own right and with their own integrity, for virtually the first time in social scientific theorizing about women. Its impact was immediate and continues to this day, in the academic world and beyond.

The purpose of this article is to report what can be learned about nurses’ ethical conflicts by the systematic analysis of methodologically similar studies. Five studies were identified and analysed for: (1) the character of ethical conflicts experienced; (2) similarities and differences in how the conflicts were experienced and how they were resolved; and (3) ethical conflict themes underlying four specialty areas of nursing practice (diabetes education, paediatric nurse practitioner, rehabilitation and nephrology). The predominant character of the ethical conflicts was (...) disagreement with the quality of medical care given to patients. A significant number of ethical conflicts were experienced as ‘moral distress’, the resolution of which was variable, depending on the specialty area of practice. Ethical conflict themes underlying the specialty areas included: differences in the definition of adequacy of care among professionals, the institution and society; differences in the philosophical orientations of nurses, physicians and other health professionals involved in patient care; a lack of respect for the knowledge and expertise of nurses in specialty practice; and difficulty in carrying out the nurse’s advocacy role for patients. (shrink)

We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series, 25 per cent received lectures and case conferences, with an ethicist in attendance, and 50 per cent served as controls. A post-intervention questionnaire was administered. Knowledge scores did (...) not differ among the groups. Confidence regarding ethical issues was significantly greater in the aggregate intervention group compared to the control group. Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls. Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile. We conclude that ethics education can have an impact on house officers' confidence and their responses to a simulated case, and that the EI was more effective than the LI. Such results have implications regarding the implementation of ethics education during residency. (shrink)

OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and principles, withdrawing life support, informed consent, and justice. Identical content was offered simultaneously (...) at the largest affiliated community hospital. SETTING: A multi-hospital university training programme from July, 1992 to June, 1994. PARTICIPANTS: Thirty-nine HOs responded in 92. Thirty HOs from the same cohort responded in 94 (response rates = 83% v 71%; P = 0.19). RESULTS: The curriculum was well received, with 96% of HOs finding the sessions stimulating. Previously validated scales of knowledge and confidence were administered at baseline and at follow-up. The average knowledge score improved 14% (P < 0.001). Confidence also improved, rising from 3.3 to 3.8 on a 5-point Likert scale (P < 0.001). These findings were independent of age, gender, religion, and prior education. The only attitudinal change was an increase in the proportion of residents who thought that ethics should be a required part of residency training (57% v 80%, P = 0.05). CONCLUSION: This curriculum appears practical, popular, and effective. It should be readily transferable to other institutions. (shrink)

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including (...) residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources. (shrink)

Purpose/methods: This study investigated the relationship between ethics education and training, and the use and usefulness of ethics resources, confidence in moral decisions, and moral action/activism through a survey of practicing nurses and social workers from four United States (US) census regions. Findings: The sample (n = 1215) was primarily Caucasian (83%), female (85%), well educated (57% with a master's degree). no ethics education at all was reported by 14% of study participants (8% of social workers had no ethics education, (...) versus 23% of nurses), and only 57% of participants had ethics education in their professional educational program. Those with both professional ethics education and in-service or continuing education were more confident in their moral judgments and more likely to use ethics resources and to take moral action. Social workers had more overall education, more ethics education, and higher confidence and moral action scores, and were more likely to use ethics resources than nurses. Conclusion: Ethics education has a significant positive influence on moral confidence, moral action, and use of ethics resources by nurses and social workers. (shrink)

The purpose of this study was to determine the development of moral judgement in first-year and senior baccalaureate nursing students. These students were enrolled in three separate nursing programmes, each of which differed significantly in ethical content. The sample totalled 180 students enrolled in three New England programmes. Programme A included an ethics course taught by a professor of ethics. Programme B integrated ethical issues into all nursing theory courses. Programme C did not include ethical content in theory courses. The (...) design was of a developmental cross-sectional study. The dependent variable was the development of moral judgement, as measured by Rest’s Defining Issues Test. The independent variable was the amount of ethics taught in the nursing programmes and the level of academic education. The senior nursing students from programme A scored significantly higher than the other senior groups on the Defining Issues Test. The conclusion is that an ethics course with group participation and a decision-making element significantly facilitated nursing students’ development of moral judgement. (shrink)

The limitations of rational models of ethical decision making and the importance of nurses’ human involvement as moral agents is increasingly being emphasized in the nursing literature. However, little is known about how nurses involve themselves in ethical decision making and action or about educational processes that support such practice. A recent study that examined the meaning and enactment of ethical nursing practice for three groups of nurses (nurses in direct care positions, student nurses, and nurses in advanced practice positions) (...) highlighted that humanly involved ethical nursing practice is also simultaneously a personal process and a socially mediated one. Of particular significance was the way in which differing role expectations and contexts shaped the nurses’ ethical practice. The study findings pointed to types of educative experiences that may help nurses to develop the knowledge and ability to live in and navigate their way through the complex, ambiguous and shifting terrain of ethical nursing practice. (shrink)