Page 335 - Encyclopedia of Nursing Research

302 n MORAL RECKONING

research, case study, and qualitative descrip- examines a more inclusive process surround-
tive analysis. Others have begun to develop ing moral distress.
M and refine quantitative means of measuring Moral reckoning is a process that occurs
moral distress and some have used mixed when nurses experience moral distress.
methods (Corley et al., 2001; Eizenberg et al., Ethicists define an ethical or moral dilemma
2009; Morris & Dracup, 2008; Raines, 2000; as a moral problem for which two or more
Sporrong et al., 2006). solutions carry equal weight, thus making
Moral distress is a pervasive problem decisions very difficult. In the early 1980s,
that may lead to a number of consequences. ethicist Andrew Jameton (1984) discovered
Causing harm to nurses, diminishing the a new type of moral problem, undefined in
quality of patient care, and contributing to previous ethics literature. He uncovered this
the nursing shortage, moral distress is a prob- problem when he asked a group of nurses to
lem that requires continued study. Strategies relate their personal stories of moral dilem-
to prevent moral distress and mitigate its mas. The nurses responses did not meet the
effects are imperative and interdisciplinary definition of “dilemma,” in which there are
cooperation is needed to further understand two solutions to a moral problem, each with
its causes and effects. equal moral weight. Rather, the nurses con-
sistently described situations in which the
Alvita Nathaniel morally correct solution was clear, yet each
felt constrained from following personal con-
victions (Jameton, 1993). Identifying this new
category of moral problem, Jameton (1984)
Moral reckoning wrote, “Moral distress arises when one knows
the right thing to do, but institutional con-
straints make it nearly impossible to pursue
The Grounded Theory of Moral Reckoning the right course of action” (p. 6). Subsequently,
in Nursing identifies a lengthy and painful Jameton (1993) stipulated that nurses who
process—before, during, and after the acute experience moral distress believe that they
phase of moral distress. Moral distress occurs participated in the action that they judged to
when a person is aware of a moral problem, be morally wrong. On the basis of Jameton’s
acknowledges moral responsibility, and original study, many nurse researchers have
makes a moral judgment about the correct studied moral distress. Findings from these,
action yet is constrained from the self-deter- mostly qualitative, studies consistently
mined morally correct action (Jameton, 1984, reinforce Jameton’s original findings. The
1992; Nathaniel, 2006; Wilkinson, 1987–1988). grounded theory of moral reckoning takes
Moral distress is not a response to a violation a conceptual perspective on a larger process
of what is unquestionably right but rather a that includes and surrounds moral distress.
violation of what the individual judges to be Moral reckoning includes a critical junc-
right. Moral distress has been studied in a ture in nurses’ lives and explains a process
number of settings and with several profes- that includes motivation and conflict, resolu-
sions. Moral distress is acknowledged as a tion, and reflection (Nathaniel, 2006). Moral
serious problem and researchers are begin- reckoning is a three-stage process that offers
ning to identify implications for education, important implications for nursing prac-
research, and practice, but few have exam- tice, education, and administration. Distinct
ined the process over time—what are the stages include the stage of ease, the stage of
conditions previous to the events that lead resolution, and the stage of reflection.
to moral distress and what are its long-term During the stage of ease, nurses are moti-
consequences? The theory of moral reckoning vated by core beliefs and values to uphold