Abstract

The purpose of this study was to define and explain how women experience moral distress in their practice of critical care nursing. Through use of the "constant comparative method", moral distress was defined as a non-linear, complex problem solving process which occurred in response to the nurse not knowing how to care for the patient when confronted with a moral dilemma. ;"Not knowing how to care" was viewed from three perspectives: a developmental readiness which paralleled Gilligan's findings about the moral development of women; a knowing about self and the patient which paralleled Belenky's findings about women's ways of knowing; and a progression of seeing the patient from a technical perspective to a humanistic perspective which paralleled Benner's findings describing nurses' progression from a novice to an expert. ;Four conditions and four patterns of the theory of moral distress evolved. The conditions were: the patient/family wishes were not known, not clear, not heard, or not acted upon; there was conflict between the patient/family wishes and those of the healthcare providers or administrators; there was conflict within the nurse about her beliefs, values, role and/or knowledge which affected her ability to care for the patient, and there was conflict between the nurse and other healthcare providers about care for the patient. One or more of these conditions were operant in the nurses' experience of moral distress. ;The patterns that wove the theory of moral distress together were: an unrelenting commitment on the part of the nurse to discover and to do what was right for the patient; a dynamic flow of action and interaction that the nurses created as she interfaced with others and integrated the information she received; a progression of being able to see the patient that moved from a technical perspective toward a humanistic perspective; and a synergistic interplay between the nurses' evolution of knowing that moved from silence to constructed and the evolution of knowing one's self and being able to separate that from knowing what was in the best interest of the patient