Abstract

The majority of the research efforts and discussions about moral development of nurses are directed at identifying or examining the ethical decision making process of the nurse while attempting to "fit" nursing actions and decisions with that of already existing theories of moral development from other disciplines. Because no studies were identified that examined the process of moral development specific to nurses, the purpose of this qualitative research was to develop a beginning substantive theory, using grounded theory methodology, to describe the process of moral development of experienced clinical nurses. The problem investigated was: What is the process of moral development that is identified by experienced clinical nurses? ;The grounded theory method of constant comparative analysis was used to collect and analyze the data from the unstructured interviews. The theoretical sample consisted of ten female nurses with a minimum of three years clinical experience in a variety of practice settings. Sampling diversity included number of years of clinical experience, practice setting, age, and education and also included considerations such as geographic mobility, military and civilian employment, and marital status. ;A conceptual model of moral development of experienced nurses evolved from the interview data. The conceptual model consists of two levels and five stages of moral development. The levels are labelled as Level I, pre-nursing and Level II, nursing. The five stages of moral development occur at Level II, the nursing level, and consist of basic nursing education, organization, profession, self, and patient. ;The core category was identified as patient integration because it explains the change and variations in the moral development of experienced nurses. Patient integration is manifested at each stage of moral development of the nurse by the subcategories of walking a mile, doing the best, and letting go. Each of these subcategories is comprised of behavioral strategies that respond to changes in maturation, self-confidence, and experiences that occur over time. ;Implications for nursing education, administration, and practice are offered. The conceptual model and core category that emerged from the data provides a basis for future research to increase saturation and density of the beginning substantive theory