The purpose of this follow-up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation. The method was qualitative, specifically grounded theory. The earlier study took place when informants were senior nursing students. The follow-up study began after the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to the 'real world' of hospital nursing? What do they describe as factors influencing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psycho-social process that explained how these new graduate nurses adapted to the real world of hospital nursing. Six stages of this process were identified: vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self-concept. Moral distress was a consequence of the effort to preserve moral integrity. It is the result of believing that one is not living up to one's moral convictions. Data supported that the most pervasive attributes of moral distress were self-criticism and self-blame, as informants judged their actions against their moral convictions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants questioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findings are grounded in social interaction and moral psychology theories.

The purpose of the study was to examine and describe what English nursing undergraduates internalize as professional values. The method was qualitative; specifically, a grounded theory approach was used. The sample comprised 12 senior baccalaureate nursing students from two educational institutions in the north of England. Informants were volunteers who gave informed consent having been briefed on the purposes of the study and how their confidentiality would be protected. Data were collected through audio-taped interviews and the constant comparative method was used to analyse data. The findings revealed that informants perceived two concepts as central to their professional values. These were respect for patients and 'caring about the little things'. They valued the rights of patients to be treated with respect, to know what was happening to them and to have a say in what happened to them. They described the 'little things' as 'an approach with patients that gets through to them'; 'getting out the mirror so they can see themselves'; 'fixing their water so they can reach it'; worrying about someone's dentures or the cat they left at home. They expected that their values would be in conflict with common hospital practice. They valued 'fitting in' and 'going along' but retained their own ideas and values until such time as these could be implemented. They perceived themselves as powerless to create change as new graduates. They believed the overwhelming power resided in the hospital system and the ward sister/charge nurse. They were not inclined toward a career in hospital nursing.

The purpose of the study was to explore the perceptions of American nursing undergraduates about professional ethics. The method was qualitative; specifically, a grounded theory approach was used. The sample comprised 23 senior baccalaureate nursing students, from a possible population of 120, who were in their final clinical rotation prior to graduation. Informants were volunteers who gave informed consent having been briefed on the purposes of the study and how their confidentiality would be protected. Data were collected through audio-taped interviews and clinical logs. Analysis was conducted through the constant comparative method. Findings revealed two concepts central to their view of good nursing. These were: (a) respect, and (b) caring. Respect was described as respect for patients and families, respect for self, colleagues and the profession. Caring was associated with showing 'concern and love', providing psychological support, getting involved, being 'cheerful and friendly' and 'taking the time' to do a good job. They did not evidence an ambiguous professional role. They espoused values consistent with the professional code of ethics. They perceived that respect for others was basic to good nursing. They believed that good nurses cared about their patients and how nursing was done. They appeared to link professionalism with good nursing.

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