Nurses’ narratives of moral identity: Making a difference and reciprocal holding

Peter, Elizabeth; Simmonds, Anne; Liaschenko, Joan

doi:10.1177/0969733016648206

Cited by 30 publications

(37 citation statements)

References 23 publications

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“…Damaged identities can result in moral distress. 28 Within our cited articles, constraints are found throughout many of the definitions, an occurrence that has also been noted by Morley et al 4 in a 2019 systematic literature review and narrative synthesis of moral distress. We found constraints to be explicitly stated or implied, yet largely lacking clarity.…”

Section: Discussionsupporting

confidence: 62%

“…Peter and Liaschenko 26 asserted that moral distress is truly a reaction to constraints of the moral identity, relationships and responsibilities of a nurse that underlie a morally uninhabitable workplace, in which incoherent understandings and unstainable practices are present. For Peter and colleagues, 27,28 moral identity is fundamental to moral agency, a moral life and is, at its core, relational. Interactions occur between the individual and others; one’s identity may flourish or be injured depending on the wellness of connections and influences.…”

Section: Discussionmentioning

confidence: 99%

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Moral distress: A concept clarification

et al. 2020

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Background Over the past few decades, moral distress has been examined in the nursing literature. It is thought to occur when an individual has made a moral decision but is unable to act on it, often attributable to constraints, internal or external. Varying definitions can be found throughout the healthcare literature. This lack of cohesion has led to complications for study of the phenomenon, along with its effects to nursing practice, education and targeted policy development. Objectives The aim of this analysis was to uncover unique definitions of moral distress as found in the nursing literature and to examine the relationship between these definitions. Research Design and Context Morse’s method of concept clarification was applied given the large body of literature which includes definitions, descriptions and measurements of the concept in research. The steps include (a) conducting a literature review; (b) analysing the literature; and (c) identifying, describing, comparing, and contrasting attributes, antecedents and consequences of each category. Findings Each of the 18 included studies described constraints in their definition of moral distress, whether implied or explicitly stated. External constraints are widely described as obstacles outside of the individual, whether institutional, systemic or situational, while internal constraints are located within the individuals themselves and are described as personal limitations, failings or weakness of will. Conclusion Upon reviewing these definitions, we determined that the term ‘internal constraints’ is problematic due to the emphasis of responsibility on the individual experiencing moral distress. We propose an alteration to ‘internal characteristics’ that will assume less responsibility of change from the individual to place a heavier onus on systemic and institutional constraints.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Moral distress: A concept clarification

et al. 2020

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“…Finally, it is important to think about how these nurses' experiences fit with the grand moral narratives of nursing. Peter, Simmonds, and Liaschenko (2018) have argued that these narratives are twofold: (a) making a difference in the lives of individuals and communities and (b) holding the identities of the vulnerable. This second narrative entails holding fast to the dignity of patients' unique identities even as their bodies deteriorate.…”

Section: Discussionmentioning

confidence: 99%

Riding an elephant: A qualitative study of nurses' moral journeys in the context of Medical Assistance in Dying (MAiD)

Pesut

Thorne

Storch

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To describes nurses' moral experiences with Medical Assistance in Dying in the Canadian context. Background Nurses perform important roles in Medical Assistance in Dying in Canada and do so within a unique context in which Medical Assistance in Dying is provided through healthcare services and where accessibility is an important principle. International literature indicates that participating in Medical Assistance in Dying can be deeply impactful for nurses and requires a high degree of moral sense‐making. Design A qualitative interview study guided by Interpretive Description using the COREQ checklist. Results Fifty‐nine nurses from across Canada participated in the study. The decision to participate in Medical Assistance in Dying was influenced by family and community, professional experience and nurses' proximity to the act of Medical Assistance in Dying. Nurses described a range of deep and sometimes conflicting emotional reactions provoked by Medical Assistance in Dying. Nurses used a number of moral waypoints to make sense of their decision including patient choice, control and certainty; an understanding that it was not about the nurse; a commitment to staying with patients through suffering; consideration of moral consistency; issues related to the afterlife; and the peace and gratitude demonstrated by patients and families. Discussion The depth of nurses' intuitional moral responses and their need to make sense of these responses are consistent with Haidt's theory of moral experience in which individuals use reasoning primarily to explain their moral intuition and in which moral change occurs primarily through compassionate social interaction. Further, work on the moral identity of nursing provides robust explanation of how nurses' moral decisions are contextually and relationally mediated and how they seek to guard patient vulnerability, even at their own emotional cost. Conclusion Medical Assistance in Dying is impactful for nurses, and for some, it requires intensive and ongoing moral sense‐making. Relevance to clinical practice There is a need to provide support for nurses' moral deliberation and emotional well‐being in the context of Medical Assistance in Dying care.

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“…The purpose of this project is to review existing nursing ethics literature about palliative sedation, and to analyze how nurses’ moral identities are portrayed within this literature. Moral identity here refers to an ongoing history of our values, our responsibilities, and our relationships, 17 inclusive of the multiple and sometimes competing relational commitments that characterize nurses’ work. For example, commitments to patients, to colleagues, and to wider social systems such as employers and even the nursing profession itself.…”

Section: Purposementioning

confidence: 99%

Moral identity and palliative sedation: A systematic review of normative nursing literature

et al. 2019

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Background: In the last two decades, nursing authors have published ethical analyses of palliative sedation—an end-of-life care practice that also receives significant attention in the broader medical and bioethics literature. This nursing literature is important, because it contributes to disciplinary understandings about nursing values and responsibilities in end-of-life care. Research aim: The purpose of this project is to review existing nursing ethics literature about palliative sedation, and to analyze how nurses’ moral identities are portrayed within this literature. Research design: We reviewed discussion papers, written by nurses about the ethics of palliative sedation, which were cited in MEDLINE, CINAHL, Nursing and Allied Health, or Philosopher’s Index (search date March 2018). Twenty-one papers met selection criteria. We performed a comprehensive review and analysis (using the Qualitative Analysis Guide of Leuven), of the values, responsibilities, and relationships reflected in authors’ portrayal of the nursing role. Findings: Two different tones are apparent in the extant nursing ethics literature. One is educational, while the other is critically reflective. Irrespective of tone, all authors agree on the alleviation of suffering as a fundamental nursing responsibility. However, they differ in their analysis of this responsibility in relation to other values in end-of-life care, including those that depend on consciousness. Finally, authors emphasize the importance of subjective and experience-based understandings of palliative sedation, which they argue as depending on nurses’ proximity to patients and families in end-of-life care. Discussion and conclusion: Based on our findings, we develop three recommendations for future writing by nurses about palliative sedation. These relate to the responsibility of recognizing how consciousness might matter in (some) peoples’ moral experiences of death and dying, to the importance of moral reflectiveness in nursing practice, and to the value of a relational approach in conceptualizing the nursing ethics of palliative sedation.

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Nurses’ narratives of moral identity: Making a difference and reciprocal holding

Abstract: Ultimately, the sustainability of nurses' moral identities may be dependent on the recognition of their own needs for professional satisfaction and care in ways that go beyond the kind of acknowledgement that patients can offer.

Cited by 30 publications

References 23 publications

Moral distress: A concept clarification

Moral distress: A concept clarification

Riding an elephant: A qualitative study of nurses' moral journeys in the context of Medical Assistance in Dying (MAiD)

Moral identity and palliative sedation: A systematic review of normative nursing literature

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