Phronesis of nurses: A response to moral distress

Abstract

Background: As moral action could help nurses reduce moral distress, it is necessary to carry out qualitative research to present the experiences in which nurses apply moral action. Aim: To describe and analyze the phronesis applied by nurses in the face of moral distress. Research design: The research participants were invited to participate in in-depth interviews. The research materials were based on the stories described by the research participants and recorded by means of first-person narrative. Narrative analysis was applied to interpret the nurses’ phronesis. Participants: Twenty-seven nurses from Taiwan. Ethical considerations: The Institutional Review Board of the Kaohsiung Medical University Hospital in Taiwan confirmed that this study passed the research ethical review. Findings: According to the narrative analysis results, the phenomenon of moral distress contains difficulty, action, and idea transformation. The difficulty is the source of moral distress, action is the practice of moral courage, and idea transformation is the nurse’s emotional movement. Action and idea transformation are collectively called phronesis in this study. Discussion: Moral distress refers to a state of suffering caused by situations in which nurses cannot carry out their ethical intentions. Phronesis is the process through which nurses take actions and relocate the subjects and is an ethical way to find relief from moral distress. Starting with empathy and respectful attitudes arising from self-reflection, nurses may be helped to get relief from the suffering of moral distress. Conclusion: Phronesis can help nurses positively face the emotional strain of moral distress. This article puts forward a narrative method to complete the four steps of phronesis: write about the care experience, identify the difficulties in the stories, seek the possibility of action, and form a new care attitude, which could help nurses learn to reduce their moral distress.

Measuring nurses’ moral courage: an explorative study

“…There is a general expectation that nurses are morally courageous, especially in challenging health care situations, such as during the COVID-19 pandemic. How and to what extent nurses show moral courage when faced with moral distress is, however, hardly been investigated (19). We found two studies supporting the presence of moral courage in the majority of nurses (20,21).…”

Nurses’ self-assessed moral courage and related socio-demographic factors

“…10,13,17,19 It becomes visible as actions in accordance with one’s own values, such as telling the truth 19,24 and intervening in the shortcomings of the care environment. 14,17,23,44 The nurse’s personal qualities, such as empathy, 21 honesty, 19 perseverance, 13,15 and sensitivity to perceive the patient’s vulnerability 11 have been found to promote moral courage.…”

“…Most of the previous studies of nurses’ moral courage have approached the concept using qualitative research designs. 11–22 Studies have revealed that moral courage appears as a desire to protect patients and to defend their rights. 10,13,17,19 Studies have identified moral courage as a personal virtue.…”

Validation of the Dutch-language version of Nurses’ Moral Courage Scale

“… 16 , 17 , 45 , 46 In nursing, research on moral courage has been fairly scarce, but it has increased in the last 10 years. The majority of studies have used qualitative research designs, 32 , 47 – 58 thus offering generalizable theoretical or inferential knowledge of moral courage, but not lending itself to measure the level and determinants of moral courage.…”