Preserving moral integrity: a follow‐up study with new graduate nurses

Abstract

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 Moral Threat of Compartmentalization: Self, Roles and Responsibility

“…They stress the moral cost one pays by endorsing a role which is perceived as a safeguard but which actually undermines one's moral integrity. Kelly (1998Kelly ( , p. 1140 notices that as the nurses realised that they cannot practice at their high standards, and that they fail to be the nurses they aspired to be, they rationalized until they created a revised professional identity: "Coping with the loss of ideals requires that one justify why one no longer does what once was valued." However rationalization here is a form of self-deception and the resulting professional identity is a social construction rather than a reflection of the self (Kelly, 1998(Kelly, , p. 1140.…”

“…Kelly (1998Kelly ( , p. 1140 notices that as the nurses realised that they cannot practice at their high standards, and that they fail to be the nurses they aspired to be, they rationalized until they created a revised professional identity: "Coping with the loss of ideals requires that one justify why one no longer does what once was valued." However rationalization here is a form of self-deception and the resulting professional identity is a social construction rather than a reflection of the self (Kelly, 1998(Kelly, , p. 1140. Kelly (1998) concludes her study emphasizing the moral distress caused by a misrepresentation of the reality of the work environment by student nurses; however significant, this aspect should not overshadow the fact that the graduate nurses ultimately compromised their high moral ideals to fit into their ward.…”

“…However rationalization here is a form of self-deception and the resulting professional identity is a social construction rather than a reflection of the self (Kelly, 1998(Kelly, , p. 1140. Kelly (1998) concludes her study emphasizing the moral distress caused by a misrepresentation of the reality of the work environment by student nurses; however significant, this aspect should not overshadow the fact that the graduate nurses ultimately compromised their high moral ideals to fit into their ward.…”

“…She states that: "Compartmentalization happens when nursing students, in moving from the worlds of academic education and hospital clinical practice, come to terms with 'two versions of nursing', each with its own standards and rules." (Kelly, 1998(Kelly, , p. 1135). The graduate nurses followed by Kelly experienced a six-stage basic psychological process which enabled them to adapt to their work reality: "vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self-concept."…”

The Battle for Business Ethics: A Struggle Theory

“…Lachman (2007) posits that personal sacrifice is often accompanied by a sense of peace because the individual stood up for a nonnegotiable principle. Kelly (1998), however, found that the struggle of nurses to preserve their moral integrity resulted in moral stress. Another possible consequence of struggle is that it can elicit a reaction from opposing forces.…”