The Moral Reasoning of Nurse Practitioners

Abstract

This qualitative research study was conducted to describe the moral reasoning utilized by participating nurse practitioners to resolve moral dilemmas in their clinical practice. Five major essential features of moral reasoning emerged from the data: the contextual framework for moral reasoning, values, influencing factors, recognizing the dilemma, and outcomes. The interrelationship of the essential features of moral reasoning provided insight into how NPs deal with moral dilemmas as well as the role that caring and the nurse-patient relationship played as a part of the moral decision making process.

Being a Good Nurse and Doing the Right Thing: a qualitative study

“…This finding supports the position that the traditional justice or care dichotomy for explaining nurses' ethical decision making is far too confining. 70 It also supports the variety of findings on ethical decision making in the nursing literature, which range from structured process, 71 to interrelated processes with varying degrees of structure, [72][73][74][75][76][77] to no process at all in lieu of a collection of experiences and feelings used by nurses to make moral choices. 78,79 These various critical thinking approaches, when taken in conjunction with the emphasis on the character of the nurse taking action, suggest the need for a much broader interpretation of ethical decision making.…”

Moral problems and distress among nurse practitioners in primary care

“…Although factors such as participant fatigue or lack of sufficient reflection on issues may have contributed to the use of the ''other'' and ''no answer'' options, NP comments suggest that the ''other'' type of moral problem might be related to the NP/ patient relationship and the conflict between the principles of respecting patient autonomy and acting beneficently toward the patient. This is not surprising when one considers, as Viens (1995) contends, that NPs generally view the NP/patient relationship as very meaningful with caring as its major theme and the NP/patient interaction as the key to successfully achieving the goal of moving patients toward health (p. 283). According to the American Nurses Association (2001), respecting patient autonomy is a highly regarded component of the nurse/patient relationship.…”

“…The theoretical framework was based upon the experience component of Wilkinson's Moral Distress Equation (1987/1988, 1989), in which a moral situation (ethical issue) + the moral decision about the right action to take in regard to that moral situation (moral problem) + perceived inability to act (in order to resolve the moral problem) = painful feelings and psychological disequilibrium (distress). The types of moral problems in this study are those described above by Jameton (1984) (moral distress, moral dilemma, moral uncertainty) and Wilkinson (1987/1988) (moral outrage), and the ethical issues are those described in the literature as commonly encountered in primary care among NPs (Beidler, 2002; Butz et al, 1998; Turner et al, 1996; Viens, 1995) and physicians (Felder, 2002; Junkerman & Schiedermayer, 1998; Sugarman, 2000).…”

“…Primary care nurse practitioners (NPs) are nurses who function in an advanced practice role, and so it is not unreasonable to assume that they, like acute care nurses, might also experience distress over moral problems in clinical practice. In fact, some research does suggest that NPs experience distress, but the value of these studies is limited because of (a) a failure to clearly define terms such as moral distress and related terms such as moral dilemma, resulting in variations in meaning and experience (Beidler, 2002;Turner, Marquis, & Burman, 1996;Viens, 1995); (b) the use of small and nonrandom samples (Beidler;Godfrey & Smith, 2002;Turner et al 1996;Viens); and (c) focusing only on specific issues or specialty areas of NP practice (Beidler;Butz, Redman, Fry, & Kolodner, 1998;Turner et al). Thus, the nature and extent of distress among NPs in primary care has not been fully described.…”

Moral Development and Reproductive Health Decisions

“…traditional framework for moral development has A been guided by the beliefs that there are age related, invariant, sequential developmental stages that range from being simple to complex and that cognitive and intellectual development influences moral reasoning (Viens, 1995). However, this conventional frame of reference has been challenged as being gender biased (Gilligan, 1982).…”