A grounded theory of moral distress in nurses
Using grounded theory methodology, this study explored the phenomenon of moral distress in nurses. The purpose of the study was to develop a substantive theory of moral distress based on data obtained from nurses about what happens to them when they are unable to act as moral agents and how they respond in these situations. Central questions guiding the study were: what is the theory that explains what happens to nurses when they are unable to provide the best patient care because of external or internal constraints to moral action and what actions do nurses take when they are constrained from acting as moral agents?
Through purposeful and theoretical sampling, 12 nurses who work in settings outside of acute care were interviewed about times when they had experienced moral distress. Face to face interviews were conducted using guiding questions. The researcher was also open to the unique experiences of the participants, therefore other topics were explored as they related to the participants' experiences of moral distress.
A Glaserian approach to data analysis was used and data collection and data analysis occurred simultaneously. Through the constant comparing of the stories told by the nurses, five clusters of categories emerged. These clusters were the individual, the environmental, the relational, the action and the emotive. Although these clusters of categories were exclusive, conceptual elements were transcontextual and interwoven into more than one cluster. These conceptual elements helped to tie the emerging theory together to explain the participants' experience with moral distress.
Participants in the study experienced moral distress, however, they were able to take action(s) to both alleviate the distress and care for patients concurrently. The majority of participants expressed job satisfaction. Perhaps working in a setting outside the hospital provided greater opportunity for autonomous practice. This, combined with the greater experience and educational level of these participants added to their abilities to cope with moral distress.