By Janet Storch, RN, PhD
Throughout the studies on nursing ethics, we found that nurses expressed continuing concerns about the many things that impeded their ethical practice of nursing. With some additional funding from the Office of Nursing Policy, Health Canada ($9,433), we were able to embed into the Leadership for Ethical Policy and Practice study a separate quantitative and qualitative study to measure the level of frequency and intensity of moral distress in hospitals in British Columbia. This study was approved for research ethics and carried out in 2006-2007 with Dr. Bernadette Pauly as PI and with Dr. Colleen Varcoe, Dr. Jan Storch and Lorelei Newton as team members. Arrangements were made for the College of Registered Nurses of BC to randomly select a predetermined number of participants based upon identified demographic characteristics (e.g. a minimum number of nurses from each health region, size of hospital, age, and education). A survey was then sent out to these RNs through the College along with a letter describing the research. Dr. Mary Corley’s moral distress survey was utilized, with modest adjustments for the Canadian context, along with a Hospital Ethical Climate Survey developed by Dr. Linda Olson and three open-ended questions (Pauly et
al., 2009). Through a small grant from Associated Medical Services (AMS), we were able to bring Dr. Mary Corley to Vancouver where she met for two days with our LEPP research team, and she later provided an open lecture on moral distress at the University of Victoria.
Through the findings of this study on moral distress, we determined that moral climate and moral distress were significantly correlated. We, therefore, suggested that moral distress should not be framed as an individual failing but should take into account organizational factors that contribute to such distress (Pauly, 2009, p. 569).
The need for additional research on this complex phenomenon, its multiple causes and effects, was emphasized. The qualitative questions were three in number and included a question asking RNs to describe a situation in which they experienced moral distress, what action they took in that situation, and what effect this situation and their actions or inaction had on patient care. Findings of this part of the study were rich in detail, and the participants described many
specific experiences of moral distress. An article by Varcoe et al. (Nursing Ethics, in press) provides a comprehensive analysis of these findings. Meanwhile, aspects of these findings have been well developed in presentations, at conferences, in peer reviewed papers, and in the development of the eight e-Learning
Modules on the Canadian Nurses Association Code of Ethics (see Selected Publications…, page 8) since the practice situations described by the RNs formed the basis of many clinical practice cases presented for reflection, and assessment.
The variations and complexities of name, descriptor, and conceptual development of moral distress and the questions that arose, lead to the development of a Symposium on Moral Distress held in Vancouver in September 2010 (see Welcoming the World… page 7).
Janet Storch is a national and international pioneer in nursing ethics and Professor Emeritus at the UVic School of Nursing.
From the 2012 Autumn Communiqué — Nursing Ethics
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