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Title: Moral decisions, moral distress, and the psychological health of nurses
Authors: Willis, Martin E.H.
Keywords: Feelings
Emotions
Distress
Process philosophy
Bricolage
Nursing
Morality
Ethics
Issue Date: 2015
Publisher: © Martin E.H. Willis
Abstract: The major focus of this thesis is the role of feelings and emotions in moral thinking/knowing, ethical conduct and, in particular, moral distress in nursing. Research has consistently found that the moral decisions nurses must make can sometimes lead to distress. However, such experiences are overly individualised in the literature. An alternative view of the person, drawing on the philosophy of Alfred North Whitehead (e.g. 1927-8/1978) and the recent work of Paul Stenner (e.g. 2008), sees human subjectivity or mind as processual and always embodied and in-the-world. The emphasis upon the body draws attention to the role of felt experiences this thesis views feelings as integral to both sense-making knowing and thinking and sensibility or emotionality. The emphasis in-the-world highlights that subjectivity is embedded within social contexts, which include relations of power and organisations of material and symbolic capital aligned with those relations. Influenced by deep empiricism (e.g. Stenner, 2011a), this thesis develops a novel bricolage methodology based on a metaphor of diffraction to explore nurses experiences of moral distress. Nurses feelings of discomfort, a particular form of feelings of knowing , appear to be the seeds of moral distress. Various situations seem to be important antecedents for these seeds to bloom into full moral distress, including certain clinical issues, ethical conflict with colleagues, and issues of competency. Nurses also experience some aspects of their job as systemic barriers to high standards of care, which can also be morally distressing. Such distress sometimes affects nurses relationships, their physical health, and their mental health. Participants have found several strategies useful in coping with their distress. It is argued that these strategies are about altering one s feelings through changing one s activities and/or environment. Additionally, past distress may remain a dormant part of a person s subjectivity and re-emerge or become (re)enacted in the narrations of those past distressing experiences. It is suggested that subjectivity entails an organisation of past experiences in the present, for present purposes and in anticipation of the future. Six dominant thematic patternings, which recurred throughout the analyses, are discussed: (i) the centrality of feelings; (ii) the relationality of felt experiences; (iii) the complexity of morality, moral conduct, and moral distress moral/ethical issues become entangled with identity, power, professional competency, and social relations; (iv) the prominence of power and interest; (v) nurses' lives as afflicted by moral distress; and (vi) life-as-process. Discussion of these motifs leads to a rethinking of moral distress. Implications for nursing practice, moral distress research and the study of feelings, emotions, and affect are discussed.
Description: A Doctoral Thesis. Submitted in partial fulfilment of the requirements for the award of Doctor of Philosophy of Loughborough University.
Sponsor: Loughborough University
URI: https://dspace.lboro.ac.uk/2134/16817
Appears in Collections:PhD Theses (Sport, Exercise and Health Sciences)

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