title: Primary care nurse practitioners' integrity when faced with moral conflict.
abstract: Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. The purpose of this grounded theory study was to describe the process NPs use to manage moral problems common to primary care. Twenty-three NPs were interviewed, commenting on hypothetical situations depicting ethical issues common to primary care. Coding was conducted using a constant comparative method. A theory of maintaining moral integrity emerged consisting of the phases of encountering conflict, drawing a line, finding a way without crossing the line, and evaluating actions. The NPs varied in their awareness and the discord encountered in conflict, and in clarity, flexibility and justification of the line drawn. A critical juncture occurred when NPs evaluated how well integrity had been maintained. Some experienced no distress while others experienced self-doubt, regret, outrage and frustration at external constraints, and attempted to reconcile through avoiding, convincing themselves, and compensating.
authors: Rush University, College of Nursing, Chicago, IL, USA. carolyn.laabs@marquette.edu
authors: Carolyn Ann
authors: CA
authors: Laabs
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D002605:Character; D003220:Conflict, Psychological; D028663:Ethical Theory; D005260:Female; D005639:Frustration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008960:Models, Psychological; D009014:Morals; D009722:Nurse Practitioners / Q000941:ethics* / Q000458:organization & administration / Q000523:psychology*; D024802:Nurse's Role / Q000523:psychology*; D009723:Nurse-Patient Relations / Q000941:ethics; D015404:Nursing Methodology Research; D010344:Patient Advocacy / Q000941:ethics / Q000523:psychology; D011209:Power, Psychological; D011320:Primary Health Care / Q000941:ethics* / Q000458:organization & administration; D017009:Professional Autonomy; D011795:Surveys and Questionnaires; D035501:Uncertainty; D028722:Virtues