Nurses' perspectives on moral distress: A Q methodology approach.
BACKGROUND
Moral distress occurs when nurses experience ethical dilemmas. Issues related to these dilemmas are addressed in some nursing education courses. Nurses' reaction to dilemma such as moral distress is relatively less noticed.


OBJECTIVE
This study aimed to identify and describe the various types of perceptions of moral distress exhibited by nurses.


METHODS
This study applied Q methodology to explore the perspectives of nurses regarding moral distress. Data were collected in two stages. First, in-depth interviews were conducted to collect nurses' opinions. Sentences that best fit the concepts of moral distress were extracted for the construction of Q statements. Second, nurses subjectively ranked these Q statements so that the relevant severity of moral distress could be determined using Q sorts. The study participants were nurses at a regional teaching hospital in northeast Taiwan. A total of 60 participants were invited to rank 40 moral distress Q statements. Ethical considerations: The study protocol was approved by the institutional review board of National Yang-Ming University Hospital. Only the participants who signed an informed consent form participated in the study. The respondents' right to withdraw from the study was respected.


RESULTS
Five types of responses were identified regarding the nurses' perspectives. These types were "conflict with personal values," "excessive of workload," "curbing of autonomy," "constraint engendered by organizational norms," and "self-expectation frustration."


CONCLUSIONS
The findings regarding nurses' experiences of moral distress can be used to construct multifaceted policies and solutions and to incorporate ethical education in training programs.
Department of Nursing, National Taiwan University Hospital, Taiwan.
Pei-Pei
PP
Chen
Department of Nursing, Yuh-Ing Junior College of Health Care & Management, Taiwan.
Hsiao-Lu
HL
Lee
School of Nursing, National Yang-Ming University, Taiwan.
Shu-He
SH
Huang
Department of Nursing, National Yang-Ming University Hospital, Taiwan.
Ching-Ling
CL
Wang
School of Nursing, National Yang-Ming University, Taiwan and Department of Nursing, National Yang-Ming University Hospital, Taiwan.
Chiu-Mieh
CM
Huang
D000328:Adult; D001291:Attitude of Health Personnel; D004993:Ethics, Nursing; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D009014:Morals; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D013315:Stress, Psychological / Q000523:psychology*; D013624:Taiwan
Moral distress; Q methodology; nurses