Abstract
BACKGROUND Nursing is a moral practice that aims at the good of patients, families and communities (Gastmans, de Casterlé and Schotsmans, 1998). However, applying ethical principles in practice is not a problem-free enterprise (Lützén et al., 2003; Schluter et al., 2008; Epstein and Hamric, 2009; Epstein and Delgado, 2010) due to the particular position that nurses have within healthcare systems, institutions and care teams. Nevertheless, the majority of nurses continue to work ethically despite moral tensions and moral distress. One possibility is that the events that follow a morally distressing situation constitute a process of moral resilience. OBJECTIVES This study aimed to examine the main concerns among intensive care nurses in respect of ethical practice, and to investigate how nurses continue to practise in an ethical way despite pressures, tensions and conflicts. Furthermore, this study aimed at developing an explanatory theory of the moral resilience process, understood as a basic social process, which follows a morally challenging situation. DESIGN This is a qualitative study drawing on Glaser and Strauss’ (1967) version of grounded theory. The data for this study consisted in field notes and interviews from 16 nurses working in intensive care. In-depth interviews were carried out with open-ended questions. Data analysis followed the method suggested by Glaser and Strauss (1967) and Glaser (1978; 2005; 2011) using the constant comparative method. ETHICAL CONSIDERATIONS The study was approved by the University Ethics Committee of the University of Surrey, UK, and by the Cantonal Ethics Committee and the Hospital Research Committee of the Southern Switzerland Hospital Organisation. Each participant signed an informed consent form. FINDINGS This study breaks new ground in addressing intensive care nurses’ main concern regarding moral practice. Harmonising connectedness is both: nurses’ main concern and the patterns that characterise moral resilience CONCLUSIONS AND RECOMMENDATIONS This study offers new insight into intensive care nurses’ moral life, moral wellbeing and strategies nurses put in place in order to achieve moral wellbeing. This study offers new perspectives that should be taken into consideration in nurses’ education and in demonstrating measures that aim to increase nurses’ moral resilience and their professional retention.