การวจยเชงคณภาพ เปนเครองมอสำคญอยางหนงสำหรบทำความเขาใจสงคมและพฤตกรรมมนษย การวจยแบบการสรางทฤษฎจากขอมล กเปนหนงในหลายระเบยบวธการวจยเชงคณภาพทกำลงไดรบความสนใจ และเปนทนยมเพมสงขนเรอยๆ จากนกวชาการ และนกวจยในสาขาสงคมศาสตร และศาสตรอนๆ เชน พฤตกรรมศาสตร สงคมวทยา สาธารณสขศาสตร พยาบาลศาสตร จตวทยาสงคม ศกษาศาสตร รฐศาสตร และสารสนเทศศกษา ดงนน หนงสอเรอง “ConstructingGrounded Theory: A Practical Guide through Qualitative Analysis” หรอ “การสรางทฤษฎจากขอมล:แนวทางการปฏบตผานการวเคราะหเชงคณภาพ” จะชวยใหผอานมความรความเขาใจถงพฒนาการของปฏบตการวจยแบบสรางทฤษฎจากขอมล ตลอดจนแนวทาง และกระบวนการปฏบตการวจยอยางเปนระบบ จงเปนหนงสอทควรคาแกการอานโดยเฉพาะนกวจยรนใหม เพอเปนแนวทางในการนำความรความเขาใจไประยกตในงานวจยของตน อกทงนกวจยผเชยวชาญสามารถอานเพอขยายมโนทศนดานวจยใหกวางขวางขน

Constructing Grounded Theory: A Practical Guide through Qualitative Analysis

Aims:The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distressBackground:Moral distress is said to occur when one has made a moral judgement but is unable to act upon it However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenonDesign:Systematic literature review and narrative synthesis (November 2015–March 2016)Data sources:Ovid MEDLINE® In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO® 1967–Present, CINAHL® Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education AbstractsReview methods:Literature relating to moral distress was systematically retrieved and subjected to relevanc

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What is 'moral distress'? A narrative synthesis of the literature

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The Politics of Women's Health: Exploring Agency and Autonomy

Decades of research have documented the frequency, sources, and consequences of moral distress. However, few studies have focused on interventions designed to diminish its negative effects. The cultivation of moral resilience-the ability to respond positively to the distress and adversity caused by an ethically complex situation-is proposed as a method to transform moral distress.

Cultivating Moral Resilience

When theory and practice in healthcare ethics started to evolve in the late 1970s, there emerged a growing consensus about how ethical principles ought to guide healthcare delivery, yet the well-being of healthcare providers received relatively little attention. Introduction of the concept of moral distress began to highlight the relationship between the moral experience of healthcare providers and the delivery of quality health care to patients. The initial definition of moral distress captured the core elements of the experience, professional values, constraints on action, and the importance of the context of healthcare delivery and served as a starting point for discussion and research. However, there were also conceptual gaps with the definition that made it difficult to move forward with effective interventions to support the well-being of healthcare providers. Through research and scholarship, we are moving toward a more nuanced understanding of moral distress that will support effective interventions. We track the evolution of the definition that reflects a growing understanding of moral distress as an experience that is complex and relational, needs to move beyond a singular disciplinary perspective, occurs in the context of a reciprocal relationship between structure and agency, and is shaped by the broader sociopolitical and cultural contexts.

What We Know About Moral Distress

Moral distress is a phenomenon that has been receiving increasing attention in nursing and other health care disciplines. Moral distress is a concept that entered the nursing literature - and subsequently the health care ethics lexicon - in 1984 as a result of the work done by American philosopher and bioethicist Andrew Jameton. Over the past decade, research into moral distress has extended beyond the profession of nursing as other health care disciplines have come to question the impact of moral constraint on individual practitioners, professional practice, and patient outcomes. Along with increased interest in the phenomenon of moral distress have come increasing critiques - critiques that in their essence point to a serious lack of conceptual clarity in the definition, study, and application of the concept. Foundational to gaining conceptual clarity in moral distress in order to develop strategies to prevent and ameliorate the experience is a careful revisiting of the epistemological assumptions underpinning our knowledge and use of the concept of moral distress. It is our contention that the conceptual challenges reveal flaws in the original understanding of moral distress that are based on an epistemological stance that holds a linear conception of cause and effect coupled with a simplistic perspective of 'constraint' and 'agency'. We need a more nuanced approach to our study of moral distress such that our ontological and epistemological stances help us to better appreciate the complexity of moral agents acting in organizational contexts. We believe that critical realism offers such a nuanced approach.

Moving from conceptual ambiguity to knowledgeable action: using a critical realist approach to studying moral distress

Aim To explore how healthcare providers in acute care mental health settings navigate ethically challenging situations, enact moral agency, practice in congruence with ethical standards and mitigate moral distress (MD). Design Grounded theory, a qualitative methodology. Methods Over 18 months between 2015 and 2017, we reviewed documents, conducted observations and interviewed multidisciplinary participants (N = 27) from inpatient and emergency departments. Participants either provided direct care (N = 14) or were in leadership positions (N = 13). Data were analysed iteratively using constant comparison, coding, memoing and theorizing, which continued until saturation was reached in July 2016. Findings The basic social process of how healthcare professionals enacted moral agency, Risking Vulnerability, occurred in the context of Systemic Inhumanity, a constant source of MD. Participants Risked Vulnerability, balancing professional obligations, clinical expertise and organizational processes with their own vulnerability in the system as they strove to practice ethically. Risking Vulnerability was composed of Pushing Back, Working Through Team Relationships and Struggling with Inhumanity. Conclusion Healthcare professionals' moral agency occurred at the nexus of structure (organizational constraints) and agency (persons). Given this, interventions for MD should be directed at all levels of healthcare to support moral agency, promote ethical practice and improve care. Impact Sociopolitical elements such as austerity measures undermined ethical practice at the level of direct care. Enactment of moral agency is dynamic, influencing experiences of MD: participants supported by leadership or colleagues to enact moral agency noted that they were not stuck in MD. Interventions supporting moral agency throughout the healthcare system are necessary to mitigate experiences of MD. Findings enhance our understanding of the role of action in the experience of MD.

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Lynn C. Musto

Papers

Moving from conceptual ambiguity to knowledgeable action: using a critical realist approach to studying moral distress

Risking vulnerability: Enacting moral agency in the is/ought gap in mental health care.