As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage it.

http://journals.sagepub.com/doi/pdf/10.1191/0969733002ne557oa

Nurse Moral Distress: a proposed theory and research agenda

UNIT I Introduction to Theory CHAPTER 1 Philosophy, Science, and Nursing CHAPTER 2 Overview of Theory in Nursing CHAPTER 3 Concept Development: Clarifying Meaning of Terms CHAPTER 4 Theory Development: Structuring Conceptual Relationships in Nursing CHAPTER 5 Theory Analysis and Evaluation UNIT II Nursing Theories CHAPTER 6 Overview of Grand Nursing Theories CHAPTER 7 Grand Nursing Theories Based on Human Needs CHAPTER 8 Grand Nursing Theories Based on Interactive Process CHAPTER 9 Grand Nursing Theories Based on Unitary Process CHAPTER 10 Introduction to Middle Range Nursing Theories CHAPTER 11 Overview of Selected Middle Range Nursing Theories UNIT III Borrowed Theories Used by Nurses CHAPTER 12 Theories From the Sociologic Sciences CHAPTER 13 Theories From the Behavioral Sciences CHAPTER 14 Theories From the Biomedical Sciences CHAPTER 15 Theories, Models, and Frameworks From Administration and Management CHAPTER 16 Learning Theories UNIT IV Application of Theory in Nursing CHAPTER 17 Application of Theory in Nursing Practice CHAPTER 18 Application of Theory in Nursing Research CHAPTER 19 Application of Theory in Nursing Administration and Management CHAPTER 20 Application of Theory in Nursing Education CHAPTER 21 Future Issues in Nursing Theory

Theoretical Basis for Nursing

Facilitating transitions: Redefinition of the nursing mission

After three decades, the efficacy of empathy in the clinical setting remains undocumented. Recently, concerns have been raised that the concept may be inappropriate and even harmful to the nurse-patient relationship. An analysis of the concept indicates that empathy consists of moral, emotive, cognitive and behavioral components. By tracing the integration of this concept into nursing, we suggest that empathy was uncritically adopted from psychology and is actually a poor fit for the clinical reality of nursing practice. Other communication strategies presently devalued, such as sympathy, pity, consolation, compassion and commiseration, need to be reexamined and may be more appropriate than empathy during certain phases of the illness experience. Directions for future research are suggested.

Exploring Empathy: A Conceptual Fit for Nursing Practice?

Context.—Therapeutic Touch (TT) is a widely used nursing practice rooted in mysticism
but alleged to have a scientific basis. Practitioners of TT claim to treat
many medical conditions by using their hands to manipulate a "human energy
field" perceptible above the patient's skin.Objective.—To investigate whether TT practitioners can actually perceive a "human
energy field."Design.—Twenty-one practitioners with TT experience for from 1 to 27 years were
tested under blinded conditions to determine whether they could correctly
identify which of their hands was closest to the investigator's hand. Placement
of the investigator's hand was determined by flipping a coin. Fourteen practitioners
were tested 10 times each, and 7 practitioners were tested 20 times each.Main Outcome Measure.—Practitioners of TT were asked to state whether the investigator's unseen
hand hovered above their right hand or their left hand. To show the validity
of TT theory, the practitioners should have been able to locate the investigator's
hand 100% of the time. A score of 50% would be expected through chance alone.Results.—Practitioners of TT identified the correct hand in only 123 (44%) of
280 trials, which is close to what would be expected for random chance. There
was no significant correlation between the practitioner's score and length
of experience (r=0.23). The statistical power of
this experiment was sufficient to conclude that if TT practitioners could
reliably detect a human energy field, the study would have demonstrated this.Conclusions.—Twenty-one experienced TT practitioners were unable to detect the investigator's
"energy field." Their failure to substantiate TT's most fundamental claim
is unrefuted evidence that the claims of TT are groundless and that further
professional use is unjustified.

Myra E. Levine

Papers

Ethical Dilemmas and Nursing Practice

The four conservation principles of nursing.

Introduction to clinical nursing

Nursing ethics and the ethnical nurse.

The Conservation Principles: A Retrospective