Preserving moral integrity: a follow-up study with new graduate nurses

The purpose of this follow-up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of h ospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 yeats following graduation. The method wa s qualitative, specifically grounded theory. The earlier study took place w hen informants were senior nursing students. The follow-up study began afte r the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to th e 'real world' of hospital nursing? What do they describe as factors influe ncing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psyche-social process that explained how thes e new graduate nurses adapted to the real world of hospital nursing. Six st ages of this process were identified: vulnerability; getting through the da y; coping with moral distress; alienation from self; coping with lost ideal s; and integration of new professional self-concept. Moral distress was a c onsequence of the effort to preserve moral integrity. It is the result of b elieving that one is not living up to one's moral convictions. Data support ed that the most pervasive attributes of moral distress were self-criticism and self-blame, as informants judged their actions against their moral con victions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants quest ioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findin gs are grounded in social interaction and moral psychology theories.