Gender-Specific Features of the Lived Experience of Moral Distress

Debra R. Hanna, PhD, RNAssociate ProfessorMolloy CollegeRockville Centre, NY 11571

This study was funded through a Molloy College Faculty

Scholarship Grant

Hanna’s Previous Work•2004: State of Science: Moral Distress

▫Analyzed themes, strengths and limitations of published research (1984-2004)

•2005: Lived Experience of Moral Distress of Nurses who Assisted with Abortions

▫Identified 3 main types of moral distress

▫Hypothesized 2 other types of moral distress

▫Identified 5 properties of moral distress

Recommendations(2004/05)

•Conduct research to understand gender differences, cultural patterns, or other population specific signs, symptoms and processes

•Seek to affirm or modify Hanna’s proposed redefinition so that instruments useful for diagnosis and measurement could be developed

Study Purpose•To determine if gender-specific features of moral distress exist, and if so, to describe them

Method & Design

•Modified phenomenological method

•Enroll male & female former child protection workers (CPWs)

•Analyze data in five realms

•Compare female RNs & female CPWs

•Compare female CPWs with male CPWs

Hanna’s Modifications•Examine the data in five realms:

•Lived Body (Corporality)•Lived Space (Spatiality)•Lived Time (Temporality)•Lived Relationship (Relationality)

•Lived Consciousness (Conscious Reflexivity)

Findings•Female CPW experience of moral distress is similar to Female RN experience

•Females undergo changes in realms of Lived Body, Space & Relationship

•Females engaged in solitary activities to enable reflection and processing the immediate harms of the experience of moral distress

Outcomes:Female Moral Distress

•Women used self-protective measures to avoid additional harm from their experience of moral distress

•Left their jobs•Set limits with certain job tasks•Changed career/life directions

Findings•Male CPW experience is different from Female CPW experience

•Male lived body experience is similar to female experience in some aspects, but what differs is what an observer is able to observe

Findings•Men remained immersed in the experience and made efforts to right the wrongs

•Men used stoic-heroic measures to manage the immediate harms of the experience of moral distress

Outcomes: Male Moral Distress

•Men kept their jobs•Sought higher levels of education•Sought promotions to gain power to right the wrongs they saw

•Men stayed immersed in the MD experience much longer than women

Similarities between men & women•All volunteers

reported disruptions in sleep, appetite, increased anxiety

•Most reported some type of gastrointestinal disturbance (nausea, vomiting, abdominal pain, diarrhea)

Similarities

•Volunteers who were parents reported heighted worry about their own children

Areas of Differences•Physical Appearance•Intimate relationships•Details recalled (or not)•Career decisions•Long-term and short-term effects of moral distress

Interpretation of Findings

Click icon to add pictureBeing able to detect the male experience of moral distress is much more difficult than detecting the female experience

Assessing Female MD•Physiological—Visceral discernment; sleep disruptions; negative changes in physical appearance

•Psychological—Anxiety; depression

•Sociological—reduced intimacy with spouse or partner; changes in work relationships

Assessing Male MD•Men are unlikely to display their experience (stoic)

•Male MD is not easily seen by others

•Male descriptions of MD experience are less detailed, factual, non-emotive

Next step for MD research

•Determine how to assess an experience that does not look the same for men and women, that can’t be observed easily, and that won’t be reported

References

•Hanna, D. R. (2004). Moral Distress: The State of the Science. Research and Theory for Nursing Practice, 18(1): 73-93.

•Hanna, D. R. (2005). The Lived Experience of Moral Distress of Nurses who Assisted with Elective Abortions. Research and Theory for Nursing Practice, 19(1): 95-124.

Thank you. Questions?Thank you.