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Learning Objective 1: The learner will be able to know the distinctive moral distress experienced by proficient nurses in Japan.
Learning Objective 2: The learner will be able to@understand of experience of the proficient nurses@need to create an ethical climate.
Methods: Qualitative research was conducted using study design and semi-structured interviews. The participants were recruited using the network sampling method. A total of 17 nurses participated in this study. According to the interview guide, participants were asked their moral distress in nursing practice. A qualitative and inductive method was applied for analysis. This study was reviewed and approved by the Research Ethics Committee and informed consent was obtained from all nurses.
Results: Six themes were extracted from the data of the experience that causes moral distress by proficient nurses. These were a impaired dignity of patients, an acting for one's own self-interests, an institutional control and constraints, an omission of care for patients, not fair or equitable, and an acting in bad faith. All nursing practice involves ethical decisions and moral distress appears to manifest within a relational and contextual environment. Nevertheless, work style of nurses in which they performed only routine work and ceased examining themselves with moral issues. Further, nurses often find institutional control and constraints in their daily clinical practice. Nurses were not able to talk with a peer professional about one's suffering. These experiences were all linked feelings of compunction and powerlessness.
Discussions: The study results suggest that patients-centered nursing demands a willingness to confront moral issues and nurses do not to struggle alone with them. It is important for nurses to support of peers, encourages respectful interactions with colleagues, and a caring for climate.