Objective: The objective of this study was to determine whether there are significant differences between crisis-deployed and non-crisis deployed military nurses in the experience of moral distress. The research question was: Do crisis-deployed military nurses experience significantly higher levels of moral distress than non-crisis deployed military nurses; specifically, the dimensions of Initial Moral Distress, Reactive Moral Distress, and Effects and Consequences of Reactive Moral Distress?
Design: A descriptive, comparative study design was used to answer the research question.
Population, Sample, Setting, and Years: Over 5000 Army Nurse Corps officers who had and had not participated in a crisis military deployment (i.e., Vietnam War, Persian Gulf War; deployment to Somalia, Bosnia, Germany, El Salvador, Panama, Honduras, Saudi Arabia) were invited to participate in the study. The data were collected in 2000. The study participants (n=959) ranged from 24 to 87 years of age with an average age of 50.5 years. The majority were female (76.8%), deployed either within or outside the U.S. (55.2%), had completed an average of 16.2 years of military service as well as an average of 15 years of non-military nursing service. The education level of the participants was high with over 47% earning a master’s or doctoral degree.
Concepts Studied: The study was guided by conceptual models of the moral distress phenomenon and the process of experiencing moral distress developed from previous research, a review of the literature, and interviews of crisis-deployed military nurses. A crisis military deployment was defined as a situation when military personnel are suddenly ordered to support an operation away from home station during a war; or a humanitarian or a peacekeeping mission. Moral distress was defined as a feeling state experienced when a person makes a moral judgment about a situation in which they are involved but experiences a barrier to acting on that judgment.
Methods: After university and Army Medical Centers’ IRB approval of the study, those agreeing to participate in the study received a sealed packet containing a cover letter, an explanation of confidentiality protections, the study measures, and instructions for return of the completed questionnaires. The study measures included a 16-item demographic information tool and the 25-item Military Nursing Moral Distress Scale (MNMDS). The three PCA derived subscales of the MNMDS had Cronbach’s alphas from a low of .80 to a high of .90 and met internal consistency criteria (>.70) for a new scale. Of the 1440 returned questionnaires, 481 had missing data or were incompletely filled out and were eliminated from the study. Data analysis was completed on 959 questionnaires from Army Nurse Corps officers who had been crisis deployed (n=529) and had not been crisis-deployed (n=430). Discriminant function analysis was used to answer the research question.
Findings: Military nurses who were crisis deployed experienced significantly higher levels of moral distress than non crisis-deployed nurses, overall. The most significant difference between crisis-deployed and non crisis-deployed military nurses was for the Effects and Consequences of Reactive Moral Distress. There were fewer differences between the two groups for the experiences of Reactive Moral Distress and Initial Moral Distress.
Conclusions: Military nurses, whether deployed or non-deployed, experience moral distress. Deployed military nurses experience significantly higher levels of moral distress related to its effects and consequences over time than non-deployed military nurses.
Implications: Previous research has demonstrated that moral distress is associated with nurse stress, burnout, and the decision to leave nursing practice. The presence of moral distress among military nurses, especially those who have been crisis-deployed, is of concern since military forces must be assured that its nurses maintain a high readiness capability and that they can perform at peak efficiency for long periods of time under uncertain conditions. Moral distress is one factor that can affect the ability of the military nurse to effectively do his or her job and thus requires the development of appropriate interventions to ameliorate its occurrence, effects, and consequences.
*This project was sponsored by the TriService Nursing Research Program, Uniformed Services University of the Health Sciences (Grant NO. 97-Z-0015); however, the content and conclusions do not necessarily represent the official position of, nor should any official endorsement be inferred by the TriService Nursing Research Program, Uniformed Services University of the Health Sciences, the Department of Defense, or the U. S. Government.
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