The concept of moral distress is not new to nursing. As early as 1984 Jameton described moral distress as occurring when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Nurses may experience moral distress when confronted with chosen treatment options that they believe are not be in the best interest of the patient, and/or do not mesh with their sense of right and wrong. Although the nursing literature documents moral distress in the clinical area, it does not address moral distress in academia. Yet anecdotal evidence indicates that moral distress also occurs in academic institutions. The author begins this article by describing the experience of moral distress and suggesting that moral distress occurs not only in the clinical setting, but also in the academic setting. This is followed by a review of the literature related to moral distress in nursing education and a discussion of the seeds of moral distress in nursing education, such as dishonesty, including cheating and plagiarism; grade inflation; and incivility. The author concludes by Identifying the professional implications of moral distress in nursing education.
Citation: Ganske, K.M., (September 30, 2010) "Moral Distress in Academia" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 6.
Keywords: Nursing education, academic dishonesty, moral distress, ethical climate, collégial incivility, grade inflation, nursing students, nurse educators, responsibility, accountability, cheating, plagiarism, college students, academia.
The nursing profession has traditionally held to a high standard of moral behavior and ethical practice. Nurses in clinical practice frequently report the distress they experience when, for example, a standard that they believe In is compromised In some fashion. Other times this distress occurs when the nurse does not believe that the treatment being provided to the patient Is in the best Interest of the patient, or does not mesh with the nurse's sense of right and wrong. Nurse educators, through anecdotal conversations and comments, have shared with this author the moral distress they have experienced when the administration of their educational unit makes a decision they do not feel Is in the best Interest of the student or the nursing profession. The following scenarios, although fictional, represent anecdotal examples of moral distress in nursing education.
William is a 24 year old nursing student who has struggled from the time he entered the nursing program. Each semester brings new challenges, and his grades skim the passing point. He is just getting by. He somehow reaches his senior year, unable to assemble grammatically correct sentences, organize a research paper, or follow the dreaded APA format as taught or described in his manual. He does his best and turns in his final paper. His professor is dismayed with the paper and returns a failing grade for his project. He appeals to her angrily, saying "I have never had a grade like this before." She Is perplexed because she knows there are many written assignments in the nursing program and wonders how he could have gotten to this point and still have passing grades. She feels she should give him the grade he has earned, but the dean has told her, "you cannot stop him now, he is about to graduate." She angrily wonders why her colleagues have not dealt with his writing appropriately. Distressed, she feels like she is shouldering responsibility for what her colleagues should have done semesters ago. Yet she knows she cannot override her dean in this situation.
Solange is a 35 year old naturalized citizen from Uruguay. She is a transfer student in the nursing program. Because she is not a native English speaker, she struggles to take tests and write papers. She was admitted to the nursing program because she had the required grade point average and took 'English as a Second Language' classes at her local community college. …