1. Gender-Specific Features of the Lived Experience of Moral Distress Debra R. Hanna, PhD, RN Associate Professor Molloy College Rockville Centre, NY 11571

2. This study was funded through a Molloy College Faculty Scholarship Grant

3. 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

4. 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

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

6. 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

7. 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)

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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)

14. Similarities Volunteers who were parents reported heighted worry about their own children

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

16. Interpretation of Findings Being able to detect the male experience of moral distress is much more difficult than detecting the female experience

17. 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

18. 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

19. 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

20. 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.

21. Thank you. Questions? Thank you.