Date of Award


Degree Name

Doctor of Nursing Science

Dissertation Committee

Patricia A. Roth, EdD, RN, Chairperson; Rosemary T. Goodyear, EdD, RN; Anna K. Ornery, DNSc, RN


moral reasoning, Nurse Practitioners, nursing, Phenomenology


The purpose of this phenomenological study was to identify the moral dilemmas experienced by nurse practitioners in their clinical practice and to describe the essential features of moral reasoning utilized by the nurse practitioners to resolve the moral dilemma. The participants in the study were ten female volunteers who were currently employed as NPs in a variety of settings. Unstructured interviews were conducted with the participants and the qualitative data was analyzed using a nine step process. Five essential features of moral reasoning emerged through the process of data analysis: values, elements in the contextual framework for moral reasoning, influencing factors, recognizing the dilemma, and outcomes. The first essential feature, values were those ideals which motivated the participants in making decisions amid competing choices in any given situation. The next essential feature, elements in the contextual framework for moral reasoning described the environment in which the NP practiced, including other persons within that setting. Elements in the contextual framework for moral reasoning also described the nurse practitioner role and referred not only to the activities the NP performed, but also to the nurse-patient relationship. Influencing factors were those elements that changed the everyday, clinical practice of the NP into one which became a moral dilemma. Influencing factors impacted the setting, the participants within the setting, and were the factors taken under consideration in the decision making process. One or more of these influencing factors were catalytic in motivating the practitioner into making a decision about the dilemma. The catalysts emerged because of certain values which were held in high esteem by the participants. Two patterns of moral reasoning were identified: independent and lateral reasoning. The nurse practitioners who utilized the independent pattern of reasoning based their decision making on self-chosen values regardless of other influences present in the situation. Lateral reasoning was a mode of reasoning where the individual chose to defer the decision to others in the environment. The implications for nursing practice, education and research based on the findings in this study are discussed. Recommendations are proposed which include further research into the essential features of moral reasoning to determine whether the findings in this study can be generalized to other nurses. It is hoped that research studies such as this will advance the knowledge of nursing and other disciplines concerning moral reasoning and ethics.

Document Type

Dissertation: Open Access



Included in

Nursing Commons