Moral discord, cognitive coping strategies, and medical intensive care unit nurses: insights from a focus group study.

Moral discord occurs when contextual factors prevent nurses from implementing felt moral mandates. Medical intensive care unit (MICU) nurses frequently confront moral issues and hold themselves personally responsible for their moral actions. They use a variety of cognitive coping strategies to deal with moral discord. This article describes common moral dilemmas encountered by MICU nurses, explores patterns of both conscious and unconscious cognitive coping behaviors, and reviews steps that nurses can take to reduce the degree of moral discord they experience.