Erlebensqualitäten moralischer Belastung professionell Pflegender und die Notwendigkeit des Schutzes der moralischen Integrität – am Beispiel der COVID-19-Pandemie

Legal Regulations and the Anticipation of Moral Distress of Prospective Nurses: A Comparison of Selected Undergraduate Nursing Education Programmes

“…They point out that the symptoms of such psychological stress may vary among nurses but include negative emotions such as anger, frustration, guilt, regret, sadness, upset, powerlessness, symptoms associated with stress and feeling torn. This description is in line with those of others who point out that moral distress is to be understood as the subjective experience of each individual nurse [ 37 , 38 , 40 , 41 ]. Yet another definition of moral distress is that provided by a systematic review by Sanderson et al [ 51 ] (p. 207) who describe moral distress as follows: the “Ethical unease or disquiet resulting from a situation where a clinician believes they are contributing to avoidable patient or community harm through their involvement in an action, inaction or decision that conflicts with their own values”.…”

“…Other dimensions of moral suffering such as moral injury [ 38 , 72 , 73 , 74 ] and moral residue [ 38 , 75 , 76 ] are being discussed in the literature with respect to the continuum of moral suffering. This continuum is understood as a person’s oscillation between the feelings of moral comfort (the individual’s moral integrity remains intact) and moral distress (the individual experiences a violation to their moral integrity) [ 39 , 40 ].…”

“…This continuum is understood as a person’s oscillation between the feelings of moral comfort (the individual’s moral integrity remains intact) and moral distress (the individual experiences a violation to their moral integrity) [ 39 , 40 ]. Moral residue is understood as the consequence of a person’s repetitive experience of unresolved moral distress in a way that causes a gradual accumulation of stress levels over time, resulting in long-lasting, residual feelings of a compromised moral integrity [ 38 , 75 ]. In respect to the dimension of moral injury, Rushton et al (p. 121) [ 41 ] define this experience as follows: “When moral distress is unrelieved or becomes chronic, or the intensity of it overwhelms a person’s capacity to remain whole, it can lead to more severe forms of moral suffering, such as moral injury”.…”

“…For example, the development of moral distress has been linked to the work environment, and ethical climate of an organisation [ 40 , 78 , 84 , 85 ]; organisational structures and frameworks [ 22 , 40 , 72 , 84 , 85 ]; high risk areas such as end-of life care, intensive care, neonatal or paediatric care [ 27 , 86 ]; the ethical complexity of care situations; active or passive demands which are put upon nurses to act in a way that is against their understanding of professional moral values [ 38 ]; the professional disposition and moral compass of the individual nurse [ 40 , 87 ]; as well as the ethical competencies and educational background of nurses [ 87 ].…”

“…These abilities may support prospective nurses in maintaining their moral integrity, understood as the “moral wholeness” (p. 78) [ 35 ] of a person or as their ability to live up “to one’s personal moral code, so that one can sleep at night, or live with oneself, having demonstrated courage, patience, and perseverance in the face of conflict” (p. 431) [ 36 ]. If a person’s moral integrity has been violated, this infringement may result in moral distress, a phenomenon of growing interest within the recent nursing literature [ 2 , 19 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ].…”