Moral Distress in Healthcare Practice: The Situation of Nurses

Austin, Wendy; Lemermeyer, Gillian; Goldberg, Lisa; Bergum, Vangie; Johnson, Melissa

doi:10.1007/s10730-005-4949-1

Cited by 133 publications

(133 citation statements)

References 21 publications

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“…Defined initially by Jameton (1984) as the painful emotions experienced by nurses in situations when they are cognizant of the morally appropriate actions to take but find themselves limited by institutional barriers, the term was subsequently applied to biomedical problems that were ''intermittently occurring and dramatic'' (Corley, 2002, p. 637). However, Austin et al (2005) pointed out that the daily practice of nurses abounds with ethical issues that are difficult to define and articulate. Furthermore, internal constraints such as fear or doubt as well as external ones may prevent the chosen action.…”

Section: Introductionmentioning

confidence: 99%

Moral distress among Ugandan nurses providing HIV care: A critical ethnography

Harrowing

Mill

2010

International Journal of Nursing Studies

110

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Section: Introductionmentioning

confidence: 99%

Moral distress among Ugandan nurses providing HIV care: A critical ethnography

Harrowing

Mill

2010

International Journal of Nursing Studies

110

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“…In this study, we call this situation ethical confrontation, which has also been called moral distress in the literature. 1 Although attending physicians and parents are generally intimately involved in the decision-making process, residents and nurses may sometimes feel powerless, having to follow through with care plans and resuscitation decisions even when they do not agree that the best decision has been made. 1 We could find no literature describing the frequency of such ethical confrontations for residents and nurses involved in the care of extremely preterm infants, nor what influences the frequency of such confrontations.…”

Section: Introductionmentioning

confidence: 99%

Moral distress in the neonatal intensive care unit: caregiver's experience

et al. 2007

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Background: The Neonatal Intensive Care Unit (NICU) can be ethically charged, which can create challenges for health-care workers.Objective: To determine the frequency with which nurses and residents have experienced ethical confrontations and what factors are associated with increased frequency.Design/Methods: An anonymous questionnaire was distributed to nurses in a university center, a high-risk obstetric service, a maternity hospital NICU with 85% in-born patients and an outborn NICU, most of whose preterm admissions are those with surgical complications. Obstetric and pediatric residents in the four universities of the province also received the questionnaire, which included demographics, opinions regarding the gestational age threshold at which resuscitation of a premature infant with bradycardia was appropriate, knowledge of cerebral palsy (CP) outcomes (as an indicator of knowledge about long-term sequelae of prematurity) and questions about ethical confrontation in the NICU.Results: Two hundred and seventy-nine caregivers participated (115 full time nurses and 164 residents). All the distributed questionnaires were completed. Frequent ethical confrontation was reported by 35% of the nurses and 19% of the residents. Among the nurses, moral distress differed significantly between work environments. Nurses working in an out-born NICU and obstetric nurses were more likely to overestimate CP prevalence (P<0.05). Nurses who overestimated CP rates had higher thresholds for resuscitation and were more likely to experience ethical confrontations. Of the residents, 60% were pediatric and 40% obstetric. All groups of residents frequently overestimated the prevalence of CP, and knowledge differed significantly by residency program (P<0.05). The residents who overestimated CP rates had higher thresholds for resuscitation, had more incorrect answers regarding prematurity outcomes and were less likely to have ethical confrontations.Conclusions: A large proportion of nurses and residents report frequent ethical confrontations. Many residents and nurses have limited knowledge of outcomes and high threshold for resuscitation. Ethical confrontation is more common among nurses with poor knowledge about outcomes, and less common in residents with poor knowledge about outcomes.

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“…The trepidation of nursing students is amplified by the culture of assimilation expected in health care (Choi, 2005;Tregunno, Peters, Campbell, & Gordon, 2009;Pross, 2005). Further, when we hear stories from the perspectives of those working as UNEs or HCAs, or those with EAL, it is apparent that health care efficiencies are only further isolating these students and putting them in situations where they are morally conflicted (Austin, Lemermeyer, Goldberg, Bergum, & Johnson, 2008) by their diverse social locations between roles and identities. Rankin and Campbell (2006) offer insight into how the transition to professional nursing practice is constructed with the backdrop of taken-for-granted measures of efficiency and health care reform.…”

Section: Discussionmentioning

confidence: 99%