Moral distress revisited: the viewpoints and responses of nurses

Abstract

Aim To present and discuss the main themes that were revealed following an analysis of the qualitative research findings that were extracted from a national survey regarding the causes and effects of moral distress amongst New Zealand nurses. Background/Introduction Moral distress continues to be a major concern amongst nurses around the world. In New Zealand, a country where nurses have just been on strike over their working conditions and the deteriorating state of their roles within the health services, it remains a major issue. Method In the original research project, large numbers of nurses supplied not only quantitative data that revealed the extent and impact of moral distress on their practices, but also extensive notes that more specifically explained the causes and effects of their moral distress. This material has since been thematically analysed and is now presented. Findings/results The data strongly suggested that New Zealand nurses experienced and attempted to respond to several major issues; that is, they were not properly supported by ‘the system’, frequently experienced problems with managers and bullying, witnessing poor care practices and collegial incompetence, and suffered from ongoing problems caused by moral residue. Conclusion Under current working conditions, nurses are struggling under an increasing weight of moral residue to maintain their ethical standards within an increasingly difficult ethical climate. Implications for nursing and health policy This research suggests that although nurses clearly seek out and use various ways to cope with moral distress in their practices, there is a continuing need for moral courage and strengthening of moral resilience that involves greater input from not just nurses themselves, but nurse managers, educators and other health services representatives.

Moral suffering in health professionals: portrait of the work environment in times of COVID-19

“…Fear of transmitting the virus (21) Family Affiliation (18) Weakened interpersonal relationships (8) Violence (8) Although they perceive moral problems differently, precarious situations or adverse working environment conditions are common among professionals, and these can trigger experiences of moral suffering (17) . The reality of the pandemic has brought new challenges and restrictions to health services, causing negative concerns and feelings in the professionals who work in these services, such as the risk of contagion, isolation, fear and anxiety (18) .…”

“…The problems that undermine the moral integrity of professionals prevent the adoption of practices consistent with their values and beliefs (17) , which becomes a danger to the maintenance of a healthy psychosocial environment and can affect your physical and mental well-being (16) and cause them moral suffering (17) .…”

“…The moral problems presented in this study as possible triggers to trigger experiences of moral suffering can be considered as contextual restrictions in the work environment that prevent action consistent with moral judgment. In large part, these factors are related to the organizational culture that does not support the moral deliberation of professionals, which can be avoided and is subject to modifications through concrete institutional actions (17) .…”

Moral reasoning as a catalyst for cultural competence and culturally responsive care

“…Some argue that organizational constraints such as lack of resources can result in nurses feeling unable to do what they know to be right (Deady & McCarthy, 2010; Jameton, 1984). The impact of working conditions on moral residue is identified (Woods, 2020). Without adequate staffing and resources, care standards are compromised and patient safety is inevitably threatened (Hessels et al, 2015; Kim et al, 2018).…”

Nurses' moral distress in end-of-life care: A qualitative study

“…A recent systematic review identified four primary factors that cause moral distress in palliative care settings: (1) personal factors; (2) patients and caregivers; (3) colleagues and superiors; and (4) environments and organisations. 12 Several studies have focused on moral distress among nursing staff, [13][14][15][16] and the triggers and consequences of moral distress associated with end-of-life care have been widely studied. [17][18][19][20][21] However, moral distress is an often neglected issue by palliative education programmes, and research has largely focused on the phenomenon as an occupational problem for nursing staff.…”