Nurses’ perceptions of and responses to morally distressing situations

Abstract

Research on moral distress has paid limited attention to nurses' responses and actions. In a survey of nurses' perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an "inability to act due to institutional constraints" or a "failure to pursue a right course of action." Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change.

Nurses’ attitudes toward ethical issues in psychiatric inpatient settings

“…Varcoe et al, 26 in their study of nurses' responses and perceptions regarding moral distress, stated that a shortage of resources or a work overload, in addition to concerns of their own competency and that of others, all contributed to unethical behaviors. When we overview the history of nursing, the Florence Nightingale Pledge, which consists of important guideline rules for nurses, is considered as the source of first ethical codes of the occupation of nursing.…”

Critical Care Nurse Work Environments 2013: A Status Report

“…42 It also results in feelings of incompetence, distancing from patients, and a negative impact on quality of care. 43 Issues contributing to moral distress include workload, incompetence of self or others leading to inadequate care, witnessing unnecessary suffering, moral compromise, and negative provider judgments about patients and/or their families. 37 Appropriate staffing and creating opportunities to discuss, learn from, and resolve morally distressing situations are strategies to limit the problem.…”

Screening Situations for Risk of Ethical Conflicts: A Pilot Study

“…Moral distress not only affects individual behavior but also the workplace environment. [52][53][54][55][56][57][58] For example, distressed health care providers can experience decreased job satisfaction, [59][60][61] unsettling physical symptoms such as insomnia and headaches, and disruptive psychological symptoms such as loss of confidence and self-worth. 26 Moreover, nurses' moral distress has been associated with absenteeism, burnout, intentions to quit, and leaving the profession.…”