Phenomenon of moral distress through the aspect of interpretive interactionism

Abstract

The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses' confidence and cultural sensitivity, so as to reduce the moral distress of nurses.

Registered Nurses' and nursing students' perspectives on moral distress and its effects: A mixed‐methods systematic review and thematic synthesis

“…A sense of powerlessness to intervene regarding care, treatment and decision‐making perceived as generating needless patient suffering and transgressing core professional values contributed to moral distress among RNs (Berhie et al, 2020; Crespo Drago et al, 2020; De Brasi et al, 2021; Deady & McCarthy, 2010; Harrowing & Mill, 2010; Ko et al, 2019; Langley et al, 2015; Nikbakht Nasrabadi et al, 2018; Prompahakul et al, 2021; Sauerland et al, 2014) and nursing students (Escolar Chua & Magpantay, 2019). This was invariably connected with interventions, treatment and care decisions perceived as futile (Asayesh et al, 2018; Browning, 2013; Choe et al, 2015; Ganz et al, 2013; Dodek et al, 2019; Dyo et al, 2016; Emmamally & Chiyangwa, 2020; Hiler et al, 2018; Hou et al, 2021; Karanikola et al, 2014; Ko et al, 2019; Latimer et al, 2021; Rezaee et al, 2019; Robinson & Stinson, 2016; Silverman et al, 2021; Wiegand & Funk, 2012; Wilson et al, 2013), overly aggressive (Rezaee et al, 2019; Wiegand & Funk, 2012) and inappropriate or unnecessary (Asgari et al, 2019; Browning, 2013; Choe et al, 2015; Christodoulou‐Fella et al, 2017; De Brasi et al, 2021; de Sousa Vilela et al, 2021; Fernandez‐Parsons et al, 2013; Forozeiya et al, 2019; Ganz et al, 2013; Ko et al, 2019; Laurs et al, 2020; Nikbakht Nasrabadi et al, 2018; Silverman et al, 2021) particularly, but not exclusively (de Sousa Vilela et al, 2021; Deady & McCarthy, 2010; Rezaee et al, 2019; Wojtowicz et al, 2014), in the context of end‐of‐life care.

We're with the patients a lot more than the providers … we see the futility a lot of the times, because we're like there's no wa...

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“…Findings are mixed regarding how perceived professional autonomy to enact moral agency when faced with moral problems in practice connected with experiencing moral distress (Caram et al, 2019; Choe et al, 2015; Christodoulou‐Fella et al, 2017; Crespo Drago et al, 2020; Dodek et al, 2019; Karanikola et al, 2014; Sarkoohijabalbarezi et al, 2017; Yeganeh et al, 2019). However, RNs' (Deady & McCarthy, 2010; Harorani et al, 2019; Hsun‐Kuei et al, 2018; Ko et al, 2019; Pergert et al, 2019; Sauerland et al, 2014; Silverman et al, 2021; Varcoe et al, 2012) and nursing students' (Escolar Chua & Magpantay, 2019; Krautscheid et al, 2017; Renno et al, 2018) perceived lack of knowledge, self‐competence and confidence in their ability to articulate concerns and fulfil their perceived moral responsibilities in ethically challenging situations generated moral distress (Deady & McCarthy, 2010; Escolar Chua & Magpantay, 2019; Harorani et al, 2019; Hsun‐Kuei et al, 2018; Ko et al, 2019; Krautscheid et al, 2017; Pergert et al, 2019; Renno et al, 2018; Sauerland et al, 2014; Silverman et al, 2021; Varcoe et al, 2012).…”

“…Others, however, seemingly remained silent. This was primarily on account of interprofessional team hierarchies, notably the perceived enduring power of the medical profession (Atashzadeh Shorideh et al, 2012; Caram et al, 2019; de Sousa Vilela et al, 2021; Deady & McCarthy, 2010; Escolar Chua & Magpantay, 2019; Ko et al, 2019; Langley et al, 2015; Pavlish et al, 2016; Renno et al, 2018; Silverman et al, 2021; Wolf et al, 2016), encapsulated in the following data extract:

Physicians believed [sic] they are above us. They order for patients and they expect us to obey them and not tell them about wrong orders.

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“…power of the medical profession(Atashzadeh Shorideh et al, 2012;Caram et al, 2019;de Sousa Vilela et al, 2021;Deady & McCarthy, 2010;Escolar Chua & Magpantay, 2019;Ko et al, 2019;Langley et al, 2015;Pavlish et al, 2016;Renno et al, 2018;Silverman et al, 2021;Wolf et al, 2016), encapsulated in the following data extract: tient is done by the nurses, it is the nurses who pass on the information. And even with our concern, they do not value our knowledge at all.…”

Phronesis of nurses: A response to moral distress

“…By combining current empirical research results to review the phenomenon of moral distress, nurses engage in personal moral judgment in the face of moral distress. [12][13][14] If nurses can adhere to their moral beliefs, they can take voluntary moral actions to safeguard the patient's best interests even if they feel difficulties, stress, and threats; this is known as moral courage in literatures. [15][16][17] Expressing moral courage and forming moral action are of great significance in reducing the feeling of moral distress.…”