Understanding Moral Distress among Eldercare Workers: A Scoping Review

Abstract

The aging of the population in Western countries will increase the use of social and health services in the future. Employees in eldercare are at risk for experiencing moral distress, which is associated with poor work ability. The causes and consequences of moral distress among eldercare workers remain undiscovered. This scoping review investigates the existing studies of causes and consequences of moral distress among eldercare workers. Additionally, it seeks evidence of interventions designed to mitigate moral distress in eldercare workers. Fourteen studies were included in the final review. Most of the included studies were qualitative, aiming to increase understanding of morally challenging situations in eldercare. We also found quantitative studies with cross-sectional designs and small sample sizes. Thus, no reliable evidence of causal effects between moral distress and worker wellbeing in eldercare was found. We found no interventions undertaken to resolve moral distress among eldercare workers, either. More research is needed on the causes and consequences of moral distress and on interventions to mitigate moral distress among eldercare workers. This is of utmost importance to increase the attractiveness of eldercare as a workplace and to improve eldercare workers’ ability to work and sustain long working careers.

Engaging Leadership and Psychological Safety as Moderators of the Relationship between Strain and Work Recovery: A Cross-Sectional Study of HSS Employees

“…Reducing job strain and moral distress are important but challenging tasks in HSS and in eldercare to improve the attractiveness of these sectors [ 46 ]. However, there are only a few interventions that have developed work and work processes to reduce job demands or moral distress, or to enhance job control [ 47 , 48 ]. This is the case despite evidence that job strain is an important risk factor for mental disorders [ 49 ] and, alone or in combination with other psychosocial factors, even for work disability [ 1 , 2 ].…”

Strategies to mitigate moral distress as reported by eldercare professionals

“…Therefore, because it is not possible to eliminate moral distress totally in the elderly care context, it can be considered as an opportunity for moral growth and possibility to develop institutional policies or practices (Carse & Rushton, 2017 ; Tigard, 2019 ) in order to enhance well being of employees. The most typical factors behind moral distress in the health and social services (HSS) are related to inadequate resources and insufficient staffing levels (Burston & Tuckett, 2013 ; Morley et al, 2020 ; Nikunlaakso et al, 2022 ), disagreements over clinical decisions (McCarthy & Gastmans, 2015 ; Wiegand & Funk, 2012 ), poor ethical climate or work environment (Lamiani et al, 2017 ; Rego et al, 2022 ), and social conflicts (Nikunlaakso et al, 2022 ; Pijl-Zieber et al, 2018 ; Woods, 2020 ). Moral distress has been established to be connected to the environment in which an employee operates, and the dimensions of moral distress may vary in different settings (Atabay et al, 2015 ).…”

“…Surprisingly, very little attention has been paid to moral distress in the context of eldercare as shown by the scoping review by Nikunlaakso et al ( 2022 ), in which they aimed to identify and to map relevant research evidence regarding moral distress in elderly care. This systematic scoping review (Nikunlaakso et al, 2022 ) included studies of causes and consequences of moral distress among eldercare workers and the intervention studies to mitigate moral distress published in years997–2022. According to the scoping review, most of the studies were qualitive and aimed to describe ethically challenging and draining situations (Nikunlaakso et al, 2022 ).…”

“…This systematic scoping review (Nikunlaakso et al, 2022 ) included studies of causes and consequences of moral distress among eldercare workers and the intervention studies to mitigate moral distress published in years997–2022. According to the scoping review, most of the studies were qualitive and aimed to describe ethically challenging and draining situations (Nikunlaakso et al, 2022 ). The causes of moral distress in eldercare were organizational restraints such as policies or inadequate resources, relational and power-related issues, conflicts with colleagues, patients and their family members, and other professionals.…”

“…Situations and decisions related to patients’ care and services may cause moral distress when professionals have different understandings about the right way to act, or when the decision-making process is unclear. In addition, a lack of workers’ competence and work safety problems can also create uncertainty and lead to moral distress (Nikunlaakso et al, 2022 ).…”