What is ‘moral distress’? A narrative synthesis of the literature

Abstract

Aims: The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress. Background: Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon. Review methods: Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis. Results: In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity. Conclusion: We suggest the combination of (1) the experience of a moral event, (2) the experience of 'psychological distress' and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress.

Covid‐19: Supporting nurses' psychological and mental health

“…(Mounk, 2020). Nurses are likely to experience moral and ethical conflict with the potential for stress and moral distress or moral injury (Bridges et al, 2013;Greenberg, Docherty, Gnanapragasam, & Wessely, 2020;Morley, Ives, Bradbury-Jones, & Irvine, 2019).…”

Moral Distress and Related Factors Among Emergency Department Nurses

“…Moral distress has different effects on nurses, patients, and health systems, and its consequences are important: in nurses, it causes them to leave the profession, and to experience isolation and burnout; when patients are faced with loss of quality of care and lack of patient protection, their irritation and discomfort will increase. Finally, organizations also suffer from the effects of this problem and are faced with heavy costs because of the loss of staff and difficulty recruiting new staff, which leads to decreases in quality of care and lack of patient satisfaction, which can endanger their professional reputation (12,13). The results of Fernandez-Parsons et al' (14) study at emergency sectors of hospitals in California, America demonstrated low intensity of moral distress (14), while Ohnishi et al (15) study in Japan's public hospitals showed high levels of moral distress.…”

Facetten von „moral distress“ im Pflegeheim

“…In seiner ursprünglichen Definition (Jameton, 1984 zit. n. [7]) bezeichnet MD die Stressreaktion, die entsteht, wenn eine Pflegeperson die moralisch richtige Handlungsweise identifiziert hat, durch externe oder interne Barrieren jedoch an der Umsetzung gehindert wird [4,18]. Der Großteil der theoretischen Modelle, Studien und Messinstrumente (z.…”

“…Die zentrale Rolle institutioneller Rahmenbedingungen, wie etwa unzureichender interdisziplinärer Kooperation, für die Entstehung von cMD wird im "Moral-crescendo"-Modell betont [4]. Einige Autoren, insbesondere Fourie [5], plädieren jedoch für eine breitere Definition, die neben cMD auch Stressreaktionen in Situatio-nen moralischer Unsicherheit, Dilemmata und Konflikte umfasst ("uncertainty MD", uMD; auch [18]). Diese breitere Konzeption erscheint auch vor dem Hintergrund empirischer Befunde sinnvoll (z.…”