The Sage Encyclopedia of Social Science Research Methods

Purpose
Moral distress is a phenomenon affecting many professionals across healthcare settings. Few studies have used a standard measure of moral distress to assess and compare differences among professions and settings.

Design
A descriptive, comparative design was used to study moral distress among all healthcare professionals and all settings at one large healthcare system in January 2011.

Methods
Data were gathered via a web-based survey of demographics, the Moral Distress Scale-Revised (MDS-R), and a shortened version of Olson's Hospital Ethical Climate Scale (HECS-S).

Findings
Five hundred ninety-two (592) clinicians completed usable surveys (22%). Moral distress was present in all professional groups. Nurses and other professionals involved in direct patient care had significantly higher moral distress than physicians (p = .001) and other indirect care professionals (p < .001). Moral distress was negatively correlated with ethical workplace climate (r = -0.516; p < .001). Watching patient care suffer due to lack of continuity and poor communication were the highest-ranked sources of moral distress for all professional groups, but the groups varied in other identified sources. Providers working in adult or intensive care unit (ICU) settings had higher levels of moral distress than did clinicians in pediatric or non-ICU settings (p < .001). Providers who left or considered leaving a position had significantly higher moral distress levels than those who never considered leaving (p < .001). Providers who had training in end-of-life care had higher average levels of moral distress than those without this training (p = .005).

Conclusions
Although there may be differences in perspectives and experiences, moral distress is a common experience for clinicians, regardless of profession.

Clinical Relevance
Moral distress is associated with burnout and intention to leave a position. By understanding its root causes, interventions can be tailored to minimize moral distress with the ultimate goal of enhancing patient care, staff satisfaction, and retention.

Moral Distress Among Healthcare Professionals: Report of an Institution-Wide Survey

Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions. This review describes the publication trend on moral distress and explores its relationships with other constructs. A bibliometric analysis revealed that since 1984, 239 articles were published, with an increase after 2011. Most of them (71%) focused on nursing. Of the 239 articles, 17 empirical studies were systematically analyzed. Moral distress correlated with organizational environment (poor ethical climate and collaboration), professional attitudes (low work satisfaction and engagement), and psychological characteristics (low psychological empowerment and autonomy). Findings revealed that moral distress negatively affects clinicians’ wellbeing and job retention. Further studies should investigate protective psychological factors to develop preventive interventions.

When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates:

Nurses are frequently confronted with ethical dilemmas in their nursing practice As a consequence, nurses report experiencing moral distress The aim of this review was to synthesize the available quantitative evidence in the literature on moral distress experienced by nurses We appraised 19 articles published between January 1984 and December 2011 This review revealed that many nurses experience moral distress associated with difficult care situations and feel burnout, which can have an impact on their professional position Further research is required to examine worksite strategies to support nurses in these situations and to develop coping strategies for dealing with moral distress

Moral distress experienced by nurses: A quantitative literature review

Background: As ongoing research explores the impact of moral distress on health care professionals (HCPs) and organizations and seeks to develop effective interventions, valid and reliable instrume...

Enhancing Understanding of Moral Distress: The Measure of Moral Distress for Health Care Professionals.

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care.

/pdf/framing-the-issues-moral-distress-in-health-care-3aoureit1z.pdf

Framing the Issues: Moral Distress in Health Care

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.

https://journals.sagepub.com/doi/pdf/10.1177/0969733011436025

Nurses’ perceptions of and responses to morally distressing situations:

Moral distress is a concept used to date in clinical literature to describe the experience of staff in circumstances in which they are prevented from delivering the kind of bedside care they believe is expected of them, professionally and ethically. Our research objective was to determine if this concept has relevance in terms of key health care managerial functions, such as priority setting and resource allocation. We conducted interviews and focus groups with mid- and senior-level managers in two British Columbia (Canada) health authorities. Transcripts were analyzed qualitatively using constant comparison to identify key themes related to moral distress. Both mid- and senior-level managers appear to experience moral distress, with both similarities and differences in how their experiences manifest. Several examples of this concept were identified including the obligation to communicate or ‘sell’ organizational decisions or policies with which a manager personally may disagree and situations where scarce resources compel managers to place staff in situations where they meet with predictable and potentially avoidable risks. Given that moral distress appears to be a relevant issue for at least some health care managers, further research is warranted into its exact nature, prevalence, and possible organizational and personal responses.

Moral Distress Among Health System Managers: Exploratory Research in Two British Columbia Health Authorities

There is a growing demand for home care services in Canada. Yet, overwhelmingly, research on patient safety has focused on institutional settings. The Canadian Patient Safety Institute convened a Core Safety in Home Care Team of researchers and decision-makers to identify priority research areas and to advance patient safety research in home care. As part of this initiative to investigate and extend our understanding of home care safety, key informant interviews were carried out with a wide range of respondents including researchers, decision-makers, service providers and regulators. In-depth audiotaped interviews were conducted in two Canadian provinces. Interpretive descriptive analyses revealed three main themes: the meaning of home care, safety concerns and the place of technology in the future of home care. Given the multidimensionality and complexity of home care as well as the challenges and strains involved, the risk to all the players is becoming increasingly evident.

/pdf/home-care-safety-perspectives-from-clients-family-members-31lkcx53u4.pdf

Jan Storch

Papers

Framing the Issues: Moral Distress in Health Care

Nurses’ perceptions of and responses to morally distressing situations:

Moral Distress Among Health System Managers: Exploratory Research in Two British Columbia Health Authorities

Home care safety perspectives from clients, family members, caregivers and paid providers.

Moral Distress among Healthcare Managers: Conditions, Consequences and Potential Responses