What is ‘moral distress’ in nursing? A feminist empirical bioethics study

Research output: Contribution to journalArticlepeer-review

Authors

Colleges, School and Institutes

External organisations

  • University of Bristol
  • Barts Health NHS Trust
  • Cleveland Clinic Foundation

Abstract

Background: The phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice. Research aim: To explore the concept of moral distress in nursing both empirically and conceptually. Methodology: Feminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis. Ethical considerations: The study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom. Findings: The empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas. Discussion: We suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress. Conclusion: The empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’.

Bibliographic note

Funding Information: The empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’. Empirical approaches empirical bioethics feminist ethics moral distress nursing practice phenomenology qualitative research theory/philosophical perspectives Wellcome Trust http://dx.doi.org/10.13039/100004440 Grant ref: 108640/Z/15/Z edited-state corrected-proof Conflict of interest The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: G.M. serves on the editorial board for the journal Nursing Ethics . Funding The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was made possible by a Society and Ethics Fellowship for Healthcare Professionals from the Wellcome Trust (Grant ref.: 108640/Z/15/Z) and also made Open Access by the Wellcome Trust. ORCID iD Georgina Morley https://orcid.org/0000-0002-0099-3597 Supplemental material Supplemental material for this article is available online. Publisher Copyright: © The Author(s) 2019. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

Details

Original languageEnglish
Pages (from-to)1297-1314
Number of pages18
JournalNursing Ethics
Volume27
Issue number5
Publication statusPublished - 1 Aug 2020

Keywords

  • Empirical approaches, empirical bioethics, feminist ethics, moral distress, nursing practice, phenomenology, qualitative research, theory/philosophical perspectives

ASJC Scopus subject areas