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  1. Influencers of ethical beliefs and the impact on moral distress and conscientious objection.Shoni Davis, Vivian Schrader & Marcia J. Belcheir - 2012 - Nursing Ethics 19 (6):738-749.
    Considering a growing nurse shortage and the need for qualified nurses to handle increasingly complex patient care situations, how ethical beliefs are influenced and the consequences that can occur when moral conflicts of right and wrong arise need to be explored. The aim of this study was to explore influencers identified by nurses as having the most impact on the development of their ethical beliefs and whether these influencers might impact levels of moral distress and the potential for conscientious objection. (...)
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  • Moral distress and intention to leave intensive care units: A correlational study.Abbas Naboureh, Masoomeh Imanipour & Tahmine Salehi - 2021 - Clinical Ethics 16 (3):234-239.
    Moral distress is a fundamental problem in the nursing profession that affects nurses. Critical care nurses are more susceptible to this problem due to the nature of their work. Moral distress may, in turn, lead to several undesirable consequences. This study aimed to determine the relationship between moral distress and intention to leave the ward among critical care nurses. This descriptive-correlational study was conducted by census method on all eligible nurses who worked in Coronary Care Unit (CCU) and Intensive Care (...)
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  • Ethical leadership outcomes in nursing: A qualitative study.Maasoumeh Barkhordari-Sharifabad, Tahereh Ashktorab & Foroozan Atashzadeh-Shoorideh - 2018 - Nursing Ethics 25 (8):1051-1063.
    Background: Leadership style adopted by nursing managers is a key element in progress and development of nursing and quality of healthcare services received by the patients. In this regard, the role of ethical leadership is of utmost importance. Objectives: The objective of the study was to elaborate on the ethical leadership and its role in professional progress and growth of nurses in the light of work condition in health providing institutes. Methods: The study was carried out as a qualitative study (...)
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  • Organizational Influences on Health Professionals’ Experiences of Moral Distress in PICUs.Sarah Wall, Wendy J. Austin & Daniel Garros - 2016 - HEC Forum 28 (1):53-67.
    This article reports the findings of a qualitative study that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were identified. (...)
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  • It Is Not Your Fault: Suggestions for Building Ethical Capacity in Individuals Through Structural Reform to Health Care Organisations: Comment on “Moral Distress in Uninsured Health Care” by Anita Nivens and Janet Buelow. [REVIEW]Sarah Winch, Michael Sinnott & Ramon Shaban - 2013 - Journal of Bioethical Inquiry 10 (3):423-424.
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  • Building an ethical environment improves patient privacy and satisfaction in the crowded emergency department: a quasi-experimental study. [REVIEW]Yen-Ko Lin, Wei-Che Lee, Liang-Chi Kuo, Yuan-Chia Cheng, Chia-Ju Lin, Hsing-Lin Lin, Chao-Wen Chen & Tsung-Ying Lin - 2013 - BMC Medical Ethics 14 (1):8-.
    Background: To evaluate the effectiveness of a multifaceted intervention in improving emergency department (ED) patient privacy and satisfaction in the crowded ED setting. Methods: A pre- and post-intervention study was conducted. A multifaceted intervention was implemented in a university-affiliated hospital ED. The intervention developed strategies to improve ED patient privacy and satisfaction, including redesigning the ED environment, process management, access control, and staff education and training, and encouraging ethics consultation. The effectiveness of the intervention was evaluated using patient surveys. Eligibility (...)
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  • Moral distress in nursing: contributing factors, outcomes and interventions.Adam S. Burston & Anthony G. Tuckett - 2013 - Nursing Ethics 20 (3):312-324.
    Moral distress has been widely reviewed across many care contexts and among a range of disciplines. Interest in this area has produced a plethora of studies, commentary and critique. An overview of the literature around moral distress reveals a commonality about factors contributing to moral distress, the attendant outcomes of this distress and a core set of interventions recommended to address these. Interventions at both personal and organizational levels have been proposed. The relevance of this overview resides in the implications (...)
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  • ‘You can give them wings to fly’: a qualitative study on values-based leadership in health care.Yvonne Denier, Lieve Dhaene & Chris Gastmans - 2019 - BMC Medical Ethics 20 (1):1-17.
    Within contemporary health care, many of the decisions affecting the health and well-being of patients are not being made by the clinicians or health professionals, but by those involved in health care management. Existing literature on organizational ethics provides insight into the various structures, processes and strategies - such as mission statement, ethics committees, ethical rounds … - that exist to create an organizational climate, which fosters ethical practices and decision-making It does not, however, show how health care managers experience (...)
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  • Toward interventions to address moral distress.Lynn C. Musto, Patricia A. Rodney & Rebecca Vanderheide - 2015 - Nursing Ethics 22 (1):91-102.
    Background: The concept of moral distress has been the subject of nursing research for the past 30 years. Recently, there has been a call to move from developing an understanding of the concept to developing interventions to help ameliorate the experience. At the same time, the use of the term moral distress has been critiqued for a lack of clarity about the concepts that underpin the experience. Discussion: Some researchers suggest that a closer examination of how socio-political structures influence healthcare (...)
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  • Moral distress in nurses in oncology and haematology units.Michela Lazzarin, Andrea Biondi & Stefania Di Mauro - 2012 - Nursing Ethics 19 (2):183-195.
    One of the difficulties nurses experience in clinical practice in relation to ethical issues in connection with young oncology patients is moral distress. In this descriptive correlational study, the Moral Distress Scale-Paediatric Version (MDS-PV) was translated from the original language and tested on a conventional sample of nurses working in paediatric oncology and haematology wards, in six north paediatric hospitals of Italy. 13.7% of the total respondents claimed that they had changed unit or hospital due to moral distress. The items (...)
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  • The role of philosophy and ethics at the edges of medicine.Bjørn Hofmann - 2021 - Philosophy, Ethics, and Humanities in Medicine 16 (1):1-12.
    Background The edge metaphor is ubiquitous in describing the present situation in the world, and nowhere is this as clearly visible as in medicine. “The edge of medicine” has become the title of books, scholarly articles, media headlines, and lecture series and seems to be imbued with hype, hope, and aversion. In order better to understand what is at stake at “the edge of medicine” this article addresses three questions: What does “the edge of medicine” mean in contemporary debates on (...)
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  • An Evaluation of Unit-Based Ethics Conversations.Lucia D. Wocial, Maureen Hancock, Patricia D. Bledsoe, Amy R. Chamness & Paul R. Helft - 2010 - Jona's Healthcare Law, Ethics, and Regulation 12 (2):48-54.
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  • Moral Distress: Tensions as Springboards for Action. [REVIEW]Colleen Varcoe, Bernadette Pauly, George Webster & Janet Storch - 2012 - HEC Forum 24 (1):51-62.
    In the previous four papers in this series, individual versus structural or contextual factors have informed various understandings of moral distress. In this final paper, we summarize some of the key tensions raised in previous papers and use these tensions as springboards to identify directions for action among practitioners, educators, researchers, policymakers and others. In particular, we recognize the need to more explicitly politicize the concept of moral distress in order to understand how such distress arises from competing values within (...)
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  • Structural Equation Modeling Analysis on Associations of Moral Distress and Dimensions of Organizational Culture in Healthcare: A Cross-Sectional Study of Healthcare Professionals.Tessy A. Thomas, Shelley Kumar, F. Daniel Davis, Peter Boedeker & Satid Thammasitboon - 2024 - AJOB Empirical Bioethics 15 (2):120-132.
    Objective Moral distress is a complex phenomenon experienced by healthcare professionals. This study examined the relationships between key dimensions of Organizational Culture in Healthcare (OCHC)—perceived psychological safety, ethical climate, patient safety—and healthcare professionals’ perception of moral distress.Design Cross-sectional surveySetting Pediatric and adult critical care medicine, and adult hospital medicine healthcare professionals in the United States.Participants Physicians (n = 260), nurses (n = 256), and advanced practice providers (n = 110) participated in the study.Main outcome measures Three dimensions of OCHC were (...)
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  • Validation of the Hospital Ethical Climate Survey for older people care.Riitta Suhonen, Minna Stolt, Jouko Katajisto, Andreas Charalambous & Linda L. Olson - 2015 - Nursing Ethics 22 (5):517-532.
    Background: The exploration of the ethical climate in the care settings for older people is highlighted in the literature, and it has been associated with various aspects of clinical practice and nurses’ jobs. However, ethical climate is seldom studied in the older people care context. Valid, reliable, feasible measures are needed for the measurement of ethical climate. Objectives: This study aimed to test the reliability, validity, and sensitivity of the Hospital Ethical Climate Survey in healthcare settings for older people. Design: (...)
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  • Organizational ethics: A literature review.Riitta Suhonen, Minna Stolt, Heli Virtanen & Helena Leino-Kilpi - 2011 - Nursing Ethics 18 (3):285-303.
    The aim of the study was to report the results of a systematically conducted literature review of empirical studies about healthcare organizations’ ethics and management or leadership issues. Electronic databases MEDLINE and CINAHL yielded 909 citations. After a two stage application of the inclusion and exclusion criteria 56 full-text articles were included in the review. No large research programs were identified. Most of the studies were in acute hospital settings from the 1990s onwards. The studies focused on ethical challenges, dilemmas (...)
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  • Development of an Administrative Ethical Behaviour Scale.Havva Öztürk - 2012 - Nursing Ethics 19 (2):289-303.
    The aim of this study was to develop an Administrative Ethical Behaviour Scale (AEBS) and to determine whether nurses found their head nurses’ behaviours ethical and to reveal head nurses’ ethical and unethical administrative behaviour. It was conducted on 264 nurses working in five state hospitals in Trabzon, Turkey. Content validity index of the scale was 0.87, item-to-total correlations ranged from 0.50 to 0.81 and Chronbach Alpha was 0.98. The scale included five subscales, i.e. truthfulness and honesty, liabilities and supremacy (...)
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  • Moral distress in nurses caring for patients with Covid-19.Henry J. Silverman, Raya Elfadel Kheirbek, Gyasi Moscou-Jackson & Jenni Day - 2021 - Nursing Ethics 28 (7-8):1137-1164.
    Background: Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic. Objective: To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency. Research design: A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses (...)
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  • Moral distress in undergraduate nursing students.Loredana Sasso, Annamaria Bagnasco, Monica Bianchi, Valentina Bressan & Franco Carnevale - 2016 - Nursing Ethics 23 (5):523-534.
    Background: Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety. Objectives: The purpose of this review was to describe how dilemmas and environmental, relational, and (...)
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  • A Health System-wide Moral Distress Consultation Service: Development and Evaluation.Ann B. Hamric & Elizabeth G. Epstein - 2017 - HEC Forum 29 (2):127-143.
    Although moral distress is now a well-recognized phenomenon among all of the healthcare professions, few evidence-based strategies have been published to address it. In morally distressing situations, the “presenting problem” may be a particular patient situation, but most often signals a deeper unit- or system-centered issue. This article describes one institution’s ongoing effort to address moral distress in its providers. We discuss the development and evaluation of the Moral Distress Consultation Service, an interprofessional, unit/system-oriented approach to addressing and ameliorating moral (...)
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  • Nurses' Responses to Initial Moral Distress in Long-Term Care.Marie P. Edwards, Susan E. McClement & Laurie R. Read - 2013 - Journal of Bioethical Inquiry 10 (3):325-336.
    While researchers have examined the types of ethical issues that arise in long-term care, few studies have explored long-term care nurses’ experiences of moral distress and fewer still have examined responses to initial moral distress. Using an interpretive description approach, 15 nurses working in long-term care settings within one city in Canada were interviewed about their responses to experiences of initial moral distress, resources or supports they identified as helpful or potentially helpful in dealing with these situations, and factors that (...)
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  • Ethical competency of nurse leaders: A qualitative study.Maasoumeh Barkhordari-Sharifabad, Tahereh Ashktorab & Foroozan Atashzadeh-Shoorideh - 2018 - Nursing Ethics 25 (1):20-36.
    Background: Ethics play an important role in activating the manpower and achieving the organizational goals. The nurse leaders’ ethical behavior can promote the care quality by affecting the nurses’ performance and bringing up several positive consequences for the organization. Objectives: The aim of this study was to identify and describe the ethical competency of nurse leaders in cultural domains and the working conditions of the Iranian healthcare setting to arrive at a more comprehensive and specific perspective. Methods: This was a (...)
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