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  1. 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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  • Consequences of clinical situations that cause critical care nurses to experience moral distress.D. L. Wiegand & M. Funk - 2012 - Nursing Ethics 19 (4):479-487.
    Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and (...)
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  • Empirical Research on Moral Distress: Issues, Challenges, and Opportunities. [REVIEW]Ann B. Hamric - 2012 - HEC Forum 24 (1):39-49.
    Abstract Studying a concept as complex as moral distress is an ongoing challenge for those engaged in empirical ethics research. Qualitative studies of nurses have illuminated the experience of moral distress and widened the contours of the concept, particularly in the area of root causes. This work has led to the current understanding that moral distress can arise from clinical situations, factors internal to the individual professional, and factors present in unit cultures, the institution, and the larger health care environment. (...)
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  • Revalidation of the Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ).J. Ahlin, E. Ericson-Lidman, A. Norberg & G. Strandberg - 2012 - Nursing Ethics 19 (2):220-232.
    The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the ‘Stress of Conscience Study’. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients. The sample consisted of 503 healthcare personnel. To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (PCA) were used to examine (...)
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  • The Impact of Moral Stress Compared to Other Stressors on Employee Fatigue, Job Satisfaction, and Turnover: An Empirical Investigation. [REVIEW]Kristen Bell DeTienne, Bradley R. Agle, James C. Phillips & Marc-Charles Ingerson - 2012 - Journal of Business Ethics 110 (3):377-391.
    Moral stress is an increasingly significant concept in business ethics and the workplace environment. This study compares the impact of moral stress with other job stressors on three important employee variables—fatigue, job satisfaction, and turnover intentions—by utilizing survey data from 305 customer-contact employees of a financial institution’s call center. Statistical analysis on the interaction of moral stress and the three employee variables was performed while controlling for other types of job stress as well as demographic variables. The results reveal that (...)
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  • Moral distress in nursing practice in Malawi.V. M. Maluwa, J. Andre, P. Ndebele & E. Chilemba - 2012 - Nursing Ethics 19 (2):196-207.
    The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...)
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  • Moral distress related to ethical dilemmas among Spanish podiatrists.M. E. Losa Iglesias, R. Becerro de Bengoa Vallejo & P. Salvadores Fuentes - 2010 - Journal of Medical Ethics 36 (5):310-314.
    Objectives To describe the distress experienced by Spanish podiatrists related to ethical dilemmas, organisational matters, and lack of resources. Design A 2008 email survey of a representative sample of 485 Spanish podiatrists presenting statements about different ethical dilemmas, values and goals at the workplace. Results The response rate was 44.8%. Of all the respondents, 57% described sometimes having to act against their own conscience as distressing. Time constraints is the main cause of moral distress (67%) and 58% of respondents said (...)
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  • Moral distress in healthcare practice: The situation of nurses. [REVIEW]Wendy Austin, Gillian Lemermeyer, Lisa Goldberg, Vangie Bergum & Melissa S. Johnson - 2005 - HEC Forum 17 (1):33-48.
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  • Nursing ethics education: Are we really delivering the good (s)?Martin Woods - 2005 - Nursing Ethics 12 (1):5-18.
    The vast majority of research in nursing ethics over the last decade indicates that nurses may not be fully prepared to ‘deliver the good’ for their patients, or to contribute appropriately in the wider current health care climate. When suitable research projects were evaluated for this article, one key question emerged: if nurses are educationally better prepared than ever before to exercise their ethical decision-making skills, why does research still indicate that the expected practice-based improvements remain elusive? Hence, a number (...)
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  • An Overview of Moral Distress and the Paediatric Intensive Care Team.Austin Wendy, Kelecevic Julija, Goble Erika & Mekechuk Joy - 2009 - Nursing Ethics 16 (1):57-68.
    A summary of the existing literature related to moral distress (MD) and the paediatric intensive care unit (PICU) reveals a high-tech, high-pressure environment in which effective teamwork can be compromised by MD arising from different situations related to: consent for treatment, futile care, end-of-life decision making, formal decision-making structures, training and experience by discipline, individual values and attitudes, and power and authority issues. Attempts to resolve MD in PICUs have included the use of administrative tools such as shift worksheets, the (...)
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  • Chinese Nurses' Ethical Concerns in a Neurological Ward.Ping Fen Tang, Camilla Johansson, Barbro Wadensten, Stig Wenneberg & Gerd Ahlström - 2007 - Nursing Ethics 14 (6):810-824.
    Our aim was to describe Chinese nurses' experiences of workplace distress and ethical dilemmas on a neurological ward. Qualitative interviews were performed with 20 nurses. On using latent content analysis, themes emerged in four content areas: ethical dilemmas, workplace distress, quality of nursing and managing distress. The ethical dilemmas were: (1) conflicting views on optimal treatment and nursing; (2) treatment choice meeting with financial constraints; and (3) misalignment of nursing responsibilities, competence and available resources. The patients' relatives lacked respect for (...)
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  • Identification of risk factors for moral distress in nurses: basis for the development of a new assessment tool.Rafaela Schaefer, Elma Lourdes Campos Pavone Zoboli & Margarida Vieira - 2016 - Nursing Inquiry 23 (4):346-357.
    This article proposes to identify risk factors for moral distress from the literature, validate them through expert analysis and provide the basis for a new tool to assess the risk of moral distress among nurses. Moral distress is related to the psychological, emotional and physiological aspects of nursing. It arises from constraints caused by various circumstances and can lead to significant negative consequences. A scoping review and validation through expert analysis were used. The research question guiding this study was as (...)
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  • Anaesthesia Care of Older Patients as Experienced by Nurse Anaesthetists.Annika Larsson Mauleon, Liisa Palo-Bengtsson & Sirkka-Liisa Ekman - 2005 - Nursing Ethics 12 (3):263-272.
    This article analyses problem situations in the context of anaesthesia care. It considers what it means for nurse anaesthetists to be in problematic situations in the anaesthesia care of older patients. Benner’s interpretive phenomenological approach proved useful for this purpose. Paradigm cases are used to aid the analysis of individual nurses’ experiences. Thirty narrated problematic anaesthesia care situations derived from seven interviews were studied. These show that experienced nurse anaesthetists perceive anaesthesia care as problematic and highly demanding when involving older (...)
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  • Moral Stress: synthesis of a concept.Kim Lützén, Agneta Cronqvist, Annabella Magnusson & Lars Andersson - 2003 - Nursing Ethics 10 (3):312-322.
    The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient’s vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that (...)
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  • Moral Responsibility: A Relational Way of Being.Inga-Britt Lindh, Elisabeth Severinsson & Agneta Berg - 2007 - Nursing Ethics 14 (2):129-140.
    This article reports a study exploring the meaning of the complex phenomenon of moral responsibility in nursing practice. Each of three focus groups with a total of 14 student nurses were conducted twice to gather their views on moral responsibility in nursing practice. The data were analysed by qualitative thematic content analysis. Moral responsibility was interpreted as a relational way of being, which involved guidance by one’s inner compass composed of ideals, values and knowledge that translate into a striving to (...)
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  • Primary Care Nurse Practitioners' Integrity When Faced With Moral Conflict.Carolyn Ann Laabs - 2007 - Nursing Ethics 14 (6):795-809.
    Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. The purpose of this grounded theory study was to describe the process NPs use to manage moral problems common to primary care. Twenty-three NPs were interviewed, commenting on hypothetical situations depicting ethical issues common to primary care. Coding was conducted using a constant comparative method. A theory of maintaining moral integrity emerged consisting of the phases of encountering conflict, drawing a (...)
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  • Ethical questions of nursing practice in hospitals and possibilities of thematization.Helen Kohlen - 2019 - Ethik in der Medizin 31 (4):325-343.
    ZusammenfassungEthische Fragen der Pflegepraxis haben sich in den letzten Jahren zugespitzt. Sie sind häufig verbunden mit einer grundsätzlichen Sorge um eine kompetente und verantwortliche Pflege, die den Bedürfnissen von Patient*innen gerecht wird. Forschungen aus drei Jahrzehnten zeigen, dass strukturelle Beschränkungen, Konflikte mit Kolleg*innen, Patient*innen und Angehörigen sowie eine Managementorientierung und die Unsichtbarkeit der Pflegearbeit, Ursachen für die grundsätzlichen Sorgen sind. Sie führen zu moralischem Stress, fehlenden Beziehungen und einer Fragmentierung der Pflege. Teilweise reagieren Pflegende widerständig, indem sie beispielsweise die Regeln (...)
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  • Ethische Fragen der Pflegepraxis im Krankenhaus und Möglichkeiten der Thematisierung: Internationale Erfahrungen aus drei Dekaden.Helen Kohlen - 2019 - Ethik in der Medizin 31 (4):325-343.
    Ethische Fragen der Pflegepraxis haben sich in den letzten Jahren zugespitzt. Sie sind häufig verbunden mit einer grundsätzlichen Sorge um eine kompetente und verantwortliche Pflege, die den Bedürfnissen von Patient*innen gerecht wird. Forschungen aus drei Jahrzehnten zeigen, dass strukturelle Beschränkungen, Konflikte mit Kolleg*innen, Patient*innen und Angehörigen sowie eine Managementorientierung und die Unsichtbarkeit der Pflegearbeit, Ursachen für die grundsätzlichen Sorgen sind. Sie führen zu moralischem Stress, fehlenden Beziehungen und einer Fragmentierung der Pflege. Teilweise reagieren Pflegende widerständig, indem sie beispielsweise die Regeln (...)
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  • Battlefield conditions: Different environment but the same duty of care.Janet Kelly - 2010 - Nursing Ethics 17 (5):636-645.
    Using an interpretative research approach to ethical and legal literature, it is argued that nursing in the battlefield is distinctly different to civilian nursing, even in an emergency, and that the environment is so different that a duty of care owed by military nurses to wounded soldiers should not apply. Such distinct differences in wartime can override normal peacetime professional ethics to the extent that the duty of care owed by military nurses to their patients on the battlefield should not (...)
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  • Moral distress in Turkish intensive care nurses.Serife Karagozoglu, Gulay Yildirim, Dilek Ozden & Ziynet Çınar - 2017 - Nursing Ethics 24 (2):209-224.
    Background:Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess moral distress suffered by (...)
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  • Moral distress in Turkish intensive care nurses.Serife Karagozoglu, Gulay Yildirim, Dilek Ozden & Ziynet Çınar - 2017 - Nursing Ethics 24 (2):209-224.
    Background:Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess moral distress suffered by (...)
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  • Moral distress related to ethical dilemmas among Spanish podiatrists.Marta Elena Losa Iglesias, Ricardo Becerro de Bengoa Vallejo & Paloma Salvadores Fuentes - 2010 - Journal of Medical Ethics 36 (5):310-314.
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  • Nurses' Workplace Distress and Ethical Dilemmas in Tanzanian Health Care.Elisabeth Häggström, Ester Mbusa & Barbro Wadensten - 2008 - Nursing Ethics 15 (4):478-491.
    The aim of this study was to describe Tanzanian nurses' meaning of and experiences with ethical dilemmas and workplace distress in different care settings. An open question guide was used and the study focused on the answers that 29 registered nurses supplied. The theme, `Tanzanian registered nurses' invisible and visible expressions about existential conditions in care', emerged from several subthemes as: suffering from (1) workplace distress; (2) ethical dilemmas; (3) trying to maintaining good quality nursing care; (4) lack of respect, (...)
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  • Healthcare professionals' perspectives on environmental sustainability.Jillian L. Dunphy - 2014 - Nursing Ethics 21 (4):414-425.
    Background:Human health is dependent upon environmental sustainability. Many have argued that environmental sustainability advocacy and environmentally responsible healthcare practice are imperative healthcare actions.Research questions:What are the key obstacles to healthcare professionals supporting environmental sustainability? How may these obstacles be overcome?Research design:Data-driven thematic qualitative analysis of semi-structured interviews identified common and pertinent themes, and differences between specific healthcare disciplines.Participants:A total of 64 healthcare professionals and academics from all states and territories of Australia, and multiple healthcare disciplines were recruited.Ethical considerations:Institutional ethics approval (...)
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  • Development of the Perceptions of Conscience Questionnaire.Vera Dahlqvist, Sture Eriksson, Ann-Louise Glasberg, Elisabeth Lindahl, Kim Lü tzén, Gunilla Strandberg, Anna Söderberg, Venke Sørlie & Astrid Norberg - 2007 - Nursing Ethics 14 (2):181-193.
    Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses’ assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The (...)
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  • Nurse moral distress and ethical work environment.Mary C. Corley, Ptlene Minick, R. K. Elswick & Mary Jacobs - 2005 - Nursing Ethics 12 (4):381-390.
    This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, (...)
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  • Clinical education of ethicists: the role of a clinical ethics fellowship.Paula Chidwick, Karen Faith, Dianne Godkin & Laurie Hardingham - 2004 - BMC Medical Ethics 5 (1):1-8.
    Although clinical ethicists are becoming more prevalent in healthcare settings, their required training and education have not been clearly delineated. Most agree that training and education are important, but their nature and delivery remain topics of debate. One option is through completion of a clinical ethics fellowship. In this paper, the first four fellows to complete a newly developed fellowship program discuss their experiences. They describe the goals, structure, participants and activities of the fellowship. They identify key elements for succeeding (...)
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  • A scoping review of the moral distress of military nurses in crisis military deployment.Juan Chen, Fan Li, Xiaomeng Hu, Pu Yang & Ying He - 2023 - Nursing Ethics 30 (7-8):922-938.
    Background “Crisis military deployment” was defined as a situation in which military personnel are suddenly ordered to duty to support an operation away from their home station and in a potentially dangerous environment. As a result of complex changes in the global political and economic landscape, military nurses are assuming an increasing number of crisis military deployment tasks. Moral distress has been widely studied among civilian nurses. However, little is known about the moral distress military nurses experience during military deployments (...)
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  • Constructing a theoretical model of moral distress.Edison Luiz Devos Barlem & Flávia Regina Souza Ramos - 2015 - Nursing Ethics 22 (5):608-615.
    Moral distress has been characterised as one of the main ethical problems affecting nurses in all health systems, and has been depicted as a threat to nurses’ integrity and to the quality of patient care. In recent years, several studies tried to investigate moral distress, its causes and consequences for health professionals, clients and organisations. However, such studies are considered controversial and vulnerable, mainly because they lack a solid philosophical and empirical basis. The present article aimed at elaborating a theoretical (...)
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  • Moral injury in healthcare professionals: A scoping review and discussion.Anto Čartolovni, Minna Stolt, P. Anne Scott & Riitta Suhonen - 2021 - Nursing Ethics 28 (5):590-602.
    Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare (...)
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  • Technologies in older people’s care.Maria Andersson Marchesoni, Karin Axelsson, Ylva Fältholm & Inger Lindberg - 2017 - Nursing Ethics 24 (2):125-137.
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