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  1. Moral distress. [REVIEW]Joan McCarthy & Chris Gastmans - 2015 - Nursing Ethics 22 (1):131-152.
    Aim: The aim of this review is to examine the ways in which the concept of moral distress has been delineated and deployed in the argument-based nursing ethics literature. It adds to what we already know about moral distress from reviews of the qualitative and quantitative research. Data sources: CINAHL, PubMed, Web of Knowledge, EMBASE, Academic Search Complete, PsycInfo, Philosophers’ Index and Socindex. Review methods: A total of 20 argument-based articles published between January 1984 and December 2013 were analysed. Results: (...)
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  • A Difference in Degree, Not Kind: Moral Stress, Distress, and Injury.Daniel T. Kim, Wayne Shelton & Bharat Ranganathan - 2024 - American Journal of Bioethics 24 (12):57-59.
    Moral distress is complex and has received varied definitions, and its distinctiveness is consequently often unclear when placed alongside related concepts like moral injury or moral stress. Buchbi...
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  • Moral distress in undergraduate nursing students.Simoní Saraiva Bordignon, Valéria Lerch Lunardi, Edison Luiz Devos Barlem, Graziele de Lima Dalmolin, Rosemary Silva da Silveira, Flávia Regina Souza Ramos & Jamila Geri Tomaschewski Barlem - 2019 - Nursing Ethics 26 (7-8):2325-2339.
    Background: Moral distress is considered to be the negative feelings that arise when one knows the morally correct response to a situation but cannot act because of institutional or hierarchal constraints. Objectives: To analyze moral distress and its relation with sociodemographic and academic variables in undergraduate students from different universities in Brazil. Method: Quantitative study with a cross-sectional design. Data were collected through the Moral Distress Scale for Nursing Students, with 499 nursing students from three universities in the extreme south (...)
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  • Moral Distress: What Are We Measuring?Laura Kolbe & Inmaculada de Melo-Martin - 2022 - American Journal of Bioethics 23 (4):46-58.
    While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals’ moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical and logistical facts (...)
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  • The Moral Distress Instrument (MDI): Development, Validation and Associations with Burnout among Finnish Social Workers.Maija Mänttäri-van der Kuip, Denise Michelle Brend & Mari Herttalampi - 2024 - Ethics and Social Welfare 18 (3):264-284.
    Moral distress (MD), the suffering experienced by professionals due to their restricted moral agency, has become a popular subject of study in the fields of social work and health care. Many of the existing measures of MD are targeted at certain professionals, such as health care workers, and are thus restricted to such contexts. This has challenged the conceptual development and empirical examination of MD as a phenomenon occurring across diverse professional groups in different work settings. This study introduces a (...)
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  • Moral Distress in Scientific Research.David B. Resnik - 2016 - American Journal of Bioethics 16 (12):13-15.
    In their target article “A Broader Understanding of Moral Distress,” Campbell, Ulrich, and Grady (2016) argue that the widely accepted definition of moral distress should be broadened to include so...
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  • Culturally-sensitive moral distress experiences of intensive care nurses: A scoping review.Mustafa Sabri Kovanci & Imatullah Akyar - 2022 - Nursing Ethics 29 (6):1476-1490.
    Background Moral distress is a phenomenon that all nurses experience at different levels and contexts. The level of moral distress can be affected by individual values and the local culture. The sources of the values shape the level of moral distress experienced and the nurses’ decisions. Aim The present scoping review was conducted to examine the situations that cause moral distress in ICU nurses in different countries. Results A scoping review methodology was adopted for the study, in line with the (...)
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  • Quiet quitting: Obedience a minima as a form of nursing resistance.Jean-Laurent Domingue, Kim Lauzier & Thomas Foth - 2024 - Nursing Philosophy 25 (3):e12493.
    In this article, we provide a philosophical and ethical reflection about quiet quitting as a tool of political resistance for nurses. Quiet quitting is a trend that gained traction on TikTok in July 2022 and emerged as a method of resistance among employees facing increasing demands from their workplaces at the detriment of their personal lives. It is characterised by employees refraining from exceeding the basic requirements outlined in their job descriptions. To understand why quiet quitting can be a tool (...)
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  • “Green informed consent” in the classroom, clinic, and consultation room.Cristina Richie - 2023 - Medicine, Health Care and Philosophy 26 (4):507-515.
    The carbon emissions of global health care activities make up 4–5% of total world emissions, placing it on par with the food sector. Carbon emissions are particularly relevant for health care because of climate change health hazards. Doctors and health care professionals must connect their health care delivery with carbon emissions and minimize resource use when possible as a part of their obligation to do no harm. Given that reducing carbon is a global ethical priority, the informed consent process in (...)
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  • The severity of moral distress in nurses: a systematic review and meta-analysis.Masoud Mohammadi, Mohammad-Rafi Bazrafshan, Mohsen Kazeminia, Behnam Khaledi-Paveh, Shamarina Shohaimi & Nader Salari - 2022 - Philosophy, Ethics, and Humanities in Medicine 17 (1):1-14.
    BackgroundMoral distress is one of the most important problems that nurses face in their care of patients. Various studies have reported the frequency and severity of moral distress in nurses. However, to date, a comprehensive study that shows the results of these research across the world was not found, therefore due to the importance of this issue, its role in the health of nurses and patients, and the lack of general statistics about it worldwide, the present study was conducted to (...)
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  • What is ‘moral distress’? A narrative synthesis of the literature.Georgina Morley, Jonathan Ives, Caroline Bradbury-Jones & Fiona Irvine - 2019 - Nursing Ethics 26 (3):646-662.
    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. Design: Systematic literature (...)
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  • Seeing Ourselves as Moral Agents in Relation to Our Organizational and Sociopolitical Contexts: Commentary on “A Reflection on Moral Distress in Nursing Together With a Current Application of the Concept” by Andrew Jameton.Patricia A. Rodney - 2013 - Journal of Bioethical Inquiry 10 (3):313-315.
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  • (1 other version)Komplexität, Komplizität und moralischer Stress in der Pflege.Settimio Monteverde - 2019 - Ethik in der Medizin 31 (4):345-360.
    Professionelles Handeln bedarf moralischen Handlungsvermögens. Im Kontext pflegerischer Weiterbildungen beschreibt der Philosoph Andrew Jameton vor über drei Jahrzehnten psychologische Reaktionen auf kompromittiertes moralisches Handlungsvermögen, die er als moralischen Stress definiert. Diese Standarddefinition hat in der Pflegewissenschaft zu einer dichten Forschung geführt und zum Vorschlag einer weiten Definition. Belegt sind gravierende Folgen von moralischem Stress auf die Patientensicherheit und auf die psychische Gesundheit von Mitarbeitenden. Der Beitrag diskutiert die Rezeption des Konzepts innerhalb der Pflegewissenschaft und die jüngst vorgeschlagene weite Definition von (...)
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  • Can United States Healthcare Become Environmentally Sustainable? Towards Green Healthcare Reform.Cristina Richie - 2020 - Journal of Law, Medicine and Ethics 48 (4):643-652.
    In 2014, the United States health care industry produced an estimated 480 million metric tons of carbon dioxide ; nearly 8% of the country's total emissions. The importance of sustainability in health care — as a business reliant on fossil fuels for transportation, energy, and operational functioning — is slowly being recognized. These efforts to green health care are incomplete, since they only focus on health care structures. The therapeutic relationship is the essence of health care — not the buildings (...)
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  • From discipline to control in nursing practice: A poststructuralist reflection.Jonathan R. S. McIntyre, Candace Burton & Dave Holmes - 2020 - Nursing Philosophy 21 (4):e12317.
    The everyday expressions of nursing practices are driven by their entanglement in complex flows of social, cultural, political and economic interests. Early expressions of trained nursing practice in the United States and Europe reflect claims of moral, spiritual and clinical exceptionalism. They were both imposed upon—and internalized by—nursing pioneers. These claims were associated with an endogenous narrative of discipline and its physical manifestation in early nursing schools and hospitals, which functioned as “total institutions.” By contrast, the external forces—diffuse yet pervasive—impacting (...)
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  • Advancing the Concept of Moral Distress.Elizabeth Peter - 2013 - Journal of Bioethical Inquiry 10 (3):293-295.
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  • Clinician Moral Distress: Toward an Ethics of Agent‐Regret.Daniel T. Kim, Wayne Shelton & Megan K. Applewhite - 2023 - Hastings Center Report 53 (6):40-53.
    Moral distress names a widely discussed and concerning clinician experience. Yet the precise nature of the distress and the appropriate practical response to it remain unclear. Clinicians speak of their moral distress in terms of guilt, regret, anger, or other distressing emotions, and they often invoke them interchangeably. But these emotions are distinct, and they are not all equally fitting in the same circumstances. This indicates a problematic ambiguity in the moral distress concept that obscures its distinctiveness, its relevant circumstances, (...)
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  • Between the patient and the next of kin in end-of-life care: A critical study based on feminist theory.Ellen Ramvi & Venke Irene Ueland - 2019 - Nursing Ethics 26 (1):201-211.
    Background: For the experience of end-of-life care to be ‘good’ many ethical challenges in various relationships have to be resolved. In this article, we focus on challenges in the nurse–next of kin relationship. Little is known about difficulties in this relationship, when the next of kin are seen as separate from the patient. Research problem: From the perspective of nurses: What are the ethical challenges in relation to next of kin in end-of-life care? Research design: A critical qualitative approach was (...)
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  • Moral Distress: An Innovative and Important Subject to Study in Brazil: Commentary on “A Reflection on Moral Distress in Nursing Together With a Current Application of the Concept” by Andrew Jameton.Valéria Lerch Lunardi - 2013 - Journal of Bioethical Inquiry 10 (3):309-312.
    There have been recurrent reports of fragilities in the Brazilian health system, especially in public institutions. In this commentary, I argue that moral distress in nursing in Brazil can still be considered an innovative and important subject of study. I also highlight the relevance of engaging educational institutions in the development of policies about environmental sustainability. It is relevant to continue studying moral distress in nursing and in health care generally in order to contribute to the transformation of reality by (...)
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  • Moral distress among undergraduate nursing students in clinical practice: A scoping review.Sara Soares dos Santos, Simone de Godoy, Agostinho A. C. Araújo, Diego Santiago Montandon, Ítalo Rodolfo Silva, Chris Gastmans & Isabel Amélia Costa Mendes - forthcoming - Nursing Ethics.
    Background: The ethical challenges faced by undergraduate nursing students and nurses may lead to moral distress, negatively affecting learning capacity and self-confidence and potentially influencing the quality of patient care. Objective: To examine the state of knowledge regarding the moral distress among undergraduate nursing students during clinical practice. Methods: This scoping review followed JBI guidelines. First, the LILACS, Web of Science, Scopus, CINAHL, PubMed/MEDLINE, PsycINFO, Embase, and ProQuest databases were consulted. Next, the reference lists of the studies included in the (...)
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  • Moral distress among acute mental health nurses: A systematic review.Sara Lamoureux, Amy E. Mitchell & Elizabeth M. Forster - 2024 - Nursing Ethics 31 (7):1178-1195.
    Moral distress has been identified as an occupational hazard for clinicians caring for vulnerable populations. The aim of this systematic review was (i) to summarize the literature reporting on prevalence of, and factors related to, moral distress among nurses within acute mental health settings, and (ii) to examine the efficacy of interventions designed to address moral distress among nurses within this clinical setting. A comprehensive literature search was conducted in October 2022 utilizing Nursing & Allied Health, Embase, CINAHL, PsychInfo, and (...)
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  • Vulnerability, Moral responsibility, and Moral Obligations: the case of Industrial Action in the Medical and Allied Professions.Henry Adobor - 2022 - Medicine, Health Care and Philosophy 25 (3):333-349.
    The article addresses issues at the nexus of physician industrial action, moral agency, and responsibility. There are situations in which we find ourselves best placed to offer aid to those who may be in vulnerable positions, a behavior that is consistent with our everyday moral intuitions. In both our interpersonal relationships and social life, we make frequent judgments about whether to praise or blame someone for their actions when we determine that they should have acted to help a vulnerable person. (...)
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  • “Speak What We Feel, Not What We Ought to Say”: Moral Distress and Bioethics. [REVIEW]Leigh E. Rich & Michael A. Ashby - 2013 - Journal of Bioethical Inquiry 10 (3):277-281.
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  • Fostering moral resilience through moral case deliberation.Suzanne Metselaar & Bert Molewijk - 2023 - Nursing Ethics 30 (5):730-745.
    Moral distress forms a major threat to the well-being of healthcare professionals, and is argued to negatively impact patient care. It is associated with emotions such as anger, frustration, guilt, and anxiety. In order to effectively deal with moral distress, the concept of moral resilience is introduced as the positive capacity of an individual to sustain or restore their integrity in response to moral adversity. Interventions are needed that foster moral resilience among healthcare professionals. Ethics consultation has been proposed as (...)
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  • Intensive care unit professionals’ responses to a new moral conflict assessment tool: A qualitative study.Soodabeh Joolaee, Deborah Cook, Jean Kozak & Peter Dodek - 2023 - Nursing Ethics 30 (7-8):1114-1124.
    Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research Design In this qualitative study, (...)
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  • Exploring the “Other” Role of Philosophy in Bioethics: The Case of Addressing Moral Distress and Rediscovering Meaning and Purpose.Allen Alvarez - 2022 - American Journal of Bioethics 22 (12):67-69.
    This commentary explores “other” needed philosophical contributions to bioethics that is implied but not mentioned explicitly in the article by Blumentahal-Barby et al. (2022). That “other” role of...
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  • Relational Narratives, Suffering, and Counselling Psychology.S. Kinyany-Schlachter - 2017 - Dissertation, City, University of London
    A diagnosis of glioblastoma multiforme, a World Health Organisation grade IV brain tumour, is devastating for patients and their families who bear the impetus of caregiving. GBM caregivers act as de facto health professionals when their loved ones are discharged prematurely from hospitals. Faced with complex healthcare needs, GBM caregivers report the highest psychological burden, and highest unmet needs of all cancer caregivers. Despite this, they rarely accessed rehabilitation services. Researchers hardly engaged with their stories. The current research on GBM (...)
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  • Educating Nurses for Ethical Practice in Contemporary Health Care Environments.Grace Pam & Milliken Aimee - 2016 - Hastings Center Report 46 (S1):13-17.
    Because health care professions exist to provide a good for society, ethical questions are inherently part of them. Such professions and their members can be assessed based on how effective they are in developing knowledge and enacting practices that further the health and well‐being of individuals and society. The complexity of contemporary health care environments makes it important to prepare clinicians who can anticipate, recognize, and address problems that arise in practice or that prevent a profession from fulfilling its service (...)
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  • “Can a Company be Bitchy?” Corporate (and Political and Scientific) Social Responsibility.Leigh E. Rich & Michael A. Ashby - 2015 - Journal of Bioethical Inquiry 12 (2):159-169.
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  • Re-defining moral distress: A systematic review and critical re-appraisal of the argument-based bioethics literature.Christine Sanderson, Linda Sheahan, Slavica Kochovska, Tim Luckett, Deborah Parker, Phyllis Butow & Meera Agar - 2019 - Clinical Ethics 14 (4):195-210.
    The concept of moral distress comes from nursing ethics, and was initially defined as ‘…when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. There is a large body of literature associated with moral distress, yet multiple definitions now exist, significantly limiting its usefulness. We undertook a systematic review of the argument-based bioethics literature on this topic as the basis for a critical appraisal, identifying 55 papers for analysis. (...)
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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 (...)
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  • (1 other version)Complexity, complicity and moral distress in nursing.Settimio Monteverde - 2019 - Ethik in der Medizin 31 (4):345-360.
    Professionelles Handeln bedarf moralischen Handlungsvermögens. Im Kontext pflegerischer Weiterbildungen beschreibt der Philosoph Andrew Jameton vor über drei Jahrzehnten psychologische Reaktionen auf kompromittiertes moralisches Handlungsvermögen, die er als moralischen Stress definiert. Diese Standarddefinition hat in der Pflegewissenschaft zu einer dichten Forschung geführt und zum Vorschlag einer weiten Definition. Belegt sind gravierende Folgen von moralischem Stress auf die Patientensicherheit und auf die psychische Gesundheit von Mitarbeitenden. Der Beitrag diskutiert die Rezeption des Konzepts innerhalb der Pflegewissenschaft und die jüngst vorgeschlagene weite Definition von (...)
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  • A vision of ethics in efficient occupational healthcare.Jessica Hemberg, Helena Nyman & Håkan Hemberg - 2019 - Nursing Ethics 26 (1):161-171.
    Background: Occupational healthcare is nowadays more and more regulated by economic demands of gain and efficiency. Aim and research questions: The aim of this study is to reach a new understanding of ethics in occupational healthcare by uncovering this from occupational healthcare nurses’ own views. The research questions are as follows: (1) What is the core of an ethical value base in occupational healthcare? (2) What does it mean for occupational healthcare nurses to fulfill their ethical value base in occupational (...)
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  • Moral Distress: Professional Integrity as the Basis for Taxonomies.Tessy Ann Thomas & Courtenay Rose Bruce - 2016 - American Journal of Bioethics 16 (12):11-13.
    There has been an ongoing appeal in the bioethics literature for a broader understanding and conceptual clarity of the phenomenon of moral distress. Several authors argue that greater conceptual cl...
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  • Moving from conceptual ambiguity to knowledgeable action: using a critical realist approach to studying moral distress.Lynn C. Musto & Patricia A. Rodney - 2016 - Nursing Philosophy 17 (2):75-87.
    Moral distress is a phenomenon that has been receiving increasing attention in nursing and other health care disciplines. Moral distress is a concept that entered the nursing literature – and subsequently the health care ethics lexicon – in 1984 as a result of the work done by American philosopher and bioethicist Andrew Jameton. Over the past decade, research into moral distress has extended beyond the profession of nursing as other health care disciplines have come to question the impact of moral (...)
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  • Can the Ethical Best Practice of Shared Decision-Making lead to Moral Distress?Trisha M. Prentice & Lynn Gillam - 2018 - Journal of Bioethical Inquiry 15 (2):259-268.
    When healthcare professionals feel constrained from acting in a patient’s best interests, moral distress ensues. The resulting negative sequelae of burnout, poor retention rates, and ultimately poor patient care are well recognized across healthcare providers. Yet an appreciation of how particular disciplines, including physicians, come to be “constrained” in their actions is still lacking. This paper will examine how the application of shared decision-making may contribute to the experience of moral distress for physicians and why such distress may go under-recognized. (...)
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  • Moral distress in nursing students: Cultural adaptation and validation study.Rocco Mazzotta, Maddalena De Maria, Davide Bove, Sondra Badolamenti, Simonì Saraiva Bordignon, Luana Claudia Jacoby Silveira, Ercole Vellone, Rosaria Alvaro & Giampiera Bulfone - 2022 - Nursing Ethics 29 (2):384-401.
    Background: Moral distress, defined as moral suffering or a psychological imbalance, can affect nursing students. However, many new instruments or adaptations of other scales that are typically used to measure moral distress have not been used for nursing students. Aim: This study aimed to translate, culturally adapt and evaluate the psychometric properties of an Italian version of the Moral Distress Scale for Nursing Students (It-ESMEE) for use with delayed nursing students (students who could not graduate on time or failed the (...)
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  • Moral failure, moral prudence, and character challenges in residential care during the Covid-19 pandemic.Settimio Monteverde - 2024 - Nursing Ethics 31 (1):17-27.
    In many high-income countries, an initial response to the severe impact of Covid-19 on residential care was to shield residents from outside contacts. As the pandemic progressed, these measures have been increasingly questioned, given their detrimental impact on residents’ health and well-being and their dubious effectiveness. Many authorities have been hesitant in adapting visiting policies, often leaving nursing homes to act on their own safety and liability considerations. Against this backdrop, this article discusses the appropriateness of viewing the continuation of (...)
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  • Ethical climate and moral distress in paediatric oncology nursing.Päivi Ventovaara, Margareta af Sandeberg, Janne Räsänen & Pernilla Pergert - 2021 - Nursing Ethics 28 (6):1061-1072.
    Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: (...)
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  • Psychometric evaluation of the Moral Distress Risk Scale: A methodological study.Rafaela Schaefer, Elma L. C. P. Zoboli & Margarida M. Vieira - 2019 - Nursing Ethics 26 (2):434-442.
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  • Guest editorial.Elizabeth Peter - 2015 - Nursing Ethics 22 (1):3-4.
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  • Caring for tomorrow’s workforce.Settimio Monteverde - 2016 - Nursing Ethics 23 (1):104-116.
    Background: Preparing tomorrow’s healthcare workforce for managing the growing complexity of care places high demands on students, educators, and faculties. In the light of worrying data about study-related stress and burnout, understanding how students manage stressors and develop resilience has been identified as a priority topic of research. In addition to study-related stressors, also moral stressors are known to characterize the students’ first clinical experiences. Objectives: However, current debates show that it remains unclear how healthcare ethics education should address them. (...)
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  • Development, validity and reliability testing the Swedish Ethical Climate Questionnaire.Catarina Fischer Grönlund, Anna Söderberg, Vera Dahlqvist, Lars Andersson & Ulf Isaksson - 2019 - Nursing Ethics 26 (7-8):2482-2493.
    Background: An ethical climate has been described as a working climate embracing shared perceptions about morally correct behaviour concerning ethical issues. Various ethical climate questionnaires have been developed and validated for different contexts, but no questionnaire has been found concerning the ethical climate from an inter-professional perspective in a healthcare context. The Swedish Ethical Climate Questionnaire, based on Habermas’ four requirements for a democratic dialogue, attempts to assess and measure the ethical climate at various inter-professional workplaces. This study aimed to (...)
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