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  1. Effect of moral empowerment program on moral distress in intensive care unit nurses.Safura Abbasi, Somayeh Ghafari, Mohsen Shahriari & Nahid Shahgholian - 2019 - Nursing Ethics 26 (5):1494-1504.
    Background: Moral distress has been experienced by about 67% of critical care nurses which causes many complications such as job dissatisfaction, loss of capacity for caring, and turnover for nurses and poor quality of care for patients as well as health system. Objective: The purpose of this research was to provide a moral empowerment program to nursing directors, school of nursing, and the heads of hospitals to reduce moral distress in nurses and improve the quality of care. Methods: This research (...)
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  • Moral Distress, Moral Residue, and the Crescendo Effect.Elizabeth Gingell Epstein & Ann Baile Hamric - 2009 - Journal of Clinical Ethics 20 (4):330-342.
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  • Nurse Moral Distress: a proposed theory and research agenda.Mary C. Corley - 2002 - Nursing Ethics 9 (6):636-650.
    As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage it.
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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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  • Pulling the heartstrings, arguing the case: a narrative response to the issue of moral agency in moral distress.A. Walsh - 2010 - Journal of Medical Ethics 36 (12):746-749.
    In this paper it is argued that moral distress is an emotional response to an ethical dilemma, and that to date, the literature has largely failed to address the fundamental questions that need to be answered in response to this emotional response. Firstly, does moral distress accurately identify a wrong being done to patients? Secondly, if it does, can nurses carry out this ‘wrong doing’, but not be responsible for the consequences of their actions? A narrative that reflects the emotional (...)
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  • 'Moral distress' - time to abandon a flawed nursing construct?Megan-Jane Johnstone & Alison Hutchinson - 2015 - Nursing Ethics 22 (1):5-14.
    Moral distress has been characterised in the nursing literature as a major problem affecting nurses in all healthcare systems. It has been portrayed as threatening the integrity of nurses and ultimately the quality of patient care. However, nursing discourse on moral distress is not without controversy. The notion itself is conceptually flawed and suffers from both theoretical and practical difficulties. Nursing research investigating moral distress is also problematic on account of being methodologically weak and disparate. Moreover, the ultimate purpose and (...)
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  • Consequences of clinical situations that cause critical care nurses to experience moral distress.Debra L. Wiegand & Marjorie 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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  • Perils of proximity: a spatiotemporal analysis of moral distress and moral ambiguity.Elizabeth Peter & Joan Liaschenko - 2004 - Nursing Inquiry 11 (4):218-225.
    The physical nearness, or proximity, inherent in the nurse–patient relationship has been central in the discipline as definitive of the nature of nursing and its moral ideals. Clearly, this nearness is in service to those in need of care. This proximity, however, is not unproblematic because it contributes to two of the most prolonged difficulties, both for individual nurses and the discipline of nursing — moral distress and moral ambiguity. In this paper we explore proximity using both a moral and (...)
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  • Perception of futile care and caring behaviors of nurses in intensive care units.Somaye Rostami, Ravanbakhsh Esmaeali, Hedayat Jafari & Jamshid Yazdani Cherati - 2019 - Nursing Ethics 26 (1):248-255.
    Objectives: Futile medical care is considered as the care or treatment that does not benefit the patient. Staff of intensive care units experience moral distress when they perceive the futility of care. Therefore, this study aimed to determine the relationship between perceptions of nurses regarding futile medical care and their caring behaviors toward patients in the final stages of life admitted to intensive care units. Method: This correlation, analytical study was conducted with 181 nursing staff of the intensive care units (...)
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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 distress experienced by nurses.Younjae Oh & Chris Gastmans - 2015 - Nursing Ethics 22 (1):15-31.
    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 (...)
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  • An Analysis and Evaluation of Student Nurses' Participation in Ethical Decision Making.Sung-Suk Han & Sung-Hee Ahn - 2000 - Nursing Ethics 7 (2):113-123.
    This study analyses the types and frequencies of ethical dilemmas and the rationale of ethical decision making in student nurses; it also evaluates their decision making. One hundred senior student nurses who were enrolled in a two-credit course in nursing ethics were asked to provide an informal description of a dilemma that they had experienced during their clinical practice. The results were as follows. The ethical dilemmas identified fell into four categories and were of 27 types. Those most frequently experienced (...)
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  • Moral distress: Developing strategies from experience.Andrew Helmers, Karen Dryden Palmer & Rebecca A. Greenberg - 2020 - Nursing Ethics 27 (4):1147-1156.
    Background Moral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such as (...)
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  • Moral Distress: A Comparative Analysis of Theoretical Understandings and Inter-Related Concepts. [REVIEW]Kim Lützén & Beatrice Ewalds Kvist - 2012 - HEC Forum 24 (1):13-25.
    Research on ethical dilemmas in health care has become increasingly salient during the last two decades resulting in confusion about the concept of moral distress. The aim of the present paper is to provide an overview and a comparative analysis of the theoretical understandings of moral distress and related concepts. The focus is on five concepts: moral distress, moral stress, stress of conscience, moral sensitivity and ethical climate. It is suggested that moral distress connects mainly to a psychological perspective; stress (...)
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  • 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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  • Moral distress in critical care nursing: The state of the science.Natalie Susan McAndrew, Jane Leske & Kathryn Schroeter - 2018 - Nursing Ethics 25 (5):552-570.
    Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. (...)
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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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  • Ethical conflicts with hospitals: The perspective of nurses and physicians.Alice Gaudine, Sandra M. LeFort, Marianne Lamb & Linda Thorne - 2011 - Nursing Ethics 18 (6):756-766.
    Nurses and physicians may experience ethical conflict when there is a difference between their own values, their professional values or the values of their organization. The distribution of limited health care resources can be a major source of ethical conflict. Relatively few studies have examined nurses' and physicians' ethical conflict with organizations. This study examined the research question ‘What are the organizational ethical conflicts that hospital nurses and physicians experience in their practice?’ We interviewed 34 registered nurses, 10 nurse managers, (...)
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  • A latent profile analysis of nurses’ moral sensitivity.Na Zhang, Jingjing Li, Zhen Xu & Zhenxing Gong - 2020 - Nursing Ethics 27 (3):855-867.
    Background: The three-dimensional model of nurses’ moral sensitivity has typically been studied using a variable-centered rather than a person-centered approach, preventing a more complete understanding of how these forms of moral sensitivity are expressed as a whole. Latent profile analysis is a person-centered approach that classifies individuals from a heterogeneous population into homogeneous subgroups, helping identify how different subpopulations of nurses use distinct combinations of different moral sensitivities to affect their service behaviors. Objective: Latent profile analysis was used to identify (...)
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  • Registered Nurses' Perceptions of Moral Distress and Ethical Climate.Bernadette Pauly, Colleen Varcoe, Janet Storch & Lorelei Newton - 2009 - Nursing Ethics 16 (5):561-573.
    Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely (...)
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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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  • Moral Distress: Inability to Act or Discomfort with Moral Subjectivity?Mark Repenshek - 2009 - Nursing Ethics 16 (6):734-742.
    Amidst the wealth of literature on the topic of moral distress in nursing, a single citation is ubiquitous, Andrew Jameton’s 1984 book Nursing practice. The definition Jameton formulated reads ‘... moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. Unfortunately, it appears that, despite the frequent use of Jameton’s definition of moral distress, the definition itself remains uncritically examined. It seems as if the context (...)
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  • Situating moral distress within relational ethics.Sadie Deschenes & Diane Kunyk - 2020 - Nursing Ethics 27 (3):767-777.
    Nurses may, and often do, experience moral distress in their careers. This is related to the complicated work environment and the complex nature of ethical situations in everyday nursing practice. The outcomes of moral distress may include psychological and physical symptoms, reduced job satisfaction and even inadequate or inappropriate nursing care. Moral distress can also impact retention of nurses. Although research has grown considerably over the past few decades, there is still a great deal about this topic that we do (...)
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  • The nurse under physician authority.T. May - 1993 - Journal of Medical Ethics 19 (4):223-229.
    A medical centre is an institution established for a specific purpose: to facilitate the health and health-related welfare of the medical centre's patients. Within this institution, there are a variety of professionals who act and interact to serve this purpose. Of particular interest is the interaction between physician and nurse. Generally, the nurse is thought to be under a certain obligation to implement a physician's orders unless there is good reason not to do so. This qualifier places a conflicting obligation (...)
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  • Moral distress experienced by psychiatric nurses in Japan.Kayoko Ohnishi, Yasuko Ohgushi, Masataka Nakano, Hirohide Fujii, Hiromi Tanaka, Kazuyo Kitaoka, Jun Nakahara & Yugo Narita - 2010 - Nursing Ethics 17 (6):726-740.
    This study aimed to: (1) develop and evaluate the Moral Distress Scale for Psychiatric nurses (MDS-P); (2) use the MDS-P to examine the moral distress experienced by Japanese psychiatric nurses; and (3) explore the correlation between moral distress and burnout. A questionnaire on the intensity and frequency of moral distress items (the MDS-P: 15 items grouped into three factors), a burnout scale (Maslach Burnout Inventory — General Survey) and demographic questions were administered to 391 Japanese psychiatric nurses in 2007—2008. These (...)
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  • 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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  • The effectiveness of narrative writing on the moral distress of intensive care nurses.Smat Saeedi, Leila Jouybari, Akram Sanagoo & Mohammad Ali Vakili - 2019 - Nursing Ethics 26 (7-8):2195-2203.
    Background: Nursing is a profession that has always been accompanied with common ethical concerns. There are some evidences which indicate that narrative writing on traumatic experiences may improve an individual’s emotional health. Objective: This study aimed to determine the effectiveness of narrative writing on moral distress of nurses working in intensive care unit. Research design: This study was a clinical trial with pre- and post-test design. The frequency and intensity of moral distress was measured by a valid and reliable questionnaire (...)
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