Moral Distress: Recognition, Diagnosis, and Treatment

Thriving at work, career calling, and moral distress among nurses

BACKGROUND

Emergency nurses who thrive at work experience positive emotions that help reduce burnout and thus enhance career calling. However, few studies have focused on the relationships among thriving at work, career calling, and moral distress among emergency nurses.

OBJECTIVES

To investigate the relationships among thriving at work, career calling, and moral distress and to explore the mediating role of career calling in the relationship between thriving at work and moral distress among emergency nurses.

DESIGN

A quantitative, cross-sectional study.

METHODS

A cross-sectional study was conducted by reference to 390 emergency nurses in China using an online survey that include the Thriving at Work Scale, the Career Calling Scale, and the Moral Distress Scale-Revised. The data were analyzed using SmartPLS software.

ETHICAL CONSIDERATION

The study was approved by the Ethics Committee of Hunan Normal University (No. 2023-388).

FINDINGS

Among emergency nurses, thriving at work is positively associated with career calling, while career calling is negatively associated with moral distress. Career calling negatively and completely mediates the relationship between thriving at work and moral distress (β = -0.087, p < 0.01).

DISCUSSION

Theoretically, the findings enhance our understanding of the relationships among thriving at work, career calling, and moral distress among emergency nurses.

CONCLUSION

By emphasizing the benefits of thriving at work, nursing managers can improve nurses' level of thriving at work by providing a favorable environment, a flexible scheduling system, and appropriate authorization as well as by ensuring organizational fairness and providing training opportunities in a hierarchical manner.

Moral distress among nurse leaders: A qualitative systematic review

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions.

Mitigating Moral Distress in Leaders of Healthcare Organizations: A Scoping Review

GOAL

Moral distress literature is firmly rooted in the nursing and clinician experience, with a paucity of literature that considers the extent to which moral distress affects clinical and administrative healthcare leaders. Moreover, the little evidence that has been collected on this phenomenon has not been systematically mapped to identify key areas for both theoretical and practical elaboration. We conducted a scoping review to frame our understanding of this largely unexplored dynamic of moral distress and better situate our existing knowledge of moral distress and leadership.

METHODS

Using moral distress theory as our conceptual framework, we evaluated recent literature on moral distress and leadership to understand how prior studies have conceptualized the effects of moral distress. Our search yielded 1,640 total abstracts. Further screening with the PRISMA process resulted in 72 included articles.

PRINCIPAL FINDINGS

Our scoping review found that leaders-not just their employees- personally experience moral distress. In addition, we identified an important role for leaders and organizations in addressing the theoretical conceptualization and practical effects of moral distress.

PRACTICAL APPLICATIONS

Although moral distress is unlikely to ever be eliminated, the literature in this review points to a singular need for organizational responses that are intended to intervene at the level of the organization itself, not just at the individual level. Best practices require creating stronger organizational cultures that are designed to mitigate moral distress. This can be achieved through transparency and alignment of personal, professional, and organizational values.

Nursing Moral Distress and Intent to Leave Employment During the COVID-19 Pandemic

BACKGROUND

Complexity in nursing practice creates an intense and stressful environment that may lead to moral distress (MD) and registered nurses (RNs) seeking other employment.

LOCAL PROBLEM

In 2020, the RN turnover rate was 8%, with postpandemic turnover projected to reach 13%.

METHODS

The Measure of Moral Distress for Health Care Professionals (MMD-HP) was used to measure the frequency and level of RNs' MD.

RESULTS

t tests showed significant differences for 16 of 27 MMD-HP items in RN intent to leave. RNs had 2.9 times the odds of intent to leave (P = .019) due to perceived issues with patient quality and safety and 9.1 times the odds of intent to leave (P < .001) due to perceived issues with the work environment. Results explained 40.3% of outcome variance.

CONCLUSIONS

MD related to work environment or patient quality and safety were significant factors in RN intent to leave their position.

Moral distress in medicine: An ethical analysis

Moral distress is a negative emotional response that occurs when physicians know the morally correct action but are prevented from taking it because of internal or external constraints. Moral distress undermines a physician's ethical integrity, leading to anger, poor job satisfaction, reduced quality of care and burnout. Scarce literature exists on the ethical aspects of moral distress in medicine. We conducted an ethical analysis of moral distress as experienced by physicians and analysed it from the literature using two predominant ethical theories: principlism and care ethics. Finally, we consider the emergence of moral distress in medicine during the COVID-19 pandemic.

Moral distress of nurses surrounding neonatal abstinence syndrome: Application of a theoretical framework

TOPIC

Neonatal nurses who care for infants with symptoms of neonatal abstinence syndrome (NAS) may experience moral distress through conflicting professional ethics. The nurse may find it difficult to simultaneously exemplify beneficence and nonmaleficence.

OBJECTIVE

The purpose of this paper is to explore the moral distress of nurses in the context of infants experiencing symptoms of NAS and apply a new conceptual model to this phenomenon. Understanding how nurses navigate moral dilemmas may provide insight into strategies to better support them to address moral conflict.

METHODS

Moral distress was explored in the context of nurses who care for infants with symptoms of NAS. A literature review was completed, followed by the application of the model onto the derived themes.

RESULTS

The theoretical application resulted in a framework that exemplifies the experience of caring for infants with symptoms of NAS and their families described by many nurses within the literature. If moral distress is not resolved, negative outcomes may be experienced by the nurse, with additional negative outcomes experienced by the family.

CONCLUSION

This theoretical model provided insight into the experience of moral distress surrounding nursing care for infants with symptoms of NAS. Additional research is needed to investigate moral residue and moral resilience in this particular caregiving dynamic.