Moral distress: A concept clarification.

Area of Science:

• Nursing
• Bioethics
• Healthcare Ethics

Background:

• Moral distress is a recognized phenomenon in nursing, occurring when nurses cannot act on their moral decisions due to constraints.
• Existing definitions of moral distress lack cohesion, complicating research and policy development.
• Understanding moral distress is crucial for nursing practice, education, and policy.

Purpose of the Study:

• To identify and analyze unique definitions of moral distress within the nursing literature.
• To examine the relationships between different definitions of moral distress.

Main Methods:

• Morse's method of concept clarification was employed.
• A comprehensive literature review was conducted.
• Attributes, antecedents, and consequences of moral distress were identified, described, compared, and contrasted.

Main Results:

• All 18 studies reviewed defined moral distress with either explicit or implied constraints.
• External constraints include institutional, systemic, or situational obstacles.
• Internal constraints were described as individual limitations or weaknesses.

Conclusions:

• The term "internal constraints" places undue responsibility on the individual experiencing moral distress.
• Proposes changing "internal constraints" to "internal characteristics".
• This semantic shift aims to reduce individual blame and emphasize systemic and institutional factors.