Moral distress in midwifery practice: A concept analysis

Area of Science:

• Midwifery
• Bioethics
• Nursing Ethics

Background:

• Moral distress is a significant and growing concern among health professionals.
• The concept of moral distress is not well-defined within midwifery practice.
• Existing definitions lack clarity and a consistent theoretical basis across healthcare professions.

Purpose of the Study:

• To comprehensively understand the concept of moral distress in midwifery.
• To identify the core attributes, antecedents, and consequences of moral distress in this context.
• To develop a midwifery-specific definition of moral distress.

Main Methods:

• Concept analysis utilizing Rodgers' evolutionary framework.
• Literature search across multiple databases, resulting in eight reviewed articles.
• Qualitative data analysis using NVivo12© software.

Main Results:

• Identified three core attributes: moral actions/inactions, conflicting needs, and negative feelings/emotions.
• Determined antecedents including clinical situations, moral awareness, uncertainty, and constraint.
• Outlined consequences encompassing adverse personal, professional, and organizational outcomes.

Conclusions:

• Affirmed the presence and impact of moral distress within midwifery practice.
• Proposed a midwifery-focused definition: 'psychological suffering following clinical situations of moral uncertainty and/or constraint, resulting in powerlessness to preserve competing moral commitments'.
• Provided evidence to support a consistent definition and understanding of moral distress in midwifery.