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Nurses are essential in patient care, upholding the ethical principles of their profession and effectively navigating ethical dilemmas. Neglecting ethical issues can lead to inadequate patient care, compromised therapeutic relationships, and moral distress among healthcare workers.
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Ethical Dilemmas I01:17

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Ethical dilemmas in nursing are of utmost importance, as they often arise from the tension between adhering to core ethical principles and the practical realities of healthcare delivery. These dilemmas require nurses to navigate complex situations where competing ethical considerations pull them in different directions.
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The Nursing Code of Ethics sets the ethical benchmark for the profession, and guides nurses in ethical analysis and decision making at the societal, organizational, and clinical levels. The code encompasses showing compassion and respect for the patient, their families, and communities in all circumstances while committing to providing patient-centered care. In addition, the code states that nurses must advocate for the patient by defending a cause or recommendation to protect their rights,...
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Moral distress in midwifery practice: A Delphi study.

Mrs Wendy Foster1, Lois McKellar2, Julie-Anne Fleet1

  • 1Clinical and Health Sciences, University of South Australia, Australia; Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA 5000, Australia.

Women and Birth : Journal of the Australian College of Midwives
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Summary

This study developed statements to measure moral distress in Australian midwives, identifying excessive workloads as a key issue. Findings establish a continuum from moral frustration to injury, informing new assessment tools.

Keywords:
Delphi techniqueEthicsMidwiferyMoral distressMoral frustrationMoral injury

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Area of Science:

  • Healthcare Ethics
  • Psychology
  • Midwifery Practice

Background:

  • Moral distress arises from conflicts between actions and personal moral beliefs, impacting workplace well-being.
  • Existing moral distress assessment tools lack specificity for Australian healthcare and midwifery.
  • This study addresses the need for tailored tools to evaluate moral distress in midwives.

Purpose of the Study:

  • To develop situational and outcome statements for moral compromise and distress in midwifery.
  • To inform the creation of a measurement tool for moral distress levels in midwives.
  • To establish a consensus-based understanding of moral distress within Australian midwifery.

Main Methods:

  • An e-Delphi methodology was employed, involving three iterative online consensus rounds.
  • Participants reached consensus on 40 statements describing morally compromising situations.
  • The study analyzed psychological outcomes associated with morally distressing situations.

Main Results:

  • Excessive workloads emerged as the most significant morally compromising situation, impacting women and families.
  • A continuum scale was developed, ranging from moral frustration to moral injury.
  • Consensus was achieved on the nature and outcomes of moral distress in midwifery.

Conclusions:

  • This research is the first to use consensus to define levels of moral compromise, frustration, distress, and injury in midwifery.
  • The findings support the concept of moral distress existing on a continuum within professional practice.
  • This study contributes essential data for developing specific moral distress assessment tools for midwives.