Understanding moral distress in home-care nursing: An interview study

Area of Science:

• Nursing
• Healthcare Ethics
• Occupational Health

Background:

• Moral distress is a prevalent issue impacting nurses' well-being across various healthcare settings.
• Understanding the specific triggers and consequences of moral distress in home-care nursing is crucial.

Purpose of the Study:

• To investigate the situations causing moral distress in home-care nursing.
• To explore how home-care nurses experience and cope with moral distress.
• To identify the consequences of moral distress on nurses' health and well-being.

Main Methods:

• A qualitative study employing reflexive thematic analysis.
• Semi-structured interviews were conducted with 20 home-care nurses in Germany.

Main Results:

• Key triggers include inadequate patient care, personal health risks, extensive responsibilities, work-life conflicts, and clashes with the billing system.
• Nurses experienced moral distress due to working autonomously in patient homes, leading to short- and long-term physical and emotional strain.
• Coping with moral distress presented challenges at both institutional and individual levels.

Conclusions:

• Moral distress is often unavoidable when care practices conflict with service and billing systems.
• Recommendations include implementing alternative organizational and billing models, such as time-based payment and expanded services.
• Systematic case and ethics meetings, alongside task delegation (e.g., wound care material prescription to registered nurses), can mitigate morally stressful situations and enhance patient care quality.