Overestimating prevalence? Rethinking boundaries and confounders of moral distress

Area of Science:

• Healthcare ethics
• Psychology
• Organizational behavior

Background:

• Moral distress, a negative reaction to morally challenging situations, impacts healthcare professionals, patients, and institutions.
• Existing research on moral distress faces validity challenges due to definitional and measurement issues.

Purpose of the Study:

• To critique current definitions and measures of moral distress.
• To highlight the conflation of moral events and psychological distress in empirical research.
• To propose a research agenda for improving the study of moral distress.

Main Methods:

• Conceptual analysis of existing definitions and measures of moral distress.
• Review of empirical studies on moral distress and work-related factors.
• Identification of limitations in current research methodologies.

Main Results:

• Current definitions and measures of moral distress conflate distinct phenomena (moral events vs. psychological distress).
• Studies often fail to differentiate between moral and non-moral events.
• Prior research overlooks the impact of broader work-related factors on distress and retention.

Conclusions:

• Existing approaches compromise the validity of moral distress research.
• Interventions may be less effective due to these methodological challenges.
• A comprehensive research agenda is needed, focusing on conceptual clarity, improved instruments, study design, and statistical methods.