The Moral Distress Model Revisited: Integrating Nurses' Experiences in the United States and United Kingdom

AbstractScholars have challenged Jameton's original conceptualization of moral distress on the basis that it is too narrow and discounts significant moral experiences. Further inconsistencies about the necessary and sufficient conditions required for moral distress to occur have heightened conceptual ambiguities. The aims of this research were to examine nurses' experiences of moral distress and to utilize these findings to critically examine a previous model of moral distress developed from data gathered in the United Kingdom. This article presents findings from a feminist interpretive phenomenological study in which nurses in the United States were interviewed about their experiences of moral distress. Nurse participants in this study described experiencing strong negative emotions in response to five distinct morally challenging situations. These situations were categorized into the same five moral events as identified in the original study, reinforcing the five subcategories identified from interviews with nurses in the United Kingdom. The most significant change to the moral distress model was centering the interpretive and evaluative component of moral distress. Understanding moral distress as subcategories enables a more precise analysis of moral distress, while retaining the power of the term "moral distress." The revised moral distress model can guide our responses to moral distress and interventions to mitigate its negative effects.