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Moral Distress Among Family Caregivers: A Concept Analysis
Tharaa Ananzeh1, Caroline F Morrison1, Elaine L Miller1
1College of Nursing, University of Cincinnati, Cincinnati, Ohio, USA.
Aim:
To examine and define the concept of moral distress among family caregivers by identifying its key attributes, antecedents and consequences.
Design:
Concept analysis.
Methods:
This study was guided by Walker and Avant's concept analysis framework. A comprehensive literature search was conducted to identify relevant studies, with 12 articles included in this analysis.
Data Sources:
PubMed, CINAHL, Scopus and PsycINFO databases were searched for articles published between February 2000 and May 2025.
Results:
Three defining attributes of moral distress in family caregivers were identified: self-directed negative emotions, internal conflict and feelings of powerlessness and helplessness. Antecedents included caregiving burden, role conflict, ethical dilemmas, complex decision-making and internal and external constraints. Consequences encompassed long-term health effects, social withdrawal, burnout and moral residue. These findings led to a conceptual definition of moral distress in family caregivers.
Conclusion:
Moral distress in family caregivers is a significant and underrecognised issue that affects caregiver well-being and the quality of care they provide. This concept analysis offers a clear conceptual definition, providing a foundation for developing research instruments and interventions.
Implications For The Profession And/Or Patient Care:
Healthcare professionals should recognise moral distress in family caregivers as a key factor impacting both caregiver well-being and patient care. Support through education, counselling and peer groups can reduce moral distress and foster more ethical, collaborative care environments.
Impact:
This study addressed the lack of clarity surrounding moral distress in family caregivers. It identified key attributes, antecedents, and consequences, and developed a clear conceptual definition. These insights will inform research, practice and policy. The findings will benefit caregivers, improve patient care and support healthcare teams.
Reporting Method:
This study followed Walker and Avant's framework and employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in article selection.
Patient Or Public Contribution:
No patient or public involvement.
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