Moral Distress in Nurses Caring for Undocumented Immigrants: A Concept Analysis

Aim: To report an analysis of the concept of moral distress among nurses caring for undocumented immigrants (UIs). Design: Concept analysis is the study design. Data Sources: Data sources included nursing and health care databases searched from 2015 to 2025. Eight articles were identified that addressed moral distress in the context of nursing care for UIs. Review Methods: Walker and Avant's method was used to identify definitions, antecedents, consequences, and empirical referents of the concept. Model, related, and contrary cases were developed to illustrate conceptual boundaries. Results: Defining attributes of moral distress among nurses caring for UIs included moral awareness, perceived or actual constraints, emotional and psychological distress, conflict between professional role and structural injustice or advocacy, and capability for reflection and growth. Antecedents were awareness of an ethical obligation or right action and encounters with UIs facing policy, institutional, or legal barriers. Consequences encompassed emotional and psychological effects such as guilt, frustration, sadness, burnout, and job dissatisfaction or turnover, moral residue, compromised patient care, and questioning of professional identity and values. Empirical referents included the Moral Distress Scale-Revised and the Moral Distress Thermometer. Conclusion: Moral distress is a pervasive and underexamined phenomenon for nurses who care for UIs. The analysis demonstrates that systemic constraints and ethical conflicts contribute to significant personal and professional consequences for nurses, ultimately threatening both workforce sustainability and delivery of equitable care. Conceptual clarity and empirical tools adapted for this context are needed to inform effective interventions.