Moral distress & moral community: A narrative review of the literature

Moral distress is recognized as a major contributor to burnout and attrition among nurses. While the sequelae of moral distress are profound, the antecedents of moral distress are multi-factorial and therefore the phenomenon is challenging to address. Many interventions target individual-level factors such as moral resilience; however, moral distress is a system-level problem. As such, there is a growing focus on developing upstream, system-level interventions to mitigate or prevent moral distress in the healthcare setting. Moral community is a system-level dynamic that reflects ethical climate and perceived organizational support, metrics that are often associated with moral distress. However, the connection between moral distress and moral community in nursing remains under-examined. Therefore, the purpose of this narrative review was to explore the relationship between moral distress and the concept of moral community in the context of nursing practice. Three categories emerged from this analysis: organizational constraints that instigate moral distress, moral community as a concept, and the role of moral community in an organization. Based on these categories, a revised definition of moral community was developed and used to synthesize a novel theoretical framework relating moral community to moral distress. Further research may apply the proposed definition of moral community and theoretical framework to (1) evaluate existing organizational ethical frameworks and (2) formulate novel interventions to address moral distress.