The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient's vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress.

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The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The theoretical perspective of the study is based on relational ethics, also referred to as ethics of care. The participants were 36 intensive care nurses from 10 general, neonatal and thoracic intensive care units. The structural characteristics of the units were similar: a high working pace, advanced technology, budget restrictions, recent reorganization, and shortage of experienced nurses. The data consisted of the participants' examples of ethical situations they had experienced in their intensive care unit. A qualitative content analysis identified five themes: believing in a good death; knowing the course of events; feelings of distress; reasoning about physicians' 'doings' and tensions in expressing moral awareness. A main theme was formulated as caring about--caring for: moral obligations and work responsibilities. Moral obligations and work responsibilities are assumed to be complementary dimensions in nursing, yet they were found not to be in balance for intensive care nurses. In conclusion there is a need to support nurses in difficult intensive care situations, for example, by mentoring, as a step towards developing moral action knowledge in the context of intensive care nursing.

The aim of this study was to analyse and describe lived experiences of support in situations characterized by critical care situations and moral stress in intensive care nursing. An exploratory interpretative study was conducted. Data consisted of interviews with 36 nurses from different types of intensive care units. The first level of analysis of data identified contextual factors, such as type and purpose of support and working conditions. On the next level of analysis five tentative interpretations were identified: (1) receiving organized support is a matter of self-determination, (2) whether to participate in organized support or to be off duty are experienced as mutually exclusive, (3) dealing with moral stress is experienced as a private matter, (4) colleagues managing moral stress serve as models in stress support and (5) not being able to deal with moral stress urges one to seek outside support. A comparison of these interpretations identified three major themes: availability, accessibility and receptivity of support. The main interpretation and conclusion were: lived experience of moral stress support involves an interconnectedness between structural and existential factors. Thus, adequate moral stress support presupposes an allowable professional climate and access to caring supervision.

The subject studied in this paper, describing uremic patients' use of coping strategies and their sense of coherence, was 48 consecutively selected patients with chronic renal failure at a Swedish hospital. The questionnaires used were the Jalowiec Coping Scale (JCS-40) and the Sense of Coherence Scale (SOC). The results showed that the patients used a variety of coping strategies, such as maintaining control, finding out more about the situation and hoping. In the use of coping styles, the confrontational style was the most favoured one, compared with the palliative and the emotive styles. There was a significant distinction between the predialysis patients and those on dialysis treatment concerning the use of strategies and coping styles. Patients on dialysis treatment showed significantly higher scores in overall strategies and in confrontational and palliative coping styles. The results revealed significant correlations between the JCS and the SOC scores, age and duration of kidney disease. Knowledge of the patients' commonly used coping strategies and sense of coherence is important when nursing care is being planned for the patient.