The concept of moral distress has been studied mainly as an occupational issue and has not been developed for use in clinical practice. This study was designed to bridge prior studies of occupational moral distress with future clinical investigations of moral distress. Study aims were to discover the essence, properties, and full content domain of the concept of moral distress in order to develop a universal definition of the concept. A modified phenomenological study of nurses' experience of a particular moral issue was conducted. A maximum variation sampling strategy was used to recruit a final sample of registered nurses (N = 10). Interior aversion is the essential act of moral distress. Five properties of the lived experience of moral distress were identified: perception, pain, valuing, altered participation, and perspective. Three types of moral distress identified in this study were: shocked, muted, and suppressed (persistent). Type of moral distress was related to situational conditions, recognition of moral ends, quality of coping processes, and temporal breadth. Negative outcomes of moral distress, which probably exist, were undetectable with this study design. The definition has been composed in universal terms, but remains tentative, since the full content domain of moral distress was largely but not definitively identified.

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PGS is not rare and elderly patients and individuals receiving large, multiple doses are particularly at risk. This iatrogenic complication may be preventable by substituting fosphenytoin for IV phenytoin.

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Moral distress, a complex human experience, has lacked a clear, complete definition. Intuitively, clinicians know that moral distress might be occurring for patients with increasing frequency due to technological advances that alter the natural order of life and death. Yet clinicians have not been able to evaluate the presence or extent of moral distress. To date, moral distress has been investigated mainly as an occupational issue using Jameton's (1984) definition, which has been problematic for several reasons. Without an adequate definition, moral distress can be unrecognized, yet have a silent, clinically significant impact on health. The literature is discussed from several perspectives to show the current state of the science in this topical area, and its potential future.