Moral distress and spiritual/religious orientation: Moral agency, norms and resilience

Abstract

Background Nurses tasked with providing care which they perceive as increasing suffering often experience moral distress. Response to moral distress in nurse wellbeing has been widely studied. Less research exists that probes practicing nurses’ foundations of moral beliefs. Aims The purpose of this phenomenological study was to gain understanding of nurse meaning-making of morally distressing situations, with particular attention to ethical norms, moral agency and resiliency, and nurse religious/spiritual orientation. Design This exploratory study employed semi-structured interviews using open-ended questions. Qualitative data analysis was assisted by MAXQDA software. Participants and research context Nine pulmonary care nurses during COVID-19 in a tertiary care teaching hospital in the northeastern United States. Ethical considerations The study was approved by the IRB. Participants were consented before the study and confidentiality was preserved. Findings/results The study revealed three main themes of meaning-making, rooted in the identity of the “good nurse”: Being true to one’s own values, pursuing ideal patient care (“doing good”), and conforming to/challenging values of the system and culture. Tensions were found between (a) nurse’s own values (b) duty to institutional norms and duty to nurse’s personal code of ethics, and (c) perceptions of institutional support in response to nurse moral distress. Religion was described as a remote source of nurse moral values, among other sources. Spiritual practices were not experienced as sufficient in coping with moral distress at the bedside. Conclusions The study suggests nurses need more opportunities to engage in reflection on their practice and values. The findings also indicate need for accessible institutional supports for nurses experiencing moral distress and strategic use of chaplains in helping with moral distress. Further research is needed on the interplay of nurse spirituality, moral agency, and reflective practice in the face of morally challenging situations.

Healthcare Workers’ Moral Distress during the COVID-19 Pandemic: A Scoping Review

“…On the other hand, five articles (n = 5) were published in 2021 (Smallwood et al 2021;Donkers et al 2021;Patterson et al 2021;Hines et al 2021;Zerach and Levi-Belz 2021), and they account for 31% of the included studies. For 2023, two studies (n = 2) were identified (Kok et al 2023;Koonce and Hyrkas 2023), representing 13% of the included studies. The studies were conducted from December 2019 (Kok et al 2023) till February 2022 (Gherman et al 2022).…”

“…The research methods used in the studies were as follows: quantitative design studies (n = 8) (Asadi et al 2022;Smallwood et al 2021;Donkers et al 2021;Hines et al 2021;Zerach and Levi-Belz 2022;Gherman et al 2022;Maffoni et al 2022;Kok et al 2023) (Koonce and Hyrkas 2023); and in four cases (n = 4), the theoretical framework of the study was not mentioned (Patterson et al 2021;Zerach and Levi-Belz 2021;Gherman et al 2022;Hegarty et al 2022).…”

“…The selection of the included articles was made by nurses (n = 4) (Asadi et al 2022;Gherman et al 2022;Koonce and Hyrkas 2023;Lemmo et al 2022), doctors (n = 2) (Patterson et al 2021;Kiziltepe and Kurtgöz 2022) and HCWs in general (n = 10) (Alonso-Prieto et al 2022; Kok et al 2023;Smallwood et al 2021;Donkers et al 2021;Ahokas and Hemberg 2022;Hines et al 2021;Zerach and Levi-Belz 2021;Fagerdahl et al 2022;Hegarty et al 2022;Maffoni et al 2022).…”

“…They had to deal with increasing infection rates and workloads inadequate for existing resources (Riedel et al 2022;Alonso-Prieto et al 2022;Zerach and Levi-Belz 2021). While working in the clinical environment, HCWs still had to face several moral and ethical dilemmas that increased moral distress (Menon and Padhy 2020), contributed to emotional burnout, and had an impact on the effectiveness of their work (Donkers et al 2021;Smallwood et al 2021;Kok et al 2023;Koonce and Hyrkas 2023). Therefore, both ethical dilemmas and basic principles of morality were at odds with each other during the pandemic.…”

Mediating role of moral resilience and professional identity in the impact of nursing interns' moral distress on compassion fatigue: a cross-sectional study

“…Moreover, constant exposure to morally challenging situations can leave individuals feeling hopeless and questioning the point of striving for ethical behavior. This can make it di cult to nd meaning in work and decrease overall moral resilience [33,53,54].…”