Moral distress in critical care nursing practice: A concept analysis

Cooke, S.L.; Booth, Richard; Jackson, Kimberley T

doi:10.1111/nuf.12786

Cited by 4 publications

(2 citation statements)

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“…Moral distress has significant implications for nurses, patients and healthcare organisations. Investigators have reported that unresolved moral distress can result in feelings of powerlessness, self‐blame, anger, frustration (Rodney, 2017), burnout, anxiety and depression (Cooke et al, 2022; Lamiani et al, 2017), deterioration of teamwork, decreases in the quality of care, challenges to patient safety (Rodney, 2017) emotional exhaustion and increased job turnover (Oh & Gastmans, 2015). When nurses experience moral distress over time, the nurses, healthcare systems and patients could suffer damaging effects.…”

Section: Discussionmentioning

confidence: 99%

“…Moral distress was described by Jameton (1984) as the resulting pain or anguish that occurs when someone knows the morally correct action they should take in a situation but cannot act accordingly. Attributes of moral distress in nursing include emotional and psychological distress and a perception of powerlessness in bringing about a change or being able to act on their moral agency (Cooke et al, 2022). Moral distress has significant implications for nurses, patients and healthcare organisations.…”

Section: Discussionmentioning

confidence: 99%

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Reflections from the frontline of nursing on acute patient deterioration

Dresser,

Teel,

Peltzer

2023

Journal of Clinical Nursing

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AimsTo describe medical‐surgical nurses' reflections on their experiences with patient deterioration.BackgroundAn extensive body of knowledge exists regarding optimal responses to acute patient deterioration within a hospital environment. Much less attention has focused on the profound psychological and emotional impact these experiences of unexpected deterioration can have on nurses who provided the supportive or rescue care. A triggering event, such as patient deterioration, or direct questioning about these experiences, can lead nurses to reflect further on the situation. Engaging in reflection is believed to enhance learning and improve clinical judgement when future complex situations arise. Findings related to nurses' reflective practice when recalling previous situations with deteriorating patients are limited. This gap in the literature provided the basis for the current project.DesignA qualitative descriptive design.MethodsTwenty medical‐surgical nurses were interviewed in 2018. The nurses were recruited through purposive sampling. Semi‐structured telephone interviews explored nurses' experiences of a patient deterioration. Conventional content analysis with iterative coding and categorising and theme development was used for data analysis.FindingsThree themes emerged as participants reflected on their experiences. The themes were, Enduring frustration and regret, Feeling deeply responsible for and to the patient and Making sense of what happened.ConclusionsMedical‐surgical nurses who care for acutely deteriorating patients can experience lasting emotional, psychological and physical concerns that often go unrecognised and untreated. Furthermore, nurses with this background commonly reported their perceived increased risk for workplace distress.Relevance to Clinical PracticeFindings from this study are important for nurses, healthcare administrators and leaders, and patients. Participating in a rescue attempt often has a negative impact on nurses' perception of workplace stress and on persistent concerns about nurses' mental and physical health. The findings can be useful in informing additional studies about the phenomenon. Findings also can inform the exploration of workplace design. Organisations should assess for factors influencing workplace stress, develop strategies to mitigate the presence of workplace stress and foster nurses' well‐being so they can respond to future scenarios of patient deterioration, while maintaining their physical and mental health.Patient or Public ContributionThis study did not include any patient or public input.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reflections from the frontline of nursing on acute patient deterioration

Dresser,

Teel,

Peltzer

2023

Journal of Clinical Nursing

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“Please, Don’t Make Me Do This”: The Role of the Ethics Consultant in Responding to and Mitigating Moral Distress

Bocchese,

Morley

2024

The American Journal of Bioethics

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Student nurses experiences of moral distress: A concept analysis

Rebecca

2024

Journal of Advanced Nursing

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AimTo understand how pre‐registration student nurses experience moral distress and refine the concept in this population.BackgroundThe experience of moral distress has positive and negative effects for health professionals and negatively impacts on patient care. Moral distress is a fluid concept which permits the experience to be varied among different populations. Despite empirical research, a concept analysis has not been performed in the student nurse population.Data SourcesElectronic databases were searched via Ebsco Host Complete and included Cinahl, Medline, APA Psych in March 2024. Search terms included ‘Moral Distress’ AND ‘Student’, ‘Moral Distress’ and ‘Baccalaureate.’ Search limits included articles between 2014 and 2024, English Language. Twenty‐five papers were included in the review and consisted of eight quantitative studies, 11 qualitative studies, three mixed methods studies and three literature/systematic reviews.MethodsAn integrated mixed research synthesis (Sandelowski, Voils, Barroso 2006) was conducted and organized into Walker, Avant's (2005) framework of antecedents, attributes and consequences. Braun and Clarkes (2006) thematic analysis was then used to generate themes from the literature.ResultsAntecedents emerged as students having moral sensitivity, they recognize unethical circumstances. Attributes identified roots of moral distress. These roots include poor patient care, harm to the patient and unsafe care. Students experience of morally reprehensible events is exacerbated by the disempowerment they experience as being ‘just a student’. Student nurses who do not exhibit moral courage and do not oppose immoral practices do so due to internal constraints which transpire as fear of conflict, withdrawal of learning opportunities, and fear of disruption to learning. This is influenced by their registered nurse supervisor relationship. Consequences of moral distress identify negative feelings, coping mechanisms and positive effects.ConclusionThe attributes of moral distress in the student nurse population have distinctive features which should be considered by nurse educators and in empirical research.Patient or Public ContributionNone, as this is a concept analysis that contributes to theory development and is not empirical research.

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Moral distress in critical care nursing practice: A concept analysis

Cited by 4 publications

References 57 publications

Reflections from the frontline of nursing on acute patient deterioration

Reflections from the frontline of nursing on acute patient deterioration

“Please, Don’t Make Me Do This”: The Role of the Ethics Consultant in Responding to and Mitigating Moral Distress

Student nurses experiences of moral distress: A concept analysis

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