Moralisches Belastungserleben von Pflegefachpersonen – Ein deskriptives Modell der Entstehung und Wirkung eines ethisch bedeutsamen Phänomens der Pflege

Legal Regulations and the Anticipation of Moral Distress of Prospective Nurses: A Comparison of Selected Undergraduate Nursing Education Programmes

“…They point out that the symptoms of such psychological stress may vary among nurses but include negative emotions such as anger, frustration, guilt, regret, sadness, upset, powerlessness, symptoms associated with stress and feeling torn. This description is in line with those of others who point out that moral distress is to be understood as the subjective experience of each individual nurse [ 37 , 38 , 40 , 41 ]. Yet another definition of moral distress is that provided by a systematic review by Sanderson et al [ 51 ] (p. 207) who describe moral distress as follows: the “Ethical unease or disquiet resulting from a situation where a clinician believes they are contributing to avoidable patient or community harm through their involvement in an action, inaction or decision that conflicts with their own values”.…”

“…If nurses are prevented from doing what they feel is morally right in a situation, and their moral integrity is at stake because they cannot fulfil their professional moral responsibility, they may experience moral distress [ 64 , 65 ], which is used to describe an experience of moral suffering [ 27 ]. Various definitions of the phenomenon of moral distress have been discussed within the literature [ 40 , 48 , 49 , 51 , 53 , 66 , 67 , 68 ]. According to Jameton (p. 6) [ 67 ], who first described it, moral distress may occur when “one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action”.…”

“…Other dimensions of moral suffering such as moral injury [ 38 , 72 , 73 , 74 ] and moral residue [ 38 , 75 , 76 ] are being discussed in the literature with respect to the continuum of moral suffering. This continuum is understood as a person’s oscillation between the feelings of moral comfort (the individual’s moral integrity remains intact) and moral distress (the individual experiences a violation to their moral integrity) [ 39 , 40 ]. Moral residue is understood as the consequence of a person’s repetitive experience of unresolved moral distress in a way that causes a gradual accumulation of stress levels over time, resulting in long-lasting, residual feelings of a compromised moral integrity [ 38 , 75 ].…”

“…These abilities may support prospective nurses in maintaining their moral integrity, understood as the “moral wholeness” (p. 78) [ 35 ] of a person or as their ability to live up “to one’s personal moral code, so that one can sleep at night, or live with oneself, having demonstrated courage, patience, and perseverance in the face of conflict” (p. 431) [ 36 ]. If a person’s moral integrity has been violated, this infringement may result in moral distress, a phenomenon of growing interest within the recent nursing literature [ 2 , 19 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ].…”

“…While the exact number of nurses experiencing moral distress are not known, some authors describe it as a widespread phenomenon [ 4 , 19 ] which has been reported in a variety of care settings internationally [ 17 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. It seems important to point out that any everyday care situation that gives rise to a moral question may result in the individual’s experience of moral distress [ 15 , 19 , 40 ]. However, some more extreme care settings or particularly challenging nursing activities, such as the autonomous participation in the process of breaking bad news (further examples will be provided in Section 3.3 .…”