Moral Distress

Definition and Characteristics

The notion of moral distress emerged in the early 1980s when Jameton, writing for nurses, drew a distinction between moral uncertainty, moral dilemmas, and moral distress. The first deals with instances when an individual is not sure what particular moral principle or value is applicable in the situation at hand. The second refers to problems when several moral principles or values are relevant, and the individual must choose between perspectives and their consequences. The third, moral distress, describes the reality of knowing the ethically correct action to take and feeling moral responsibility, but being unable to act in accordance with personal views due to organizational constraints. In such situations, individuals are faced with having to choose between their own integrity or participating in wrongdoing. Wilkinson expanded the understanding of this phenomenon by adding that there is a psychological dimension, a psychological disequilibrium created by disrespecting personal beliefs. First in 1995 and again in 2001, Corley published a Moral Distress Scale. It identified frequently occurring issues that were problematic for nurses, as well as severe morally distressing situations.

The ethics of care, among other ideas, has influenced the understanding of moral distress. In 1995, Liaschenko furthered the discussion of moral distress by describing nurses as “artificial persons” who find themselves in a stressful, complex situation. They are healing professionals and patient advocates who at times inflict pain against their will due to supervisory directives, institutional policies, and bureaucratic practices. In 2000, Penticuff and Waldren noted that the work setting, both actual and perceived, affects the ethical choices made by nurses.

Moral distress is a multidimensional phenomenon that can affect a person physically, emotionally, spiritually, and socially. Consciously knowing the appropriate action to take, but being unable to act, can damage a person's sense of integrity and authenticity. Long-term moral distress can result in the loss of [Page 1413]moral integrity, causing the individual to not behave according to professed values and convictions, nor be able to effectively deal with moral conflicts.

During times of moral distress, frustration, anxiety, anger, and guilt are common emotions, because individuals often feel powerless, afraid of repercussions, or reluctant to act. These feelings occur during the period known as initial distress. Some individuals after identifying the divergence between their personal views or values, and those of the workplace, have the self-assurance, courage, and interpersonal skills to seek to resolve the difference. Others do not. The latter is referred to as reactive distress. If the distress becomes too acute, it can cause illness, relationship breakups, the loss of a job, and even the abandonment of a career. Moral distress is detrimental to the nursing profession because highly qualified individuals are leaving the profession or are not choosing to enter it.

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