Conference Publication Details
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McCarthy, J
2nd Annual Conference, NMPDU HSE Southern Area
Moral Distress: Knowing What's Right and Doing What's Wrong
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Moral distress is a concept that has been increasingly deployed in nursing discourse in recent years. It describes a response that can occur when an individual, having made a moral judgement as to the right course of action in a particular situation, is unable to act upon their judgement because they are constrained in some way. Such a constraint might be personal e.g. based on fear or lack of resolve. Or the constraint might be situational e.g. institutional rules or lack of resources.

This paper charts the history of the concept of moral distress since its first deployment in 1984 by the philosopher, Andrew Jameton. Research studies of moral distress that I consider, suggest that the experience of moral distress over time can lead to feelings such as anger, anxiety and self-blame and prompt nurses to work fewer hours or to leave their employment altogether. In turn, these studies indicate that moral distress among nurses seriously impacts on the quality of patient care that nurses provide e.g. nurses avoid patients and are desensitised to patients’ needs.  Alternatively, some research also suggests that moral distress can act as a catalyst for change, prompting nurses to challenge poor employment conditions, bad practices and inadequate standards of care.

My paper is also concerned with the way in which the concept of moral distress has evolved into a kind of catch all repository for all that is difficult or painful in nursing practice. The very notion of moral distress itself conjures the idea that a life and work without moral stress is possible – and this I think is unrealistic. Moreover, I suggest that a morally engaged life must, of necessity, be a morally stressed life. I am also concerned about the fact that research so far has been largely confined to determining the extent of moral distress among nurses. Assuming that all of the different groups working in the health care services are morally sensitive and sometimes morally constrained, I suggest that limiting consideration and research to nurses’ experiences alone will have the effect of trivializing moral distress and marginalizing nurses’ genuine moral concerns.

I conclude that, while there is no doubt that moral distress is a rich metaphor that captures a sorely neglected area of nursing practice, it is best to treat it critically and to expand the horizon of its application.

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