Page 334 - Encyclopedia of Nursing Research

MORAL DISTRESS n 301

constraints. Nurses experience moral distress cultural pressures or by rationalizing, deny-
as a result of physicians and nurses having ing, or trivializing or distancing themselves
different moral orientations, different deci- from moral problems (Deady & McCarthy, M
sion-making perspectives, and adversarial 2010). In addition, evidence suggests that
physician–nurse relationship (Corley, 1995; prolonged or repeated moral distress leads
Davies et al., 1996; Liaschenko, 1995; Oberle to loss of nurses’ moral integrity (Kelly, 1998;
& Hughes, 2001; Powell, 1998; Sundin-Huard Rushton, 1995; Wilkinson, 1987–1988).
& Fahy, 1999; Wilkinson, 1987–1988). Moral distress sometimes causes cause
Moral distress results in unfavorable unpleasant physical and affective prob-
outcomes for both nurses and patients. It can lems. Physical reactions include weeping
lead to physical and psychological problems, (Anderson, 1990; Fenton, 1988), sweating,
sometimes for many years (Anderson, 1990; palpitations, headaches, diarrhea, and sleep
Davies et al., 1996; Fenton, 1988; Kelly, 1998; disturbances (Anderson, 1990; Nathaniel,
Krishnasamy, 1999; Nathaniel, 2006; Perkin 2006; Wilkinson, 1987–1988). Affective reac-
et al., 1997; Wilkinson, 1987–1988). Among tions include anger, frustration, depression,
participants in one study, every respondent shame, embarrassment, grief, sadness, and a
described some detrimental effect of moral sense of ineffectiveness (Austin et al., 2008).
distress (Elpern, Covert, & Kleinpell, 2005). The early studies of moral distress
Some nurses lose their capacity for caring, focused on nurses, but within the last decade,
avoid patient contact, and fail to give good moral distress has been identified as a prob-
physical care because of moral distress lem for a variety of disciplines around the
(Corley, 1995; Hefferman & Heilig, 1999; globe. Researchers from Canada, Norway,
Kelly, 1998; Millette, 1994; Nathaniel, 2006; Spain, Ireland, Portugal, Sweden, Uganda,
Redman & Fry, 2000; Wilkinson, 1987–1988). Jordan, China, Chile, and Israel have dem-
Individuals may cope with moral distress in onstrated the presence of moral distress
a variety of ways including avoiding patient among physicians, podiatrists, psycholo-
interaction, acting in secret, working fewer gists, psychiatrists, childbirth educators,
hours, leaving the unit in search of better con- nurse anesthetists, respiratory care prac-
ditions, or dropping out of nursing altogether titioners, pharmacists, physical therapists,
(Austin, Kagan, Rankel, & Bergum, 2008; dental hygienists, health systems managers,
Kelly, 1998). Austin, Bergum, and Goldberg and rehabilitation professionals (Eizenberg,
(2003) suggest that some nurses have stopped Desivilya, & Hirschfeld, 2009; Krishnasamy &
listening to the call of their patients, having Plant, 1998; Losa Iglesias, Becerro de Bengoa
chosen to avoid engagement. Vallejo, & Salvadores Fuentes, 2010; Mitton,
The psychosocial consequences of moral Peacock, Storch, Smith, & Cornelissen, 2010;
distress include blaming others, excusing Mrayyan & Hamaideh, 2009; Mukherjee,
their own actions, self-criticism, self-blame Brashler, Savage, & Kirschner, 2009; O’Ryan,
(Kelly, 1998), anger, sarcasm, guilt, remorse 2010; Radzvin, 2008; Schwenzer & Wang,
(Fenton, 1988; Wilkinson, 1987–1988), frustra- 2006; Sporrong, Höglund, & Arnetz, 2006;
tion, sadness, withdrawal, avoidance behav- Sporrong, Höglund, Hansson, Westerholm,
ior, powerlessness, dispiritedness (Austin & Arnetz, 2005).
et al., 2003), burnout (Davies et al., 1996), Moral distress remains a relatively
betrayal of personal values, sense of insecu- immature concept. It has been studied from
rity, self-doubt, unease (Deady & McCarthy, a number of theoretical perspectives and
2010), low self-worth (Krishnasamy, 1999), methods. Because of the nature of moral dis-
and effects on spirituality (Elpern et al., tress, most nurse researchers have chosen to
2005). Nurses may also choose to desensitize use qualitative methods including grounded
themselves by adapting or acquiescing to theory, ethnography, phenomenology, survey