title: Nurses' perceptions of and responses to morally distressing situations.
abstract: Research on moral distress has paid limited attention to nurses' responses and actions. In a survey of nurses' perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an "inability to act due to institutional constraints" or a "failure to pursue a right course of action." Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change.
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, BC V6 T 2B5 Canada. colleen.varcoe@nursing.ubc.ca
authors.forename: Colleen
authors.initials: C
authors.lastname: Varcoe
authors.forename: Bernie
authors.initials: B
authors.lastname: Pauly
authors.forename: Jan
authors.initials: J
authors.lastname: Storch
authors.forename: Lorelei
authors.initials: L
authors.lastname: Newton
authors.forename: Kara
authors.initials: K
authors.lastname: Makaroff
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009014:Morals; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000941:ethics / Q000458:organization & administration / Q000523:psychology*; D036301:Qualitative Research; D013315:Stress, Psychological / Q000523:psychology*