title: Toward interventions to address moral distress: navigating structure and agency.
abstract: BACKGROUND
  The concept of moral distress has been the subject of nursing research for the past 30 years. Recently, there has been a call to move from developing an understanding of the concept to developing interventions to help ameliorate the experience. At the same time, the use of the term moral distress has been critiqued for a lack of clarity about the concepts that underpin the experience.
  
  
  CONCLUSIONS
  Some researchers suggest that a closer examination of how socio-political structures influence healthcare delivery will move moral distress from being seen as located in the individual to an experience that is also located in broader healthcare structures. Informed by new thinking in relational ethics, we draw on research findings from neuroscience and attachment literature to examine the reciprocal relationship between structures and agents and frame the experience of moral distress.
  
  
  CONCLUSIONS
  We posit moral distress as a form of relational trauma and subsequently point to the need to better understand how nurses as moral agents are influenced by-and influence-the complex socio-political structures they inhabit. In so doing, we identify this reciprocity as a framework for interventions.
authors.affiliation: University of British Columbia, CanadaMonash University, Australia lynnmusto@gmail.com.
authors.forename: Lynn C
authors.initials: LC
authors.lastname: Musto
authors.affiliation: University of British Columbia, Canada.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Rodney
authors.affiliation: Monash University, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Vanderheide
mesh_terms: D003220:Conflict, Psychological; D004993:Ethics, Nursing; D006801:Humans; D009014:Morals; D015404:Nursing Methodology Research / Q000379:methods; D013315:Stress, Psychological / Q000150:complications / Q000209:etiology / Q000523:psychology*
keywords: Interventions; moral distress; moral habitability; relational trauma; structure and agency