Pulling the heartstrings, arguing the case: a narrative response to the issue of moral agency in moral distress

Abstract Andrew Jameton in 1984 coined the concept of moral distress as: “knowing what to do in an ethical situation, but not being allowed to do it” This original description presupposes that the right moral act can be identified and precludes situations of doubt and uncertainty. The 1984 definition emphasizes barriers that make it impossible for someone to do what they ought to do. Whereas Jameton in a revision in 2013 of his original concept emphasized reduction of the psychological dimensions, Peter& Liaschenko stress the element of moral agency. Moral distress then is a threat to the moral integrity of the professional. This requires three-step ananlysis: first, what is the moral question?; two, what are morally adeguate answers to this question?; three, what ethically appropriate actions are under pressure in the given situation? This will be illustrated with examples from the COVID-19 pandemic.

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Conceptualising Work-Related Moral Suffering—Exploring and Refining the Concept of Moral Distress in the Context of Social Work

The British Journal of Social Work ◽

10.1093/bjsw/bcz034 ◽

2019 ◽

Vol 50 (3) ◽

pp. 741-757 ◽

Cited By ~ 2

Author(s):

Maija Mänttäri-van der Kuip

Keyword(s):

Social Work ◽

Moral Agency ◽

Moral Distress ◽

Empirical Literature ◽

Front Line ◽

Complex Dynamic ◽

Work Related ◽

Conceptual Clarity ◽

Valid Instrument ◽

Nursing Literature

Abstract In the nursing literature, work-related suffering due to restricted moral agency is commonly considered under the concept of moral distress. This concept has resonated strongly amongst nursing scholars since the 1980s and has recently gained ground amongst social work scholars as well. However, the research on moral distress suffers from inadequate conceptual clarity; this has led to multiple and disparate ways of empirically studying the phenomenon. This article examines the conceptualisations of moral distress applied in the nursing and social work literature and identifies and discusses the challenges and potential problems related to them. The article sheds light on the complex, dynamic and relative nature of the phenomenon, which has not been sufficiently acknowledged in the existing empirical literature. Despite its complexities and defects, as highlighted in this article, the concept of moral distress can serve as an important tool for understanding and analysing experiences of moral suffering in front line social work. However, defining this experience in all its complexity and devising a valid instrument to measure it remain a major challenge.

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Moral distress in The Last of us: Moral agency, character realism, and navigating fixed gaming narratives

Computers in Human Behavior Reports ◽

10.1016/j.chbr.2021.100163 ◽

2021 ◽

pp. 100163

Author(s):

Karoline A. Anderson

Keyword(s):

Moral Agency ◽

Moral Distress

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Enhancing Nurse Moral Agency: The Leadership Promise of Doctor of Nursing Practice Preparation

OJIN: The Online Journal of Issues in Nursing ◽

10.3912/ojin.vol23no01man04 ◽

2018 ◽

Vol 23 (1) ◽

Author(s):

Pamela Grace

Keyword(s):

Transformational Learning ◽

Moral Agency ◽

Ethics Education ◽

Nursing Practice ◽

Moral Distress ◽

Good Practice ◽

Nurse Leaders ◽

Best Interests ◽

Doctor Of Nursing Practice ◽

Ethical Content

An expansive and growing body of literature documents the problem of nurses’ moral distress when they are unable to carry out actions that they perceive to be in the best interests of patients. Further, nurse leaders and educators are not always well prepared to help nurses to develop moral agency. Moral agency is the ability to provide good care and overcome obstacles to good practice. One reason for the lack of preparation is that ethics education in academia, and in ongoing nurse education, has been inconsistent or has focused more on dilemmas than the ubiquitous everyday practice issues. The purpose of this article is to discuss goals of the nursing profession, contemporary challenges to good nursing practice, and leadership from those educated as Doctors of Nursing Practice (DNP). The author argues that the proliferation of (DNP) programs, focused as they are on leadership in practice settings, presents a unique opportunity to prepare nurse leaders who are, first and foremost, skilled and knowledgeable about the ethical content of everyday nursing practice. An ‘ethics matrix’ is described and proposed as an essential base for DNP education upon which all other knowledge is built, with specific discussion of types of leadership and the relationship of transformational learning to transformational leadership.

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Confronting moral distress in Nursing: recognizing nurses as moral agents

Revista Brasileira de Enfermagem ◽

10.1590/s0034-71672013000700004 ◽

2013 ◽

Vol 66 (spe) ◽

pp. 33-38 ◽

Cited By ~ 17

Author(s):

Franco A. Carnevale

Keyword(s):

Professional Practice ◽

Moral Agency ◽

Nursing Practice ◽

Moral Distress ◽

Ethical Standards ◽

Moral Agents ◽

Moral Engagement

The concept of moral distress has brought forth a substantively different way of understanding some of the difficulties confronted by nurses in their practice. This concept highlights that nurses' distress can be an indication of nurses' conscientious moral engagement with their professional practice that has confronted practices or an environment that impedes them from acting according to their own ethical standards. Moral distress can be an indicator of problems in nurses' practice environments. This concept is described and related to moral agency in nursing practice. Selected research on moral distress is reviewed, followed by a discussion of recommendations for addressing this problem.

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Moral distress

Nursing Ethics ◽

10.1177/0969733014557139 ◽

2014 ◽

Vol 22 (1) ◽

pp. 131-152 ◽

Cited By ~ 96

Author(s):

Joan McCarthy ◽

Chris Gastmans

Keyword(s):

Moral Agency ◽

Quantitative Research ◽

Moral Distress ◽

Empirical Literature ◽

Professional Lives ◽

Healthcare Provision ◽

Original Definition ◽

Structural Inequities ◽

Academic Search ◽

Different Sources

Aim: The aim of this review is to examine the ways in which the concept of moral distress has been delineated and deployed in the argument-based nursing ethics literature. It adds to what we already know about moral distress from reviews of the qualitative and quantitative research. Data sources: CINAHL, PubMed, Web of Knowledge, EMBASE, Academic Search Complete, PsycInfo, Philosophers’ Index and Socindex. Review methods: A total of 20 argument-based articles published between January 1984 and December 2013 were analysed. Results: We found that like the empirical literature, most authors in this review draw on Jameton’s original definition and describe moral distress in psychological–emotional–physiological terms. They also agree that moral distress is linked to the presence of some kind of constraint on nurses’ moral agency, and that it is best understood as a two-staged process that can intensify over time. There is also consensus that moral distress has an important normative meaning, although different views concerning the normative meaning of moral distress are expressed. Finally, the authors generally agree that moral distress arises from a number of different sources and that it (mostly) affects negatively on nurses’ personal and professional lives and, ultimately, harms patients. However, despite this consensus, many authors take issue with the way in which moral distress is conceptualized and operationalized. Moreover, while some worry that identifying nurses as a group of health professionals whose voices are ignored or marginalized might disempower nurses and encourage them to avoid their moral responsibilities, others take situations involving moral distress as indicative of more fundamental, structural inequities at the heart of contemporary healthcare provision. Conclusion: We conclude that research on moral distress in nursing is timely and important because it highlights the specifically moral labour of nurses. However, we suggest that significant concerns about the conceptual fuzziness and operationalization of moral distress also flag the need to proceed with caution.

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Moral Agency in the Context of Global Volunteering

Creative Nursing ◽

10.1891/1946-6560.24.3.158 ◽

2018 ◽

Vol 24 (3) ◽

pp. 158-162

Author(s):

Michele Upvall ◽

Marcia Sue DeWolf Bosek ◽

Martha Turner

Keyword(s):

Moral Agency ◽

Moral Distress ◽

Code Of Ethics ◽

Student Nurses ◽

Ethical Code ◽

Case Study Approach ◽

Study Approach ◽

American Nurses Association

Today there are many global volunteer opportunities for nurses and student nurses. While the intentions of volunteers may be good, the result may be harmful to the volunteer and/or the host, creating a situation of moral distress. An ethical code provides guidance and promotes moral agency. We discuss elements of the American Nurses AssociationCode of Ethics with Interpretive Statementsand apply them to the experience of global volunteering through a case study approach.

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