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A Recommendation for Expanding the Definition of Moral Distress Experienced in the Workplace

Published online by Cambridge University Press:  29 October 2013

Monique Frances Crane*
Affiliation:
Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
Piers Bayl-Smith
Affiliation:
Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
John Cartmill
Affiliation:
Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
*
address for correspondence: Monique Crane, Building C3A Department of Psychology, Macquarie University, Sydney NSW 2109, Australia. Email: Monique.crane@mq.edu.au
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Abstract

Despite the importance of moral distress in the nursing scholarship, little attention is paid to the phenomena in the psychological literature as an important occupational stressor. A factor limiting the application of moral distress to other occupational settings is its definitional features. First, a necessary condition of moral distress is the acknowledgment prior to behaviour initiation that behaviour will contravene personal moral ideals. Second, the definition of moral distress specifies that the inability to act in accordance with one's moral framework is driven by institutional constraints (non-autonomous behaviour). This article proposes that moral distress not be limited in these ways, and makes two central contributions to resolve this core problem. We offer a critique and extension of the conceptual definition of moral distress. Fourteen Australian medical doctors participated in a semi-structured interview regarding occupational morally distressing events. Medical doctors were chosen for our interviews because they are an occupational population with considerable decision-making autonomy. Based on the findings, two recommendations are made: (1) that the definition of moral distress is not limited to events where decision-making and behaviour is non-autonomous, and (2) moral distress should not be limited to occasions where the moral conflict is identified prior to decision-making or behaviour. An alternative definition of moral distress is proposed. We conclude that while organisational limitations are an important precipitate of moral distress, they are not a necessary condition for its emergence.

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Articles
Copyright
Copyright © The Authors 2013 

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References

Baldwin, P.J., Dodd, M., & Wrate, R. W. (1997). Young doctors’ health — I. How do working conditions affect attitudes, health and performance? Social Science & Medicine, 45, 3540.Google Scholar
Brehm, J.W., & Cohen, A.R. (1962). Explorations in cognitive dissonance. New York: Wiley.CrossRefGoogle Scholar
Brooks, P.M., Lapsley, H.M., & Butt, D.B. (2003). Medical workforce issues in Australia: ‘Tomorrow's doctors – too few, too far’. Medical Journal of Australia, 179, 206208.Google Scholar
Corley, M.C., Elswick, R.K., Gorman, M., & Clor, T. (2001). Development and evaluation of a moral distress scale. Journal of Advanced Nursing, 33, 250256.CrossRefGoogle ScholarPubMed
Corley, M.C., Minick, P., Elswick, R. K., & Jacobs, M. (2005). Nurse moral distress and ethical work environment. Nursing Ethics, 12, 382390.Google Scholar
Elpern, E.H., Covert, B., & Kleinpell, R. (2005). Moral distress of staff nurses in a medical intensive care unit. American Journal of Critical Care, (6), 523530.Google Scholar
Else-Quest, N.M., Higgins, A., Allison, C., & Morton, L.C. (2012). Gender differences in self-conscious emotional experience: A meta-analysis. Psychological Bulletin, 138, 947981.Google Scholar
Fahrenkopf, A.M., Sectish, T.C., Barger, L.K., Sharek, P.J., Lewin, D., Chiang, V.W., . . . Wiederman, B.L. (2008). Rates of medication errors among depressed and burnt out residents: Prospective cohort study. BMJ: Clinical Research Edition, 336, 488491.Google Scholar
Feskanick, J., Hastrup, J.L., Marshall, J.R., Colditz, G.A., Stampfer, M.J., Willett, W.C., & Kawachi, I. (2002). Stress and suicide in the nurses’ health Study. Journal of Epidemiology and Community Health, 56, 9598.Google Scholar
Festinger, L. (1957). A theory of cognitive dissonance. Stanford, CA: Stanford University Press.Google Scholar
Festinger, L., & Carlsmith, J.M. (1959). Cognitive consequences of forced compliance. Journal of Abnormal Psychology, 58, 203210.Google Scholar
Gallery, M.E., Whitley, T.W., Klonis, L.K., Anzinger, R.K., & Revicki, D.A. (1992). A study of occupational stress and depression among emergency physicians. Annuals of Emergency Medicine, 21, 5864.Google Scholar
Gray-Toft, P., & Anderson, J.G. (1981). Stress among hospital nursing staff: Its causes and effects. Social Science and Medicine-Part A Medical Sociology, 15, 639647.Google Scholar
Gutierrez, K.M. (2005). Critical care nurses’ perceptions of and responses to moral distress. Dimensions of Critical Care Nursing, 24, 229241.CrossRefGoogle ScholarPubMed
Hamric, A.B. (2012). Empirical research on moral distress: Issues, challenges, and opportunities. HEC Forum: An Interdisciplinary Journal on Hospitals’ Ethical and Legal Issues, 24, 3949.CrossRefGoogle ScholarPubMed
Hanna, D. (2004) Moral distress: The state of the science. Research and Theory in Nursing Practice, 18, 7393.Google Scholar
Healy, C.M., & McKay, M.F. (2000). Nursing stress: The effects of coping strategies and job satisfaction in a sample of Australian nurses. Journal of Advanced Nursing, 31, 681688.Google Scholar
Higgins, E.T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94, 319–40.Google Scholar
Higgins, E.T., & Bargh, J.A. (1987). Social cognition and social perception. Annual Review of Psychology, 38, 369425.Google Scholar
Higgins, E.T., Bond, R.N., Klein, R., & Strauman, T. (1986). Self-discrepancies and emotional vulnerability: how magnitude, accessibility, and type of discrepancy influence affect. Journal of Personality and Social Psychology, 51, 515.CrossRefGoogle ScholarPubMed
Higgins, E.T., Klein, R., & Strauman, T. (1985). Self-concept discrepancy theory: A psychological model for distinguishing among different aspects of depression and anxiety. Social Cognition, 3, 5176.CrossRefGoogle Scholar
Hsu, K., & Marshall, V. (1987). Prevalence of depression and distress in a large sample of Canadian residents, interns, and fellows. American Journal of Psychiatry, 144, 15611566.Google Scholar
Jackall, R. (1988). Moral mazes: The world of corporate managers. New York: Oxford University Press.Google Scholar
Jameton, A. (1984). Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Jex, S.M., Hughes, P., Storr, C., Baldwin, D.C., Conard, S., & Sheehan, D.V. (1991). Behavioral consequences of job related stress among resident physicians: The mediating role of psychological strain. Psychological Reports, 69, 339349.Google Scholar
Kälvemark, S., Höglund, A.T., Hansson, M.G., Westerholm, P., & Arnetz, B. (2004). Living with conflicts-ethical dilemmas and moral distress in the health care system. Social Science & Medicine, 58 (6), 10751084.Google Scholar
Kleppa, E., Sanne, B., & Tell, G.S. (2008). Working overtime is associated with anxiety and depression: The Hordaland Health Study. Journal of Occupational and Environmental Medicine, 50, 658666.Google Scholar
Lglesias, E., Vallejo, R.B.B., & Fuentes, P.S. (2010). Moral distress related to ethical dilemmas among Spanish podiatrists. Journal of Medical Ethics, 36, 310314.CrossRefGoogle Scholar
Lindeman, S., Laara, E., Hakko, H., & Lonnqvist, J. (1996). A systematic review on gender-specific suicide mortality in medical doctors. The British Journal of Psychiatry, 168 (3), 274279.Google Scholar
Litz, B.T., Stein, N., Delaney, E., Lebowitz, L., Nash, W.P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 695706.Google Scholar
Lützén, K., Cronqvist, A., Magnusson, A., & Andersson, L. (2003). Moral stress: Synthesis of a concept. Nursing Ethics, 10, 312322.Google Scholar
Lützén, K., & Kvist, B.E. (2012). Moral distress: A comparative analysis of theoretical understandings and inter-related concepts. HEC Forum: An Interdisciplinary Journal on Hospitals’ Ethical and Legal Issues, 24, 1325.Google Scholar
Ohnishi, K., Ohgushi, Y., Nakano, M., Fujii, H., Tanaka, H., Kitaoka, K., . . . Narita, Y. (2010). Moral distress experienced by psychiatric nurses in Japan. Nursing Ethics, 17, 726740.Google Scholar
Opie, T., Dollard, M., Lenthall, S., Wakerman, J., Dunn, S., Knight, S., & MacLeod, M. (2010). Levels of occupational stress in the remote area nursing workforce. Australian Journal of Rural Health, 18, 235241.CrossRefGoogle ScholarPubMed
Price, J., Tangney, J.P., Stuewig, J., & Mashek, D.J. (2007). Moral emotions and moral behavior. Annual Review of Psychology, 58, 345372.Google Scholar
Pitt, E., Rosenthal, M., Gay, T.L., & Lewton, E. (2004). Mental health services for residents: More important than ever. Academic Medicine, 79, 840844.Google Scholar
Rice, E.M., Rady, M.Y., Hamrick, A., Verheijde, J.L., & Pendergast, D.K. (2008). Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital. Journal of Nursing Management, 16, 360373.Google Scholar
Severinsson, E. (2003). Moral stress and burnout: Qualitative content analysis. Nursing and Health Sciences, 5, 5966.Google Scholar
Shanafelt, T.D., Bradley, K.A., Wipf, J.E., & Back, A.L. (2002). Burnout and self-reported patient care in an internal medicine residency program. Annuals of Internal Medicine, 136, 358367.Google Scholar
Simon, H.A. (1996). Models of my life. Cambridge, MA: MIT PressGoogle Scholar
Simon, H.A. (1999). The potlatch between political science and economics. In Alt, J.E., Levi, M., & Ostrom, E. (Eds.), Competition and cooperation: Conversations with Nobelists about economics and political science (pp. 112119). Cambridge, UK: Cambridge University Press.Google Scholar
Sporrong, S.K., Hoglund, A.T., & Arnetz, B. (2006). Measuring moral distress in pharmacy and clinical practice. Nursing Ethics, 13, 416427.Google Scholar
Sundin-Huard, D., & Fahy, K. (1999). Moral distress, advocacy and burnout: Theorising the relationships. International Journal of Nursing Practice, 5, 813.Google Scholar
Tomioka, K., Morita, N., Saeki, K., Okamoto, N., & Kurumatani, N. (2011). Working hours, occupational stress and depression among physicians. Occupational Medicine, 61,163170.CrossRefGoogle ScholarPubMed
Tyler, P., & Cushway, D. (1998). Stress and well-being in health-care staff: The role of negative affectivity, and perceptions of job demand and discretion. Stress Medicine, 14, 99107.Google Scholar
Weinstein, N.D. (1989) Optimistic biases about personal risks. Science, 246, 12321233.Google Scholar
Wicklund, R.A., & Brehm, J.W. (1976). Perspectives on cognitive dissonance. Oxford, UK: Lawrence Erlbaum.Google Scholar
Wilkinson, J.M. (1987/1988) Moral distress in nursing practice: Experience and effect. Nursing Forum, 23, 1629.Google Scholar
Zuzelo, P.R. (2007). Exploring moral distress in registered nurses. Nursing Ethics, 14, 344359.Google Scholar