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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*
Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
Piers Bayl-Smith
Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
John Cartmill
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:
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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.

Copyright © The Authors 2013 

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