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The concept of moral distress is not new to nursing. As early as 1984 Jameton described moral distress as occurring when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Nurses may experience moral distress when confronted with chosen treatment options that they believe are not be in the best interest of the patient, and/or do not mesh with their sense of right and wrong. Although the nursing literature documents moral distress in the clinical area, it does not address moral distress in academia. Yet anecdotal evidence indicates that moral distress also occurs in academic institutions. The author begins this article by describing the experience of moral distress and suggesting that moral distress occurs not only in the clinical setting, but also in the academic setting. This is followed by a review of the literature related to moral distress in nursing education and a discussion of the seeds of moral distress in nursing education, such as dishonesty, including cheating and plagiarism; grade inflation; and incivility. The author concludes by identifying the professional implications of moral distress in nursing education.

Moral distress occurs when one knows the ethically correct action to take but feels powerless to take that action. Research on moral distress among nurses has identified that the sources of moral distress are many and varied and that the experience of moral distress leads some nurses to leave their jobs, or the profession altogether. This article considers both moral distress and moral residue, a consequence of unresolved moral distress. First, we will explain the phenomenon of moral distress by providing an historical overview, identifying common sources, and describing strategies for recognizing moral distress. Next we will address moral residue and the crescendo effect associated with moral residue. We will conclude by considering ways to address moral distress and the benefits of a moral distress consult service.

Intro -- Acknowledgments -- Contents -- Contributors -- 1: Introduction -- 1.1 The Organization of the Book -- References -- 2: What We Know About Moral Distress -- 2.1 Moral Distress: Evolution of the Concept -- 2.2 Conceptual Origin and Evolution of the Definition -- 2.3 Challenges and Critiques of the Definition -- 2.4 Appreciating the Reciprocity of Structure and Agency -- References -- 3: Healthcare Professional Narratives on Moral Distress: Disciplinary Perspectives -- 3.1 Reviews of Moral Distress in Nursing and in Social Work -- 3.1.1 Moral Distress in Nursing: Looking Back to Move Forward -- 3.1.1.1 Introduction -- 3.1.1.2 The Moral Milieu of an Institution: Predecessor Literature -- 3.1.1.3 Shaping and Re-Shaping the Moral Milieu -- 3.1.1.4 Ethics Education and Enduring Issues in Nursing -- 3.1.1.5 Various Critiques of Moral Distress -- 3.1.1.6 Conclusion -- 3.1.2 Social Work Perspective: Moral Distress -- 3.1.2.1 Introduction -- 3.1.2.2 Limitations in Empirical Scholarly Work -- 3.1.2.3 Moral Distress in Social Work -- 3.1.2.4 Root Causes of Moral Distress in Social Work -- 3.1.2.5 Implications for Social Work Education and Practice -- 3.2 Part 2: Healthcare Professional Perspectives -- 3.2.1 A Source of Moral Distress: The Corporatization of Medicine -- 3.2.2 Moral Distress: A Psychiatrist Perspective -- 3.2.3 Physicians' Experiences of Moral Distress and Burnout -- 3.2.3.1 Physician Narratives -- Legal Rights in Organ Donation: Directed Donation -- Right to Information: International Medical Care -- Patient-Physician Communication: Gestational Carrier -- 3.2.4 A Chaplain's Perspective on Moral Distress -- 3.2.5 Moral Distress in Pediatric Nursing and Research -- 3.2.6 Pharmacist's Perspective on Moral Distress in Palliative Care: A Narrative -- References -- 4: A Broader Understanding of Moral Distress

In this article the author examines the concepts of moral distress and moral courage within the context of nursing practice. Examples of challenging healthcare situations from the United Kingdom and Ireland are discussed in the light of the examination of these two concepts. The examples illuminate features of healthcare situations that need to be considered in relation to different organisational and cultural contexts. This requires an understanding of the complexity of clinical contexts and an appreciation of the fallibility and vulnerability of nurses and other practitioners. The goal of this article is to encourage healthcare organisations to create supportive structures and sensitive leadership that will enhance moral courage in the work setting.

Concentrates on the element of moral distress--the fact that someone is distressed on account of what he takes to be the immorality or the depravity of another's behaviour. Considers the place of this sort of distress, this element of disturbance, in what is perhaps the most influential of the modern liberal arguments for toleration--the argument in John Stuart Mill's essay, On Liberty. (DCL)

People are sometimes distressed by the bare knowledge that lifestyles are being practised or opinions held which they take to be immoral. Is this distress to be regarded as harm for the purposes of Mill's Harm Principle? I argue, first, that this is an issue that is to be resolved not by analysis of the concept of harm but by reference to the arguments in On Liberty with which the Harm Principle is supported. Secondly, I argue that reference to those arguments makes it clear beyond doubt that, since Mill valued moral confrontation and the shattering of moral complacency as means to social progress, he must have regarded moral distress as a positive good rather than as a harm that society ought to intervene to prevent. Thirdly, I relate this interpretation to Mill's points about temperance, decency and good manners. I argue, finally, that my interpretation is inconsistent with Mill's underlying utilitarianism only if the latter is understood in a crudely hedonistic way.

Intro -- Vorwort -- Inhaltsverzeichnis -- Abkürzungsverzeichnis -- Tabellenverzeichnis -- Abbildungsverzeichnis -- 1. Erleben von ethisch-moralischen Konflikten als Ausdruck ethischer Sensibilität? -- 1.1 Bedeutsamkeit ethischer Sensibilität im professionellen Pflegehandeln -- 1.2 Erleben von ethisch-moralischen Konflikten und die Besonderheit des Intensivmedizinischen Bereichs -- 1.3 Ziel der Forschungsarbeit und Fragestellung -- 1.4 Allgemeines Vorgehen und Aufbau der Arbeit -- 2. Ethische Konflikte und Moral Distress -- 2.1 Ethisch-moralische Konflikte: Ätiologie und Bedeutung -- 2.2 Moral Distress -- 2.2.1 Intrinsische Faktoren -- 2.2.2 Extrinsische Faktoren -- 2.2.3 Auslösende Klinische Situationen -- 2.2.4 Folgen von Moral Distress -- 2.2.5 Prävention von Moral Distress -- 2.3 Fazit -- 3. Das Setting Intensivstation -- 3.1 Die Intensivmedizin im Spannungsfeld der Interessen -- 3.2 Die Rolle der Pflegenden im intensivmedizinischen Bereich -- 3.3 Zentrale ethisch-moralische Konfliktbereiche im intensivmedizinischen Bereich -- 3.4 Fazit -- 4. Hypothesen und Forschungsdesign -- 4.1 Hypothesenentwicklung -- 4.2 Fragebogenentwicklung -- 4.2.1 Fragen zum Arbeitsalltag -- 4.2.2 Fragen zur Wahrnehmung ethischer Konflikte im Klinikalltag -- 4.2.3 Fragen zur Person -- 4.2.4 Pretest des Fragebogens -- 4.3 Rekrutierung der Befragten und Erhebung der Daten -- 5. Ergebnisse -- 5.1 Deskriptive Darstellung der Ergebnisse -- 5.1.1 Demografische Daten -- 5.1.2 Arbeitsbedingungen, -belastungen und -zufriedenheit -- 5.1.3 Ethische Konflikte und daraus resultierende Belastungen -- 5.1.4 Bildung von Scores -- 5.2 Darstellung von Zusammenhängen und Hypothesentestung -- 5.2.1 Hypothese 1 -- 5.2.2 Hypothese 2 -- 5.2.3 Hypothese 3 -- 5.2.4 Hypothese 4 -- 5.2.5 Hypothese 5 -- 5.2.6 Hypothese 6 -- 5.2.7 Hypothese 7 -- 5.2.8 Hypothese 8.

BACKGROUND: As 'disease detectives' and directors of public health programs, field epidemiologists play essential roles in protecting public health. Although ethical issues receive considerable attention in medical and research settings, less is known about ethical challenges faced by field epidemiologists in public health programs. Similarly, little is known about moral distress among field epidemiologists, i.e., situations in which they are constrained from acting on what they know to be morally right. Moral distress is strongly associated with empathy fatigue, burnout, reduced job retention, and disengagement. To better understand ethics training needs for field epidemiologists, in February 2019, members of TEPHIConnect, an online and mobile networking platform for Field Epidemiology Training Program (FETP) alumni, were invited to participate in an anonymous survey about ethical challenges and moral distress. RESULTS: Among 126 respondents from 54 countries, leading causes of ethical dilemmas included inadequate informed consent (61%), inequitable allocation of resources (49%), and conflicts of interest (43%). These occur primarily in settings of disease outbreaks (60%); research (55%); and public health programs at the state, province, or national level (45%) or community level (43%). Work-related moral distress was reported by 91% of respondents, including 26% who experience it "frequently" or "almost always." Field epidemiologists working in low- and low-middle income countries were more likely to report moral distress "frequently" or "almost always" than those in higher-income countries (33.0% vs 9.1%, P = 0.006). The most common perceived contributors to moral distress included excessive stress and work demands (30%) and inadequate support from leaders (25%). CONCLUSIONS: Field epidemiologists face significant work-related ethical challenges, which are endemic to public health and political systems. A substantial proportion of field epidemiologists also experience some degree of moral distress, often in ...