Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants.
Objective:
This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures.
Research Design:
This is a survey of the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts.
Participants and Research Context:
No research participants were part of this analysis.
Ethical Considerations:
This article offers a conceptual analysis and recommendations only.
Findings:
The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress.
Discussion:
Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants.
Conclusion:
This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations.
KesslerIHeronP. NHS modernization and the role of HCAs. Br J Health Assist2010; 4(7): 318–320.
4.
JametonA. Nursing practice: the ethical issues. Englewood Cliffs, NJ: Prentice Hall, 1984, pp. 63–82.
5.
FourieC. Who is experiencing what kind of moral distress? Distinctions for moving from a narrow to a broad definition of moral distress. AMA J Ethics2017; 19(6): 578–584.
MorleyGIvesJBradbury-JonesC, et al.What is ‘moral distress’? A narrative synthesis of the literature. Nurs Ethics. Epub ahead of print 8 October 2017. DOI: 10.1177/0969733017724354.
8.
EpsteinEGHamricAB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics2009; 20(4): 330–342.
9.
AustinCLSaylorRFinleyPJ. Moral distress in physicians and nurses: impact on professional quality of life and turnover. Psychol Trauma2017; 9(4): 399–406.
10.
BurstonASTuckettAG. Moral distress in nursing: contributing factors, outcomes and interventions. Nurs Ethics2012; 20(3): 312–324.
11.
PaulyBMVarcoeCStorchJ. Framing the issues: moral distress in health care. HEC Forum2012; 24(1): 1–11.
Pijl-ZieberEMAwosogaOSpenceleyS, et al.Caring in the wake of the rising tide: moral distress in residential nursing care of people living with dementia. Dementia2018; 17(3): 315–336.
14.
De VeerAJEFranckeALStruijsA, et al.Determinants of moral distress in daily nursing practice: a cross sectional correlational questionnaire survey. Int J Nurs Stud2013; 50(1): 100–108.
15.
SneesbyL. Ethical and moral dilemmas caring for people who are dying: why we need to plan in advance. BMJ Support Palliat Care2011; 1: 108.
16.
FryerSBellamyGMorganT, et al.‘Sometimes I’ve gone home feeling that my voice hasn’t been heard’: a focus group study exploring the views and experiences of health care assistants when caring for dying residents. BMC Palliat Care2016; 15(1): 78.
17.
SpenceleySWitcherCSGHagenB, et al.Sources of moral distress for nursing staff providing care to residents with dementia. Dementia2017; 16(7): 815–834.
18.
YoungAFroggattKBrearleySG. ‘Powerlessness’ or ‘doing the right thing’ – moral distress among nursing home staff caring for residents at the end of life: an interpretive descriptive study. Palliat Med2017; 31(9): 853–860.
19.
MatthewsHWilliamsonI. Caught between compassion and control: exploring the challenges associated with inpatient adolescent mental healthcare in an independent hospital. J Adv Nurs2016; 72(5): 1042–1053.
20.
HamricABBorchersCTEpsteinEG. Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Prim Res2016; 3(2): 1–9.
21.
MorleyG. What is ‘moral distress’ in nursing? How, can and should we respond to it?J Clin Nurs. Epub ahead of print 1 March 2018. DOI: 10.1111/jocn.14332.
22.
SchluterJWinchSHolzhauserK, et al.Nurses’ moral sensitivity and hospital ethical climate: a literature review. Nurs Ethics2008; 15(3): 304–321.
23.
BaykaraZGDemirSGYamanS. The effect of ethics training on students recognizing ethical violations and developing moral sensitivity. Nurs Ethics2015; 22(6): 661–675.
24.
NejadsarvariNAbbasiMBorhaniF, et al.Relationship of moral sensitivity and distress among physicians. Trauma Mon2015; 20: e26075.
25.
ParkMKjervikDCrandellJ, et al.The relationship of ethics education to moral sensitivity and moral reasoning skills of nursing students. Nurs Ethics2012; 19(4): 568–580.
26.
ChoeKParkSYooSY. Effects of constructivist teaching methods on bioethics education for nursing students: a quasi-experimental study. Nurse Educ Today2014; 34(5): 848–853.
27.
SchaeferRVieiraM. Ethical competence as a coping resource for moral distress in nursing. Text Cont Nurs2015; 24(2): 563–573.
28.
GradyCDanisMSoekenKL, et al.Does ethics education influence the moral action of practicing nurses and social workers?Am J Bioeth2008; 8(4): 4–11.
29.
LangK. The professional ills of moral distress and nurse retention: is ethics education an antidote?Am J Bioeth2008; 8(4): 19–21.
30.
CannaertsNGastmansCCasterléBD. Contribution of ethics education to the ethical competence of nursing students: educators’ and students’ perceptions. Nurs Ethics2014; 21(8): 861–878.
31.
WaltonMK. Sources of moral distress. In: UlrichCMGradyC (eds) Moral distress in the health professions. Cham: Springer, 2018, pp. 79–93.
32.
PennyNHEwingTLHamidRC, et al.An investigation of moral distress experienced by occupational therapists. Occup Ther Health Care2014; 28(4): 382–393.
33.
KaranikolaMAlbarranJDrigoE, et al.Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy. J Nurs Manag2013; 22(4): 472–484.
34.
StorchJLKennyN. Shared moral work of nurses and physicians. Nurs Ethics2007; 14(4): 478–491.
35.
GreenBOeppenRSSmithDW, et al.Challenging hierarchy in healthcare teams – ways to flatten gradients to improve teamwork and patient care. Br J Oral Maxillofac Surg2017; 55: 449–453.
36.
BrowningEDCruzJS. Reflective debriefing: a social work intervention addressing moral distress among ICU nurses. J Soc Work End Life Palliat Care2018; 14(1): 44–72.
37.
TraudtTLiaschenkoJPeden-McAlpineC. Moral agency, moral imagination, and moral community: antidotes to moral distress. J Clin Ethics2016; 27(3): 201–213.
JohnsonRBuzziG. Handy guide to the care certificate. Br J Health Assist2016; 10(12): 602–605.
40.
RepenshekM. Moral distress: inability to act or discomfort with moral subjectivity?Nurs Ethics2009; 16(6): 734–742.
41.
BeumerC. Innovative solutions: the effect of a workshop on reducing the experience of moral distress in an intensive care unit setting. Dimens Crit Care Nurs2008; 27(6): 263–267.
42.
MolazemZTavakolNSharifF, et al.Effect of education based on the ‘4A Model’ on the Iranian nurses’ moral distress in CCU wards. J Med Ethics Hist Med2013; 6: 5.
