Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions. This review describes the publication trend on moral distress and explores its relationships with other constructs. A bibliometric analysis revealed that since 1984, 239 articles were published, with an increase after 2011. Most of them (71%) focused on nursing. Of the 239 articles, 17 empirical studies were systematically analyzed. Moral distress correlated with organizational environment (poor ethical climate and collaboration), professional attitudes (low work satisfaction and engagement), and psychological characteristics (low psychological empowerment and autonomy). Findings revealed that moral distress negatively affects clinicians’ wellbeing and job retention. Further studies should investigate protective psychological factors to develop preventive interventions.
American Board of Internal Medicine (ABIM) Foundation (2002) Medical professionalism in the new millennium: A physician charter. Annals of Internal Medicine136(3): 243.
2.
AustinWRankelMKaganL. (2005) To stay or to go, to speak or stay silent, to act or not to act: Moral distress as experienced by psychologists. Ethics & Behavior15(3): 197–212.
3.
BaggsJGRyanSAPhelpsCE. (1992) The association between interdisciplinary collaboration and patient outcomes in medical intensive care. Heart & Lung21(1): 18–24.
4.
BeumerCM (2008) Innovative solutions: The effect of a workshop on reducing the experience of moral distress in an intensive care unit setting. Dimensions of Critical Care Nursing27(6): 263–267.
5.
BrowningAM (2013) Moral distress and psychological empowerment in critical care nurses caring for adults at end of life. American Journal of Critical Care22(2): 143–151.
6.
BurgessLIrvineFWallymahmedA (2010) Personality, stress and coping in intensive care nurses: A descriptive exploratory study. Nursing in Critical Care15(3): 129–140.
7.
BurstonASTuckettAG (2012) Moral distress in nursing: Contributing factors, outcomes and interventions. Nursing Ethics20(3): 312–324.
CohenJSEricksonJM (2006) Ethical dilemmas and moral distress in oncology nursing practice. Clinical Journal of Oncology Nursing10(6): 775–780.
10.
CorleyMC (2002) Nurse moral distress: A proposed theory and research agenda. Nursing Ethics9(6): 636–650.
11.
CorleyMCElswickRKGormanM. (2001) Development and evaluation of a moral distress scale. Journal of Advanced Nursing33(2): 250–256.
12.
CorleyMCMinickPElswickRK. (2005) Nurse moral distress and ethical work environment. Nursing Ethics12(4): 381–390.
13.
DalmolinGDLLunardiVLLunardiGL. (2014) Moral distress and Burnout syndrome: Are there relationships between these phenomena in nursing workers?Revista latino-americana de enfermagem22(1): 35–42.
14.
De VeerAJFranckeALStruijsA. (2013) Determinants of moral distress in daily nursing practice: A cross sectional correlational questionnaire survey. International Journal of Nursing Studies50(1): 100–108.
15.
ElpernEHCovertBKleinpellR (2005) Moral distress of staff nurses in a medical intensive care unit. American Journal of Critical Care14(6): 523–530.
16.
EpsteinEGHamricAB (2009) Moral distress, moral residue, and the crescendo effect. The Journal of Clinical Ethics20(4): 330–342.
17.
EpsteinRMHundertEM (2002) Defining and assessing professional competence. JAMA: Journal of the American Medical Association287(2): 226–235.
18.
FørdeRAaslandOG (2008) Moral distress among Norwegian doctors. Journal of Medical Ethics34(7): 521–525.
19.
GanzFDRaananOKhalailaR. (2013) Moral distress and structural empowerment among a national sample of Israeli intensive care nurses. Journal of Advanced Nursing69(2): 415–424.
20.
GutierrezKM (2005) Critical care nurses’ perceptions of and responses to moral distress. Dimensions of Critical Care Nursing24(5): 229–241.
21.
HamaidehSH (2014) Moral distress and its correlates among mental health nurses in Jordan. International Journal of Mental Health Nursing23(1): 33–41.
22.
HamricAB (2012) Empirical research on moral distress: Issues, challenges, and opportunities. HEC Forum24(1): 39–49.
23.
HamricABBlackhallLJ (2007) Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate. Critical Care Medicine35(2): 422–429.
24.
HamricABBorchersCTEpsteinEG (2012) Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research3(2): 1–9.
25.
HannaDR (2004) Moral distress: The state of the science. Research and Theory for Nursing Practice18(1): 73–93.
26.
HigginsJPGreenS (2011) Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at: www.cochrane-handbook.org (accessed 3 November 2014).
27.
HojatMFieldsSKVeloskiJJ. (1999) Psychometric properties of an attitude scale measuring physician-nurse collaboration. Evaluation and the Health Profession22(2): 208–220
28.
HuffmanDMRittenmeyerL (2012) How professional nurses working in hospital environments experience moral distress: A systematic review. Critical Care Nursing Clinics of North America24(1): 91–100.
JimenezCNavia-OsorioPMDiazCV (2010) Stress and health in novice and experienced nursing students. Journal of Advanced Nursing66(2): 442–455.
31.
KaranikolaMNAlbarranJWDrigoE. (2014) Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy. Journal of Nursing Management22(4): 472–484.
32.
KirchlerEHölzlE (2006) Twenty-five years of the Journal of Economic Psychology (1981–2005): A report on the development of an interdisciplinary field of research. Journal of Economic Psychology27(6): 793–804.
33.
LakeET (2002) Development of the practice environment scale of the Nursing Work Index. Research in Nursing and Health25(3):176–188.
34.
LaschingerHKSFineganJShamianJ. (2001) Impact of structural and psychological empowerment on job strain in nursing work settings. Journal of Nursing Administration31(5): 260–272.
35.
LawrenceLA (2011) Work engagement, moral distress, education level, and critical reflective practice in intensive care nurses. Nursing Forum46(4): 256–268.
36.
LazzarinMBiondiADi MauroS (2012) Moral distress in nurses in oncology and haematology units. Nursing Ethics19(2): 183–195.
37.
LeggettJMWassonKSinacoreJM. (2013) A pilot study examining moral distress in nurses working in one United States burn center. Journal of Burn Care & Research34(5): 521–528.
McAndrewNSLeskeJSGarciaA (2011) Influence of moral distress on the professional practice environment during prognostic conflict in critical care. Journal of Trauma Nursing18(4): 221–230.
40.
McCarthyJDeadyR (2008) Moral distress reconsidered. Nursing Ethics15(2): 254–262.
41.
McCarthyJGastmansC (2015) Moral distress: A review of the argument-based nursing ethics literature. Nursing Ethics22(1): 131–152.
42.
McDanielC (1997) Development and psychometric properties of the ethics environment questionnaire. Medical Care35(9): 901–914.
43.
MasonVMLeslieGClarkK. (2014) Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: A pilot study. Dimensions of Critical Care Nursing33(4): 215–225.
44.
MittonCPeacockSStorchJ. (2010) Moral distress among healthcare managers: Conditions, consequences and potential responses. Healthcare Policy6(2): 99.
45.
MolazemZTavakolNSharifF. (2013) Effect of education based on the “4A Model” on the Iranian nurses’ moral distress in CCU wards. Journal of Medical Ethics and History of Medicine6: 5.
NuttgensSChangJ (2013) Moral distress within the supervisory relationship: Implications for practice and research. Counselor Education and Supervision52(4): 284–296.
48.
OhnishiKOhgushiYNakanoM. (2010) Moral distress experienced by psychiatric nurses in Japan. Nursing Ethics17(6): 726–740.
49.
OlsonL (1998) Hospital nurses’ perceptions of the ethical climate of their work. Image: Journal of Nursing Scholarship30(4): 345–349.
50.
PapathanassoglouEDKaranikolaMNKalafatiM. (2012) Professional autonomy, collaboration with physicians, and moral distress among European intensive care nurses. American Journal of Critical Care21(2): e41–e52.
51.
PaulyBVarcoeCStorchJ. (2009) Registered nurses’ perceptions of moral distress and ethical climate. Nursing Ethics16(5): 561–573.
52.
PeterELiaschenkoJ (2004) Perils of proximity: A spatiotemporal analysis of moral distress and moral ambiguity. Nursing Inquiry11(4): 218–225.
53.
PetticrewMRobertsH (2006) Systematic Reviews in the Social Sciences: A Practical Guide. Malden, MA: Blackwell Publishing.
54.
PiersRDVan Den EyndeMSteemanE. (2012) End-of-life care of the geriatric patient and nurses’ moral distress. Journal of the American Medical Directors Association13(1): 80.e7–80.e13.
55.
ProttasDJ (2013) Relationships among employee perception of their manager’s behavioral integrity, moral distress, and employee attitudes and well-being. Journal of Business Ethics113(1): 51–60.
56.
QuinnRShepardL (1974) The 1972–73 Quality of Employment Survey. Ann Harbor, MI: Univeristy of Michigan, Survey Reasearch Center.
57.
Quiñones-VidalELoźpez-GarcíaJJPeñaranda-OrtegaM. (2004) The nature of social and personality psychology as reflected in JPSP, 1965–2000. Journal of Personality and Social Psychology86(3): 435–452.
58.
RushtonCH (2006) Defining and addressing moral distress: Tools for critical care nursing leaders. AACN Advanced Critical Care17(2): 161–168.
59.
RushtonCHKaszniakAWHalifaxJS (2013) Addressing moral distress: Application of a framework to palliative care practice. Journal of Palliative Medicine16(9): 1080–1088.
60.
SassoLBagnascoABianchiM. (2016) Moral distress in undergraduate nursing students: A systematic review. Nursing Ethics. 23(5): 523–534.
61.
SauerlandJMarottaKPeinemannMA. (2014) Assessing and addressing moral distress and ethical climate, Part 1. Dimensions of Critical Care Nursing33(4): 234–245.
62.
SchluterJWinchSHolzhauserK. (2008) Nurses’ moral sensitivity and hospital ethical climate: A literature review. Nursing Ethics15(3): 304–321.
63.
ShepardA (2010) Moral distress: A consequence of caring. Clinical Journal of Oncology Nursing14(1): 25–27.
64.
SilénMSvantessonMKjellströmS. (2011) Moral distress and ethical climate in a Swedish nursing context: Perceptions and instrument usability. Journal of Clinical Nursing20(23–24): 3483–3493.
65.
SporrongSKHöglundATArnetzB (2006) Measuring moral distress in pharmacy and clinical practice. Nursing Ethics13(4): 416–427.
66.
SpreitzerGM (1995) Psychological empowerment in the work-place: Dimensions, measurement, and validation. The Academy of Management Journal38(5): 1442–1465.
67.
StammHB (2009) Professional Quality of Life: Compassion Satisfaction and Fatigue (ProQOL) (Version 5). Available at: http://www.proqol.org
68.
TullyA (2004) Stress, sources of stress and ways of coping among psychiatric nursing students. Journal of Psychiatric and Mental Health Nursing11(1): 43–47.
69.
VarjusSLSuominenTLeino-KilpiH (2003) Autonomy among intensive care nurses in Finland. Intensive and Critical Care Nursing19(1): 31–40.
70.
WiggletonCPetrusaELoomisK. (2010) Medical students’ experiences of moral distress: Development of a web-based survey. Academic Medicine85(1): 111–117.
71.
WilkinsonJM (1988) Moral distress in nursing practice: Experience and effect. Nursing Forum23(1): 16–29.
72.
WocialLDWeaverMT (2013) Development and psychometric testing of a new tool for detecting moral distress: The Moral Distress Thermometer. Journal of Advanced Nursing69(1): 167–174.
73.
ZuzeloPR (2007) Exploring the moral distress of registered nurses. Nursing Ethics14(3): 344–359.
