Moral Distress: Strategies for Maintaining Moral Integrity

Moral distress has been identified as a contributing factor to nurse burnout, stress, and job dissatisfaction. It has been defined as knowing the ethically correct action to take, but being unable to act because of internal or external barriers. This article explores moral distress through discussing the ethical principles most closely related to moral distress, illustrating perioperative situations in which it may occur, and providing tools to manage moral distress in the complex perioperative environment. The American Association of Critical-Care Nurses' 4A's to Rise Above Moral Distress are presented to address moral distress within the perioperative nursing practice.