Moral distress: Terminology, theories and models

Empirical researchers traditionally pay attention to ethical problems and decision-making situations related to the provision of medical and nursing care to patients. They are also interested in the fields of medicine and workplaces where such problems are solved most frequently. In recent years, however, growing interest has been paid to what the medical staff experiences in cases where the proposed care is not ethically correct, and may endanger the patient. Our surveillance study focuses on the concept of moral distress of nurses. We distinguish it from other types of distress (somatic, psychological and spiritual) owing to its ethical dimension. The study shows that it is a complex phenomenon which is not easy to define. Among other things, the value system of nurses, their moral sensitivity and moral courage play an important role. The moral distress of nurses changes over the course of time: we distinguish the initial moral distress, and then, after a period of time, the reactive moral distress. The study presents four theoretical models of moral distress. Attention is paid mainly to two of them: Model with cumulating negative impacts over time (accumulation of moral residues) and a model of progress and potential consequences of moral distress. The last part of the study describes two basic determinants of moral distress: internal (sociological and psycho-ethical characteristics of nurses) and external (specificity of the decision situation, the influence of members of the health care team, rules of functioning of the medical facility and its ethical climate, and the socio-cultural specificity of the country).