Moral Distress: Contributing Factors, Outcomes and Interventions. an Overview of the Nursing Literature

Wednesday, 1 August 2012: 10:30 AM

Adam S. Burston, BN, GCertNsg, (Med/Surg), MHServMgt
School of Nursing & Midwifery, The University of Queensland, South Brisbane, Australia
Anthony G. Tuckett, BN, MA, PhD
School of Nursing and Midwifery, The University of Queensland, Milton BC, Australia

Learning Objective 1: The learner will be able to recognize and describe key contributing factors and outcomes of moral distress.

Learning Objective 2: The learner will be able to describe interventions to aid in the recognition and reduction of the intensity and frequency of moral distress encounters.


Explore moral distress research across the nursing discipline to identify contributing factors, understand common outcomes, identify appropriate interventions, and detect knowledge gaps.


Cumulative Index to Nursing and Allied Health (CINAHL) 1982-2010; PsycINFO 1980-2010; Medline 1982-2010 and Social Science Citation Index (SSCI) plus Arts and Humanities Citation Index 1982-2010 were used. Key words used were: moral distress, moral distress scale, nursing home* and long-term care. Mining of reference lists provided additional sources. The review excluded doctoral dissertations, abstracts to meetings, and papers not published in English. Furthermore, a number of electronic journal and online content alerts were established. While the review did not set out to answer a specified question, it was conducted in a systematic manner providing a rigorous representation of the literature.


Factors identified as contributing to moral distress stem from; individual characteristics, site specific systems, and/or broader external influences; and tend to be similar across care contexts. The attendant outcomes of this distress may manifest internally or externally, and are generally deleterious. A range of interventions have been proposed, but implemented sporadically and on a small scale. It appears that few intervention studies have been undertaken. 


The relevance resides in the implications moral distress has on the nurse and the nursing workforce. Moral distress contributes to decreased quality of care, diminished workplace satisfaction, physical and emotional illness, burnout, and staff turnover. Costly flow on effects such as increased length of stay and the need for additional treatment interventions can arise. Poor care provision is deleterious to an organizations reputation. Change must be nurse driven, and engaging this next step is crucial if any real benefit is to be realized. Robust, contemporary organisations must address these issues to remain viable in a challenging healthcare environment.