Moral Distress in Healthcare

Identify a clinical situation in which you have experienced moral distress, what you did to address moral distress. This does not need a psychiatric situation. Are there any evidenced-based approaches to address moral distress? Please use at least two peer-reviewed or scholarly references to support your work.


Moral Distress in Healthcare

According to the American Association of Critical Care Nurses (2020), moral distress happens when a person understands the ethically proper thing to do but is unable to do so. One acts in a way contradictory to one’s personal and professional values, which undermines one’s integrity and authenticity. Moral distress occurs when restrictions impede moral choices and behaviors. Psychiatrists express their struggles with doing the right thing for individual patients within a social framework that sets unreasonable demands on psychiatric expertise. According to Austin et al. (2018), there are two types of moral distress: initial and reactive.

Initial distress refers to the sentiments of annoyance, anger, and worry that people experience when confronted with institutional hurdles and disagreements over ideals with others. If the initial distress is not alleviated, reactive distress may occur. Austin et al. (2018) further define moral distress as pain or sadness compromising the mind, body, or interrelations as a consequence of a circumstance in which the individual is aware of a moral problem, affirms moral responsibility, and makes a moral conviction about the right approach; yet, as a result of actual or imagined constraints, engages in inherent ethical malfeasance. The paper aims to discuss clinical moral distress risks, the consequences of moral distress in healthcare, and ways to address moral distress.

Many external obstacles can limit or prevent nurses from performing as they desire, causing moral distress. Short staffing, poor communication, working with unprofessional colleagues, bullying, and an absence of a positive work environment are all unit-level problems, according to the AACN tool that could potentially lead to moral distress (AACN, 2020). Organizational reasons include insufficient personnel, a lack of resources, cost-cutting demands, hospital rules, a power hierarchy, poor communication, and budgetary constraints. If not addressed, these variables can have a negative impact on moral distress.

Individuals and organizations are both affected by moral distress. It can cause emotional symptoms such as frustration, anger, anxiety, guilt, headaches, palpitations, vomiting, and psychological depression, including emotional exhaustion, loss of self-worth, nightmares, reduced job satisfaction, and depersonalization of patients. Repeated instances of moral distress that are not addressed can build up as moral residue, leading to nurses suffering burnout and quitting their occupations or careers (Morley et al., 2019). Organizations incur turnover expenses as a result of job attrition. More significantly, unresolved moral anguish might severely influence patient care quality, potentially leading to adverse patient events. This not only impacts an organization’s reputation in the community, but it may also result in increased liability risk due to mistakes.

An example of moral distress is understaffing, where an organization employs more doctors but keeps the number of nurses constant despite the workload involved in patients. For example, in Japan, psychiatric care is governed by the Mental Health and Welfare Act, which emphasizes voluntary hospitalization. This Act stipulates that all mental inpatients be allowed to communicate freely and that all voluntarily accepted inpatients be informed of their right to leave the facility. In 2006, 38.4% were involuntarily admitted (Ohnishi et al., 2018). There is a significant disparity in staffing between Japanese mental institutions and normal hospitals. According to (Ohnishi et al., 2018), the number of medical physicians per 100 beds in mental institutions was only 3.3, while it was 12.9 in general hospitals. In mental institutions, the number of nurses per 100 beds was 17.5; in general hospitals, the figure was 42.1 (Ohnishi et al., 2018). A shortage of personnel leads to insufficient or inadequate treatment and abuses of patients’ rights, such as diapering incontinent patients, isolating those who protest, and compelling patients to take medicine without justification, all of which pose a moral conflict for caregivers. Assault by nursing personnel, abuse, and unlawful isolation as punishment were common in hospitals with severely low staffing levels (Ohnishi et al., 2018). Due to Japan’s present medical-economic scenario, hospital managers place a greater focus on physicians and a lesser emphasis on nurses.

How To Address Moral Distress

The nurse must be proactive and take action while dealing with moral distress. A nurse feeling moral distress should determine the root, which might be a policy issue or a lack of collaboration among team members. The second part is a self-evaluation, which begins by identifying the intensity of the distress. Wocial and Weaver’s Moral Distress Thermometer might be useful for nurses in diagnosing oral distress. On self-assessment, the nurse must ascertain readiness to take action. The AACN publication “4A’s to Rise Above Moral Distress” proposes asking oneself questions like; How crucial do you think it is to try to alter the situation? How crucial would a change in the situation be to your colleagues/unit? How significant would a change be? (Davis & Batcheller, 2020).

It should be noted that in some circumstances, the law requires the nurse to intervene. For example, failing to report child or elder abuse exposes the nurse to legal culpability. Nurses must also examine if the standard of care is being broken since failing to speak out may result in a state licensing board complaint or a lawsuit connected to patient damage. The third step is to create a plan. This may be accomplished by gathering information and discussing issues with a trusted colleague to ensure that a solid strategy is in place. Self-care should be part of the strategy. According to Davis and Batcheller (2020), the ANA Code of Ethical with Interpretive Statements, the state board of nursing, the ethics counseling service at work, and the organization’s employee support program are all resources that can aid a nurse in analyzing the situation and establishing a strategy. The fourth step is to communicate your concerns to the right authorities. Given the moment and place, the nurse should communicate the information in a calm and polite manner. Following the line of command is also critical, especially if complaints are not being addressed. Documentation is also an important step. Conversations, including who was spoken to, what information was communicated, and the reaction. If the information is relevant to a patient scenario, the nurse should enter it into the patient’s health record (Davis & Batcheller, 2020). If the nurse is dealing with a problematic team member or an organizational policy, they should keep a personal record to track the actions taken.


Repeated exposure to morally challenging situations causes professionals to experience moral distress, which leads to burnout and turnover. Nurse leaders may educate their employees about the dangers of moral distress, including burnout. They may also encourage employees to use the tools already available via their companies, lobby for new resources, and work with their teams to establish implementation strategies. To reduce moral suffering, nurse leaders must collaborate with hospital administrations and unit-based advocates.


AACN. (2020). Moral Distress in Nursing: What You Need to Know.

Austin, W. J., Kagan, L., Rankel, M., & Bergum, V. (2018). The balancing act: psychiatrists’ experience of moral distress. Medicine, Health Care, and Philosophy11(1), 89–97.

Davis, M., & Batcheller, J. (2020). Managing moral distress in the workplace; Creating a resiliency bundle. Nurse Leader18(6), 604–608.

Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2019). What is “moral distress”? A narrative synthesis of the literature. Nursing Ethics26(3), 646–662.

Ohnishi, K., Ohgushi, Y., Nakano, M., Fujii, H., Tanaka, H., Kitaoka, K., Nakahara, J., & Narita, Y. (2018). Moral distress experienced by psychiatric nurses in Japan. Nursing Ethics17(6), 726–740.

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