Understanding Moral Distress

Contributing to the research on moral distress, Cynda Rushton (2017) has recently elaborated on the traditional definition adding, “Moral distress is a predictable response to situations where nurses recognize that there is a moral problem, have a responsibility to do something about it, but cannot act in a way that preserves their integrity.”

The sources of moral distress are numerous, as described by Mary C. Corley (2002). They can include:

  • Patients or families who request ongoing life-sustaining medical treatments even when medically unnecessary or inappropriate

  • Lack of communication between health care clinicians and patients/loved ones resulting in mistrust, avoidance, or false hope

  • Inadequate staffing or staff support, especially in the context of difficult medical decisions

  • Patients/loved ones/or providers who do not allow adequate pain management

As the research on moral distress has developed, the additional concepts of moral residue and the crescendo effect have appeared in the literature (Epstein & Hamric, 2009). Moral residue is the cumulative effect of having experienced previous morally distressing events. The lingering memory of having participated in or felt an accomplice to medical care that went against one’s personal values leaves a wound that can be carried into new interactions that feel similar. Over time, increasing moral residue causes ever-increasing moral distress peaks that may eventually build to a crisis point of a moral distress crescendo.

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For reflection alone or together:

Moral distress is also defined as that “damned if I do, damned if I don’t” inner conflict.

When have you experienced moral distress?

What helped you move through it?

Supportive Care Coalition