Moral distress and constraints (tied together)

Moral distress was (on one prominent reading) originally proposed as a phenomenon wherein nurses knew the right thing to do but were constrained from doing it. Since then, the concept has evolved to include a broader array of phenomena, notably including those where the nurse does not know the right thing to do. In this article I argue that this purported evolution has actually been a step in the wrong direction, and that we would do well to return to (one reading of) the original understanding of the concept. There are both negative and positive reasons for this return. The negative reason is that the original arguments in favor of broadening the concept were undermotivated. The more practical reason is that removing the centrality of institutional barriers to the concept of moral distress also shifts the onus of ameliorating that distress away from the institution. Concepts have power, and how we think about a problem shapes what solutions we are likely to consider.

What is original about this work?

This work brings novel counterarguments against the expansion of moral distress to include cases such as those of moral indecision. I also articulate how (one reading of) the more traditional definition is not susceptible to dangerous educational practices relating to empowerment and distress transference.

What impact is the work likely to have on care practice, leadership, research and/or education?

I believe this work has the potential to change how people think and teach about moral distress. This can effect positive change in practice, as people return to focusing on institutional constraints rather than sending the message that nurses need to adjust their internal states. Despite being (on one reading) an older view, I argue that it is consistent with more recent insights on the importance of moral resiliency. I also hope it will redirect much of the conceptual research on moral distress generally—both theoretical and empirical.