Nurses’ Moral Distress in the Time of Covid-19 Needs to be Further Explored and Addressed

Abstract

“Moral distress” is a term used to describe a phenomenon that is of great clinical significance and may have disastrous consequences not only for nurses (or other healthcare professionals), but also for patients. It was first defined by Jameton as “constraint distress”, namely, “the psychological distress of being in a situation in which one is constrained from acting on what one knows to be right.” Later, the definition of moral distress expanded to include not only the so-called “constraint distress”, but also the so-called “uncertainty distress” that compromises the values and moral integrity of the person who is experiencing it. At any rate, in the literature there have been offered various and overlapping accounts of moral distress. Moral distress is inherent in nursing. Not surprisingly, during the COVID-19 pandemic the risk of moral distress among ICU nurses is high. The unprecedented and unique pandemic nursing care circumstances revealed a new broader concept of nurse moral distress that is integrated, with an intrapersonal dimension and an interpersonal dimension. There have been proposed various interventions for mitigating moral distress among nurses working in COVID-19 healthcare settings. Among these interventions are included nurses’ self-reflection to be aware of their own moral distress, nurses’ autobiographic narration of memories and emotions, creating conditions promoting’ spirituality, addressing newly appeared institutional shortcomings in mental healthcare settings, and training nurses in ethical issues and dilemmas. Exploring nurses’ moral distress in the COVID-19 context and developing interventions to address it are ongoing. Starting points for future research emerged from this literature review.