Understanding moral distress

What is it about?

Background Moral distress is a widespread issue for nurses, endangering their health. This study explored the causes, experiences, consequences, and coping strategies related to moral distress in home-care nursing. Aim The study aimed to identify morally distressing situations and their impacts on home-care nurses in Germany. Research Design A qualitative interview study with reflexive thematic analysis was conducted. Participants and Context Semi-structured interviews were held with 20 home-care nurses (14 female, 6 male) between April and August 2023 at locations of their choice. Ethical Considerations Approval was obtained from the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. Findings Moral distress arose from inadequate care, inability to safeguard personal health, extended responsibilities, work-life conflicts, and tensions between professional ethics and billing systems. Working alone in patients' homes intensified these challenges. Nurses reported destructive cognitions, negative emotions, physical symptoms, and long-term health consequences. Coping strategies were limited and addressed at both institutional and individual levels. Conclusions Moral distress in home-care nursing often stems from conflicts between care delivery and billing systems. Addressing this requires alternative organization and billing methods, such as time-based payments, expanded services, systematic case and ethics meetings, and the delegation of medical tasks like prescribing wound materials to nurses. These measures could reduce moral distress and enhance patient care quality.

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Photo by Georg Arthur Pflueger on Unsplash

Photo by Georg Arthur Pflueger on Unsplash

Why is it important?

Insight into Moral Distress: The study sheds light on specific situations that trigger moral distress in home-care nursing, contributing to a deeper understanding of this phenomenon. This is particularly relevant as moral distress significantly impacts the health of nurses and the quality of care. Focus on Home-Care Context: It highlights the unique conditions of home-care nursing, such as working in patients' private environments and the associated challenges, which have received less attention in prior research. Long-Term Effects: By examining the physical, emotional, and cognitive consequences of moral distress, the study underscores the urgency of implementing measures to protect nurses. Practical Recommendations: The study provides concrete suggestions for improving organizational and structural conditions, such as time-based remuneration, expanded services, and ethics meetings. These recommendations can help reduce moral distress and enhance working conditions in home-care nursing. Improvement of Patient Care: Reducing moral distress could also enhance the quality of care and patient satisfaction, emphasizing the study’s relevance to the broader healthcare system. Thus, the study offers essential impulses for practice-oriented changes and lays the groundwork for further research in a crucial yet underexplored area of nursing science.

Perspectives