Hamric Ann B
School of Nursing, Virginia Commonwealth University, P.O. Box 980567, Richmond, VA 23298-0567, USA.
HEC Forum. 2012 Mar;24(1):39-49. doi: 10.1007/s10730-012-9177-x.
Studying a concept as complex as moral distress is an ongoing challenge for those engaged in empirical ethics research. Qualitative studies of nurses have illuminated the experience of moral distress and widened the contours of the concept, particularly in the area of root causes. This work has led to the current understanding that moral distress can arise from clinical situations, factors internal to the individual professional, and factors present in unit cultures, the institution, and the larger health care environment. Corley et al. (2001) was the first to publish a quantitative measure of moral distress, and her scale has been adapted for use by others, including studies of other disciplines (Hamric and Blackhall 2007; Schwenzer and Wang 2006). Other scholars have proposed variations on Jameton's core definition (Sporrong et al. 2006, 2007), developing measures for related concepts such as moral sensitivity (Lutzen et al. 2006), ethics stress (Raines 2000), and stress of conscience (Glasberg et al. 2006). The lack of consistency and consensus on the definition of moral distress considerably complicates efforts to study it. Increased attention by researchers in disciplines other than nursing has taken different forms, some problematic. Cultural differences in the role of the nurse and understanding of actions that represent threats to moral integrity also challenge efforts to build a cohesive research-based understanding of the concept. In this paper, research efforts to date are reviewed. The importance of capturing root causes of moral distress in instruments, particularly those at unit and system levels, to allow for interventions to be appropriately targeted is highlighted. In addition, the issue of studying moral distress and interaction over time with moral residue is discussed. Promising recent work is described along with the potential these approaches open for research that can lead to interventions to decrease moral distress. Finally, opportunities for future research and study are identified, and recommendations for moving the research agenda forward are offered.
对于从事实证伦理学研究的人来说，研究像道德困扰这样复杂的概念是一项持续的挑战。对护士的定性研究揭示了道德困扰的体验，并拓宽了该概念的范围，尤其是在根本原因方面。这项工作使人们形成了目前的认识，即道德困扰可能源于临床情况、个体专业人员内部的因素以及单位文化、机构和更大的医疗保健环境中存在的因素。科利等人（2001年）率先发表了道德困扰的定量测量方法，她的量表已被其他人改编使用，包括其他学科的研究（哈姆里克和布莱克霍尔，2007年；施温泽和王，2006年）。其他学者对贾梅顿的核心定义提出了不同版本（斯波隆等人，2006年、2007年），并为诸如道德敏感性（卢岑等人，2006年）、伦理压力（雷恩斯，2000年）和良心压力（格拉斯伯格等人，2006年）等相关概念制定了测量方法。道德困扰定义缺乏一致性和共识，这使得对其进行研究的努力变得相当复杂。除护理学科外，其他学科的研究人员给予了更多关注，形式各异，有些还存在问题。护士角色的文化差异以及对被视为对道德完整性构成威胁的行为的理解，也对基于研究建立对该概念的连贯理解的努力构成了挑战。本文回顾了迄今为止的研究工作。强调了在工具中捕捉道德困扰根本原因的重要性，特别是在单位和系统层面，以便使干预措施能够有针对性。此外，还讨论了研究道德困扰以及随着时间推移与道德残留相互作用的问题。介绍了近期有前景的工作以及这些方法为可能导致减少道德困扰干预措施的研究带来的潜力。最后，确定了未来研究的机会，并提出了推进研究议程的建议。
