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Moral Distress and Effects on Critical Care Nurses


Wiegand and Funk (2014) explored the moral distress experiences of nurses, the causes of such experiences, and the effects they had on nurses’ practice, attitude, and future decisions and actions. The research questions were, “(a) What situations caused moral distress for critical care nurses? (b) What were the consequences of each of the situations? and (c) What would the critical care nurses do differently if faced with a similar situation in the future?” (Wiegand & Funk, 2014, p. 481). The notion of moral distress is a key concept of the research. The authors defined moral distress as “a type of moral conflict that occurs when one knows the right thing to do, but can’t pursue the right action” (Wiegand & Funk, 2014, p. 481). The author hypothesizes that experiences of moral distress can alter the future practices of a nurse.

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The method in this research was surveying. The authors asked their respondents to answer several open-ended questions about moral distress. Analysis of answers allowed evaluating to which extent the nurses’ behavior in mental distress situations in the future would differ from their behavior in similar situations in the past. Sixty-two percent of participants reported that, in a similar mental distress situation, they would do the same thing they had done previously. It means that those nurses, who had intervened in the decision-making in a difficult ethical situation, would do it again, while those who had not intervened, would not attempt to do so. However, the remaining 38 percent reported that they, on the contrary, would change their practice. Also, surveyed nurses’ perception of the effects of mental distress on patients and families was analyzed. The authors conclude that recognition and analysis of the influence of moral distress on nurses’ practice should be studied more thoroughly to help health care providers everywhere overcome such difficulties more effectively.

Research Methods Evaluation

In the introductory part of the article, the authors provide a literature review. First of all, it includes general background information on moral distress as an integral part of ethical decision-making in nursing. Second, based on twenty academic sources, the authors describe some known and studied effects of moral distress on nurses.

Although the subject of nurses’ distress from ethical dilemmas at work has been studied for decades, “the consequences of the [moral distress] situations for patients and families remain unexplored” (Wiegand & Funk, 2014, p. 480). Therefore, the research is current and relevant to present-day health issues because it studies factors that influence attitudes, behaviors, and decision-making of health care providers.

The research is non-experimental. It employed only one method: surveying. The results were coded and used to describe the distress consequences by comparing the answers of different respondents and grouping some of the answers. Therefore, the research type is mixed. Survey results were analyzed quantitatively to produce statistics and answer the question, “How many nurses would change their practice?” But also, the results were analyzed qualitatively to answer the question, “How were the respondents affected by mental distress?”

The survey forms were initially given to 204 nurses. All of them worked at a university medical center but in six different adult critical care units. The sampling was convenience-based. Only 47 nurses (23 percent) completed the surveys and returned them to the researchers. According to the authors, a low return rate is normal in mental distress studies (Wiegand & Funk, 2014). After processing the demographical data of the 47 respondents, it was found that the sample included women and men of four races. The age of the respondents was 25 to 61 (mean 41). Their nursing experience was two and a half months to 33 years (mean 15 years). Such a sample can be considered appropriate for a survey. However, the low return rate undermines the sample’s representativeness.

The research by Wiegand and Funk (2014) is one of the early studies of the effects of nurses’ ethical distress on their work with patients. The authors explain the importance of this topic and the reasons to explore it more profoundly in the future. The article provides a literature review and a theoretical framework for future studies. Also, the authors manage to define several effects of moral distress on nurses’ practice and categorize these effects. This categorization can be used by further studies in the area, as well as it can be revised or augmented. The research methods that the authors had developed can be useful, too. The open-ended questions used in the survey can be employed in more advanced qualitative studies like in-depth interviews.

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Considering the research’s rather ambitious goal, i.e. to explain the consequences of ethical distress for a nurse in his or her professional activities, single research cannot be sufficient in terms of representativeness, comprehensiveness, or generalizability. I appreciate the theoretical framework and the methodology that Wiegand and Funk (2014) had developed. However, I would narrow down the research topic. For example, the authors could focus on just one kind of moral distress effects, such as changes in practice, interactions with doctors, interactions with patients, etc. However, the breadth of the research is justified by the fact that it is one of the early studies to explore the area of consequences of nurses’ moral distress. Another possible improvement could be advancing the research methods to include interviews or observation, which could provide more profound qualitative data.

The writing is clear and straightforward. Specific professional vocabulary is not used heavily. I think the research can be read and understood by a person who is not familiar with nursing very well.

Further research can be conducted on the subject to better understand the consequences of moral distress. When the knowledge of such consequences and their characteristics is accumulated, “future studies need to address strategies to reduce the incidence of moral distress and to identify effective strategies to manage moral distress” (Wiegand & Funk, 2014, p. 486). This will be a major contribution to the ethical aspect of nursing.

Ethics studies are an important part of health care education because health care providers constantly face ethical dilemmas. In the area of ethics, some researchers studied how ethical decision-making and possible frustration from it can affect medical staff members, particularly nurses. Wiegand and Funk (2014) took the next step and raised the issue of the effect of moral distress, i.e. inability to do the right thing due to various reasons, on the nurses’ further behavior and decision-making. The research provides an unusual perspective, a relatively new topic, coherent methodology, and valuable results for future studies in this area. I think the research is interesting and useful for nursing ethics, which is one of the relevant topics in today’s health care.


Wiegand, D. L., & Funk, M. (2012). Consequences of clinical situations that cause critical care nurses to experience moral distress. Nursing Ethics, 19(4), 479–487.

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