The process of moral distress development: A virtue ethics perspective

This theoretical paper proposes a new perspective to understand the moral distress of nurses more fully, using virtue ethics. Moral distress is a widely studied subject, especially with respect to the determination of its causes and manifestations. Increasing the theoretical depth of previous work using ethical theory, however, can create new possibilities for moral distress to be explored and analyzed. Drawing on more recent work in this field, we explicate the conceptual framework of the process of moral distress in nurses, proposed by Ramos et al., using MacIntyrean virtue ethics. Our analysis considers the experience of moral distress in the context of a practice, enabling the adaptation of this framework using virtue ethics. The adoption of virtue ethics as an ethical perspective broadens the understanding of the complexity of nurses’ experiences of moral distress, since it is impossible to create a ready model that can cover all possibilities. Specifically, we describe how identity, social context, beliefs, and tradition shape moral discomfort, uncertainty, and sensitivity and how virtues inform moral judgments. Individuals, such as nurses, who are involved in a practice have a narrative history and a purpose (telos) that guide them in every step of the process, especially in moral judgment. It is worth emphasizing that the process described is supported by the formation of moral competence that, if blocked, can lead to moral distress and deprofessionalization. It is expected that nurses seek to achieve the internal good of their practice, which legitimizes their professional practice and supports them in moral decision-making, preventing moral distress.

1. Morley, G, Bradbury-Jones, C, Ives, J. What is “moral distress” in nursing? A feminist empirical bioethics study. Nurs Ethics 2020; 27(5): 1297–1314.
Google Scholar | SAGE Journals | ISI2. Ramos, FRS, Barlem, ELD, Brito, MJM, et al. Conceptual framework for the study of moral distress in nurses. Texto Contexto—Enferm 2016; 25(2): 1–10.
Google Scholar | Crossref3. Caram, CS, Peter, E, Brito, MJM. Invisibility of the self: reaching for the telos of nursing within a context of moral distress. Nurs Inq 2019; 26(1): e12269.
Google Scholar | Crossref | Medline4. Macintyre, A . After virtue. 3rd ed. Notre Dame, IN: Notre Dame Press, 2007, p. 286.
Google Scholar5. Van Hooft, S . Understanding virtue ethics. London: Routledge, 2014, p. 192.
Google Scholar | Crossref6. Pellegrino, ED . Toward a virtue-based normative ethics for the health professions. Kennedy Inst Ethics J 1995; 5(3): 253–277.
Google Scholar | Crossref | Medline | ISI7. Mcauliffe, D, Williams, C, Briskman, L. Moral outrage! Social work and social welfare. Ethics Soc Welfare 2016; 10(2): 87–93.
Google Scholar | Crossref8. Oakley, J . A Virtue ethics approach. In: Kuhse, H, Singer, P (eds) A companion to bioethics. 2nd ed. London: Blackwell, 2009, p. 584.
Google Scholar | Crossref9. Armstrong, AE . Towards a strong virtue ethics for nursing practice. Nurs Philos 2006; 7(3): 110–124.
Google Scholar | Crossref | Medline10. Vanlaere, L, Gastmans, C. Ethics in nursing education: learning to reflect on care practices. Nurs Ethics 2007; 14(6): 758–766.
Google Scholar | SAGE Journals | ISI11. Arries, E . Virtue ethics: an approach to moral dilemmas in nursing. Curationis 2005; 28(3): 64–72.
Google Scholar | Crossref | Medline12. Tong, R . The ethics of care: a feminist virtue ethics of care for healthcare practitioners. J Med Philos 1998; 23(2): 131–152.
Google Scholar | Crossref | Medline13. Liaschenko, J, Peter, E. Nursing ethics and conceptualizations of nursing: profession, practice and work. J Adv Nurs 2004; 46(5): 488–495.
Google Scholar | Crossref | Medline | ISI14. Jameton, A . Nursing practice: the ethical issues. Englewood Cliffs, NJ: Prentice-Hall, 1984, p. 331.
Google Scholar15. McCarthy, J, Gastmans, C. Moral distress: a review of the argument-based nursing ethics literature. Nurs Ethics 2015; 22(1): 131–152.
Google Scholar | SAGE Journals | ISI16. Gallagher, A . Moral distress and moral courage in everyday nursing practice. OJIN 2010; 16(2): 1–7.
Google Scholar17. Corley, MC . Nurse moral distress: a proposed theory and research agenda. Nurs Ethics 2002; 9(6): 636–650.
Google Scholar | SAGE Journals | ISI18. Dalmolin, GL, Lunardi, VL, Lunardi, GL, et al. Nurses, nursing technicians and assistants: who experiences more moral distress? Rev Esc Enferm USP 2014; 48(3): 521–529.
Google Scholar | Crossref | Medline19. Lützén, K, Dahlqvist, V, Eriksson, S, et al. Developing the concept of moral sensitivity in health care practice. Nurs Ethics 2006; 13(2): 187–196.
Google Scholar | SAGE Journals | ISI20. Hodkinson, K . How should a nurse approach truth-telling? A virtue ethics perspective. Nurs Philos 2008; 9(4): 248–256.
Google Scholar | Crossref | Medline21. Dubar, C . A crise das identidades: a interpretação de uma mutação [The identity crisis. The interpretation of a mutation]. São Paulo, Brazil: Editora da Universidade de São Paulo, 2009, p. 292.
Google Scholar22. Weaver, K, Morse, J, Mitcham, C. Ethical sensitivity in professional practice: concept analysis. J Adv Nurs 2008; 62(5): 607–618.
Google Scholar | Crossref | Medline | ISI23. Austin, W . The terminal: a tale of virtue. Nurs Ethics 2007; 14(1): 54–61.
Google Scholar | SAGE Journals | ISI24. Aristotle . The Nicomachean ethics. New York: Oxford University Press, 2009, p. 277.
Google Scholar25. Epstein, EG, Delgado, S. Understanding and addressing moral distress. OJIN 2010; 15(3): 1–13.
Google Scholar26. Epstein, EG, Hamric, AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics 2009; 20(4): 330–342.
Google Scholar | Medline

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