Framing the Issues: Moral Distress in Health Care

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care

Gathering speed and taking flight : multi-country qualitative data analysis

OBJECTIVE: Preparation for the conduct of multi-country research is analogous to securing the aircraft and taxiing down the runway in anticipation of flight. The process of designing and implementing data analysis strategies for a research project entitled “Nursing practice in HIV prevention and care in Sub-Saharan Africa and the Caribbean” is described. Management of qualitative data from two of the project tools will be used to highlight the ethical considerations, electronic and telecommunications challenges, wide range of expertise, and other practical and logistical issues that were encountered. METHODS: Investigators, collaborators, research assistants, and students representing five countries worked together to develop protocols and frameworks for the management and analysis of data. RESULTS: Analysis teams identified barriers and created innovative strategies for learning the necessary skills to manage data efficiently and rigorously. Because the intent of the study is to build leadership capacity for research and policy development among nurses in low and middle income countries, identifying and addressing best practices collaboratively was an important initial part of the process. CONCLUSIONS: A successful journey begins by ensuring all team members are on board. The authors will discuss the communication strategies and resources that were established in order to maximize capacity building and consistent analysis in this multi-country program of research