Moral Distress in Nursing: End-of-Life Care Challenges
This paper examines the ethical and moral distress experienced by nursing professionals, particularly those providing end-of-life and palliative care to terminally ill patients, including children. It explores how conflicts between personal values, professional duties, and institutional constraints generate internal and external obstacles to quality care. Drawing on clinical literature, the paper discusses the consequences of moral distress on nurse well-being, job satisfaction, and patient outcomes, and concludes by emphasizing the need for organizational strategies that recognize nurses' contributions, foster ethical environments, and promote collaborative professional discourse.
- Introduction: Ethical and Moral Distress in Nursing: Defines moral distress and its sources in nursing
- Barriers to Palliative and End-of-Life Care: Internal and external obstacles to effective care delivery
- Moral Distress and Pediatric Patient Care: Impact of distress on nurses caring for dying children
- Significance of Moral Distress in the Nursing Profession: Consequences for job satisfaction, retention, and reform
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- Grounds abstract ethical concepts in concrete clinical scenarios, such as bedside nurses being ignored when reporting inadequate pain management in dying children.
- Connects individual nurse experience to broader organizational and professional consequences, including burnout, attrition, and diminished patient care quality.
- Uses peer-reviewed nursing literature consistently to support each claim, lending credibility to the argument.
Key academic technique demonstrated
The paper demonstrates effective synthesis of multiple empirical sources to build a cumulative argument. Rather than relying on a single study, it draws on several clinical and ethical nursing research works to show that moral distress is both a personal and systemic problem, with consequences at the individual, institutional, and patient-care levels.
Structure breakdown
The paper opens with a conceptual definition of moral distress and its sources, then moves to specific clinical examples — particularly in pediatric palliative care — illustrating how moral distress manifests in practice. A clearly labeled section on significance then synthesizes research findings about outcomes such as reduced job satisfaction and professional attrition, closing with a call for organizational reform. The structure moves logically from problem definition to evidence to implications.
Introduction: Ethical and Moral Distress in Nursing
Ethical and moral distress may result in feelings of irritation and helplessness. Such distress transpires when nursing professionals are required to behave in ways that contradict their ideals. Nurses' integrity may be undermined by this disregard for professional and personal values. Nurses are caught in a quandary between their duty to offer comfort in death and their duty to abide by the orders of the physician (Davies et al., 1996).
Obstacles may emerge when healthcare personnel cannot act in accordance with professional norms and personal ideals. These obstacles can be both internal and external. Internal obstacles arise from ineffective communication and gaps in job-based skills and knowledge among nursing staff, hindering the provision of adequate palliative care. External obstacles occur when the opinions of nursing staff are not sought or valued in the workplace. Such obstacles must be addressed to ensure both proper patient care and the job satisfaction of nurses.
Barriers to Palliative and End-of-Life Care
Literature indicates that when nursing professionals believe they are no longer able to help terminally ill patients recover, they begin to experience profound feelings of helplessness, sorrow, and uncertainty. They are often unsure how to navigate the challenge of delivering both curative and palliative care to such patients (Yam, Rossiter, & Cheung, 2001). Clear examples of this include difficulties in case management and pain management.
Bedside nurses who remain with a young patient for much of the day may be best positioned to evaluate how effective the current pain treatment regimen is, as well as other end-of-life requirements. Yet when a nurse reports poor pain control or requests a patient care meeting, that input may go unheeded. Being ignored in this way tends to leave nurses feeling irritated, offended, and dissatisfied with the care being delivered.
References
Dalmolin, G. d., Lunardi, V. L., Barlem, E. L., & Silveira, R. S. (2012). Implications of moral distress on nurses and its similarities with burnout. Texto contexto - enferm, 21(1).
Davies, B., Clarke, D., Connaughty, S., Cook, K., MacKenzie, B., & McCormick, J. (1996). Caring for dying children: Nurses' experiences. Pediatric Nursing, 22(6), 500–507.
Gallagher, A. (2010). Moral distress and moral courage in everyday nursing practice. OJIN: The Online Journal of Issues in Nursing, 16(2).
Morgan, D. (2009). Caring for dying children: Assessing the needs of the pediatric palliative care nurse. Pediatric Nursing, 35(2), 86–91.
Schluter, J., Winch, S., Holzhauser, K., & Henderson, A. (2008). Nurses' moral sensitivity and hospital ethical climate: A literature review. Nursing Ethics, 15(3), 304–321.
Yam, B., Rossiter, J., & Cheung, K. (2001). Caring for dying infants: Experiences of neonatal intensive care nurses in Hong Kong. Journal of Clinical Nursing, 10(5), 651–659.
Create your account
Always verify citation format against your institution’s current style guide requirements.