SynthesisNursing ethics2019
What is 'moral distress'? A narrative synthesis of the literature.
Synthesis in Nursing ethics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 171 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
171 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Moral conflicts in home-based care: a meta-synthesis of qualitative research.BMC medical ethics · 2025Pooled it
- Moral distress among acute mental health nurses: A systematic review.Nursing ethics · 2024Pooled it
- Registered Nurses' and nursing students' perspectives on moral distress and its effects: A mixed-methods systematic review and thematic synthesis.Nursing open · 2023Pooled it
- Simple Interventions for Pediatric Residents' Moral Distress: A Randomized, Controlled Experiment.Pediatrics · 2023Trial
- An expert-driven consensus framework for the study of potentially morally injurious events and their impacts: findings from an e-Delphi study.European journal of psychotraumatology · 2026Article
- Navigating communication barriers in phlebotomy: Strategies and ethical tensions in routine care.PEC innovation · 2026Article
- Magnet Recognition, Leadership Responsiveness, and Nurse Moral Distress: A Multilevel Mediation Analysis.Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing · 2026Observational
- Violence, Stigma, and Moral Injury in Nursing During the COVID-19 Pandemic: A Qualitative Analysis From 18 Countries in Latin America and the Caribbean.Nursing inquiry · 2026Article
- [Visceral surgery in mass casualty incidents due to disasters, crises and war].Chirurgie (Heidelberg, Germany) · 2026Review
- Challenges in Transitional Phases of Foster Care for Older Adults: Perspectives of Foster Caregivers.Scandinavian journal of caring sciences · 2026Article
- Moral distress: sometimes, there is no fix.Medicine, health care, and philosophy · 2026Review
- Navigating Ethical Challenges in CAR-T Treatment.HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues · 2026Article
- Mapping the conceptualisation, contributing factors and interventions of moral distress among healthcare providers in Africa: a scoping review.BMJ global health · 2026Article
- Professional Values, Work Environment and Job Satisfaction Among Critical Care Nurses in Palestine: A Descriptive Cross-Sectional Study.Nursing open · 2026Article
- Moral distress and moral injury in healthcare: A review and instrument analysis.Journal of health psychology · 2026Review
- Moral distress and associated factors among nurses working in public hospitals in West Arsi Zone, Ethiopia. a cross-sectional study.BMC nursing · 2026Article
- Moral distress in healthcare professionals working with motor neuron disease.Palliative & supportive care · 2026Article
- The Marginalization of Spiritual Dimensions in Nursing Moral Injury Research: A Bibliometric Analysis, 2018-2025.Journal of religion and health · 2026Article
- From silence to dismissal; nursing managers' strategies in dealing with nurses' professional misconduct: a qualitative study.BMC nursing · 2026Article
- Medical Challenges in Caring for Older Adults With Type 2 Diabetes and Dementia: A Qualitative Interview Study Using SCAT to Compare Primary Care Physicians and Diabetes Specialists in Japan.Journal of general and family medicine · 2026Article
111 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
aimsThe aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress.
backgroundMoral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon.
designSystematic literature review and narrative synthesis (November 2015-March 2016). DATA SOURCES: Ovid MEDLINE REVIEW
methodsLiterature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis.
resultsIn all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity.
conclusionWe suggest the combination of (1) the experience of a moral event, (2) the experience of 'psychological distress' and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.