Moral Distress and the Governance of Attention in Nursing: A Hanian Reading of the Structural Restriction of Moral Agency.

Contemporary nursing is increasingly shaped by performance pressures, demands for traceability, and technological mediation. These developments do more than add tasks to everyday clinical work. They also shape what nurses can attend to, how they judge situations, and whether they are able to sustain the care they believe a patient needs. This article examines moral distress as a structural restriction of moral agency: nurses may recognise what a situation requires yet find themselves unable to act accordingly. Drawing on Byung-Chul Han's analyses of performance, psychopolitics, infocracy, and the palliative society, we develop a tetradic matrix that relates these contemporary logics to four goods of nursing care: attention, clinical judgement, alterity, and hope. In practice, these goods refer to sustained presence, prudent deliberation, recognition of the patient as a singular person, and hope understood as non-abandonment. Applied to the nursing metaparadigm, the matrix shows how clinical time, attention, documentation, and technological mediation can become places where moral agency is either supported or weakened. The article therefore argues for a shift in the ethical evaluation of nursing work: from a narrow focus on individual resilience towards the governance of attention and the institutional conditions that make responsible care possible.