| Summary: | Within this thesis, I explore the concept of ‘moral distress’ in nursing using both theoretical and empirical methods. Using a feminist empirical bioethics methodology, I explore issues of voice, power, responsibility and relationships and the way in which these impact nurses’ experiences of moral distress. I present qualitative data from interviews with 21 critical care nurses in which they describe different moral events that caused them to feel the various emotions of ‘distress’. Using the empirical findings and tort law, I suggest causal criteria which explains the causal story between the moral event and distress, determining whether one’s distress ought to be regarded as moral distress. I argue for a broader conceptualisation of moral distress based upon the empirical findings and I provide normative reasons why we ought to accept this broader understanding. I argue that due to the complexity of clinical-ethical decision-making and prognostication that moral distress ought to be divorced from ‘knowledge of the right thing’, that this broader definition may encourage moral dialogue between healthcare professionals, and that to disregard these experiences as moral distress deprives these individuals of the tools to make sense of their own moral experiences. I construct a moral distress model which captures the definition of moral distress, the compounding factors that exacerbate/mitigate moral events, responses to moral distress and the interaction of moral distress to other related concepts. Finally, I provide recommendations for ways we can respond to moral distress in clinical practice and policy, and possible areas for further research.
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