Moral distress in midwifery practice : A concept analysis

Journal article


Foster, Wendy, McKellar, Lois, Fleet, Julie-Anne and Sweet, Linda. (2022). Moral distress in midwifery practice : A concept analysis. Nursing Ethics. 29(2), pp. 364-383. https://doi.org/10.1177/09697330211023983
AuthorsFoster, Wendy, McKellar, Lois, Fleet, Julie-Anne and Sweet, Linda
Abstract

Research suggests that the incidence of moral distress experienced by health professionals is significant and increasing, yet the concept lacks clarity and remains largely misunderstood. Currently, there is limited understanding of moral distress in the context of midwifery practice. The term moral distress was first used to label the psychological distress experienced following complex ethical decision-making and moral constraint in nursing. The term is now used across multiple health professions including midwifery, nursing, pharmacy and medicine, yet is used cautiously due to confusion regarding its theoretical and contextual basis. The aim of this study is to understand the concept of moral distress in the context of midwifery practice, describing the attributes, antecedents and consequences. This concept analysis uses Rodgers’ evolutionary framework and is the first stage of a sequential mixed-methods study. A literature search was conducted using multiple databases resulting in eight articles for review. Data were analysed using NVivo12©. Three core attributes were identified: moral actions and inactions, conflicting needs and negative feelings/emotions. The antecedents of clinical situations, moral awareness, uncertainty and constraint were identified. Consequences of moral distress include adverse personal professional and organisational outcomes. A model case depicting these aspects is presented. A midwifery focused definition of moral distress is offered as ‘a psychological suffering following clinical situations of moral uncertainty and/or constraint, which result in an experience of personal powerlessness where the midwife perceives an inability to preserve all competing moral commitments’. This concept analysis affirms the presence of moral distress in midwifery practice and provides evidence to move towards a consistent definition of moral distress.

KeywordsConcept analysis; maternity cares; midwifery; midwifery workforce; moral distres
Year01 Jan 2022
JournalNursing Ethics
Journal citation29 (2), pp. 364-383
PublisherSage Publications Ltd. (UK)
ISSN0969-7330
Digital Object Identifier (DOI)https://doi.org/10.1177/09697330211023983
PubMed ID34538155
Web address (URL)https://journals.sagepub.com/doi/10.1177/09697330211023983
Open accessPublished as non-open access
Research or scholarlyResearch
Page range364-383
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online19 Sep 2021
Publication process dates
Deposited02 Oct 2024
Additional information

© The Author(s) 2021.

Place of publicationUnited Kingdom
Permalink -

https://acuresearchbank.acu.edu.au/item/90yz5/moral-distress-in-midwifery-practice-a-concept-analysis

Restricted files

Publisher's version

  • 7
    total views
  • 0
    total downloads
  • 0
    views this month
  • 0
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

‘There is no other option’ : Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia
McKellar, Lois, Fleet, Julie-Anne and Adelson, Pamela. (2024). ‘There is no other option’ : Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia. Australian Journal of Rural Health. 32(1), pp. 67-79. https://doi.org/10.1111/ajr.13066
Evaluation of a regional midwifery caseload model of care integrated across five birthing sites in South Australia : Women's experiences and birth outcomes
Adelson, Pamela, Fleet, Julie-Anne and McKellar, Lois. (2023). Evaluation of a regional midwifery caseload model of care integrated across five birthing sites in South Australia : Women's experiences and birth outcomes. Women and Birth. 36(1), pp. 80-88. https://doi.org/10.1016/j.wombi.2022.03.004
Examining the transformation of midwifery education in Australia to inform future directions : An integrative review
McKellar, Lois, Graham, Ms Kristen, Sheehan, Athena, Fleet, Julie-Anne, Sidebotham, Mary and Sweet, Linda. (2023). Examining the transformation of midwifery education in Australia to inform future directions : An integrative review. Women and Birth. 36(2), pp. 155-166. https://doi.org/10.1016/j.wombi.2022.11.010
Yourtime : The development and pilot of a perinatal mental wellbeing digital tool using a co-design approach
McKellar, Lois, Steen, Mary, Charlick, Samantha J., Andrew, Jane, Altieri, Benjamin and Gwilt, Ian. (2023). Yourtime : The development and pilot of a perinatal mental wellbeing digital tool using a co-design approach. Applied Nursing Research. 73, pp. 1-8. https://doi.org/10.1016/j.apnr.2023.151714
Examining the Influence of Self-compassion Education and Training Upon Parents and Families When Caring for their Children : A Systematic Review
Othman, Shwikar, Steen, Mary, Wepa, Dianne and McKellar, Lois. (2022). Examining the Influence of Self-compassion Education and Training Upon Parents and Families When Caring for their Children : A Systematic Review. Open Psychology Journal. 15(1), pp. 1-16. https://doi.org/10.2174/18743501-V15-E221020-2022-39
Identifying the priorities for midwifery education across Australia and New Zealand : A Delphi study
Sidebotham, Mary, McKellar, Lois, Walters, Caroline, Gilkison, Andrea, Davis, Deborah and Gamble, Jenny. (2021). Identifying the priorities for midwifery education across Australia and New Zealand : A Delphi study. Women and Birth. 34(2), pp. 136-144. https://doi.org/10.1016/j.wombi.2020.05.011
Midwifery-led care in South Australia : Looking back to move forward
McKellar, Lois, Newnham, Elizabeth, Fleet, Julie-Anne and Adelson, Pamela. (2021). Midwifery-led care in South Australia : Looking back to move forward. Women and Birth. 34(5), pp. 537-545. https://doi.org/10.1016/j.wombi.2020.10.011
Two decades of Birth Centre and midwifery-led care in South Australia, 1998–2016
Adelson, Pamela, Fleet, Julie-Anne, McKellar, Lois and Eckert, Marion. (2021). Two decades of Birth Centre and midwifery-led care in South Australia, 1998–2016. Women and Birth. 34(1), pp. 84-91. https://doi.org/10.1016/j.wombi.2020.05.005
Simulation in midwifery education : A descriptive explorative study exploring students’ knowledge, confidence and skills in the care of the preterm neonate
Stoodley, Cathy, McKellar, Lois, Steen, Mary and Fleet, Julie-Anne. (2020). Simulation in midwifery education : A descriptive explorative study exploring students’ knowledge, confidence and skills in the care of the preterm neonate. Nurse Education in Practice. 42, pp. 1-7. https://doi.org/10.1016/j.nepr.2019.102635
Shared decision aids in pregnancy care : A scoping review
Kennedy, K., Adelson, Pamela, Fleet, Julie-Anne, Steen, Mary, McKellar, Lois, Eckert, Marion and Peters, Micah D J. (2020). Shared decision aids in pregnancy care : A scoping review. Midwifery. 81, pp. 1-13. https://doi.org/10.1016/j.midw.2019.102589
Women’s barriers to weight loss, perception of future diabetes risk and opinions of diet strategies following gestational diabetes: An online survey
Gray, Kristy L., McKellar, Lois, O’reilly, Sharleen L., Clifton, Peter and Keogh, Jennifer. (2020). Women’s barriers to weight loss, perception of future diabetes risk and opinions of diet strategies following gestational diabetes: An online survey. International Journal of Environmental Research and Public Health. 17(24), pp. 1-12. https://doi.org/10.3390/ijerph17249180
A public e-survey to explore community understanding of the role of the midwife in Australia
McKellar, Lois, Brown, Angela and Adelson, Pamela. (2019). A public e-survey to explore community understanding of the role of the midwife in Australia. European Journal of Midwifery. 3(November), pp. 1-9. https://doi.org/10.18332/ejm/114226
Validation of the Australian Midwifery Standards Assessment Tool (AMSAT) : A tool to assess midwifery competence
Sweet, Linda, Bazargan, Maryam, McKellar, Lois, Gray, Joanne and Henderson, Amanda. (2018). Validation of the Australian Midwifery Standards Assessment Tool (AMSAT) : A tool to assess midwifery competence. Women and Birth. 31(1), pp. 59-68. https://doi.org/10.1016/j.wombi.2017.06.017
It's more than just luck : A qualitative exploration of breastfeeding in rural Australia
McKellar, Lois, Fleet, Julie and Dove, Shona. (2018). It's more than just luck : A qualitative exploration of breastfeeding in rural Australia. Women and Birth. 31(3), pp. 177-183. https://doi.org/10.1016/j.wombi.2017.09.005
Exploring routine hospital antenatal care consultations : An ethnographic study
Wright, Diane, Pincombe, Jan and McKellar, Lois. (2018). Exploring routine hospital antenatal care consultations : An ethnographic study. Women and Birth. 31(3), pp. 162-169. https://doi.org/10.1016/j.wombi.2017.09.010