Moral distress in midwifery practice : A Delphi study

Journal article

Foster, Wendy, McKellar, Lois, Fleet, Julie-Anne and Sweet, Linda. (2023). Moral distress in midwifery practice : A Delphi study. Women and Birth. 36(5), pp. e544-e555. https://doi.org/10.1016/j.wombi.2023.04.005
AuthorsFoster, Wendy, McKellar, Lois, Fleet, Julie-Anne and Sweet, Linda
Abstract

Background
Moral distress is a psychological concept that describes the harm associated with actions or inactions that oppose an individuals’ moral beliefs. Moral distress is linked to moral compromise in the workplace that may negatively impact mental wellbeing. Current tools available to assess moral distress are not specific for the Australian health care system or midwifery practice.

Aim
The aim of this study was to develop a list of situational and outcome statements associated with moral compromise and levels of moral distress in midwifery to inform the development of a tool to measure levels of moral distress in midwives.

Methods
This e-Delphi study was the third stage of a sequential exploratory mixed-methods study. Using an online strategy, three iterative rounds of e-Delphi were collected and analysed for consensus on situations leading to moral distress and the associated psychological outcomes.

Findings
Twenty participants contributed across the three rounds. Consensus was met in 40 morally compromising situation statements. The highest level of consensus related to excessive workloads and the associated negative impact of this on women and families. Consensus on outcomes following exposure to morally distressing situations led to the development of a continuum scale from moral frustration to moral injury.

Discussion/conclusion
This is the first study to use a consensus method to establish different levels of moral compromise, frustration, distress, and injury in midwifery practice. The findings of this study contribute to a growing body of literature that supports the concept of moral distress occurring across a continuum.

Keywordsmoral distress; midwifery; ethics; delphi technique; moral injury; moral frustration
Year2023
JournalWomen and Birth
Journal citation36 (5), pp. e544-e555
PublisherElsevier Ltd
ISSN1871-5192
Digital Object Identifier (DOI)https://doi.org/10.1016/j.wombi.2023.04.005
PubMed ID37164777
Scopus EID2-s2.0-85158893562
Page rangee544-e555
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online17 Aug 2023
Publication process dates
Accepted25 Apr 2023
Deposited27 May 2025
Additional information

© 2023 Published by Elsevier Ltd on behalf of Australian College of Midwives.

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