Moral Distress Among Regulated and Unregulated Care Providers Employed in Long Term Care Settings

Abstract

The purpose of this research was to describe the experience of moral distress among regulated and unregulated nursing personnel employed in Long Term Care (LTC) facilities. The specific research questions were: 1) Do regulated and unregulated nursing personnel experience moral distress? 2) What is the nature of moral distress in LTC facilities? 3) How do nursing personnel describe and perceive the experience of moral distress? 4) What are the organizational factors that participants perceive as contributing to or reducing moral distress in their workplace? A qualitative, descriptive, study design was used. Semi-structured interviews were the method of data collection and analysis was conducted using thematic content analysis as proposed by Miles and Huberman’s (1994). A purposive sample of 16 participants was recruited from two LTC facilities. Participants described work experiences in which they felt they were unable to do the “right thing”. There were four kinds of situations that gave rise to moral distress: end of life care, resident behaviours, other direct care provider behaviours and the work environment. The experience of moral distress was described in terms of an initial emotional reaction, followed by a response, with resolved or unresolved outcomes. Half of the examples described by participants as giving rise to moral distress, remained unresolved. Participants also identified organizational factors that prevented moral distress and assisted with its resolution such as, educational courses, administrative leadership and pastoral support.