Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Dr. Cheryl Forchuk


Nursing is a practice grounded in ethics. Every nursing act is measured against requisite moral standards to do no harm, to promote justice, to be accountable, and to provide safe and competent care. However, as nurses attempt to act, there may be obstacles to pursuing the course of care as agreed to with the patient: inadequate staffing, cost-containment strategies, and policy constraints. In attempting to reconcile ideals of practice with what may be an opposing reality, nurses may experience moral distress.

The purpose of this study was to examine how structural empowerment, psychological empowerment, interprofessional collaboration, compassion, and the perception of the quality of care affect nurses’ perceptions of moral distress and the relationship between moral distress and intention to leave. It is organized in an integrated article format comprised of 4 papers. The first paper traces how the concept of nurse moral obligation and the possible sources of nurse moral distress. The second paper is a scoping review of the variables that have been correlated with moral distress. The literature suggests the constructs structural and psychological empowerment, interprofessional collaboration, quality of care, and intention to leave are associated with it. Compassion is also considered as it is a core nursing attribute. The third paper concerns itself with understanding compassion fatigue and compassion in a nursing context. The fourth article reports the findings of a study conducted to exam the relationships of the variables structural and psychological empowerment, interprofessional collaboration, compassion, quality of care, and intent to leave with the variable moral distress. The study confirmed the hypothesized relationships between structural empowerment, psychological empowerment, quality of care, and moral distress but not between moral distress and intent to leave. One mediating but no moderating relationships were found. The findings of these papers demonstrate that moral distress continues to be an important issue in nursing. With these findings and with those from other studies there is an opportunity to begin the work on studies to evaluate strategies to mitigate moral distress as it relates to the nurse-patient therapeutic relationship.

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