The Invisible Wound: An Integrative Review of Moral Distress in Critical Care and Oncology Nursing – Causes, Consequences, and Evidence-Based Coping Strategies
Abstract
Background: Moral distress, the psychological anguish experienced when one knows the right action to take but is constrained from taking it, is a pervasive and debilitating phenomenon in nursing. Nurses working in high-acuity environments, including Critical Care and Oncology, are at exceptional risk given the frequency of ethically complex decisions related to end-of-life care, the futility of treatment, and resource allocation. Aim: The purpose of this integrative review was to synthesize a decade of literature (2015-2024) focused on the unique causes and consequences of moral distress among Critical Care and Oncology nurses and to assess the effectiveness of evidence-based coping and mitigation strategies. Methods: A systematic search of five databases (CINAHL, PubMed, PsycINFO, Scopus, and Web of Science) was conducted, yielding peer-reviewed articles for final analysis following Whittemore and Knafl's methodology. Results: The analysis identified four primary causative domains: perceived futile care, institutional constraints, poor communication, and team dissonance. Consequences were categorized at the individual level-burnout, PTSD, turnover intent-and organizational level-compromised care and high turnover. Effective interventions were multi-level, ranging from individual-focused strategies of moral resilience training, mindfulness, and peer support to system-level initiatives such as ethics debriefings, unit-based ethics committees, and transformative leadership. Conclusion: Moral distress is not an individual failing but rather a symptom of systemic ethical conflict. Thus, a sustainable solution requires a dual-pronged approach that simultaneously fosters individual moral resilience and transforms organizational structure and cultures to support ethical practice. Proactive, system-wide initiatives are required to mitigate this "invisible wound" and to preserve the nursing workforce.
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Authors
Copyright (c) 2024 Tahani Nazal Naqaa Alshammari, Nashmeyah Hmadian Al Rashedy, Sabahah Saad Dabis Alazmi, Amnah Menwer Fayed Alrashidi, Abdulmajeed Mudhi Al Shammari, Reem Hamad Abdullah Alshammari, Lafi Menwer Lafi Alharbi, Sadun Fuhayd Sadun Almuhayfir, Ayman Fehaid S Almohifer, Bushra Ahmed Alabdullatif, Majedah Nayyaf Alotaibi, Faisal Abdulaziz Altayyar
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