HEC Forum

, Volume 28, Issue 1, pp 53–67 | Cite as

Organizational Influences on Health Professionals’ Experiences of Moral Distress in PICUs

  • Sarah Wall
  • Wendy J. Austin
  • Daniel Garros

This article reports the findings of a qualitative study (secondary analysis) that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units (PICUs) across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were identified. This study provides a rare and important multi-disciplinary perspective on this topic and the findings have implications for administrators and leaders who seek to improve the moral climate of healthcare delivery.


Organizational ethics Ethical climate Leadership Healthcare team 


  1. Austin, W. (2012). Moral distress and the contemporary plight of health professionals. HEC Forum, 24, 27–38.CrossRefGoogle Scholar
  2. Bell, J., & Breslin, J. M. (2008). Healthcare provider moral distress as a leadership problem. JONA’s Healthcare Law, Ethics, and Regulation, 10(4), 94–97.CrossRefGoogle Scholar
  3. Childs, B. H. (2000). From boardroom to bedside: A comprehensive organizational healthcare ethics. HEC Forum, 12(3), 235–249.CrossRefGoogle Scholar
  4. Corley, M. C., Minick, P., Elswick, R. K., & Jacobs, M. (2005). Nurse moral distress and ethical work environment. Nursing Ethics, 12(4), 381–390.CrossRefGoogle Scholar
  5. Grob, C., Leng, J., & Gallagher, A. (2012). Educational responses to unethical healthcare practice. Nursing Standard, 26(41), 35–41.CrossRefGoogle Scholar
  6. Hall, P. (2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, Suppl. 1, 188–196.CrossRefGoogle Scholar
  7. Hart, S. E. (2005). Hospital ethical climates and registered nurses’ turnover intentions. Journal of Nursing Scholarship, 37(2), 173–177.CrossRefGoogle Scholar
  8. Houston, S., Casanova, M. A., Leveille, M., Schmidt, K. L., Barnes, S. A., Trungale, K. R., & Fine, R. L. (2013). The intensity and frequency of moral distress among different healthcare disciplines. Journal of Clinical Ethics, 24(2), 98–112.Google Scholar
  9. Jameton, A. (1984). Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  10. Kalvemark, S., Hoglund, A. T., Hansson, M. G., Westerholm, P., & Arnetz, B. (2004). Living with conflicts-ethical dilemmas and moral distress in the health care system. Social Science and Medicine, 58(6), 1075–1084.CrossRefGoogle Scholar
  11. Lützén, K., & Kvist, B. E. (2012). Moral distress: A comparative analysis of theoretical understandings and inter-related concepts. HEC Forum, 24, 13–25.CrossRefGoogle Scholar
  12. Lützén, K., & Schreiber, R. (1998). Moral survival in a nontherapeutic environment. Issues in Mental Health Nursing, 19, 303–315.CrossRefGoogle Scholar
  13. Mayan, M. (2009). Essentials of qualitative inquiry. Walnut Creek, CA: Left Coast Press.Google Scholar
  14. McCarthy, J., & Deady, R. (2008). Moral distress reconsidered. Nursing Ethics, 15, 254–262.CrossRefGoogle Scholar
  15. Opel, D. J., Wilfond, B. S., Brownstein, D., Diekema, D. S., & Pearlman, R. A. (2009). Characterisation of organisational issues in paediatric clinical ethics consultation: A qualitative study. Journal of Medical Ethics, 35, 477–482.CrossRefGoogle Scholar
  16. Pauly, B., Varcoe, C., & Storch, J. (2012). Framing the issues: Moral distress in health care. HEC Forum, 24, 1–11.CrossRefGoogle Scholar
  17. Pauly, B., Varcoe, C., Storch, J., & Newton, L. (2009). Registered nurses’ perceptions of moral distress and ethical climate. Nursing Ethics, 16(5), 561–573.CrossRefGoogle Scholar
  18. Pentz, R. D. (2000). Core values: An ethics committee’s foray into management theory. HEC Forum, 12(3), 225–234.CrossRefGoogle Scholar
  19. Robinson, M., & Cottrell, D. (2005). Health professionals in multi-disciplinary and multi-agency teams: Changing professional practice. Journal of Interprofessional Care, 19(6), 547–560.CrossRefGoogle Scholar
  20. Rushton, C. H., Kaszniak, A. W., & Halifax, J. S. (2013). A framework for understanding moral distress among palliative care clinicians. Journal of Palliative Medicine, 16(9), 1074–1079.CrossRefGoogle Scholar
  21. Schluter, J., Winch, S., Holzhauser, K., & Henderson, A. (2008). Nurses’ moral sensitivity and hospital ethical climate: A literature review. Nursing Ethics, 15(3), 304–321.CrossRefGoogle Scholar
  22. Silverman, H. J. (2000). Organizational ethics in healthcare organizations: Proactively managing the ethical climate to ensure organizational integrity. HEC Forum, 12(3), 202–215.CrossRefGoogle Scholar
  23. Storch, J. L., Rodney, P., Pauly, B., Brown, H., & Starzomski, R. (2002). Listening to nurses’ moral voices: Building a quality health care environment. Canadian Journal of Nursing Leadership, 15(4), 7–16.CrossRefGoogle Scholar
  24. Storch, J. L., Schick Makaroff, K., Pauly, B., & Newton, L. (2013). Take me to my leader: The importance of ethical leadership among formal nurse leaders. Nursing Ethics, 20(2), 150–157.Google Scholar
  25. Varcoe, C., Doane, G., Pauly, B., Rodney, P., Storch, J. L., Mahoney, K., et al. (2004). Ethical practice in nursing: Working the in-betweens. Journal of Advanced Nursing, 45(3), 316–325.CrossRefGoogle Scholar
  26. Varcoe, C., Pauly, B., Storch, J., Newton, L., & Makaroff, K. (2012a). Nurses’ perceptions of and responses to morally distressing situations. Nursing Ethics, 19(4), 1–13.CrossRefGoogle Scholar
  27. Varcoe, C., Pauly, B., Webster, G., & Storch, J. (2012b). Moral distress: Tensions as springboards for action. HEC Forum, 24, 51–62.CrossRefGoogle Scholar
  28. Wall, S., & Austin, W. (2008). The influence of teams, supervisors and organizations on healthcare practitioners’ abilities to practise ethically. Nursing Leadership, 21(4), 85–99.CrossRefGoogle Scholar
  29. Webster, G. C., & Baylis, F. (2000). Moral Residue. In S. B. Rubin & L. Zoloth (Eds.), Margin of error: The ethics of mistakes in the practice of medicine. Hagersstown, MD: University Publishing Company.Google Scholar
  30. Winkler, E. C. (2005). The ethics of policy writing: How should hospitals deal with moral disagreement about controversial medical practices? Journal of Medical Ethics, 31, 559–566.CrossRefGoogle Scholar
  31. Wolpe, P. R. (2000). From bedside to boardroom: Sociological shifts and bioethics. HEC Forum, 12(3), 191–201.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.Faculty of Nursing and John Dossetor Health Ethics CentreUniversity of AlbertaEdmontonCanada
  2. 2.Faculty of Medicine and John Dossetor Health Ethics CentreEdmontonCanada
  3. 3.Pediatric Intensive Care UnitStollery Children’s HospitalEdmontonCanada

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