Healthcare professionals (HCWs) often experience moral stress and distress when faced with ethical dilemmas in which aligning their actions with their core moral beliefs becomes difficult. During major crises like disasters or pandemics, these ethically complex moments become far more common, mainly due to the growing mismatch between what patients need and the limited resources available. That said, the concepts of moral stress and moral distress are applied inconsistently across the literature, with definitions that vary widely and remain ambiguous. This investigation seeks to explore and scrutinize how HCWs themselves portray morally difficult situations (referred to as moral stress), while also sharpening a precise definition via detailed conceptual examination. Qualitative information was gathered via a survey completed by 16,044 Swedish HCWs who took part in an online COVID-19 training program during autumn 2020. In all, 643 open-ended written responses detailing experiences of moral stress were analyzed.
Content analysis revealed three central themes: (1) “Seeing, but being prevented from acting; feeling insufficient/inadequate and constrained in the profession,” (2) “Someone or something hindered me; organizational structures as an obstacle,” and (3) “The pandemic hindered us; pandemic-related obstacles.” Together, these three themes align under one overarching theme: “Being prevented from providing good care.” This overarching theme frames moral stress as different types of barriers that stop healthcare workers from offering high-quality care to those in need and from following through on their natural empathic instincts in a professional capacity. The themes are reviewed alongside well-known definitions of moral stress and assessed using conceptual analysis techniques. From this process, an improved definition of moral stress was created, drawing directly from one of the previously established definitions. On the strength of the research outcomes and the conceptual evaluation, the newly formulated definition is argued to meet essential criteria for adequacy. It is critically important to establish a clear and consistent understanding of moral stress, a concept that has been interpreted in varied ways across different fields. Such clarity is necessary to ensure we are all referring to the same thing and to support the creation of targeted strategies that help prevent the damaging consequences associated with this issue.
