Moral distress in neuroscience nursing: an evolutionary concept analysis.

Moral distress has been explored within a number of nursing contexts, including critical care, neuroscience, and end-of-life decision making. Although the antecedents and consequences of this concept continue to be uncovered, its unique attributes remain ambiguous. This analysis aims to clarify the concept of moral distress, contribute new insights about moral distress to nursing as a whole and to the subspecialty of neuroscience nursing in particular, and enhance advancements in nursing knowledge and practice. Literature published in English between 1987 and 2009 was searched using the Cumulative Index to Nursing and Allied Health Literature and Google Scholar databases. Eleven journal articles were used in the final analysis. Rodgers' evolutionary model of concept analysis was used in this study. Four comprehensive attributes were formulated to describe moral distress in neuroscience nursing: negative feelings, powerlessness, conflicting loyalties, and uncertainty. These attributes are intimately related, holding true meaning only when viewed within the context of one another and with respect to the historical and philosophical underpinnings of nursing praxis. This analysis demonstrates the fluidity, complexity, and multifacetedness of moral distress. Knowledge of the conceptual attributes presented herein will facilitate recognition and validation of personal experiences within the neuroscience nursing community.