Exploring hematology oncology nurses experiences of moral distress using a grounded theory approach

Moral distress is historically defined as occurring when an individual knows the right thing to do, but due to institutional or interpersonal constraints, is unable to do it. Moral distress is associated with increased burnout and turnover for healthcare professionals and potentially even adverse outcomes for patients, all of which are costly for healthcare systems. Moral distress is most prominent in emergency room, intensive care and oncology nurses, with most studies focused on nurses in the emergency and intensive care settings. While moral distress has been broadly defined for oncology nurses there is a dearth of information specific to hematology-oncology nurses, for whom extended length of stay related to treatment and related toxicities may influence the contributing factors to their experience of moral distress, distinct from those experienced by emergency and intensive care nurses. This qualitative study applied a Grounded Theory approach to explore hematology-oncology nurses’ experience of moral distress. The use of constant comparison techniques within this methodology allowed for exploration and identification of patterns of moral distress in this unique nursing population and relationships between those patterns. These insights informed what contributing factors to moral distress may be similar to or distinct from those experienced by nurses in other specialties. The identification of these contributing variables informs more robust theoretical models and can guide the development of interventions specific to the hematology-oncology nursing community.