Concept Analysis of Moral Distress in Pain Management.

Objective: Managing pain continues to be a difficult issue worldwide. Pain management has ethical connotations, with the potential to result in moral distress in nurses. The aim of this concept analysis is to analyze moral distress in pain management.

Design: Walker and Avant's method of concept analysis was utilized to determine attributes, antecedents, and consequences of moral distress in pain management.

Methods: Literature searches in The Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Web of Science, and Pub Med were performed. The search identified and utilized 16 articles in the concept analysis.

Results: Four major attributes of moral distress in pain management are discussed: (1) feeling of ownership of patient pain, (2) perceived powerlessness, (3) frustration, and (4) feelings of conflict between pain management situation, personal values, and professional values of nursing. Antecedents were patients experiencing pain, barriers, and having knowledge of the right thing to do. Consequences included nurse burnout, turnover and exit from the profession, compromised patient care, emotional withdrawal from patients, depersonalization of patients, and feelings of complicity and wrongdoing.

Conclusions: This concept analysis provides a foundation for future research examining moral distress in pain management.