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Reducing Moral Distress in Case Managers

Moffat, Mary BSN, MEd, MLIS

doi: 10.1097/NCM.0000000000000039

Purpose: Moral distress can be caused by ethical conflicts that are common in acute care settings. Hospital case managers are unique caregivers in hospital environments. Case managers are advocates who coordinate organizational, clinical, and personal standards. Ethical conflicts embedded in performing delegated responsibilities are burdensome, therefore creating a risk for moral distress. Mindfulness education is suggested as a meaningful process to mitigate moral distress for frontline caregivers.

Primary Practice Setting: Moral distress describes organizational, clinical, and personal ethical conflicts and constraints a caregiver experiences in acute care settings.

Findings/Conclusions: Theories and tools addressing moral distress continue to evolve. Researchers are revising and creating new tools defining moral distress, but triggers and responses vary among ethically conflicted nurses. Causes of moral distress include burden and frequency of ethical conflict and constraints leading to depression, anger, and impaired perception of competency. Little attention has been given to hospital case management as a caregiving profession at risk. The ethical dilemmas research defines as “risks” for moral distress are prevalent in the ethical responsibilities delegated to case management.

Implications for Case Management Practice: The hospital case manager's responsibilities contain compelling and competing ethical priorities of patient advocate, organization representative, and competent professional. General suggestions to moderate moral distress have been inadequate in mitigating the problem, because they do not adequately offer the caregiver a way to identify and process moral distress. Causes and conditions describing moral distress due to ethical conflicts are similar to themes of suffering and awareness identified in mindfulness and other reflective exercises. A workshop series introducing reflective practices is an appropriate approach to reduce negative outcomes of moral distress in caregiver roles.

Mary Moffat, BSN, MEd, MLIS, held the nursing program director of finance position in the Department of Care Coordination within a teaching hospital in Boston, MA, for 15 years. She is currently a candidate for a PhD in Education at Ohio University.

Address correspondence to Mary Moffat, BSN, MEd, MLIS, The Gladys W. and David H. Patton College of Education, Ohio University, McCracken Hall 133, Athens, OH 45701 (

The authors thank Dr. John Henning, PhD, associate dean for academic engagement and outreach, whose infinite patience, humor, and encouragement fueled this article's mission.

The author reports no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.