Exploring moral distress in Australian midwifery practice |
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| Institution: | 1. Clinical and Health Sciences, University of South Australia, Australia;2. College of Nursing and Health Sciences, Flinders University, Australia;3. School of Nursing and Midwifery, Deakin University and Western Health Partnership, Australia;1. School of Nursing and Midwifery, Griffith University, Australia;2. Western Health, St Albans, VIC, Australia;3. Transforming Maternity Care Collaborative, Australia;4. School of Nursing & Midwifery, Faculty of Health, Deakin University, Australia;1. NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia;2. School of Medicine, The University of Notre Dame Australia, Broadway, NSW, Australia;3. School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia;4. Obstetrics and Gynaecology Department, Canberra Hospital, Canberra, ACT, Australia;5. Royal Australian and New Zealand College of Obstetricians and Gynaecologists, East Melbourne, VIC, Australia;6. Next Practice Health, Erina, Sydney, NSW, Australia;7. Maternity Service, Wollongong Hospital, Wollongong, NSW, Australia;1. Auckland University of Technology, AUT Department of Management, Private Bag 92006, Victoria Street West, Auckland 1142, New Zealand;2. Ludwig-Maximilians-Universität München, Faculty of Psychology, Raum 3432, Leopoldstr. 13, 80802 München, Germany;3. Auckland University of Technology, AUT Midwifery Department, Private Bag 92006, 640 Great South Road, Manukau, Auckland 2104, New Zealand;4. New Zealand College of Midwives, PO Box 21-106, Edgeware, Christchurch 8143, New Zealand;1. JBI, School of Public Health, Faculty of Health and Medical Science, University of Adelaide, Australia;2. Curtin Medical School, Curtin University, Bentley, WA, Australia;3. Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia;4. Ngangk Yira Research Centre for Aboriginal Health & Social Equity, Murdoch University, Murdoch, WA, Australia;5. Still Aware, South Australia, Australia;6. UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia |
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| Abstract: | ProblemAustralian midwives are considering leaving the profession. Moral distress may be a contributing factor, yet there is limited research regarding the influence of moral distress on midwifery practice.BackgroundMoral distress was first used to describe the psychological harm incurred following actions or inactions that oppose an individuals’ moral values. Current research concerning moral distress in midwifery is varied and often focuses only on one aspect of practice.AimTo explore Australian midwives experience and consequences of moral distress.MethodsSemi-structured interviews were used to understand the experiences of moral distress of 14 Australian midwives. Interviews were recorded and transcribed verbatim. Data were analysed using thematic analysis and NVIVO12©.FindingsThree key themes were identified: experiencing moral compromise; experiencing moral constraints, dilemmas and uncertainties; and professional and personal consequences. Describing hierarchical and oppressive health services, midwives indicated they were unable to adequately advocate for themselves, their profession, and the women in their care.DiscussionIt is evident that some midwives experience significant and often ongoing moral compromise as a catalyst to moral distress. A difference in outcomes between early career midwives and those with more than five years experiences suggests the cumulative nature of moral distress is a significant concern. A possible trajectory across moral frustration, moral distress, and moral injury with repeated exposure to morally compromising situations could explain this finding.ConclusionThis study affirms the presence of moral distress in Australian midwives and identified the cumulative effect of moral compromise on the degree of moral distress experienced. |
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| Keywords: | Moral distress Midwifery workforce Workforce sustainability Ethics Moral Compromise |
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