First Advisor

Copeland, Darcy A.

Second Advisor

Pool, Natalie M.

First Committee Member

Henry, Melissa L.

Second Committee Member

Karlin, Nancy

Degree Name

Doctor of Philosophy

Document Type

Dissertation

Date Created

8-2025

Department

College of Natural and Health Sciences, Nursing, Nursing Student Work

Abstract

Moral distress is a well-known phenomenon among hospital-based bedside nurses that is damaging and dangerous to patients, nurses, the healthcare system, and society. There is a gap in the literature related to the experience of moral distress (MD) among hospital-based nurse case managers. The purpose of this qualitative research study was to understand the experience of MD for the hospital-based nurse case manager and identify triggering events and consequences of MD. The following research questions guided this study:

Q1 What is the experience of MD among hospital-based nurse case managers?

Q1a What do they identify as causes or precursors of MD?

Q1b How do they describe the personal and professional consequences of MD?

Q1c What do they identify as helpful in managing their experiences of MD?

Q1d What do they identify as barriers to managing their MD?

Guided by Guzys’ (2021) moral distress model, 11 hospital-based nurse case managers were recruited and participated in semi-structured interviews via Zoom. Transcripts were analyzed using Braun and Clarke's (2006) thematic analysis. In this study, MD was described as inherent to practice. The constraints associated with MD were grouped into three categories: patient-centered, role-related, and system constraints. Consequences of MD included negative and positive professional consequences and negative personal consequences. Factors that participants considered helpful for managing moral distress were identified. Workplace factors beneficial for the management of MD included supportive leadership, peer support, and time to process moral distress. Prominent barriers to managing MD identified in this study were the perception of continued constraint, peer pressure from bedside nurses, and compounding cases of constraint and MD. Insights from this study could be utilized to manage and mitigate the risk of MD and foster a resilient workforce capable of meeting current and future challenges.

Abstract Format

html

Keywords

hospital-based nurse case manager; case management; moral distress; qualitative description

Places

Greeley, Colorado

Extent

221 pages

Local Identifiers

Leas_unco_0161D_11352.pdf

Rights Statement

Copyright is held by the author.

Digital Origin

Born digital

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