Guest editorial Beyond moral distress: Preserving the ethical integrity of nurses

Every year, I meet a new group of postgraduate nursing students who come together to study ethics at an advanced level. For some, it is the first time in their careers that they have been able to express their ethical concerns in such a forum, or in some cases, in any formal setting; for others, it is a confirmation that not all perceived failures relating to moral issues are necessarily of their or their nursing colleagues ’ own making. For all, it is a bitter-sweet confirmation of the difficulties involved in dealing with those sometimes painful moral problems that they have encountered over what is often several years of practice. Indeed, it is as if through the exchange of narratives, each student feels not only marginally unburdened but free to finally state those things that really matter to them in a forum where others actually appreciate their opinions. But then at some point, we come to an examination of what is currently called nursing ‘moral distress’, and slowly but surely, a rising degree of exasperation and annoyance emerges around the room, as one by one the students all focus on the same question, namely, ‘What are we to do about moral distress?’ Moral distress is a phenomenon that is a reality in nursing however it is labelled or packaged, and what-ever the experts say it is or it is not. Whenever a group of experienced nurses identify a collection of unre-solved or poorly resolved ethical issues in their workplaces, it will exist in one form or another.1 It is moral distress (as opposed to other possibilities of nursing distress) when there exists a moral element or threat to