Moral distress among healthcare workers is not a single event but a cumulative experience shaped by personal, relational and institutional factors, according to a qualitative study published in BMC Medical Ethics. The research, led by Samuel Orton with colleagues including Joanne Durkin, Timothy Haydon and Daniel Fleming, was published on 28 October 2026 as an open access article.
The study is a secondary analysis of qualitative data originally collected to explore healthcare workers’ experiences of ethical encounters. Moral distress emerged as a prominent, unprompted theme during the primary research, prompting the authors to examine it in depth. The team notes that moral distress is a well-documented phenomenon among healthcare workers and is associated with negative psychological outcomes and detrimental impacts on patient care, staff wellbeing and health system sustainability.
Data were drawn from four focus groups involving 26 registered health professionals at an Australian teaching hospital. Participants reflected on a progressively complex fictional patient case study. Although the primary study did not set out to investigate moral distress specifically, its prominence across the focus groups warranted secondary analysis. The researchers used a combined inductive and deductive coding approach, applying an a-priori code of “moral distress” and iteratively developing codes into themes, which are presented in a descriptive framework. The study is reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Participants described moral distress arising from three interrelated drivers. The first was constrained agency and voice: an inability to raise ethical concerns, not being heard or acknowledged, or having to enact decisions made by others. This finding points to the relational dimension of ethical difficulty in clinical settings, where the capacity to speak up may be limited by professional position or workplace dynamics.
The second driver was systemic constraints. Participants pointed to organisational hierarchy, resource and logistical limitations, and a sense of being overwhelmed by structural and societal factors. These constraints sit outside the control of individual clinicians, yet they shaped how ethical encounters unfolded and how distress was experienced.
The third driver involved deficits in preparedness and understanding. Participants described a lack of ethical deliberative frameworks, insufficient training, and shouldering what they perceived as an unreasonable ethical burden in decision making. Together, the three drivers suggest that moral distress accumulates through the interplay of personal, relational and institutional factors as healthcare workers navigate the ethical complexity embedded in clinical practice.
The study also identified protective factors, which the authors describe under the term “moral safety”. These included cultivating shared understanding through dialogue and support, and camaraderie and collaboration among colleagues. The concept of moral safety offers a counterpoint to the drivers of distress, suggesting that relational and collegial supports can buffer the ethical strain of clinical work.
The authors conclude that interventions focused on individual resilience risk mislocating responsibility for what is a systemic issue. Instead, their findings highlight the need for structural responses: procedural frameworks for ethical deliberation, organisational cultures that reduce hierarchical barriers to voice, and formal spaces for collective processing of morally difficult experiences.
The researchers present their conceptual framework as a foundation for future research and targeted institutional interventions. As a qualitative study based on focus groups at a single Australian teaching hospital, using a fictional case study as its prompt, the findings describe participants’ reported experiences rather than measured outcomes, and the authors frame the framework as a basis for further investigation rather than a tested intervention.
The article was published under open access terms in BMC Medical Ethics, with the accepted manuscript shared early to provide faster access to peer-reviewed research; this version is subject to further edits and will be replaced by the final Version of Record.
Subject of Research: Healthcare workers' experiences of moral distress when navigating ethical complexity in clinical practice
Article Title: How healthcare workers experience moral distress while navigating ethical complexity: a qualitative study
Article References: Orton, S., Durkin, J., Haydon, T., & Fleming, D. (2026). How healthcare workers experience moral distress while navigating ethical complexity: a qualitative study. BMC Medical Ethics. https://doi.org/10.1186/s12910-026-01645-7
Image Credits: AI Generated
DOI: 10.1186/s12910-026-01645-7
Keywords: moral distress, healthcare workers, medical ethics, qualitative research, focus groups, ethical decision making, organisational hierarchy, moral safety, staff wellbeing, BMC Medical Ethics, secondary analysis, clinical practice
News Source: Ophelia Keating. (October 28, 2026). Healthcare workers describe moral distress driven by hierarchy, systems and unpreparedness. Scienmag.
