Psychological Trauma or Moral Distress? A Response to Foli’s Middle-Range Theory of Nurses’ Psychological Trauma

Résumé

Objective: To discuss the significant similarities between Foli’s psychological distress theory and the moral distress literature. Background: Foli presents a middle-range theory to conceptualize the issues nurses face personally, professionally and within healthcare organizations as types of psychological trauma. In presenting their theory, Foli’s goal is to facilitate nurses’ communication about their experiences and analyze the organizations' responsibility for these traumas. However, other scholars have described the issues nurses face personally, professionally and within their organizations as moral distress. We believe that there are significant similarities between Foli’s psychological distress and moral distress, potentially creating confusion for researchers and theorizing about critical issues facing nurses. Methods: In this discussion paper, we highlight the ethics and morality inherent to the nursing profession, define moral distress and the impact it can have on the nurse and their patients, and
discuss the types of situations/issues that cause moral distress. We then contrast moral distress with Foli’s psychological trauma theory. Finally, we then discuss the literature about psychological trauma theory and Foli’s suggestions to nurses in comparison to moral distress literature. Results/Conclusion: There appears to be no difference between the psychological trauma theory and the moral distress literature. We recommend conceptional clarity about how the theory of psychological trauma is different from moral distress. Otherwise, we wonder if scholars’ time will be spent trying to determine whether the issue is a psychological trauma or moral distress, rather than building on existing research that exists in the moral distress body of literature.