Ethical Climate and Moral Distress: A Logic Model Approach to Supporting Advanced Practice Nurses
DOI:
https://doi.org/10.61978/curatio.v2i2.1398Keywords:
Moral Distress, Advanced Practice Nurses, Organizational Constraints, Coping Strategies, Ethics Support, Healthcare LeadershipAbstract
Advanced Practice Nurses (APNs) frequently encounter moral distress when organizational, team-based, or personal constraints prevent them from acting according to their ethical convictions. This study investigates the types of constraints APNs face, their effects on moral distress, and the coping strategies used to mitigate these effects. A mixed-methods design was adopted. Quantitative data were gathered using validated tools including the Moral Distress Scale-Revised and the Moral Distress Scale for Psychiatric Nurses. Qualitative data were collected through interviews and focus groups. Regression analyses were used to explore associations between constraint types and distress outcomes, while framework synthesis and thematic analysis were employed to build a logic model. Team-level constraints were the most frequently reported (38%), followed by individual (32%) and systemic (30%) barriers. Regression models showed significant associations between systemic and team-level constraints and higher moral distress scores. Distress was positively correlated with burnout and intention to leave. Ethics consultations, team debriefings, and resilience-building programs effectively reduced distress. A logic model was developed to illustrate pathways from constraints to outcomes, identifying leverage points for organizational intervention. Organizational constraints significantly shape the ethical experience and well-being of APNs. Interventions that strengthen ethics education, institutional support, and collaborative dialogue are essential for reducing moral distress and enhancing professional sustainability. The logic model provides a strategic framework for policy development and institutional reforms.
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