Moralisk stress är ett fenomen som kan uppstå när det sker ett moraliskt dilemma på grund avatt organisatoriska ramförutsättningar kolliderar med yrkesutövarens personliga värderingar.Tidigare forskning visar att fenomenet påverkar socialarbetare negativt genom varierandesymtom. Däremot råder det en kunskapslucka gällande återfinnandet av fenomenet hosutövare av socialt arbete inom den ideella sektorn. Syftet med studien är att undersöka omoch i så fall i vilka avseenden utförare av socialt arbete inom den ideella sektorn erfararmoralisk stress, genom att jämföra fenomenets närvaro i både Sverige och Tanzania.Fenomenet har undersökts med hjälp av semistrukturerade intervjuer med tre olikafrivilligorganisationer i respektive land och har sedan analyserats med hjälp av tematiskanalys. Resultaten visar både likheter och skillnader vid förekomsten av moralisk stress. Bådaländer står inför organisatoriska hinder och riskfaktorer som orsakar moralisk stress sombegränsad beslutsrätt och personalbrist. Det framkommer också skillnader som kan förklarasutifrån den samhälleliga kontexten och dess förutsättningar som klientmotstånd och motståndfrån tillhörande community. En central skyddsfaktor för båda länderna är kollegialt stöd inomarbetsplatsen som både kan motverka och åtgärda upplevelsen av fenomenet. / Moral distress is a phenomenon that can occur when a moral dilemma presents itself becauseof a collision between institutional limitations and personal values. Research shows that thephenomenon has a negative effect on social workers through various symptoms. However,there is a gap within the knowledge of the occurrence of the phenomenon among practitionersof social work within the nonprofit sector. The aim of this study is to examine if and in whatway moral distress occurs among practitioners of social work in the nonprofit sector and tomake a comparison between two different cultures through examining the phenomenon inboth Sweden and Tanzania. To examine the phenomenon, semi structured interviews havebeen conducted with three different organizations in each country which have later on beenanalyzed thematically. The results show both differences and similarities regarding theoccurrence of moral distress. Both countries face institutional limitations and risk factorssuch as, limited right of decision and shortage of staff, that can cause moral distress. Beyondthis there are also differences that can be explained by the cultural context and its conditionssuch as resistance from the client and its community. A distinguished similarity in bothcountries is the available peer support within the organization that seems to both prevent andremedy the experience of the moral distress.

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The aims of this thesis were to explore nurses' experiences of stress in the ICU (I), to analyze experiences of moral concerns in intensive care nursing from the perspective of relational ethics (II), to describe the synthesis of the concept of moral stress and to identify preconditions for moral stress (III) and to analyse and describe lived experiences of support in situations characterized by critical care situations and moral stress in intensive care (IV).The design was exploratory and descriptive. Material in studies I, II and IV consisted of interviews with intensive care nurses (10 head nurses and 26 staff nurses) employed in general, thoracic and neonatal intensive care units in five hospitals located in different parts of Sweden. The material in study III data from two studies of professional issues in nursing were used for the analysis: one concerned psychiatric nursing and the other was the previously referred study I.In study I qualitative content analysis and descriptive interpretation was used in the analysis. The main theme 'stress induced by dissonant imperatives' formulated in the analysis. Dissonant imperatives are composed of the four sub-themes: 1) controlled by the working situation - needing to be in control, 2) constrained by prioritisation - wanting to do more, 3) lacking authority to act - knowing that something should be done, and 4) professional distance - interpersonal involvement. In study II qualitative content analysis and descriptive interpretation were used in the analysis. A main theme was formulated, 'caring about-caring for: tensions between moral obligations and work responsibilities in intensive care nursing'. Five sub-themes were formulated 1) believing in a good death, 2) knowing the course of events, 3) feelings of distress, 4) reasoning about the physicians and 5) expressing moral awareness. In the study III a hypothetical-deductive method was used. The findings indicate that moral stress is independent of context-given specific pre-conditions: 1) nurses are morally sensitive to the patient's vulnerability, 2) nurses experience external factors preventing them from doing the best for the patient, and 3) nurses feel that they have no control over the situation. In the study IV an interpretive method was used. The first level of analysis of data identified contextual factors, such as type and purpose of support and working conditions. Thereafter five tentative interpretations were revealed: 1) receiving organised support is a matter of self-determination, 2) whether to participate or to be off duty is experienced mutually as exclusive, 3) dealing with moral stress is experienced as a private matter, 4) colleagues managing moral stress serve as models in stress support, and 5) not being able to deal with moral stress urges one to seek outside support. A comparison of these interpretations identified three major themes: availability, accessibility and receptivity of support. The main interpretation of data was: "lived experience of moral stress support involves an interconnectedness between structural and existential factors".A comprehensive understanding was formulated using the four studies (I, II, III and IV). Moral stress was found to be influential on the caring competence. Conflicts between different competences were found leading to a shift in focus away from the patients leading to a possible decrease in the caring competence. Moreover, the subtle resistance among nurses toward participation in organized moral stress support may obstruct the development of nurses' caring competence. Accordingly, imbalance, due to moral stress, between different competences hinders the development of collectively shared caring competence.

This paper provides an analysis of Bradshaw and Colleagues' model of military healthcare professionals' moral distress experiences. Using novel interview data collected from Canadian Forces healthcare professionals, the steps of the model are validated or potential refinements are suggested. / Military healthcare professionals (HCPs) may experience moral distress during international deployment. Moral distress is experienced when a HCP faces a moral dilemma, e.g., knows the morally correct course of action but is blocked from taking it, or where all available courses of action require something of moral significance be given up. While the literature indicates that moral distress often negatively impacts the mental health of the individual and the effectiveness of the organization, limited research has examined moral distress amongst military HCP. Many similar stressors and psychological health problems are present for both civilian and military HCP; however, the unique context of deployment necessitates further examination. This thesis explores the military HCP experience with moral distress by using Bradshaw and colleague’s model of progression from the encounter with a moral dilemma to the impact on individuals and organizations. Through the analysis of novel interviews collected by the Ethics in Military Medicine Research Group (EMMRG), Bradshaw and colleague’s model of military moral distress is compared to participant’s experiences and qualitatively analysed, with the results outlining where the model is supported and where refinement is recommended. These challenges were then supported by a literature review from the disciplines of virtue and feminist ethics, moral psychology, bioethics, and civilian HCP moral distress research. Two novel and significant revisions to the model are suggested: representing and integrating the cumulative experience of moral distress, and re-conceptualizing the resolution process based on the consideration of contextual controllability on moral responsibility. / Thesis / Master of Science (MS) / This thesis examines the experience of moral distress in military healthcare professionals (HCPs) while working abroad, where a HCP faces a moral dilemma, e.g., knows the morally correct course of action but is blocked from taking it or it requires something of moral significance be given up. This thesis analyses the most recent model of military HCP moral distress (Bradshaw, et al., 2010) by comparing it to the experiences described by participants in the Ethics in Military Medicine Research Group (EMMRG) study. The results outline support for the model as well as novel suggestions for revision, which are supported by literature from a variety of disciplines. Two adjustments to Bradshaw and colleague’s model are suggested: clearer representation of the cumulative nature of moral distress as well as a reconceptualization of the resolution process to consider the influence of the immediate and extended environment on moral responsibility.