Illuminating moral distress: A grounded theory study informed by critical realism

Abstract

What is it about social work that makes it so ethically challenging? Why do social workers seem to feel moral distress so accurately captures their experiences? And why has there been so much conceptual confusion regarding moral distress? Although well documented in other helping professions, moral distress has not been well represented in the SW literature. Yet, social workers are accustomed to working in ethical challenging conditions. Building from the seminal work of previous scholars and backed with practical experiences from current practitioners this study applies critical realist methodology to grounded theory methods to reconstruct a conceptual model of moral distress. A mix of qualitative and quantitative studies have established the groundwork for further analysis. Empirical evidence was gathered through interviews with experienced social workers. Data analysis was conducted through an abductive lens intended to integrate all potential theoretical explanations. Participants described situations that gave rise to significant moral consequences that impacted their mental health and professional career. They described feelings of frustration, anger, resentment, and self-defeat related to an inability to act on their perceived ethical duty. Ethical challenges were categorized into 5 commonly described themes. 1) Powerlessness 2) Advocacy for Social Justice and its influence on social workers 3) Moral impact of undemocratic work environments 4) Self-determination and barriers preventing participant’s efforts to empower clients 5) Moral consequences for social workers working within the medical model. The 5 major themes have been recognized as the leading factors giving rise to moral distress. This study exposes the interrelated features and underlying mechanisms leading to moral distress in social work and demonstrates that moral distress is more complex and dynamic than scholars have previously specified.