Moral distress, shame, and professional identity in older adult care

BackgroundMoral distress is an increasingly recognized ethical concern in healthcare, particularly in older adult care, where it is associated with negative consequences for nurses, patients, and healthcare organizations. Although widely studied, its emotional dimensions, particularly the role of shame, remain insufficiently understood.AimTo explore nurses' experiences of moral distress, shame, and professional identity in older adult care, as well as their perspectives on support and development opportunities that can alleviate moral distress and its consequences.Research designQualitative exploratory design. In-depth semi-structured interviews.Participants and research contextFifteen nurses in an older adult care context. Years of professional experience ranged from 4 to 46. Ethical considerationsEthical approval was obtained from the Committee on Research Ethics at Åbo Akademi University, Finland, and permission was granted by the participating Wellbeing Services County. Written and oral informed consent was obtained from all participants. The study adhered to the Finnish National Board on Research Integrity (TENK, 2023) guidelines on good scientific practice.FindingsThree main themes were identified: Moral distress as a pervasive threat to professional identity, Shame and moral conflict in the experience of moral distress, and Organizational conditions and strategies for managing moral distress. DiscussionMoral distress was perceived as closely linked to shame and professional identity. The findings underscore the need to address emotional and organizational dimensions of moral distress in care for older adults.ConclusionsMoral distress in older adult care is a pervasive, multidimensional, and sustained phenomenon shaped by individual factors and organizational conditions. Efforts to reduce moral distress should move beyond individual coping strategies and include structural and cultural changes that support nurses' professional and ethical values and encourage open dialogue. Addressing moral distress is important not only for supporting nurses but also for safeguarding the quality and sustainability of care in older adult settings.