{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T11:47:03Z","timestamp":1792324023885,"version":"4.4.0"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"abstract":"<jats:p>Moral distress is recognized as a major contributor to burnout and attrition among nurses. While the sequelae of moral distress are profound, the antecedents of moral distress are multi-factorial and therefore the phenomenon is challenging to address. Many interventions target individual-level factors such as moral resilience; however, moral distress is a system-level problem. As such, there is a growing focus on developing upstream, system-level interventions to mitigate or prevent moral distress in the healthcare setting. Moral community is a system-level dynamic that reflects ethical climate and perceived organizational support, metrics that are often associated with moral distress. However, the connection between moral distress and moral community in nursing remains under-examined. Therefore, the purpose of this narrative review was to explore the relationship between moral distress and the concept of moral community in the context of nursing practice. Three categories emerged from this analysis: organizational constraints that instigate moral distress, moral community as a concept, and the role of moral community in an organization. Based on these categories, a revised definition of moral community was developed and used to synthesize a novel theoretical framework relating moral community to moral distress. Further research may apply the proposed definition of moral community and theoretical framework to (1) evaluate existing organizational ethical frameworks and (2) formulate novel interventions to address moral distress.<\/jats:p>","DOI":"10.1177\/09697330261490842","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:10:54Z","timestamp":1792127454000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Moral distress &amp; moral community: A narrative review of the literature"],"prefix":"10.1177","author":[{"given":"Gaelyn","family":"Grant","sequence":"first","affiliation":[{"name":"Boston College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9077-1404","authenticated-orcid":false,"given":"Aimee","family":"Milliken","sequence":"additional","affiliation":[{"name":"Boston College"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.4037\/aacnacc2020285"},{"key":"e_1_3_4_3_2","unstructured":"Nursing Solutions Inc. NSI national health care retention & RN staffing report. https:\/\/www.nsinursingsolutions.com\/documents\/library\/nsi_national_health_care_retention_report.pdf (2026) March 2026."},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.4037\/aacnacc2016275"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2022.04.015"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2023.2224270"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202202-111IP"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0268375"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-015-3505-1"},{"key":"e_1_3_4_10_2","volume-title":"Nursing practice: the ethical issues","author":"Jameton A","year":"1984","unstructured":"Jameton A. Nursing practice: the ethical issues: Prentice-Hall, 1984."},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/23294515.2019.1586008"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2022.2044544"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191710640"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/nup.12419"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/jan.16135"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1086\/JCE2016273201"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","unstructured":"Morley G Field R Horsburgh CC et al. Interventions to mitigate moral distress: a systematic review of the literature. Int J Nurs Stud; 121. DOI: 10.1016\/j.ijnurstu.2021.103984. Epub ahead of print 2021.","DOI":"10.1016\/j.ijnurstu.2021.103984"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1086\/730869"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.2307\/3562818"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733019845127"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733021992448"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","unstructured":"Liaschenko J Peter E. Fostering nurses\u2019 moral agency and moral identity: the importance of moral community. Hastings Cent Rep; 46. DOI: 10.1002\/hast.626. Epub ahead of print 2016.","DOI":"10.1002\/hast.626"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/10497323231213825"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/NJH.0000000000000456"},{"key":"e_1_3_4_25_2","first-page":"221","article-title":"The medical profession as a moral community","volume":"66","author":"Pellegrino ED","year":"1990","unstructured":"Pellegrino ED. The medical profession as a moral community. Bull N Y Acad Med 1990; 66: 221\u2013232.","journal-title":"Bull N Y Acad Med"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/15271544211054435"},{"key":"e_1_3_4_27_2","unstructured":"American Nurses Association. Code of ethics for nurses 2025. https:\/\/codeofethics.ana.org\/home"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1086\/734775"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733015615172"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2016133"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.16089"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-022-07848-z"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.3912\/OJIN.Vol29No03PPT65a"}],"container-title":["Nursing Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261490842","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09697330261490842","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261490842","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T11:17:03Z","timestamp":1792322223000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09697330261490842"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":32,"alternative-id":["10.1177\/09697330261490842"],"URL":"https:\/\/doi.org\/10.1177\/09697330261490842","relation":{},"ISSN":["0969-7330","1477-0989"],"issn-type":[{"value":"0969-7330","type":"print"},{"value":"1477-0989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"article-number":"09697330261490842"}}