Defense Date


Graduation Date

Fall 1-1-2017


One-year Embargo

Submission Type


Degree Name



Health Care Ethics


McAnulty College and Graduate School of Liberal Arts

Committee Chair

Gerard Magill

Committee Member

Henk ten Have

Committee Member

Joris Gielen


Moral Distress, Moral Residue, Crescendo Effect, Organizational Culture, Systems Thinking, Organizational Leadership and Methods of Communication.


Abstract: The question that this dissertation seeks to answer is whether or not a Systems Approach to Moral Distress can serve to positively address issues of moral distress within the Long-Term Care setting. Because moral distress has largely been understood as a phenomenon of the individual, efforts to address and reduce incidents of moral distress have focused almost entirely on the individual and his or her reaction to specific triggers. Building upon the existing literature this dissertation argues that previous efforts to understand moral distress within the healthcare setting have been limiting in two very important aspects. The first in acknowledging that much of the research related to moral distress in healthcare has focused almost exclusively on issues of moral distress within the acute care setting. The second limiting factor relates to how efforts to identify and reduce incidents of or moral distress have largely focused on the individual and his or her response to specific triggers. This dissertation shifts the perspective away from a strict focus on the acute care setting and explores moral distress within the long-term care setting. In addition, the dissertation expands the argument from looking solely at individual responses to specific triggers to a systems approach of identifying and reducing incidents of moral distress organizationally within the long-term care setting. Three specific areas of focus are explored applying systems thinking to each: the Culture of the organization, the Leadership of the organization and the methods of Communication utilized within the organization.