Moral Distress

Measuring Moral Distress in Community Pharmacists

  • Cathal T. Gallagher & Richard C. O’Neill
  • Department of Pharmacy, University of Hertfordshire, College Lane, Hatfield, AL10 9AB.

Aims & Objectives

The aim of this research is to investigate incidences of moral distress among community pharmacists. Among the objectives of the study are: to construct and validate an instrument to measure moral distress in community pharmacists; and to determine the extent to which community pharmacist experience moral distress in their working lives.


Moral distress occurs when one believes one knows morally right thing to do, but other constraints make it impossible to pursue the desired course of action. Current literature has focused on nurses and their struggle with moral distress. There have been very few studies of moral distress among pharmacists; however, a large number of studies, primarily among practitioners of various disciplines of nursing, have identified moral distress as a major source of workplace fatigue and stress, which in turn have been shown to be causal factors for increased medication error rates.

Moral distress has also been identified as a statistically significant predictor of decreased job satisfaction, and increased staff turnover. Decreased levels of health and job satisfaction, and increased job turnover have been identified in community pharmacists in the UK, although, to date, no effort has been made to link this phenomenon to moral distress, despite such a link having been identified in other healthcare professionals.

The tool most commonly used to quantify moral distress is specific to the nursing profession. There is currently no validated tool to quantify moral distress in community pharmacists.


To identify situations occurring in daily practice that contain ethical dilemmas and are experienced as stressful, three focus groups will be formed. The results of focus group interviews will be thematically analysed. Items identified as significant will be used in the development of a questionnaire, the intention of which will be to measure moral distress among community pharmacists.

The new instrument will be subject to assessment of content validity before being distributed to a sample of UK-based community pharmacists. The completed questionnaires will be analysed to determine which items generate the greatest levels of moral distress.


Pharmacy is a highly regulated profession with many complex and technical rules, both legal and professional. Pharmacists often come into conflict with a variety of regulators, including the GPhC, the NHS, and the courts.

Workforce pressure has been shown in other healthcare professions to be precipitated by moral distress. An understanding of the causes of moral distress in community pharmacy feeds into the strategy of stress reduction as a means of reducing medication errors.

The pharmacy regulator recently highlighted very heavy attrition rates seen among students and newly qualified members of the pharmacy profession. Identification of the degree of moral distress experienced by pharmacists will allow for the implementation of strategies to alleviate such stress, by dealing with its underlying causes.


This project is now complete – see the final report.