Moral Distress, Work Engagement, and Meaningful Work in Healthcare: A Narrative Review

Abstract

The psychological well-being of healthcare professionals is increasingly recognized as a critical determinant of patient safety, quality of care, and healthcare system sustainability. Among the constructs most relevant to this domain are moral distress, work engagement, and meaningful work. This narrative review aimed to synthesize conceptual and empirical evidence on these three constructs and to examine their interrelations and implications for healthcare practice. A selective narrative review of the literature was conducted, integrating theoretical frameworks, systematic and integrative reviews, and empirical studies, resulting in a final synthesis of 41 articles. Moral distress arises when clinicians are prevented from acting in accordance with their ethical convictions, often due to institutional or systemic constraints, and has been consistently associated with burnout, turnover, and compromised quality of care. In contrast, work engagement – characterized by vigor, dedication, and absorption – and meaningful work – reflecting the perception that professional activities have meaning and purpose – function as protective factors that enhance resilience and sustain intrinsic motivation. Evidence highlights the central role of organizational climate, leadership, resource availability, and ethical culture in shaping experiences of distress, engagement, and meaningfulness, a dynamic further intensified during the COVID-19 pandemic. The synthesis emphasizes that organizational and systemic interventions, including ethics consultation, supportive leadership, workflow redesign, and resilience-building programs, are essential to mitigate moral distress and promote engagement and meaningful work. The integration of these constructs aligns with the Quadruple Aim, reinforcing the premise that caring for healthcare professionals is indispensable to caring for patients.