An Arts-Based Inquiry Exploring Social Workers’ Experiences of Moral Distress

Background and Purpose: Moral distress comprises the adverse psychological, spiritual, and emotional effects experienced when individuals feel hindered from acting in accordance with their ethical and moral principles. Factors including resource limitations, staffing shortages, overwhelming heavy caseloads, and bureaucratic obstacles may influence decisions that conflict with the social worker’s personal and professional values. This conflict can lead to perceptions of moral violation, thereby resulting in moral distress. Although some existing social work scholarship has addressed moral distress through more traditional research methods, there is a need for research employing approaches that foster critical self-reflection and a deeper understanding of moral distress. This study was guided by the research question, “What do arts-based research methods reveal about social workers’ experiences with moral distress?”

Methods: This study included a sample of 15 social workers residing in a southern state. Data were collected during an arts-based focus group and included: 1) collages created by participants illustrating their experiences with moral distress; 2) written responses to open-ended prompts about their artwork; and 3) a semi-structured focus group where participants discussed creating art about moral distress. Photographs of the collages, written responses, and the transcript of the focus group were uploaded to Dedoose for analysis utilizing polytextual thematic analysis. Coding was carried out through a multi-stage, inductive process, with codes applied to each image in the collages and line-by-line to participants’ written responses and the focus group transcript. These codes were subsequently organized into categories, from which themes were generated. An audit trail and peer debriefing were documented to enhance the rigor and trustworthiness of the research.

Results: This study generated four themes. These included:

1. The moral distress experienced by social workers is intensified by the current United States political climate. This theme illustrates that moral distress manifests in social workers as a response to contemporary events impacting their work, potentially magnifying the effects of moral distress.
2. Moral distress is a felt and physiological experience. Participants explained moral distress was felt physically and emotionally. The phenomenon induced self-doubt, sensations of being controlled, and lead to intense emotional responses such as anxiety and depression.
3. Moral distress is characterized as a form of death and destruction. Participants utilized symbols such as tornadoes, fires, and graveyards to depict moral distress.
4. Moral distress motivates social workers’ resistance. These findings convey that such experiences prompt social workers to organize and advocate against policies that induce moral distress, thereby fostering moral courage.

Conclusion and Implications: Examining social workers’ experiences with moral distress utilizing arts-based research methods offers a holistic understanding of this phenomenon. This study contributes to the growing evidence-base exploring moral distress among social workers. Results underscore the influences of broader political discourse on social workers’ daily professional lives and well-being. Further, results demonstrate that moral distress is more than just a psychological state; moral distress is a whole-person experience, felt physiologically. Taken together, results suggest political, organizational, and systemic constraints must be considered as integral components of social workers’ experience of moral distress.