Demoralization and remoralization: a review of these constructs in the healthcare literature

Development of the constructs of demoralization and remoralization began in the psychiatric literature in the 1970s when a psychiatrist in the USA observed a pattern of characteristics in people referred to him for depression, which he believed, was not depression. These characteristics included hopelessness, helplessness, isolation, low self-esteem and despair. Such characteristics are often termed existential distress. Distinguishing between depression and the existential distress of demoralization is still central in the literature. This is important as successful responses to each condition differ. Research into these constructs has broadened and contributions now come from many different countries and multiple health disciplines, including nursing. This study presents a review and exploration of these constructs in the healthcare literature in an attempt to bring them to the attention of greater numbers of nurses. Facilitating remoralization requires time and sensitivity to people's personal narratives. Difficulty in achieving such a response in the present efficiency climate of many health institutions can lead to moral distress.