Moral Distress : A Very Real And Present Issue

Nursing is a career that is governed by a set of ethical principles. The duties of a nurse consist of care and support and its important that nurses are aware of their professional ethics. These principles are put into place to uphold and maintain moral values in healthcare. The American Nurses Association (ANA) code of ethics for nurses consists of nine provisions, outlined in the Code of Ethics for nurses with Interpretive Statements. These provisions are constructed to blueprint the role and responsibilities of a nurse. The chosen provisions being discussed will refer to the three main principles of patient autonomy, patient confidentiality, and patient rights.

As the nursing profession progresses throughout the years, its nature becomes more complex in meeting the professional standards and codes of ethics that are required by all nurses. The American Nurses Association has a specific code of ethics that each nurse should follow and adopt as their own beliefs. The public and the patients should be the priority when providing care in the healthcare setting. The knowledge and education that nurses’ gain is valuable and allows them to encourage health, avoid illness, restore health, and aid in coping for those who are all ill. (LeMone, pp.192) Given that the code of ethics is put into place, there are many registered nurses who violate these codes in various situations. The following will discuss

Ethical issues can cause a lot of tension and emotional turmoil. Before starting a career in the healthcare profession, nurses must know the code of, the importance of the Nurse Practice Acts and other types of laws, as well as the nurse’s liability when working with patients. Nursing is an ever-evolving profession that has gone through drastic changes in the last few decades, but ethics is still as important as ever. Ethical concepts, nurse practice acts, laws and commitment admissions will be further discussed.

Nursing is not an easy job and those who chose it as their profession are truly special people. Nurses are confronted with ethical decisions that need to be made on a daily basis. Often they know the right thing to do but because of circumstances like institutional structure and conflicts with others, obstacles are created and distress ensues (Jenner, 2001). It is during times like these that nurses must rely on the training that they have received as well as the code of ethics that has been set down for their profession in order to do the right thing.

According to Doane and Varcoe (2015) ethical inquiry is essential about the question, what is good, right and just that nurse must incorporate into their nursing practice to afford ethical problem. This form of inquiry emphasizes that every moment of nursing interaction involve ethics and that ethics is a “deeply personal process that is lived in the complexity and ambiguity of everyday nursing work” (Doane & Varcoe, 2015). When complexity and ambiguity of nursing practice is apparent to nurses through the involvement in caring for patient, then ethic of care can be brought forward as a compass to guide moral decision making and ethical care. As stated by Doane and Varcoe that research has shown that when staff and other resources are scarce,

Such factors may affect the degree to which nurses are able to fulfill their moral obligations and/or the number and type of ethical dilemmas they may face.

Moral distress is experienced by nurses every day in today’s health care system. Moral distress has been found to be manifested as anger, frustration, guilt, loss of self-worth, depression, powerlessness and helplessness (Zuzelo, 2007, p. 346). Failure to recognize and manage moral distress is causing nurses to be “burned out” have high turnover rate, and even leaving nursing profession all together.

Nurses are at the front line of care and are the ones responsible for the safety and protection of a patient. Principals that are involved in this situation are "beneficence, nonmaleficence, ethical fading, fidelity, rationalization, boundaries" (Porter-O'grady & Malloch, 2016, pg. 215). While these are the primary principles there seem to additional principles that are involved; these are organizational integrity, ethical erosion, moral reasoning, whistle-blowing, and autonomy. In school many nurses are taught autonomy and to use critical thinking skills; currently many nurses in hospital feel that they are not encouraged to use these skills which contribute to job dissatisfaction and dilemmas (Van Oostveen, Mathijssen, & Vermeulen, 2015).

Moral distress is describe as the phenomenon in which a nurse understands and has clarity about a right action to take, but is constrained from taking it. It differs from an ethical dilemma in which there is recognition of a problem; in which at least two ethically justifiable but opposing solutions can be applied (American Nurses Association, 2014). Moral distress was first recognized among the nursing field; because of this, many of the studies have focused on the nursing population. However moral distress has also expanded to many other fields, making it now a multidisciplinary concern

Moral competence is one of the components that influenced development of nurses’ competence at the workplace. Moreover, society nowadays requires moral competence in the nursing curricula which highlight as an individual’s ability to live up to a personal moral code and role responsibilities (Taylor, 1994; Jormsri et al., 2005). Within nursing competency, caring behaviour is highlighted as a major component in the moral competence. Caring behaviour is described as competence, confidence, conscience and commitment of nurses in the clinical setting (Roach, 1987). Taylor (1994) argues that, moral competence is bringing to ethical issues encountered in the nurses’ practice. Jormsri et al., (2005) highlighted the acquisition of moral competence is explored by personal, social and professional values and define moral competence as ability of individuals to recognize their feelings in specific situations, a reflection of their feeling may respond to their decision making and critical thinking in the clinical

average levels over warm of emotional, subscale many authors as the main phase and trigger syndrome. The depersonalization and feeling about showed that nurses have higher degrees of emotional shame compared in imitation of technicians and nursing. Have Despite the nurses current a lower involvement along patients agreeable after the hospital, that bear an intense emotive accountability among their each day work; it are responsible because the smooth functioning of the health care, the place those take care sordid nurses, constantly Wight charged by the hospital regime or enterprise within addition in conformity with physicians, as to patient

Her research shows a relationship in the amount of moral codes an individual has, and their ability to handle environmental pressures to conform to the expectations of others (Laabs, 2009, p. 431). Laabs quotes that “it is a process in that the person recognizes that there will be challenges to their moral integrity, for which they must be prepared, and expects to grow in their ability to manage challenges (Laabs, 2009, p. 433)”. In Laabs research strategies, she found that moral distress was decreased when “the individual employed avoidance, utilize self-protective measures, communication, building relationship with others, as well as advocating for patients and themselves (Laabs, 2009, para. 435)”. However, Laabs research also noted that the “pressure to conform and horizontal hostility as Bartholomew calls the reputation among nurses of eating their young and each other’, has been shown to contribute to moral distress. Research has found that ‘discounting self is an actual strategy employed by nurses in ethical decision making, one that includes fear of retaliation or being labeled as disruptive, reacting to moral problems rather than reflecting on them, distancing oneself due to lack of knowledge and uncertainty, and conforming to the dictates of others, all results in ‘lateral violence’ (Laabs, 2009, para. 437)”.

Therefor they place themselves in a highly stress environment in order to provide the best care possible (Jensen,& Key,2009.p 32). However, at times there are many factors could interfere with one’s conscience and sometimes questioning. These factors cause the person to unable or failing to provide for the care that the patient require. For example, a nurse working in an emergency department might encounter a patient who is a Jehovah’s witness who is in need for blood transfusion, but due to their belief and teaching, the producer cannot be done. The nurses in this situation might feel conflicted with their conscience as they cannot do anything to help. In a prolong situation it can leads to the nurses felling useless, frustrated anger, burnout job dissatisfaction out, emotional detachment from patients which could lead to deteriorate the patient-caregiver relationship, as there is nothing that they can do but rather than to respect their choices and provide best care possible by (Genuis, & Lipp,

Nursing, in my view, has always been a field in which moral courage was inherent. Nursing is one of the few fields in which individuals disregard their own personal wellbeing in favor of other people’s health. Moral courage is an elusive topic to define, as it is such an intangible concept. According to Murray, “moral courage is considered to be the pinnacle of ethical behavior; it requires a steadfast commitment to fundamental ethical principles despite potential risks, such as threats to reputation, shame, emotional anxiety, isolation from colleagues, retaliation, and loss of employment (2010.) To exemplify this issue, Murray continued to give an example of moral courage with a novice nurse named Emily.

The following case presentation illustrates the moral distress a nurse may experience when her patient advocacy meets resistance, and her moral courage is challenged. It also describes ineffective management strategies to help nurses resolve the problem. If doctor or supervisors will hear Joanna and could recognize early that patient has ruptured abdominal aortic aneurysm, the surgery would save Mrs. Kelly life. Joanna 's conflicting values were feeling that something is not right with the patient. She was doing what was in her power to make others pay attention that