Moral Distress: American Association Of Critical Care Nurses

According to the article “Understanding and Addressing Moral Distress” the last 23 years have not changed. “Moral distress occurs when nurses know the ethically correct action to take but feels powerless to take that action” (Epstein & Delgado, 2010). Moral distress often encompasses nurse’s feelings of dissatisfaction, aggravation, anger, and are conflicting with the requirements of care, and the fundamental views of the work environment. Moral distress also can cause nurses to be overwhelmed, often leading them to believe that leaving the work setting, and the profession is the only answer, due to the negative impact of ethical challenges, emotional sufferings, and the intuition only worrying about the cost of nursing care. (Corley,

Nurses rely on personal knowledge and their professional skills to provide ethical care (Creasia & Friberg, 2011). In everyday practice, nurses must balance the needs of their patients against those of the organization, society and themselves. They strive to deliver the highest level of care for patients, but adjusting for limited organizational and personal resources often requires difficult decisions. This paper explores the following scenario suggested by Maville and Huerta: “You are a nurse providing home care to a mother, and you suspect child abuse after observing the mother’s reaction to her child” (as cited by Arizona State University, 2014). When faced with a moral dilemma, a competent nurse incorporates ethical, bioethical and legal considerations. In the proposed story, incorporating the nursing ethics of advocacy, beneficence, nonmaleficence and collaboration will guide the nurse towards an appropriate and legal course of action.

When working in a health or social care setting professional practitioners are very often with situations involving moral dilemmas. Therefore it is important for the health, care and social workers to understand morality and the meaning of moral decisions and how they are linked to the practice of heath and social care.

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.

Stage one: Denial- The individual may be in denial or act is everything is normal without yet

Note: This stage is sometimes confused with Resignation, which is when the patient could not care less about her/his ordeal, thinks

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

The final stage, however, is a little different. One does not have a challenge to overcome so much as a lesson to learn. The person must look back on their life and see the mistakes they have made. They can also see the wise decisions reached and good times had. And it is at this point that most people either see meaning or resentment in their lives.

In the article ¨Moral Distress And Avoidance Behavior In Nurses Working In Critical Care And Noncritical Care Units,” by Mary Jo De Villers, she states ¨it has been predicted that there will be a shortage of 500,000 nurses in the United States by 2025.¨ This counts for the United States alone. Many articles state that more and more research is being done on moral distress relating to nurses all around. This leaves researchers wondering, could this be the main reason for the shortage of nurses? Moral distress comes into play dramatically with specific nurses such as pediatric intensive care, neonatal intensive care, and intensive care unit. Many of the nurses have to deal with life-or-death situations on a daily basis working in those units. Dealing with that dilemma daily makes it harder for this medical staff to go back to the hospital. All nurses deal with some kind of moral distress, but critical care nurses suffer from a more intense level of distress.

The first stage is denial. This is the initial shock. For some people this stage may be fast

Moral distress in Nursing is described in this article as “the psychological conflict that occurs when a nurse has to take actions that conflict with what they believe is right, for example, due to restrictions in practice policies within institutions” (“Limiting Impact of Moral Distress in Nursing”). Moral distress often times happens due to “a lack of patient care due to inadequate continuity (rated 6.4 by nurses on a Likert scale of 0-16), poor communication (5.8) or inadequate staffing levels

Wlaker and Avant (1995) model of concept analysis. The meaning of Moral distress. The Merriam webtster online dicitionary (2017) does not offer a definition of the word moral distress but rather offered definition of each word separateley. Moral is defined as pertaining to notion of right and worong in human behavior (moral, 2017). The online ethymology dictionary (2017) states that the origin of moral is latin term “moralis” which means manners and proper behavior . The tem moral is used nursing to describe the moral resposability of nurses in providing care that is in best interst of patient ( Lutzen et al.,p 313). Ethics is another term that is used interchangeably with morals. Beauchamps and Childress

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.

Two central themes to understanding the human condition are suffering and morality. Humans contrive morality to be a set of values deemed right or wrong in a society, and are often defined by institutions. These guidelines shape the way people live and how they react to life’s circumstances. Suffering is one emotion crucial to the understanding of existence. In a time of pain, an individual often seeks direction from a higher power, like the church. Institutions such as religion are a way of expressing morality and a means to cope with suffering, a crucial understanding of the human condition.