Nurses ' Moral Distress And Anxiety Level

Ethical dilemmas are the main common challenges faced by nurses, during practice almost on daily basis. These dilemmas can erupt amongst nurses themselves, or nurses and doctors and the worst between nurses and patients.

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 confront numerous dilemmas throughout their professional lives. The different types of dilemmas include, but are not limited to, ethical, moral, and legal dilemmas. These are the three most common dilemmas in nursing. A dilemma can be defined in many different ways. But all dilemmas are situations in which you have to make a difficult choice. Chiaranai (2011) states that an “ethical dilemma is a circumstance that arises from fundamental conflicts between ethical beliefs, duties, principles and theories” (p. 250). Therefore, an ethical dilemma forces the nurse to address thought on what is right and what the harm might be to the patient.

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.

A moral distress involves two components. It is when a person has emotional and physical stress when one knows the right action to take but are unable to do the action. A moral distress also occur when a person acts in a way regardless of their values and moral beliefs “which undermines your integrity” (American Association of Critical Care Nurses [AACCN], 2004)..

Moral distress is an ethical issue recently recognized in literature as afflicting nurses in the intensive care unit (ICU). ICU nurses often face conflicting dilemmas where the nurse knows the ethically and clinically correct course of action, but feels powerless to act due to numerous internal and external constraints. This creates feelings of frustration, isolation, and anxiety eventually leading to burnout or leaving the profession altogether. Due to an already approaching nursing shortage, healthcare organizations should put more emphasis on nursing satisfaction and retention in the workplace. This can be accomplished by addressing nursing experiences of moral distress. This correlation study proposes if using the 21-item questionnaire Moral Distress Scale-Revised (MDS-R) in the adult critical care unit properly identifies the intensity of moral distress and frequency of its occurrence. Identifying the primary issue allows further understanding and narrows interventions to focus to the true problem. Overall, results have shown that ICU nurses experience moderate to high levels of moral distress. These findings support the need for proper identification of moral distress, with further research focusing on effective interventions aimed at alleviating moral distress based on the identified root cause.

Jameton defines moral distress as, occurring when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Oncology nurses find themselves struggling with moral distress in an oncology unit, which is where cancer patients are cared for and educated by the nurse. An oncology nurse suffers moral distress when they know the right course of action, but feel powerless to act out the choice because of the institution or its policies, lack of resources, lack of support, or legal limits. Oncology nurses provide care over an extended period of time and often administer aggressive treatments. Oncology nurses witness the implications of life-prolonging interventions that may contradict with the delivery of care. By witnessing the adverse effects of this treatment, especially affects the nurse when the goals of care are to provide compassion rather than curative. Moral distress affects the oncology nurse, their emotions, their relationship with patients, other health providers, or family members.

In an article titled “Understanding and Addressing Moral Distress” put out by the American Nurses Association (ANA)/The Online Journal of Issues in Nursing; Moral Distress was defined by Andrew Jameton in 1984 as “a phenomenon in which one knows the right action to take, but is constrained from taking it.” Jameton also added, “Moral distress is different from the classical ethical dilemma in which one recognizes that a problem exists, and that two or more ethically justifiable but mutually opposing actions can be taken” (ANA/OJIN/2010, Jameton, 1984). Within the same article Hardingham, (2004) wrote “Although implied but not explicitly stated in the earlier definition, moral distress involves a threat to one’s moral integrity” (ANA/OJIN/2010, Hardingham, 2004).

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

Moral distress is defined by the American Nurses Association (2015), as “knowing the morally right thing to do, but institutional, procedural, or social constraints make doing the right thing nearly impossible, threaten core values and moral integrity.” The base of nursing is built on the nurse-patient relationship with the nurse caring and advocating on behalf of the patient. When perceived helplessness limits the nurse from performing what she/he perceives to be the morally correct action then moral residue can develop. Webster and Baylis (2000) have labelled ‘moral residue’ as what happens when unresolved moral distress over time is allowed to accumulate. Both Moral distress and moral residue have an impact on nursing

Moral distress is a very real and present issue in healthcare today. In the article, it discusses how nurses must sometimes sacrifice patient care in an attempt to be cost efficient. For the ones who became a nurse to help people, much stress can result sometimes leading to desensitization and disengagement. The researchers for “Nurse Moral Distress: A Survey Identifying Predictors and Potential Interventions” give supporting evidence that certain work environment factors can increase moral distress. The following will discuss aspects of this study to help determine its validity.

Nursing profession was built on the core of thorough ethical judgments, and practicing nursing was traditionally established on a solid commitment to quality, conviction, obligation, and a good moral sense that extend to all patients (Tschudin, 2013). However, in today’s world, nurses are constantly finding themselves in clinical circumstances that involve moral judgement and conflicts in care delivery. This is due to the cutting-edge in technological interventions, complexity in patients’ health, and managed care (Lachman, 2012). The transformations in the delivery of care have produced the environment that enhances ethical

A literature review was performed using the following databases: MEDLINE, Embase, CINAHL, PsychInfo, Web of Science and Cochrane Library for articles published between January 1984 and December 2011 on nurses’ moral distress. This review was inclusive of studies that featured: empirical research with a quantitative study design, addressed moral distress experienced by nurses, based on a conceptual framework of moral distress as defined by Jameton, Wilkinson, or Corely, and published in English (Oh and Gatsmans, 17). This was the criterion required to screen the studies for inclusion in the review.

These ethical codes are not just for clinical roles but also for their personal roles. Patients are the focal point in nursing care. Nurses’ role is to ensure efficient and compassionate nursing care with relief in pain. Personally, I may be against abortions or unwanted use of drugs but have to comply with ethics and support the physician rather than completely refusing to contribute and overcoming the ethical dilemma (Dinh, 2012). Values and virtues are emphasized as an appreciation of moral respect of nurses as well as the patients. Ethics guide me to serve the needy irrespective of their socioeconomic conditions in promoting health and alleviating pain. The balance between personal values and the values of the nursing profession brings wholeness of the character. Nursing depends on identifying dignity of self as well as that of the patient. The common reason for these codes, values and virtues is to provide efficient compassionate patient care with reduced suffering. Nurses with compassion and cultural knowledge deem to be committing towards health care for people, community and nation (Dinh, 2012).

Workplace stress is investable. Job pressures, deadlines, difficult boss, case over loads, difficult colleagues and difficult customers can be a source of stress to many workers. The nursing profession is also filled with elements that can lead to extreme stress and often times these stress can lead to health hazards and risks. In this paper, the source of stress in the nursing profession will be evaluated,