Exploring The Moral Distress Of Registered Nurses

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

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.

Burkhardt, M. & Nathaniel, A. (2008). Ethics & issues: In contemporary nursing, (3rd ed.) Clifton Park, NJ: Delmar

Nurses are faced with ethical issues and dilemmas on a regular basis. Nurses must understand his or her values and morals to be able to deal adequately with the ethical issues he or she is faced with. Some ethical issues nurses are exposed to may be more difficult than others and the ethical decision making process is learned over time.

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.

Truth-telling is an important issue within the nurse-patient relationship. Nurses make decisions on a daily basis regarding what information to tell patients. The specific issue in question is whether a nurse should abide by the Code of Ethics for Nurses by revealing the truth to the patient or refrain from telling the truth to the patient because they are respecting the wishes of the patient’s family. Nurses and health care professionals should always tell the truth to their patients unless the patient forgoes their rights to autonomy or cannot think for themselves. By providing the patient with the truth, they allow the patient to come to terms with their conditions and give them the options for further treatment.

While the nursing profession is fulfilling, it is not without challenges. Nurses are faced with a multitude of ethical dilemmas in clinical practice on a daily basis. According to Fant (2012) no matter where nurses function in their diverse roles, they are faced with ethical decisions that can impact them and their patients. Some examples of moral issues that nurses encounter in contemporary nursing practice and research include but not limited to: refusal of treatment, scarcity of resources, disagreement with caregivers, treating patients with impaired decision-making, futile treatment decisions for cancer patients, end-of-life decisions, advanced treatment directives, and euthanasia (Leuter, Petrucci, Mattei, Tabassi, & Lancia, 2013).

Following the appropriate ethics is of extreme importance in the nursing profession. “Ethics are of universal concern and crucial in all professional healthcare” (Gustafsson & Stenberg, 2017, p.420). The leading goal in nursing is to achieve patient-centered care. According to Arnold and Boggs (2016), “Patient centered care focuses on fully partnering with the client to provide care that incorporates his or her values and preferences to give safe, caring, compassionate and effective care” (p.25). In order to provide a well-grounded, caring environment, nurses need to be able to balance their personal differences with the ethical care standards they are obligated to provide patients (Gustafsson & Stenberg, 2017). Nurses spend the most time with patients; therefore, they eventually will develop a “sense of rightness” (Gustfasson & Stenberg, 2017, p.420).

Nurses are constantly challenged by changes which occur in their practice environment and are under the influence of internal or external factors. Due to the increased complexity of the health system, nowadays nurses are faced with ethical and legal decisions and often come across dilemmas regarding patient care. From this perspective a good question to be raised would be whether or not nurses have the necessary background, knowledge and skills to make appropriate legal and ethical decisions. Even though most nursing programs cover the ethical and moral issues in health care, it is questionable if new nurses have the depth of knowledge and understanding of these issues and apply them in their practice

Ethical issues in nursing will always be an ongoing learning process. Nurses are taught in nursing school what should be done and how. Scenarios are given on tests with one right answer. However, there are situations that nurses may encounter that may have multiple answers and it is hard to choose one. “Ethical directives are not always clearly evident and people sometimes disagree about what is right and wrong” (Butts & Rich, 2016). When an ethical decision is made by a nurse, there must be a logical justification and not just emotions.

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

Tracey, it appears to me that moral stress can also be referred as “caught in between” dilemma, where a nurse has the necessity to make a decision that has both positive and negative implications. The decision that a nurse makes can be pleasing to others or condones some situation. Sometimes, the nurse’s decision feels that something is quite not right but knows that no matter what his or her actions will be supported by management or is considered acceptable. Also, I like those stirring questions that you brought up, Tracey. Ethical conduct is based not only on what is right, but also on the need for the behavior to be fair and beneficial for all concerned. Behavior is driven by intent and; unethical behavior is driven by the intent to benefit

Butts, J.B and Rich,K., (2013,March 1). Ethics in professional nursing care. 3rd Edition. Jones and Bartlett.

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