Are you familiar with the term moral distress as it applies to nursing and our practice? The first thing we need to do is define what we’re talking about in this context. One definition used is according to Jameston “as feelings that are painful, and a psychological imbalance or disequilibrium that occurs when nurses find themselves in situations where they feel unable to do the right thing.” The American Nurses Association has addressed this concept in the Code of Ethics which was revised and published in 2015. Moral distress is said to present when a nurse is unable to act according to their belief, morals, and values when it comes to patient care. The dilemma may result when a nurse tries to act in what she believes is in the best interest of the patient, but because of workplace practices and/or politics, the nurse feels unable to act.
Why is this an issue that nurses need to recognize and deal with? Some authors believe not addressing moral distress can lead to decreased effectiveness as a nurse and as a team member. Other possible negative outcomes could be work related stress and burnout and the nurse leaving that job or the profession altogether.
An article by the American Nurses Association gives some examples of moral distress. This list recognized that individual nurses will be impacted in their own unique way. This is not a ‘one size fits all’ situation. Examples of moral distress that nurses might face include (1) inappropriate use of healthcare resources, (2) inadequate staffing, (3) inadequate patient pain relief, and (4) giving false hope to patients and their families. Another cause of moral distress might include power imbalance between the staff nurse and administration where policies conflict with patient care.
A lot of the literature addresses issues/situations related to critical care and end-of-life settings. However, moral distress can be found in all settings and patient care situations. Nurses often find themselves at odds with administration when providing care. Hospital policy requires patient teaching before discharge and as nurses we know that is our responsibility. However, nurses may find it difficult to meet this requirement because of care requirements, staffing, and/or patient/family needs. What is the nurse to do? Defying hospital policy could lead to disciplinary action for the nurse or if the nurse follows policy and discharges the patient without teaching for the patient/family, then the risk of negative outcome looms large. Also if there are negative outcomes, the nurse might be blamed.
Nurses, we do not have to feel powerless and experience moral distress without some recourse. You can seek support from your peers or you can seek counsel from your nursing leadership. A very powerful intervention for individual nurses who are not prepared to walk away from their job is to seek counseling. Most employers provide some type of employee assistance program. This service is confidential and can help a nurse develop needed coping skills. If all else seem to not be working, the possibly of coaching and or outside help might provide the guidance and support you need. As a nurse we are also responsible for obtaining education to keep ourselves informed. Be aware of the resources available in the profession to help you deal with difficult situations.
As a nurse, there are some suggested strategies to help reduce moral distress. Some actions take more courage and the nurse needs to be aware of the possible consequences, both personal and professional. At the extreme, one’s actions could require the nurse to leave her present positon. Before that position is taken, other stops might be helpful. (1) If at all possible, gather support from your peers. (2) Instead of confronting the situation when you are emotional, step back, gather your thoughts and facts. (3) Be prepared to offer solutions. (4) Be clear about the problem gather your facts, be sure your suggestions and suggested interventions are ground in evidence based practice.