Moral distress in nursing

This year the Nurse Manager Round Table tackled moral distress and burnout for correctional nurses.

Moral distress in nursing

All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you. Nathaniel West Virginia University, Charleston Analysisofqualitativedataresultedinansrcinalsubstantivegroundedtheoryofmoralreckoninginnursing,athree-stageprocess.

Afteranoviceperiod,thenurse experiences a stage of ease in which there is comfort in the workplaceand congruence of internal and external values. This Moral distress in nursing the nurse into the stage of resolution, inwhichheorsheeithergivesupormakesastand.

Thenursethenmovesintothestage of reflection in which he or she lives with the consequences and iter-atively examines beliefs, values, and actions. This studysetsthe stage forfurther investigation ofmoral distress. The theoryof moral reckoning challenges nurses to tell their stories, examine conflicts,and participate as partners in moral decision making.

Morally laden questions about right and wrong, harmand benefit, rights and responsibilities are inherent in modern health care. Even though scant research exists on this impor-tant subject, the concept of moral distress is used often to describe the painnurses feelduring thesetroubling times.

Italsocon-tributes to problems with nurse-patient relationships and thus affects thequality, quantity, and cost of nursing care Erlen, ; Hamric, ;Jameton, ; Nathaniel, ; Wilkinson, The author wishes to acknowledge Dr.

Barney Glaser, who served as a mentorfor this study. Moral distress is a major contributor tonurses leaving their work setting and even the profession. Moral distress,however,isanarrowconceptthatfailstoexplainthelong-term,ongoingpro-cess that nurses experience. Moral distress in nursing theory of moral reckoning in nursing is the first to identify a pro-cess that includes the stages of ease, resolution, and reflection and to pointout workplace deficiencies as a serious moral problem in nursing.

Nursessuffer and their lives are forever changed as a direct result of morally trou-bling patient care situations. Telling their stories emerged as integral to theprocessofreflectingandasapowerfuldata-gatheringstrategy. Moral Distress and Nursing Care Development of the theory of moral reckoning in nursing began with areview of the extant literature on moral distress, a significant problem innursing.

Althoughreportsofthenumberofnurseswhoexperiencemoraldis-tressvary,thereisevidencethatmoraldistressiscommonandmaybeacon-tributing factor to the critical shortage of nurses in the workforce. Theimme-diate and ultimate consequences of moral distress include nurses blamingothers; excusing their own actions; self-criticizing;self-blaming; experienc-ing anger, sarcasm, guilt, remorse, frustration, sadness, withdrawal, avoid-ancebehavior,powerlessness,burnout,betrayalofvalues,senseofinsecurity,low self-worth; internalizing anguish; and, possibly, developing aggressivebehavior patterns Davies et al.

Physicalcomplaints reported by nurses who experience moral distress include weep-ing, palpitations, headaches, diarrhea, and sleep problems Anderson, ;Fenton, ; Wilkinson, Thus, moral distress may be a factor in the present nursing shortage—a self-perpetuating downward spiral.

Purpose The purpose of this research was twofold: This study began with the following broad researchquestion: Toallowcontinueddiscoveryandflexibilityofexploration,asis appropriate to grounded theory research, the initial research question wasnarrowed and redirected as the research progressed.

Moral Distress In Nursing | allnurses

Moral distress is pain affecting the mind, the body, orrelationships that results from a patient care situation in which the nurse isaware of a moral problem, acknowledges moral responsibility, and makes amoral judgment about the correct action, yet, as a result of real or perceivedconstraints,participates,eitherbyactoromission,inamannerheorsheper-ceives to be morally wrong Jameton, ; Nathaniel, ; Wilkinson, Design This research utilized qualitative interview data to develop a substantivegrounded theory that was developed in strict accordance with the classicmethod as described by Glaser and Strauss and subsequently byGlaser, Informants were highly educated and experienced: Also, 19 participants were Caucasian, 1 was Hispanic, and1 was Native American.

To ensure the protection of human participants, the proposal for this re-search was examined and approved by the institutional review board for theprotection of human research participants.

Informed consent was obtained. Interviewswereconductedinprivate,nonworksettingsthataffordedprivacyto the nurses as they told their stories. The only potential risk identified waspsychological distress that might occur during or following the interview.

In the adver-tisement, nurses were asked to either e-mail or call toll free the principleinvestigatorifheorshehadeverbeeninvolvedinatroublingpatientcaresit-uation that caused distress.

Participants were not excluded based on genderor minority status. The target population included all registered nurses whohad ever experienced distress in relation to a moral or ethical problem in apatient care situation. All those responding to the advertisement were inter-viewed until saturation of categories and their properties was reached.

Method Grounded theory is an inductive method that moves from the systematiccollection of data in a substantive area to the development of a multivariateconceptual theory.

For this study, interviews were unstructured and casual.

Conceptual and Theoretical Tensions

An interview method that Glaser suggests offers an efficient yetmeaningfulmixofinterview,observation,andconceptualization. Because of the sensitive nature of the information and the likelihoodthat participants would be less likely to share dangerous information, theinterviews were not recorded on tape.Moral distress is also a common problem in the nursing field, particularly critical care nursing.

Moral distress in nursing

For clinicians in any of these roles, moral distress arises when the system or other people interfere with our ability to relieve a dying patient’s suffering. Since moral distress is not solely a nursing issue, the other disciplines need to be involved, especially social work and medicine.

Management needs to support floor nurses by openly allowing dialogue regarding moral distress and conducting support groups.


If possible, get the ethics committee involved. Case Study and Questions Paper details: Compose a 3 page paper in which you do the following: Address the potential root causes for the moral distress in the situation. How communication and collaboration could be improved Develop an institution wide approach which would acknowledge and address moral distress within the organization Please refer to the [ ].

Nurses are at risk of developing compassion fatigue and moral distress, which can worsen mental health. They also have very high rates of occupational burnout (40%) and emotional exhaustion (%). Burnout and exhaustion increase the risk for illness, medical error, and suboptimal care provision.

Mar 25,  · Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for .

Moral distress is a leading cause of clinical burnout and job dissatisfaction. During this session the presenter will give strategies to recognize and address moral distress to keep clinicians engaged and.

Moral Distress and Building Resilience - Johns Hopkins Nursing Magazine