Moral Distress, Ethical Climate and Nursing Ethics

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,

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)..

Nursing is a field that requires a true understanding about ethics. Ethics by definition is the study or use of moral belief. Morality is the the act of actually following these beliefs. So to follow the code of ethics is to be moral. Each nurse is expected to follow the standards set out by the code of ethics from the American Nurse Association (ANA) and from his or her place of employment in order to practice morally.

Ethics is an essential aspect of health care practice and those working in the nursing profession are often subject to frequent ethical dilemmas. It is essential for all nurses to be aware of the importance of ethics in health care and to practice within the ethico-legal parameters that govern the profession. However, while this is relatively easy in theory, ethics is not a black and white subject and often one’s culture, upbringing, attitudes and beliefs can influence what one views as ethical and this can therefore influence practice. This report will discuss the importance of ethics in nursing practice. The definition of ethics will firstly be presented followed

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.

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

Nurses have traditionally placed a high value on the worth and dignity of others. The nursing profession requires integrity of its members; that is, a member is expected to do what is considered right regardless of the personal cost (13). Because nurses deal with the most fundamental human events – birth, death, and suffering- they encounter many ethical issues surrounding these sensitive areas. Nurses can make better moral decisions by thinking in advance about their beliefs and values and about the kinds of problems they may encounter in caring for their clients (201). This paper discusses the professional ethics, and explaining the impact of personal, cultural and spiritual values in nursing profession.

Thus, the word, ‘moral distress’ was first appeared on a book in 1984 by Andrew Jameton, who discussed the status of women and their power position in decision making in nursing (Epstein & Delgado, 2010). As the number of nurse increase, the physician’s dominance started to be seen as a problem, and ethicist and philosopher started to support nurses, consequently nurses started to gain power (Jameton, 2013). Since then, many researches have been done worldwide to theorize the issue of moral distress, to identify the causes from multiple aspects, to list the impact on the nurse who experiences moral distress, to implication on patient care or stuffing issue, and finally to determine the solution to the issue. Interestingly, although the institutional working condition and working relationship with physicians were identified as a contributing factor from early on, moral distress was initially theorized as an individual’s phenomenon originated in the individual’s behavioral issue (Epstein & Delgado, 2010). Therefore, research was focused on the internal

Thank you for very interesting and eye-opening post. Reading your post, and as it is exemplified in posts from our colleagues as well, moral distress and the moral residue is an ongoing problem in many healthcare settings. Pauly, Varcoe, & Storch (2012) point out that many types of research have shown that moral distress is a widespread problem for many healthcare professionals in a wide range of acute and community healthcare settings. It seems that nurses often find themselves in the position of compromising their moral integrity. And, when moral integrity is threatened, for sure moral distress will occur. And, when moral distress stays unresolved, it can over time bring about moral residue. I do not think that we can eliminate moral distress, however, we can try to minimize it. Pauly et al. (2012) indicated that more research in the area of moral distress and the moral residue is needed. Also, joined ethics education of nurses, physicians, and other members of healthcare teams are the way how to minimize moral distress in healthcare settings.

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).

The education of a nurse provides the framework for their future career. At times it may be challenging or problematic in deciphering what is ethical or what is most favourable for the patient’s welfare especially when there are not mutual or reciprocal values between the nurse and patient. To illustrate, education programs for nurses prepare students for competent, safe, compassionate, and ethical practice and enable them to achieve the entry-to practice competencies expected of new graduates (Canadian Nurses Association, 2015). Graduates must demonstrate a wide range of skills and abilities. For example, tasks requiring appropriate responses in situations of stress or conflict. The education of nursing allows students to work through and understand ethical situations as this will be an ongoing part of the profession. Ethical issues are part of daily nursing practice and every nurse has an obligation to have the knowledge, skills, and abilities to recognize and address them (“Focus on Ethics”, 2015, p. 14). Hence, having a strong ethical foundation is a key component to a successful career (“Focus on Ethics”, 2015, p. 14). Even the best nurses may find themselves struggling with ethical concerns on the job (“Focus on Ethics”, 2015, p. 14). The education for the nursing profession tends to focus on professional behavior and making sure that decision-making is

Moral distress is the biggest ethical issue needed to be addressed with nurses. Addressing ethical issues nurses encounter in healthcare is key to the delivery of quality patient care and retention of qualified staff. Moral distress can adversely affect patient care and is associated with employee burnout and job turnover.

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

Each nurse , as a moral agent, practices and makes choices based on their socialization and their psychological orientation, using their innate and learned attributes (Crigger & Godfrey, 2011; Godfrey & Crigger, 2012). They make decisions for and about patients (and about their own behavior), and grow or recover from these decisions by reflecting upon its merits and its outcome. This reflection upon