Moral Distress: An Increasing Problem Among Nurses

moral distress

An ICU nurse struggles to reconcile repeated surgeries and transfusions for a comatose patient who has little chance of recovery. An oncology nurse knows a patient wants to refuse treatment but doesn’t do so because his physician and family want him to “fight on.” A nurse on a geriatric unit knows she’s not giving needed care to patients because of poor staffing.

Situations such as these are all too common and can give rise to moral distress. Moral distress occurs when nurses recognize their responsibility to respond to care situations but are unable to translate their moral choices into action.

As explained in “Moral Distress: A Catalyst in Building Moral Resilience,” one of the CE articles in our July issue, this “inability to act in alignment with one’s moral values is detrimental not only to the nurse’s well-being but also to patient care and clinical practice as a whole.” […]

AJN in July: Opioids and Chronic Pain, Moral Distress, Prediabetes, More

CE Feature: Appropriate Use of Opioids in Managing Chronic Pain.”

Unintentional death related to prescription opioids has been identified as a public health crisis, owing in part to such factors as insufficient professional training and medication overprescription, misuse, and diversion. The authors discuss current best practices for prescribing opioids for chronic pain, emphasizing patient assessment and essential patient teaching points regarding safe medication use, storage, and disposal, and after you find a more permanent solution people could totally quit opioids by using a detox methods that goes from medicine to even a detox tea like leptinteatox. There are some medicines or supplements that are more easy to use, depending on the problem, like the peruvian brew, that helps with erectile dysfunction and is pretty safe. After that you only need to be careful with stds diseases you can go and test at https://www.stdaware.com/chlamydia-test.

CE Feature: “Moral Distress: A Catalyst in Building Moral Resilience.”

Moral distress is a pervasive problem in nursing: an inability to act in alignment with one’s moral values is detrimental not only to the nurse’s well-being but also to patient care and clinical practice as a whole. […]

Recent Decline in U.S. Opioid Prescriptions: Good News But Some Concerns

by frankieleon/ via flickr by frankieleon/ via flickr

It was widely reported in the past week that there have been steady declines in the number of opioid prescriptions in the U.S. for the past three years, with the declines the steepest in some of the states considered to have the worst opioid misuse crises.

This is good news, suggesting that efforts to address some problem areas like renegade pain clinics prescribing for profit, patients who go from doctor to doctor seeking opioid prescriptions, and the diversion of legitimate opioid prescriptions may be starting to bear fruit.

A balanced overview of the situation can be found in this New York Times article. The authors also acknowledge that patients in pain are now facing new hurdles to pain relief, quoting the director of one prominent medical school’s program on pain research education and policy: “The climate has definitely shifted. . . . It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response.”

Much of the reporting on the opioid epidemic lumps all people who take opioids into one big statistical brew. While startling and alarming numbers about overdoses from legal and illegal opioids steal the headlines, little media and scholarly analysis focuses on the lower likelihood of opioid misuse or overdose […]

Earth Day 2016: A Call for Less Toxic Homes, Safer Health Care Facilities

By Barbara Polivka, PhD, RN, professor and Shirley B. Powers Endowed Chair of Nursing Research, University of Louisville, Kentucky

EarthNASAAs we celebrate the 46th Earth Day, it’s good to look back.

  • Earth Day was founded by U.S. senator Gaylord Nelson and started as a national environmental teach-in on April 22, 1970. An estimated 20 million Americans gathered that day at sites across the nation.
  • An important result of the enormous public response to the first Earth Day celebration was the subsequent creation of the U.S. Environmental Protection Agency and the Clean Air Act.
  • Earth Day became an international celebration in 1971 when the UN Secretary General talked about it at a Peace Bell Ceremony in New York City.

Earth Day is a time to think about how we affect the environment and how we are affected by the environment.

Health Care Without Harm is an international organization promoting environmental health and justice. If you aren’t familiar with Health Care Without Harm I urge you to go to their web site to see how health care organizations are decreasing their environmental impact. Health care facilities are taking the following steps:

  • Eliminating medical devices containing mercury and using safer non-mercury alternatives.
  • Eliminating pthalate-containing medical devices made of PVC, such as IV bags and tubing (exposure to pthalates may harm the liver, kidneys, lungs, and reproductive organs) and 
2016-11-21T13:01:17+00:00 April 22nd, 2016|Ethics, Nursing|0 Comments

CDC Opioid-Prescribing Guideline for Chronic Pain: Concerns and Contexts

by frankieleon/ via flickr by frankieleon/ via flickr

By Jacob Molyneux, senior editor

The CDC’s new Guideline for Prescribing Opioids for Chronic Pain was released this week. The context for this comprehensive new guideline is widespread concern about opioid-related overdose deaths and substance abuse in the U.S.

The guidelines make 12 main recommendations, among them the following:

  • nonpharmacologic or nonopioid pharmacologic treatments should be considered “preferable” first-line therapy for those with chronic pain.
  • a daily opioid dosage limit of morphine milligram equivalents should be imposed.
  • immediate-release opioids should be prescribed before moving to extended-release formulations.
  • urine testing should precede new opioid prescriptions for chronic pain and treatment goals should be set.
  • clinicians should prescribe the lowest possible number of days’ worth of medication for acute pain (often three days or less).
  • prescription drug monitoring program (PDMP) databases should be consulted to determine patients’ past histories of opioid prescriptions.

Some of the recommendations would seem to be no-brainers, such as consulting PDMPs when writing new prescriptions. Others, such as a “one-size-fits-all” daily dosage limit and restrictions on the use of extended release formulations, have raised alarms among pain management experts. See, for example, “I’m Worried About People in Pain,” a recent AJN Viewpoint essay by Carol Curtiss, a nurse and pain management expert, who notes the increased stigmatization experienced by pain patients and the chilling effects of new restrictions on doctors’ prescribing, to […]