Defending Against Moral Distress

A collaborative initiative offers recommendations to build moral resilience.

All nurses have at some point been faced with situations that challenge their values. Whether dealing with families or patients or the actions of colleagues, we may be faced with acting (or not acting) in accordance with our professional or personal values. I can easily recall several situations (which I detail in my February editorial) that involved unnecessary invasive procedures and surgery or removing life support.

Such situations take a toll on the individual and the care team and ultimately have a negative effect on patient care quality. Moral distress is not something that can be entirely eliminated—there will always be situations that provoke angst. But individuals can build moral resilience if they learn to recognize it when it occurs and if their organizations support them in finding ways to manage ethically challenging situations. […]

2017-02-06T09:15:27-05:00February 3rd, 2017|Ethics, Nursing|0 Comments
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AJN in February: Improving CKD Outcomes, Nurses and Patient Safety, Moral Distress, More

The February issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE Feature: “Improving Outcomes for Patients with Chronic Kidney Disease: Part 1”

The burden of chronic kidney disease (CKD) is rising both in this country and worldwide. An estimated 10% to 15% of U.S. adults are currently living with CKD. The greatest opportunities to reduce the impact of CKD arise early, when most patients are being followed in primary care; yet many clinicians are inadequately educated on this disease. This two-part article aims to provide nurses with the basic information necessary to assess and manage patients with CKD. This month, part 1 offers an overview of the disease, describes identification and etiology, and discusses ways to slow disease progression. Part 2, which will appear next month, addresses disease complications and treatment of kidney failure.

CE Feature: “Nursing’s Evolving Role in Patient Safety”

In its 1999 report To Err Is Human: Building a Safer Health System, the Institute of Medicine suggested that between 44,000 and 98,000 Americans die annually as a result of medical errors. The report urged health care institutions to break the silence surrounding such errors and to implement changes […]

2017-01-30T10:39:50-05:00January 30th, 2017|Nursing|0 Comments
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‘She’s Alive Because Of You’: A Nurse’s Advocacy Pays Off

Katie L. George, DNP, RN, AG-ACNP, CCRN. Photo courtesy of Katie L. George. Katie L. George, DNP, RN, AG-ACNP, CCRN

While attending this year’s American Association of Critical-Care Nurses National Teaching Institute meeting, AJN editor-in-chief Shawn Kennedy heard a story that she felt all nurses needed to hear as a reminder of the impact a nurse’s advocacy can have on a patient.

Critical care nurse Katie George, just a few years into her career when the events in the story took place, was caring for Ms. A., a young woman whose spinal cord had been nearly severed in a car accident.

Faced with a prognosis suggesting that Ms. A.’s quality of life would be poor and that she would have to remain on a ventilator, Ms. A.’s family made what they felt was the humane decision to have her removed from life support. But Ms. A.’s fiancé—and her nurse Katie George—were convinced that Ms. A., who seemed to be able to communicate by blinking in response to questions, should at least be given the chance to make the decision for herself.

Ms. A. was suffering from locked-in syndrome, a condition in which the patient is conscious and eye […]

2016-11-21T13:00:53-05:00October 20th, 2016|Nursing, nursing perspective, patient experience|1 Comment
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Nurses Take Action on Moral Distress

Nurses gather at the Johns Hopkins School of Nursing to address this growing problem.

A nurse struggles to reconcile repeated surgeries and transfusions for a premature infant with the child’s slight chance of survival. 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 is not giving needed care to patients because of inadequate staffing.

From left, Katherine Brown-Saltzman, Kathryn Trotochaud, Lisa Lehmann, Heidi Holtz From left, Katherine Brown-Saltzman,
Paula Goodman-Crews, Lisa Lehmann, Heidi Holtz

Situations like these are not rare for nurses and often give rise to moral distress—that is, when nurses recognize their responsibility to respond to care situations but are unable to translate their moral choices into action.

Moral distress in nursing has risen to unprecedented levels, contributing to burnout and staff shortages and imperiling safe, quality health care.

Seeking solutions.

Nursing researchers, clinicians, organization representatives, and other stakeholders convened in Baltimore on August 11-12 for an intense invitational workshop called State of the Science Symposium: Transforming Moral Distress to Moral Resiliency in Nursing. The meeting focused on how to best address moral distress.

The 46 participants heard from […]

2017-02-03T14:50:26-05:00August 16th, 2016|Nursing, nursing perspective|0 Comments
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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.” […]

2016-11-21T13:01:03-05:00July 18th, 2016|Ethics, Nursing, patient safety|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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