Ethics Class 6

suffering

occurs when a person's integrity and  sense of self are threatened can be caused by moral distress

Moral Distress

"Physical or emotional suffering that is experienced when constraints(internal or external) prevent one from following the course of action that onebelieves is right." can also occur when:you act in a manner contrary to your personal and professional values, which undermines your integrity and authenticity.

moral distress affects the workplace

Nurses may experiencethe following: • Poor communication • Lack of trust • Defensiveness • Lack of collaboration across disciplines • High turnover rates

Prevalence of Moral distress

• 1 in 3 nurses have experienced moral distress • In one study close to 50% of nurses left  their units or the nursing field because of moral distress • Approximately 50% of nurses have acted against their consciences in providing care to terminally ill patients

2. Affirm

• Affirm your distress and your commitment to take care of yourself (help to create a healthy work environment) • Validate your feelings and perceptions with others (talk with your coworkers!) • Affirm your professional responsibility to act (ANA Code of Ethics for Nurses) Goal: You make a commitment to address moral distress

1. Ask

• Am I, or my peers, feeling symptoms or  showing signs of suffering (physical,  emotional, behavioral, spiritual) ? • Have coworkers, friends, or family members noticed these signs & behaviors in me? Goal: Awareness that moral distress  is present

3. Assess

• Identify sources of your distress (e.g., patient care situation, policy or practice, lack of collaboration) • Determine the severity of your distress  (0=no distress to 5=very distressed) • Determine your readiness to act (consider  the risk & benefits to action) If you are not ready to take action, continue  to ASK & AFFIRM Goal: Make an Action Plan

impact of moral distress on nurses

• Physically withdraw from the bedside• Loose capacity for caring• Avoid patient contact• Physical & psychological problems• Fail to give good physical care• Leave the profession altogether

common responses to suffering

1. Physical (i.e., fatigue, headaches, impaired  sleep) 2. Emotional (i.e., anger, fear, guilt, anxiety,  depression) 3. Behavioral (i.e., apathy, avoidance,  depersonalization of patients) 4. Spiritual (i.e., loss of meaning, loss of faith)

4. Ask

Prepare to act ~ Develop a self-care plan  ~ Identify internal & external barriers ~ Identify sources of support  (coworkers,nurse manager,  advanced practice nurse, chaplain,  counselor) ~ Investigate outside resources for  guidance (ANA Code of Ethics) Goal: Take Action (implement strategies) When you Act ... • Anticipate setbacks- Temporary setbacks may occur due topersonal or professional change• Maintain desired change- Continue to implement 4 A's to resolve moraldistress-ReevaluateGoal: You preserve your integrity and authenticity

Moral Distress among health professionals

When one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action  When nurses and other health care professionals face constraints on their ability to practice ethically and feel forced to compromise professional values and standards of practice they may experience moral distress "All too often we leave the workplace bone tiredand soul weary, trying to shake off the sticky residue of moral distress, that awful realization that we could not give patients the care they deserved."

4 A's

to rise above moral distress: -ask -affirm -assess -act To provide a tool that helps healthcare professionals to identify, assess, and take action when situations that cause moral distress arise in the workplace.

moral dilemma

when two or more principles or values conflict. There can be good reasons to support mutually inconsistent actions (i.e.,both are ethically permissible). A moral dilemma can cause moral distress