Moral Distress of a Patient When in Critical Care Unit Essay

Moral Distress of a Patient When in Critical Care Unit Essay

Moral Distress is caused by nurses’ work that involves hard moral choices that result in an emotional or physical suffering, painful ambiguity, contradiction, frustration, anger, guilt and an avoidance of patients (Butts, 2015). Furthermore, it is a situation when a nurse feels that task differs from what he/she thinks it is ethically the correct thing to do. According to American Association of Critical-care Nurses (2004), nurses use the Four A’s plan as a guide to identify and analyze moral distress:Moral Distress of a Patient When in Critical Care Unit Essay

Ask appropriate questions to become aware that moral distress is present. For example, a nurse is faced with a situation when family members decide to remove do not resuscitate (DNR) orders for a 90 year old terminally ill patient because the family states “We are not yet ready to let go, we need to give our dad a fighting chance”. They still decided this even though they were given all the information they needed to make a decision. The nurse follows the wishes of the family to get the order done, even though the nurse feels like it is the wrong decision to do. The nurse feels angered and frustrated with this decision. The nurse then asks herself “Am I feeling this way because of this decision by my patient’s family?”

Affirm your distress and commitment to take care of yourself and address moral distress. The nurse in this situation acknowledges the feeling of distress and decides to make a commitment to address the moral distress.Moral Distress of a Patient When in Critical Care Unit Essay

Assess sources of your moral distress to prepare for an action plan. In this situation the nurse recognizes that the source is the decision of family members to remove DNR orders for the patient who is elderly and terminally ill. She feels it’s futile. She feels like the patient would suffer unnecessarily when the patient arrests.

Act to implement strategies for changes to preserve your integrity and authenticity. In this situation, she may decide to seek support from her charge nurse or other senior nurses on how they dealt with this type of situation.

Two types of moral distress
Moral distress was originally defined in 1984 as the phenomenon in which a person knows the right action to take but is constrained from taking it.3 In 1992, a distinction was made between two types of moral distress: initial and reactive.4 Initial moral distress is the acute phase when a person is faced with institutional obstacles and conflicts that cause feelings of anger, frustration, and anxiety. Once the acute phase ends, the individual may experience reactive moral distress-also known as moral residue-when the distress isn’t resolved in an acceptable way.Moral Distress of a Patient When in Critical Care Unit Essay

Although definitions have varied and evolved since the idea of moral distress was first introduced, its central meaning remains the same: moral distress is an ethical dilemma where the nurse believes he or she knows the right action to take but feels unable to act due to internal or external influences.6,7

The concept has recently garnered a lot of attention in the nursing world. Many nurses experience moral distress but fail to recognize it. Research has shown that moral distress may eventually lead to burnout and an increase in nurses’ intentions to leave their jobs, and potentially the nursing profession, due to the stress and psychological impact.8,9 Nurses, administrators, and educators must be able to recognize moral distress and intervene as appropriate.Moral Distress of a Patient When in Critical Care Unit Essay

Moral vs. emotional distress
Emotional distress, which is also common in nursing, is separate and distinct from moral distress. It arises when the individual faces distressing situations, whereas moral distress develops when a person acts against his or her core values. In the case study, for example, Gina may experience emotional distress when she provides care for a child who may have been a victim of abuse. She experiences moral distress when she must provide aggressive care that she believes to be futile and inhumane. While emotional distress can be considered a healthy, normal process, moral distress is decidedly not because it reflects a violation of a person’s core values and responsibilities, which can have powerful negative consequences on the individual.5

Sources of moral distress
Moral distress in nursing has been attributed to three sources: clinical situations, internal constraints, and external constraints.10

* Conflicts with other healthcare providers, controversial end-of-life decisions, excessive workload, and working with colleagues believed to be incompetent are examples of clinical situations that cause moral distress to nurses.Moral Distress of a