Moraldistress is the psychological disequilibrium when a person believes he or
she knows the right course of action to take but cannot carry out that action because of an obstacle, such as institutional constraints or lack of power. (source: Arizona Bioethics Network). Moral distress has been studied in nurses—mainly acute care nurses—since the 1980s. Although imperfectly defined and measured, moral distress appears to be strongly related to professional burnout and patient safety issues in a variety of health care professionals including doctors. (see NYT article “When Doctors and Nurses Can’t Do the Right Thing” Pauline Chen, 2-5-09).
A 2010 symposium focused on moral distress was held at the University of Victoria on Vancouver Island. As reported recently by Bernadette Pauly and her colleagues in the journal Healthcare Ethics Committee Forum (2012, issue 24) interventions targeting moral distress have focused on individual coping skills of nurses and other providers. (I’ve mainly seen interventions such as deep breathing, meditation and journaling.) Most research has focused on acute care nurses and has reinforced the notion of “nurse as victim” in the hierarchical hospital system. Pauly and colleagues called for greater attention to structural issues involved with moral distress, including the ethical climate of the hospital administration. In addition, they questioned the current emphasis in nursing education on teaching ethical frameworks instead of specific guidance and skills in how to navigate increasingly complex ethical terrain in everyday practice. They also recommended interprofessional education—bringing together nursing, medical and other health professions students for this sort of ethics education.
The journal Narrative Inquiry in Bioethicshas a call for stories about moral distress from nurses and other health care clinicians. It would be great to see submissions from nurses working in schools, public health, home health, community-based clinics, and occupational health sites, as well as from acute care settings. This is your chance to contribute to a forum that could contribute to some positive structural changes in our health care system—and not just more deep breathing and meditation trainings.
Here’s the information: Narrative Inquiry in Bioethics Call for Stories
Narrative Symposium: The Many Faces of Moral Distress Among Clinicians
Edited by Cynda Hylton Rushton, PhD, RN, F.A.A.N. and Renee Boss, MD, MHS
Narrative Inquiry in Bioethics will publish an issue devoted to personal stories from clinicians regarding situations that cause moral distress and how they have responded to them. Moral distress arises when professionals find that they are unable to act in accordance with their moral convictions. The focus of this inquiry is on the personal and professional short- and long-term impact of moral distress and the ways that clinicians respond to and make meaning from that distress. Appropriate contributors might include nurses, physicians, social workers, nursing assistants, clinical ethicists, occupational and physical therapists, and professionals in training. We want true, personal stories in a form that is easy to read.
In writing your story, you might want to think about:
· Which specific clinical situations give rise to moral distress? Why?
- How do you experience moral distress—physically, psychologically, socially or spiritually?
- How do you deal with moral distress? In past distressing situations
o Did you take actions that allowed you to uphold your deepest values?
o What conditions within yourself, the people involved, and the external environment allowed you to do this?
o How did you made sense of the situation?
- What have been the short or long term consequences?
o Have you ever been professionally disciplined for acting upon your moral conviction?
o How has moral distress affected your job performance or your commitment to your job?
o What has been left undone or been the residual impact?
o How have your own values evolved as a result of moral distress?
- How would you change the system (e.g., policies, hierarchies, processes) to alleviate moral distress within your position? Do you think it can be alleviated, or is it inevitable?
You do not need to address all of these questions—write on the issues that you think are most important to share with others. You do not need to be a writer, just tell your story in your own words. We plan to publish 12 stories (800 – 2000 words) on this topic. Additional stories may be published as online-only supplemental material. We also publish two to four commentary articles that discuss the stories in the journal.
If you are interested in submitting a story, we ask you first to submit a 300-word proposal—a short description of the story you want to tell. Please include a statement about what type of clinician you are and what kind of environment you work in (no institutional names are needed). Inquiries or proposals should be sent to the editorial office via email: narrativebioethics@gmail.com. We will give preference to story proposals received by Oct 31st. For more information about the journal Narrative Inquiry in Bioethics, the guidelines for authors, and privacy policies, visit our webpage with Johns Hopkins University Press at: http://www.press.jhu.edu/journals/narrative_inquiry_in_bioethics/guidelines.html
Josephine, thanks so much for writing a blog about moral distress. In studying ethical practice for over a decade, our Uvic Nursing ethics research team consistently found that a key issue for nurses is moral distress that arises when they are unable to meet their ethical standards of practice. Based on our research, we found that nurses do routinely voice and attempt to take action their concerns but are often silenced which contributes to increasing moral distress (See Stop the Noise! From Voice to Silence in Canadian Journal of Nursing Leadership). This runs counter to early definitions of moral distress in which moral distress was thought to be an inability to act. We highlight how nurses are consistently trying to take action but are often silenced pointing to the structural conditions that shape moral distress. A key area for expanding understanding of moral distress is to move beyond study of acute care nursing to look at moral distress in other settings. For example, our public health research team is focusing on ethical concerns of public health practitioners in reducing health inequities. Thanks again for profiling this issue and moving discussions on the science forward.