Considering Care. A Descriptive Study of Moral Distress. Elizabeth Smith, MS, RN, PMHCNS-BC, CHPN Toby Bressler, PhD, RN, OCN

Transcription

1 Considering Care A Descriptive Study of Moral Distress Elizabeth Smith, MS, RN, PMHCNS-BC, CHPN Toby Bressler, PhD, RN, OCN

2 What is Moral Distress? Initial Definition: occurring when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action (Jameton, 1984). Later Definition: includes psychological disequilibrium and negative feeling state thus acknowledging it to be an emotional response (Wilkinson, 1988). Expanded Definition: a psychological response to morally challenging situations such as those of moral constraint or moral conflict or both (Fourie, 2013).

3 Consequences of Moral Distress Psychological and physical exhaustion Frustration, anger, depression, guilt, powerlessness Avoidance behaviors Decreased job satisfaction Negative impact on quality of care patient/family experience

4 Description of Study Unit 28 bed Respiratory Care Unit Patient characteristics: - Average age 82 years old - Majority identify as Jewish, most are Orthodox Jews - Many with advanced dementia, serious neurological injury, anoxic encephalopathy - Being sustained on artificial life support (ventilators, artificial feedings, dialysis, vasopressors)

5 Medical Decision-Making of Orthodox Jews Halachah Collective body of Jewish law which guides all aspects of daily life, religious practices, rituals and customs, and medical decisions Supreme sanctity of life; religious obligation to preserve life Central role of Rabbi

6 Study Questions What is the experience of nursing staff? Do they experience moral distress?

7 Study Design Exploratory descriptive qualitative study Protection of human subjects: IRB Eleven focus groups with semi-structured interview format Anonymous demographic form Purposive selection of transcripts Content analysis to identify themes

8 Demographics of Study Sample n=27 (71%) participation Days Nights < 40 yrs of age 38% 84% At least BS-BSN 54% 85% Certification 40% 8% Av. yrs experience Av. yrs in current position

9 Study Findings Contributors to moral distress in common with other studies: Medical treatment perceived to cause pain and prolonged suffering Providing unrealistic hope to patients and families Workload/overload

10 Unique Themes of This Study Nurses expectations not fully realized Significance of teamwork Cultural mismatch

11 Limitations Nurses only Recommendation for interdisciplinary research Focus group Group think Crosspollination Information sharing

12 Implications/Conclusions Further research warranted Other disciplines Family perspective Evaluation of interventions Valuing Nurses

13 Interventions Education Support Building Resilience Enhancing Work Environment

14 As a nurse, we have the opportunity to heal the heart, mind, soul and body of our patients, their families and ourselves. They may forget your name, but they will never forget how you made them feel Maya Angelou

15 Acknowledgements The participants of this study Nursing Team on Gellman 7 West! Lisa Segreto, RN Nurse Manager Gellman 7 West Dorothy Jean Graham-Hanna, RN Vice President Nursing; Department of Medicine Tom Smith, RN: Chief Nursing Officer Dr. Debra Hanna, PhD, RN: Key Personnel

16 Selected References 1. American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD. 2. Burston AS, Tuckett AG. Moral distress in nursing: contributing factors, outcomes and interventions. Nurs Ethics 2012; 20(3): Ferrell B. Understanding the moral distress of nurses witnessing medically futile care. Oncol Nurs Forum 2006; 33(5): Fourie C. Moral distress and moral conflict in clinical ethics. Bioethics 2013; Jameton A (1984). Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice Hall. 6. Kompanje EJ, Piers RD, Benoit, DD. Causes and consequences of disproportionate care in intensive care medicine. Curr Opin Crit Care 2013; 19(6): Rushton CH: defining and addressing moral distress: Tools for critical care leaders. AACN Advanced Critical Care 2006; 17(2): Schluter J, Winch S, Holzhauser K, Henderson A. Nurses moral sensitivity and hospital ethical climate: a literature review. Nurs Ethics 2008; 15(3): Varcoe C, Pauly B, Storch J, Newton L, Makaroff K. Nurses perceptions of and responses to morally distressing situations. Nurs Ethics 2012; 19(4): Wilkinson JM. Moral distress in nursing practice: experience and effect. Nurs Forum ; 23(1):