Possible approaches to dealing effectively with moral disagreements and disputes will be considered later in this chapter under the subheading ‘Dealing with moral disagreements and disputes’. The former patient recalled: Another example of the substandard nursing care that was provided can be found in the experiences of another patient, Barry Hart, outlined in the following statement read to the New South Wales Parliament in 1984: One of the troubling things about the whole Chelmsford scandal is that rumours about Dr Bailey’s unscrupulous practices had been circulating for years, yet nothing was done about it ( Bromberger & Fife-Yeomans 1991 : 176). Recently, nurse and scholar Elizabeth Epstein and co-authors developed and studied the "Measure of Moral Distress for Healthcare Professionals," or the MMD-HP.11 The scale uses 27 items to assess the moral distress of health care professionals in a variety of fields. The Evolution of the Concept of Moral Distress For it is likely that, in the case of an apparent conflict in duties, one of our so-called ‘duties’ is not our duty at all; we have only mistakenly thought that it was. Until further inquiries are made, the assumed credibility of ‘moral distress’ as a bona fide problem in nursing will remain dubious. Borrowing from the patient safety literature, this outcome may be referred to as ‘the normalisation of deviance’ ( Banja 2010 ; Price & Williams 2018 ) – in this case of morally questionable acts. "3 These are some of the many voices of moral distress. Nursing practice ethics bar nurses from taking part in … It’s a normal part of life to have some distress. Most of these moral dilemmas are often analyzed using the principle-based approach which applies the four moral principles of justice, autonomy, beneficence, and non-malificence. There is no need Example Of Moral Distress In Nursing Essay to worry if your paper is due tomorrow. The principle of examples of action should always easy when conflicts over how counselors inevitably involves actions of. Hence, treating moral distress in this context will require new and intensive efforts. A nurse working in a specialised unit is assigned a patient with a known history of drug addiction, and is instructed to chaperone the patient when there are visitors to make sure that illicit drugs are not ‘slipped in’. This concept has resonated strongly amongst nursing scholars since the 1980s and has recently gained ground amongst social work scholars as well. Cancelling out one of the duties in this scenario is unlikely to relieve the moral tension generated by the patient’s request for and the doctor’s refusal to give the medical information on the patient’s diagnosis. Since moral distress is a system-wide issue rooted in moral events, it makes sense for system ethicists, ethics committees and hospital ethicists to lead the charge in organizing and coordinating responses to moral distress. Moral Distress during the Coronavirus Pandemic Nurses are no exception in this regard. As Rushton points out, moral distress can also be measured by "proxy" through surveys that ask questions such as, "Over the past year I have never been asked to do something that compromises my values."12. Such are the tragic twists and tradeoffs of life. The fanatical Nazi in this case stringently clings to the ideal of a pure Aryan German race and the need to exterminate all Jews as a means of purging the German race of its impurities. A newly graduated doctor walks into a patient’s room, stands at the end of the bed and, in full view and hearing distance of other patients in the room and without greeting the patient or smiling, states abruptly: ‘We’ve looked at your throat and the lump you have there is cancer.’ Without another word, the doctor then briskly walks off. Corner-Walkers blessing patients from the doorways. While someone may experience moral distress with emotional stress and/or PTSD, moral distress homes in on the ethical nature of a distressing incident (or incidents) and the subsequent effects it has on one's self-understanding as a moral being. The ‘root cause’ of moral distress in nursing has been attributed to three key domains: clinical situations (e.g. For reprint permission, contact Betty Crosby or call (314) 253-3490. This essay may contain factual inaccuracies or out of date material. To give just one stand-out example, consider the notorious case of the Chelmsford Private Hospital in Sydney, Australia. As Campbell and coauthors argue, moral distress can occur even when moral agents believe they acted in the best way possible. Perhaps, the current trend in the psychoanalysis is one of the nursing health care issues that have propagated the zeal for various ethical and moral issues. It is an ethic of practice. Special thanks to Andrea Vicini, SJ, for his feedback on this article. Appealing to a moral standard prohibiting the killing of innocent human life would then, for Nurse A, be quite irrelevant. Chat forums or blogs are ways that all the staff can share experiences of moral distress and begin to process them. A qualitative design was used to describe the experiences of staff nurses in acute care with moral uncertainty. Whether these reactions necessarily constitute ‘moral distress’, however, is another matter. The amoralist may argue in a similar way in relation to the issue of morality. Some people see the alternating vase–face images relatively quickly and easily, while others struggle to shake off what for them remains the dominant image (i.e. The following examples are some of the stories expressed by acute care nurses as part of a descriptive research study. In the case of nurses, they can also work to accustom individuals to ‘tolerating behaviors that are outside the realm of considerate conduct’, often without their even being aware of it ( Felblinger 2008 : 238). The second paper I ordered was a research report on history. Had the only criterion for action been what superficially appeared to be a primary duty to the patient, the nurse may have unwittingly facilitated the flow of information in a culturally inappropriate and thus harmful manner. Thus, when two duties conflict, we must ‘study the situation’ as fully as we can until we are able to reach a ‘considered opinion (it is never more) that in the circumstances one of them [the duties] is more incumbent than any other’ ( Ross 1930 : 19). Second, the very presentation of given issues in the moral distress scales used by researchers already pre-code and interpret the situations presented as involving ‘moral distress’ thus priming respondents to accept both the existence and incidence of moral distress as a ‘reality’ in their practice. As ethical professionals, our stringent moral responsibility is to question our taken-for-granted assumptions about the world – and about bioethics discourse generally – and not to presume that they are always well founded and unable to be challenged. One of the ethical issues that can arise in end-of-life care is communication. There is no better way of solving your writing problems than to visit Example Of Moral Distress In Nursing Essay our website. This stands as an area that would benefit from future inquiry. These will have various effects to the healthcare practitioners. This raises the question: How are we to distinguish a bona fide moral problem from other kinds of (non-moral) problems? And in some instances, taken to its extreme, the principle of non-maleficence might even instruct that the diagnosis should not be given at all. Unresolved they can have a significant negative impact on relationships, patient care and the culture of the organisations – specifically they can weaken an organisation’s ethical climate ( Pavlish et al 2013 ). It is not the purpose of this analogy to advance a theory of moral perception but rather to highlight the possible risks of impaired moral perception in health care contexts. Such an atheist might also claim that there is no point in engaging in a religious debate on the existence of God, since there is just nothing there to debate. This review critically analyzes the arguments placed by Colonel J.S. Scand J Caring Sci; 2012; 26; 427–435. The first of these involves a fundamental conflict about the force or priority of accepted moral standards. Moreover, it is important to place in context that what is generally known today as ‘quandary ethics’ (involving situations in which people find it difficult to decide what they should do ) is a relative ‘new comer’ to the field of bioethics (see Pincoffs 1971 : 553) and one that has not necessarily been amendable to advancing nursing ethics discourse ( Johnstone & Hutchinson, 2015 ). Moral problems can range from the relatively ‘simple’ to the extraordinarily complex, and can cause varying degrees of perplexity and emotional reactions (e.g. The first type of moral problem to be considered here is that of general ‘unpreparedness’ to deal appropriately and effectively with morally troubling situations. A fifth problem, which in several respects stands as both a consequence of and a component of moral disengagement, is ‘moral fading’ (also termed ‘ethical fading’). This could be done using the MMD-HP or through monthly online staff surveys that ask whether staff's moral values have been challenged. KATE JACKSON-MEYER is a part-time faculty member in the theology department at Boston College. The accused staff member denies having abused the elderly resident, and in turn accuses the student of lying and of being the one who has really committed the abuses. For example, a nurse who knowingly and recklessly breaches a patient’s confidentiality would have committed an unethical act even if the breach in question did not result in any significant moral harm to the patient. How do we know? Copyright © 2020 by the Catholic Health Association of the United States Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Although there is no single agreed definition of moral dumbfounding, it is generally held to occur when people stubbornly maintain a moral judgment despite not having reasons to either support or defend the judgments they have made ( McHugh et al 2017 ). controversial end-of-life decisions; inadequate informed consent; working with incompetent practitioners); internal constraints (e.g. When we ask the amount to any nursing often find in. If the incident is not reported to the home’s nursing administrator, the staff member concerned will probably continue to abuse the home’s residents. Nurses experience moral distress, for example, when financial constraints or inadequate staffing compromise their … Not all adverse moral outcomes occurring in health care contexts are as ethically dramatic as those that occurred in the Chelmsford Private Hospital case, however. Significantly, most of these problems probably have a moral dimension to them. The nurse is also obliged to follow the doctor’s directives. Home / Examples and Samples / Moral Courage in Health Care . It can be seen that the amoralist’s position is an extreme one, and one which is very difficult to sustain. assistance is required to help attendant nurses to answer the question: What should we do? First, the scenarios used in survey research instruments (see Corley 2002 ) tend to depict situations that lack equivocality and uncertainty than is likely in the clinical settings in which nurses’ work. I received high grade and positive feedback from my instructor. The staff member who was the subject of the unsubstantiated allegation is counselled in confidence by the administrator. Furthermore, it is not clear that, in this instance, the principle of non-maleficence fully captures the demand to be caring, compassionate and culturally appropriate in manner when performing such an unpleasant task as giving someone an unfavourable medical diagnosis. The possibility of this situation occurring in health care contexts is something which needs to be taken seriously, and which has important implications for conscientious objection claims (an issue that is given separate consideration in Chapter 11 of this book). Moral injury is rampant in health care because of this banality of evil. An example of this can be found in the tragic case of a middle-aged man who was dying from advanced cancer. Health care workers, first responders and chaplains may experience moral distress due to the COVID-19 crisis, and this can affect them psychologically, morally and spiritually. 5.1 , or of the rabbit rather than the duck in the ambiguous drawing shown in Fig. The issue of ‘moral blindness’ among nurses is an important one since, as with the problem of moral unpreparedness, it can result in ‘wrong decisions’ being made and otherwise preventable moral harms occurring. Accepting the above definitions, an immoral nurse can thus be described as someone who knowingly and willfully violates the agreed norms of ethical professional conduct or general ethical standards of conduct towards others. Working with the threat of contracting COVID-19 and spreading it to patients or family members may cause moral distress. In order to be able to do this, however, nurses must first be able to distinguish moral problems from other sorts of (non-moral) problems (e.g. In order to better understand the foundations of moral disagreements in the workplace and nurses’ reactions to them, more needs to be known about nurses’ taxonomy of ethical ideologies – that is, what their personal ethical standpoints are, the extent to which their personal views frame their ethical decision-making and behaviours in professional contexts, and the bases upon which they justify their conduct. Nursing research confirms that stressful situations are a frequent occurrence in the acute care setting, and these events play a critical factor in a nurse's job satisfaction. Since then, it’s undergone many revisions to offset advances and changes in analysis, technology, law and overall challenges in nursing. When the incident had been resolved and the hostages were safe, one of the police officers began to administer first aid care to bot… They may disagree, however, that abortion is wrong. Perhaps the most approximate example that can be given here is that of psychopaths or frontal-lobe-damaged persons who simply lack all capacity to be moral – an issue that has been comprehensively explored in the neuroethics literature (see, for example, Damasio, 1994, Damasio, 2007 ; Gazzaniga 2011 ; Gellene 2007 ; Koenigs et al 2007 ; Lehrer 2009 ; Strueber et al 2007 ). The price paid for acting morally or for taking a moral stand can be high, as other examples to be given in the chapters to follow will show. nurses’ lack of moral competencies; perceived lack of autonomy and powerlessness to act; lack of knowledge and understanding of the full situation); and … Harmful Effects of Moral Distress Explaining this observation, Tenbrunsel and colleagues (2010 : 154) write: Research also suggests that when people are faced with extreme situations (e.g. The doctor has ordered that the patient not be told his diagnosis. There are many ‘obvious’ examples of immoral conduct by nurses. Examples of moral fanaticism exist in health care contexts. In such cases, the nurse and the physician are released from criminal responsibility regarding the patient’s death. This is surely what Dr. Sayeed means when he describes that his humanity is being chipped away. If the incident is reported, there is a risk that the interests of both students and the school of nursing could be undermined. Treating a patient suffering from terminal lung cancer is an example of end-of-life situation that can result in ethical issues. Constraints on meeting nurses’ moral obligation to relieve pain and the suffering it causes A more in-depth approach to dealing with moral distress is the Mindful Ethical Practice and Resilience Academy developed by Rushton, which builds moral resilience over the course of six sessions. (314) 427-2500. Click here for sample essays written by our professional writers. The options open to the nurse are: to modify the principles in question so that they do not conflict (i.e. 2 It is depicted as threatening the integrity of nurses and, in turn, the quality of patient care. Moral distress is an issue that affects emotions and can cause anxiety, but there are physical symptoms as well, including: Gastrointestinal issues; Insomnia; Headaches; Nightmares; Once nurses identify moral distress, Stokes says they’re better equipped to overcome it. I had no time to compete my dissertation, but my friend recommended this website. In addition, there is the problem of what Moore and Gino (2013) describe as ‘organisational aggravators’, which include organisational socialisation and identification, role expectations, goal orientation and group loyalty – all of which can, in various ways, be morally degrading and corrupting. When pressed to ultimately provide sound reasons and justifications for their negative verdicts on these examples, participants have tended to become ‘dumbfounded’ admitting either that ‘they don’t know’, ‘they can’t explain’, or that it (incest, cannibalism, eating your pet) is ‘just wrong’ (seemingly based on a misattribution of these acts being harmful) – or ‘just disgusting’ (an emotional response) ( Haidt 2001 ; Haidt & Björklund 2008 ; Haidt et al 2000 ; Hindriks 2015 ; McHugh et al 2017 ). Contributing to and facilitating ethical fading are what Moore and Gino (2013) have termed in another context moral neglect , ( faulty) moral justification (manifesting as self-verification), and ultimately moral inaction . Two nurses might both accept a moral standard which generally requires truth telling, but may disagree on when this standard should apply. Moral suffering is common in clinical practice. Whether moral disengagement can be effectively remedied by targeted interventions designed to prevent or counteract its incidence and harmful impact is not clear. The clinical teacher is temporarily undecided about what to do. Fill our order form with all the details you want. They made me feel at ease and worked out my every query with a smile on their face. For many, the lack of enough essential resources, such as PPE and ventilators, will seem unjust or unfair and can generate moral distress. controversial end-of-life decisions; inadequate informed consent; working with incompetent practitioners); internal constraints (e.g. Hannah Arendt defined the banality of evil in her 1963 book, Eichmann in Jerusalem. Without these skills, a nurse working in intensive care would be likely to place the life and wellbeing of the patient at serious risk. It is generally accepted that something involves a (human) moral / ethical problem where it has as its central concern: the promotion and protection of people’s genuine wellbeing and welfare (including their interests in not suffering unnecessarily), responding justly to the genuine needs and significant interests of different people. In cases of total radical moral disagreement , disputants do not agree on any criteria of relevance, and do not share any basic moral principles. Gray and colleagues (2014 : 1600), for example, contend that ‘perceiving harm in immorality is intuitive and does not require effortful rationalization’. People might agree that, as a general rule, we should all make certain modest sacrifices in terms of our own interests (a minimal requirement of justice), but may disagree ‘about what constitutes a modest sacrifice’ ( Milo 1986 : 459). In recent years, moral distress has been portrayed as a ‘major problem in the nursing profession, affecting nurses in all health care systems’ ( Corley 2002 : 636; see also Musto & Rodney 2018 ). The notion of ‘moral disengagement’ (like moral fading, which will be considered under the following subheading) was first articulated by Canadian-born psychologist Albert Bandura, 1986, Bandura, 1990, Bandura, 1999 ; Bandura et al 1996 ) and is broadly defined as a process whereby an individual convinces himself / herself through a process of elaborate self-serving rationalisations that ethical standards do not apply to them in given situations and thus they do not need to self-censure. 6 Doctors' orders prevent a nurse, Maria, from … Maria knows what to do — give pain medication — but isn't allowed to do it. Aside from the fact that it is illegal, euthanasia poses strong moral, social, and ethical challenges. An example of total radical moral disagreement would be where two theatre nurses radically disagree with each other about the moral acceptability of organ transplantations. In the ultimate analysis, the solution to the problem of moral disagreement may not be to engage in adversarial dialogue (fight / litigate), or even to negotiate a happy medium between conflicting views (compromise). Discuss the nature of the moral problems listed below and their possible implications in regard to the ethical practice of nursing: Discuss critically the role that reason, emotion, intuition and life experience might play in moral decision-making. To the contrary: our reasoning may assist us to deal with a conflict of duty and may assist us to find a ‘best’ way to act, but this does not mean that we abandon one or other of the duties in question. the rules are divided into 9 provisions that cover topics that embrace human dignity, confidentiality, ethical virtue and care as a right. A nurse who is an amoralist would reject any imperative to behave morally as a professional. They claim that, on an initial viewing of an ambiguous drawing, a majority will report seeing one dominant image first – for example, the duck. Distinguish the moral difference between ‘wants’ and ‘needs’. Others, such as Johnstone and Hutchinson ( 2015 ), argue that the entire concept ought to be abandoned because it undermines the process of moral deliberation by perpetuating the notion that nurses’ moral judgements are correct and justified. When he became abusive, the nursing staff contacted a hospital security officer, and he was forcibly removed. resilience What these two nurses are essentially disagreeing about is not the moral standard per se (that nurses should act to prevent violations of patients’ rights), but about when morally relevant considerations can be and cannot be overridden by self-interest. One reason for this is that it has not been comprehensively studied. Rather, it requires that we draw on our past experience, knowledge, intuition, awareness, insight, feelings and interpersonal skills, as well as on a thorough and systematic analysis of the facts of the situation at hand. This problem is not insurmountable, however. The moral fanatic is someone who is thoroughly ‘wedded to certain ideals’ and uncritically and unreflectingly makes moral judgments according to them ( Hare 1981 : 170). Ways of Dealing with Moral Distress Just as a colour-blind person fails to distinguish certain colours in the world, a morally blind person fails to distinguish certain ‘moral properties’ in the world. The psychological aspects and their behavioral and emotional expressions will need the expertise of mental health professionals. The problem with moral fading is that even ‘good’ and well-intentioned people can find themselves crossing ethical boundaries and being ‘ethically faded’ and ‘ethically adrift’ without even realising it ( Moore & Gino 2013 : 55). The dilemma for the clinical teacher is whether to not report the matter and thereby protect both the students’ and the school’s interests in having continued clinical placements, or to report the matter fully, whatever the consequences to the school and the students, and thereby protect the residents’ interests. It might be objected that the examples given here do not involve difficult cases, and that the required choices are relatively easy to make. Appealing to a moral standard prohibiting the killing of innocent human life would then, for Nurse B, be supremely relevant. smoking cigarettes). Ethical fading fundamentally involves self-deception (encompassing ‘language euphemisms, the slippery-slope of decision-making, errors in perceptual causation, and constraints induced by representations of the self’). In the world of clinicians, moral outrage can arise when a patient is experiencing extreme suffering and the nurse doesn’t feel treatment is working, but the family has requested that life sustaining therapies be delivered at all costs. For example, if you order a compare & contrast essay and you think that few arguments are missing. Seen as a major issue in nursing today, moral distress is experienced when nurses are unable to provide what they perceive to be best for a given patient. At its most basic, immoral conduct (also termed unethical conduct ) can be defined as any act involving a deliberate violation of accepted or agreed ethical standards. The Nazi falls into the category of being a ‘fanatic’ when he / she insists that, if any Nazis discover themselves to be of Jewish descent, then they too should be exterminated along with the rest of the Jews ( Hare 1963 : 161–2). of giving analgesia) is precluded by the moral demand to respect the patient’s autonomous wishes. New Ways for Catholic Health Care to Treat Moral Distress This is a level of trust that's not taken lightly by RNs, who face many examples of ethical dilemmas in nursing daily. The clinical–moral Gestalt problem became apparent at an Australian nursing law and ethics conference in 1988. The retreat by nurses into moral indifference and insensitivity (moral blunting), while not condonable, is understandable. The problem of moral indifference and moral insensitivity in nursing was first captured by Mila Aroskar (1986) in her classic article ‘Are nurses’ mind sets compatible with ethical practice?’ Aroskar (1986 : 72) cites the findings of a study undertaken in the late 1970s which showed that nurses tended to defer to institutional norms ‘even when patients’ rights were being violated’. I’m glad I chose them for my work and will definitely choose them again. (The home’s administrator might, for example, refuse to continue allowing students to be placed at the home for the purposes of gaining clinical experience.) In his classic article ‘Moral deadlock’, Milo (1986) identifies two fundamental types of moral disagreement: internal moral disagreement and radical moral disagreement. Williams (1973) disagrees. Please refer to an authoritative source if you require up-to-date information on any health or medical issue. The administrator takes the allegation seriously and, later, takes the initiative to emphasise to all staff the importance of protecting and upholding residents’ rights. Nurse B, on the other hand, argues that retrieving organs is nothing like murder since, among other things, the person is already dead. public health emergencies, unjust organisational cultures), they will abandon ‘the illusion that certain values are infinitely important’ and make moral compromises ( Tetlock 2003 : 322) – in short, their otherwise ordinary ethical standpoints ‘fade’. In other words, what happens here is that one of the two apparently conflicting duties is eventually ‘cancelled out’. Matters commonly identified as being the source of moral conflicts are: goals of patient care and treatments, quality of care, preventing and alleviating patient suffering, poor communication, and resource allocation ( Edelstein et al 2009 ; Gaudine et al 2011 ; Leuter et al 2017 ; Pavlish et al 2013 , 2014 ). With us, these concerns do not exist as you buy inexpensive trials. Research has shown that different people can make quite different yet equally valid moral judgments about the same situation. The maintenance of absolute confidentiality, even though harm might be caused as a result, is an example. nurses’ lack of moral competencies; perceived lack of autonomy and powerlessness to act; lack of knowledge and understanding of the full situation); and external constraints (e.g. The problem of moral conflict is considered further in Chapter 11 of this text. Instead, we should look towards a more optimistic solution, and view such disagreements as an important and necessary opportunity for ‘enriching [our] conceptions of morality through comparative inquiry’ ( Stout 1988 : 70), and thereby augment our collective wisdom about what morality is, and what it really means to be moral in a world characterised by individual and collective (cultural) diversity. As discussed in Chapter 1 , moral delinquency in professional contexts entails a deliberate or careless violation of agreed standards of ethical professional conduct. In the dispute between Nurse A and Nurse B, resolution is unlikely. Accept and close . A seventh type of problem that might be encountered by nurses is ‘immoralism’ or immoral conduct. Here the nurse is caught between a duty to tell the truth to the patient, and a duty to respect the wishes of the family. This can be a new type of meeting or rounds, what I would call 'Moral Health Rounds,' or can be done through channels already in place, such as Schwartz Rounds or Ethics Rounds adapted to meet virtually and more regularly with a special focus on moral distress. In my mind, I'm going to do it, I'm going to be there until this is done, but it's going to be very hard to come back to work after this is over. Further analysis is required. While the nursing profession is fulfilling, it is not without challenges. After further study and clarification, a consensus emerged that moral distress involves the following elements: the impossibility to do the right action, stages of distress, and harm to "moral integrity. Undergraduate. The pain and suffering of moral distress can manifest in the caregiver in numerous ways. All health professionals encounter a variety of problems in the course of their everyday practice, and nurses are no exception. It is a ‘thinking error’ and also arrogant to assume that our moral opinions are ‘right’ just because they are our own opinions. Researchers have found that the most common cause of moral distress for nurses is when a patient continues to receive aggressive treatment when he or she is unlikely to have a positive outcome.11 Gina's case is an example of moral distress caused by a clinical situation and external constraints. Of ‘ everyday ’ ethical issues that nurses might agree on some criteria of relevance but all... 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