There are a number of hazards in virtually any profession, and nursing is not an exception. One of such hazards is the problem of moral distress. It can affect both nursing staff in the clinical setting and nurse educators in the academia. In this paper, the definition of moral distress will be given. Because the author of this paper has not experienced the symptoms of moral distress (as described by Ganske (2010)), the contributing factors to moral distress in academia and in the clinical setting will be discussed, and their consequences will be described.
According to one of the earliest definitions of moral distress, it is the stress that occurs “when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” (as cited in Ganske, 2010, p. 2). It should be distinguished from a moral dilemma, when a person is not sure which option to take because they represent conflicting values (Burston & Tuckett, 2012, p. 312). Moral distress might be experienced by representatives of a wide range of professions, nursing being one of them. Nursing personnel often may face it as a result of being unable to care for their patients in a way that they see as the most beneficent due to the bounds imposed on them (Ganske, 2010, p. 2).
Ganske (2010) argues that moral distress can often be experienced by nurses not only in the clinical but also in the educational setting. Among the factors named as contributing to it in the academia, academic dishonesty, bullying or other types of incivility, and grade inflation are named (Ganske, 2010, p. 1, 4). Moral distress experienced by nurse educators in the academia may lead to numerous adverse results in the educational setting. Ganske (2010) names some symptoms of the moral distress: “mental pain, sleeplessness, and guilt” (p. 6). It is clear that such feelings, psychological and emotional reactions can have a significant negative effect on the faculty’s enthusiasm and desire to teach, which might reduce the quality of their courses and/or increase the rates of turnover (Ganske, 2010, p. 7-8).
Moral distress in the clinical setting can be caused by both individual factors (traits of character, experience, relationships, worldview) and external factors (staffing, resourcing, quality of medical treatment and care, moral atmosphere of the setting, and the type of practice) (Burston & Tuckett, 2012, p. 314, 317). It is stated that moral distress leads to a number of outcomes which may be classified as “consequences for the self and others and consequences also for the system” (Burston & Tuckett, 2012, p. 318). Towards oneself, a nurse may experience horror or anticipatory dread during a situation that leads to distress; a distressed nurse often feels disappointed, self-doubtful, lacking self-esteem, demoralized, helpless. A nurse may undergo a severe depression. Sometimes they give up and experience burnout. Towards others, a nurse might become easily irritated, bitter, cynical, or, on the other hand, dismayed or stunned. Towards the system, it is important that not many nurses attempt to address the system which causes the situation of the moral distress. In many cases, they may avoid any conflict situations or even their patients. Nurses might consider leaving their current position or their place of work; some, having experienced severe burnout, even quit their profession completely (Burston & Tuckett, 2012, p. 318-319).
To sum up, moral distress emerges when a person is unable to follow the course of actions they perceive as the right one due to institutional constraints. It can be experienced in a variety of professions, and nurses and nurse educators are among them. There are a number of contributing factors to moral distress, and it leads to numerous negative consequences in both the educational and the clinical settings.
References
Burston, A. S., & Tuckett, A. G. (2012). Moral distress in nursing: Contributing factors, outcomes and interventions.Nursing Ethics, 20(3), 312-324. Web.
Ganske, K. M. (2010). Moral distress in academia.Online Journal of Issues in Nursing, 15(3), 1-10. Web.