Moral distress in the nursing profession



Moral distress in the Nursing Profession

Introduction

Moral distress as a concept is not limited to nursing. It can be experienced in all professions and in all work settings. Austin, Rankel, Kagan, and Lemermeyer (2005), in their study of moral distress in psychologists, defined moral distress as “the state experienced when moral choices and actions are thwarted by constraints” (p.197). Using the language of moral reflection among professors, Brown and Gillespie (1999), in their paper on moral distress in universities, also described moral distress as an experience of being constrained from doing the right thing.

Discussion

The nursing profession has traditionally held to a high standard of moral behavior and ethical practice. Nurses in clinical practice frequently report the distress they experience when, for example, a standard that they believe in is compromised in some fashion. Other times this distress occurs when the nurse does not believe that the treatment being provided to the patient is in the best interest of the patient, or does not mesh with the nurse's sense of right and wrong. Nurse educators, through anecdotal conversations and comments, have shared with this author the moral distress they have experienced when the administration of their educational unit makes a decision they do not feel is in the best interest of the student or the nursing profession. The following scenarios, although fictional, represent anecdotal examples of moral distress in nursing education.

Example

William is a 24 year old nursing student who has struggled from the time he entered the nursing program. Each semester brings new challenges, and his grades skim the passing point. He is just getting by. He somehow reaches his senior year, unable to assemble grammatically correct sentences, organize a research paper, or follow the dreaded APA format as taught or described in his manual. He does his best and turns in his final paper. His professor is dismayed with the paper and returns a failing grade for his project. He appeals to her angrily, saying “I have never had a grade like this before.” She is perplexed because she knows there are many written assignments in the nursing program and wonders how he could have gotten to this point and still have passing grades. She feels she should give him the grade he has earned, but the dean has told her, “you cannot stop him now, he is about to graduate.” She angrily wonders why her colleagues have not dealt with his writing appropriately. Distressed, she feels like she is shouldering responsibility for what her colleagues should have done semesters ago. Yet she knows she cannot override her dean in this situation.

Moral Distress in Nursing Education

Moral distress as a phenomenon has been confirmed by researchers such as Hamric and Blackhall, (2007); Corley, Minick, Elsick, and Jacobs, (2005); and Gutierrez, (2005). However, virtually all of the healthcare-related research on moral distress that was found during the literature search occurred in clinical practice settings; this research was frequently associated with end-of-life situations. No reports were found describing moral ...