Nursing Situation

You are an APN working in a busy emergency department. A patient is brought in by ambulance after being found unconscious in his home. The patient is a 65-year-old man with a history of chronic obstructive pulmonary disease (COPD) and heart failure. He is also morbidly obese and has a poor social support system.

The patient is in respiratory distress and is immediately intubated and placed on a ventilator. He is also given fluids and medications to stabilize his heart. However, the patient’s condition continues to deteriorate and he goes into cardiac arrest.

The code team is called and they are able to resuscitate the patient. However, the patient remains in a coma and is not expected to recover. The family asks you if there is anything else that can be done.

You know that the patient is on a ventilator and that he is receiving aggressive treatment. However, you also know that the patient’s prognosis is very poor. You are faced with the difficult decision of whether or not to continue life-prolonging treatment.

Definition of Moral Distress

Moral distress is a state of psychological disequilibrium that occurs when an individual knows the right thing to do, but is prevented from doing it by constraints, such as organizational policies, laws, or the actions of others.

Evidence-Based Literature

Moral distress is a well-documented phenomenon in the nursing literature. A study by Corley et al. (2001) found that moral distress was a common experience among nurses, with 80% of respondents reporting that they had experienced moral distress in the past year. The study also found that moral distress was associated with negative psychological and physical health outcomes for nurses.

Personal, Professional, and Organizational Factors

There are a number of personal, professional, and organizational factors that can contribute to moral distress in nurses. Personal factors include the nurse’s own values and beliefs, as well as their level of experience and confidence. Professional factors include the nurse’s role and responsibilities, as well as the ethical codes and standards of the nursing profession. Organizational factors include the policies and procedures of the healthcare organization, as well as the culture of the organization.

In the case scenario, the APN is experiencing moral distress due to a number of personal, professional, and organizational factors. The APN’s personal values and beliefs tell her that she should do everything possible to save the patient’s life. However, the APN’s professional role and responsibilities require her to make decisions based on the best interests of the patient. The organizational policies and procedures of the healthcare organization also limit the APN’s ability to make decisions about the patient’s care.

Interventions and Strategies

There are a number of interventions and strategies that can be used to address moral distress in nurses. These interventions can be at the personal, professional, and organizational level.

At the personal level, nurses can develop coping mechanisms to deal with moral distress. This may include talking to a trusted colleague, seeking professional counseling, or engaging in relaxation techniques. Nurses can also advocate for changes to healthcare policies and procedures that they believe are contributing to moral distress.

At the professional level, healthcare organizations can develop ethics committees and policies that support nurses in making ethical decisions. Organizations can also provide nurses with training on ethical decision-making and moral distress.

At the organizational level, healthcare organizations can create a culture of compassion and respect for nurses. This includes providing nurses with the resources and support they need to make ethical decisions and to care for patients in a way that is consistent with their values and beliefs.

Differentiation of Moral Distress from Other Ethical Responses

Moral distress is different from other ethical responses, such as moral uncertainty, dilemma, conflict, and residue.

• Moral uncertainty is a state of not knowing what the right thing to do is. This is often due to a lack of information or conflicting ethical principles.
• Moral dilemma is a situation in which there are two or more morally acceptable options, but each option has negative consequences.
• Moral conflict is a situation in which a person feels torn between two or more moral obligations.
• Moral residue is the lingering feeling of discomfort or unease that can occur after making an ethical decision.

Moral distress is different from these other ethical responses because it occurs when a person knows the right thing to do, but is prevented from doing it. This can be a very difficult and stressful experience for nurses.

I hope this nursing situation illustrates moral distress related to a clinical problem that an APN is likely to encounter in practice. I have defined and explained