Paper
Thursday, 20 July 2006
This presentation is part of : Ethical Issues
Exploring the Moral Distress of Registered Nurses
Patti Rager Zuzelo, EdD, APRN-BC, CS, School of Nursing, La Salle University and Albert Einstein Healthcare Network, Philadelphia, PA, USA
Learning Objective #1: describe ethical dilemmas RNs identify as morally distressing within the context of clinical practice.
Learning Objective #2: identify strategies for reducing the occurrence of high frequency, highly distressing moral conflicts or improving the moral disequilibrium associated with rare but distressing ethical dilemmas.
Registered Nurses (RNs) employed in an urban healthcare environment identified moral distress and systems of moral support as significant concerns. This study describes RNs’ moral distress and conceptualizes moral distress as the painful feelings and/or psychological disequilibrium that occur when nurses comprehend the morally appropriate action a situation requires, but cannot carry out that particular action because of institutional constraints (Jameton, 1993). Data were collected using the Moral Distress Scale (MDS) developed by Corley (2002). An open-ended questionnaire for qualitative data was included with the MDS as was a demographics form. Instruments were distributed to direct care providing RNs working on in-patient clinical areas. The study was granted IRB approval. Survey return signified informed consent. Respondents (N = 86) returned surveys over 5 months. Responses were analyzed for descriptive statistics using SPSS 12.5. Qualitative data were thematically analyzed. Respondents ranged in years of practice from 1 to 38 years. A majority had not earned college credit or continuing education credits in biomedical ethics. Half had earned a BSN. Sixty-three percent had never initiated an Ethics Committee consultation. Events identified as morally distressing include: following family’s wishes for patient care even though the nurse disagreed with the plan, working with staffing levels perceived as “unsafe,” continuing life support for patients due to family wishes despite patients’ poor prognoses, following orders for pain medication therapy despite its ineffectiveness, and providing care that does not relieve suffering because of physician fears concerning pain medication dosage. A high frequency distressing event included carrying out orders for unnecessary tests and treatments. Qualitative data analysis revealed that nurses sought support and information from Nurse Managers, pastoral services, and colleagues. RNs requested further information on biomedical ethics and suggested ethics rounds as well as a non-punitive environment surrounding the initiation of ethics committee consultations.

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See more of The 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)