The document discusses moral distress experienced by nurses. Moral distress occurs when a nurse knows the right course of action but is unable to take it due to obstacles. This causes psychological imbalance and physical/emotional symptoms. It differs from burnout, jading, grief, and compassion fatigue. Moral distress stems from institutional, resource, legal, and policy constraints. It leads to implications like lack of empowerment, job dissatisfaction, and high turnover. Preventing moral distress involves educational, communicative, and organizational strategies like ethical training and committees, improved communication, and increased support/resources for nurses.

1. IMPACT & OUTCOMES OF MORAL DISTRESS
IN NURSING: ISSUES & IMPLICATIONS
Saramma Samuel
Principal
RVS College of Nursing, Sulur
Coimbatore 641402

2. OBJECTIVES
• Comprehend the term Moral
Distress
• Recognize the difference
between moral distress,
burn out, grief out, Jading &
Compassionate fatigue.
• Factors causing Moral
Distress
• Issues and Implications of
Moral Distress
• Strategies to prevent Moral
Distress.

3. Definition of Moral Distress
Moral distress (MD) was first described
in the 1980s and was expressed as
suffering that arises from incoherence
between one’s actions and convictions.
In other words, one knows what is the
right thing to do but recognizes
herself/himself as unable to pursue
such an action.

4. The psychological
disequilibrium
that occurs when
a person believes
he/she knows the
right course of
action, but
cannot carry out
that action
because of some
obstacle.

5. Psychological
imbalance
pain, anguish,
helplessness,
conflict in
moral values

7. Burn out:
Individual or group stress related
to one’s relationship with the work
environment.

8. Jading:
is a process leading to exhaustion from
being overdriven to perform long,
continued labor & or severe tedious tasks

9. Grief out:
Repeated sustained and often
unresolved grief and loss.

10. Compassion fatigue:
Gradual
lessening over
time of ability
to be
compassionate.

11. ETIOLOGY OF MORAL DISTRESS
 institutional constraints
 lack of power
 lack of resources and/or
support
 legal limits
 when nurses disagree with
a course of action that has
been chosen
 inability to complete basic
nursing function/role

12. Contd…
•Declining resources
•Conflict of use of
resources, violation of
personal morals/values,
•Poor quality & futile care
•Unsuccessful advocacy
•Policy constraints
•Treatment of patients as
objects

13. Features of Moral Distress

14. Manifestations Intrusive thoughts
Disturbing dreams
Anxiety
Depression
Irritability
Fatigue
Difficulty in sleeping
Crying spells
Anorexia
Insomnia
Muscle pain
Sweating
Detachment from
others
Emotional numbing

15. Physical
•Fatigue/
exhaustion
•Lethargy/
hyperactivity
•Weight gain/loss
•Susceptibility to
illness
•Persistent
physical ailments
•Headaches
•GI symptoms
•Impaired sleep
•Impaired mental
processes
•Forgetfulness
Emotional
• Anger
• Fear
• Guilt
• resentment
• Confusion
• Sorrow
• Depression
• Cynical
• Sarcasm
• Emotional outbursts
• Emotional shutdown
• Overwhelmed
• Anxiety
• Hurt
• Frustration
Behavioral
• Addictive behavior
• Controlling
behaviors
• Offender behavior
• Boundary violations
• Over/under
involvement
• Apathy
• Avoidance
• Agitation
• Shaming others
• Victim behaviors
• Depersonalization
• Feeling of being
unable to act
• Crying due to work
related issues
Spiritual
• Loss of meaning
• Crisis of faith
• Loss of control
• Loss of self-worth
• Disrupted religious
practice
• Disconnection with
people, work,
community

16. Crescendo Effect (solid lines indicate
moral distress, dotted lines indicate moral
residue)

17. Lingering distress is called
Moral Residue. Moral residue is
long-lasting and powerfully
integrated into one’s thoughts
and views of the self. It is this
aspect of moral distress—the
residue that remains—that can
be damaging to the self and
one’s career, particularly when
morally distressing episodes
repeat over time.
MORAL RESIDUE

18. IMPLICATIONS & OUTCOMES
Lack of power in decision
making
Feelings of guilt, limits self
efficacy
Job dissatisfaction & High
turnover
Abandonment of the
profession
High cost for training,
recruitment.

19. Prevention & Coping Strategies for Moral Distress
Educational Dimension
strengthen reflections about ethical
issues,
use of power,
maintain ethical dialogue with
other professionals,
promote socializing and
discussions about care provided

20. COMMUNICATIVE DIMENSION
• Multi professional
communication
• Ethical Committee Rounds

21. Organizational Dimension:
• Involvement of Nurse
leaders in creating
organizational policies &
decisions.
• Incorporating safety
measures
• Hire more nurses
• Improve ethical practices

22. Other Strategies include:
• Analysis of Cause
• Self awareness/ self
monitoring
• Address real issues
• Debriefing/ talking about it
• Holding Ethical dialogue with
senior professionals
• Skill building
• Working out grief, coping
• Getting assistance in ‘Letting
go’

23. Exercise Moral courage
is the courage to
take action
for moral reasons
despite the risk of
adverse
consequences