Moral distress at work - do you know what to do?

Monday, July 9, 2012 - 3:56pm

You want to do the right thing for a patient, but you feel something stands in your way. Perhaps a power dynamic or lack of resources is a barrier to action; maybe the family’s wishes conflict with your personal beliefs about what is best for a patient; or you may simply feel ill-equipped to address a particular issue that affects patient care.

Not being able to be true to your values and beliefs causes moral distress. In health care, moral distress is common, particularly among nurses. “Nurses have multiple obligations - to their profession, to the employer, to the physician, and ultimately to the patient,” says Leslie McLean, project manager with Cancer Care and co-ordinator of CHES’s Clinical Ethics Consultation service, “This can sometimes create competing challenges.”

Moral distress affects other health professionals as well and shows up in a number of ways. Because health care tends to be hierarchical, some professionals may not feel they can speak up when their opinion conflicts with the beliefs or actions of someone in a greater position of authority, whether real or perceived.

If moral distress goes unresolved, it can build up over time, leaving what’s called moral residue. As Leslie explains, “Evidence indicates that moral residue can result in changes that are personal (unresolved feelings of incompetence, frustration, anxiety and depression) and professional (avoidance of patients, burnout) and consequently compromises patient care.” So how do we deal with moral distress - as individuals, teams and an organization - to prevent moral residue?

“Communication is critical,” says Leslie. “Talking about the issue, acknowledging what’s going on and having an opportunity to have your voice heard - even if it doesn’t change the outcome - is very helpful.”

Not sure you’re equipped to have these conversations? Capital Health Ethics Support (CHES) can help. CHES offers moral distress workshops where people can draw on and learn from their own experience as well as from case studies. In addition, CHES offers ongoing ethics rounds, and is available for clinical consultations to help your team work through difficult ethical situations.

“We’re never going to get rid of moral distress all together,” says Leslie. “But there are ways of effectively working through the issues and letting them go.”

To learn more or to contact CHES, please call (902) 473-1564.