Although countering moral distress involves various tactics, keeping your eye on a few key ones can be beneficial.
1. Prioritize professional growth.
Whatever your career strategy you can never educate yourself too much about ethical issues and moral distress. The more you know the better prepared you’ll be for addressing whatever uncomfortable scenarios come your way. You don’t have to join an ethics committee or even become a nurse ethicist to understand the topic, even though they’re both worthy goals. By mining your organization’s continuing education opportunities and keeping tabs on your professional society’s resources you can become a savvy participant. For instance, in The 4A’s to Rise Above Moral Distress, the American Association of Critical-Care Nurses (AACN) provides an extensive blueprint for helping nurses and nursing staffs create a healthier work environment. With ask, affirm, assess, and act as guidelines, the AACN’s moral distress handbook demonstrates how to recognize and overcome the stress.
2. Sharpen other edges.
In addition to a supportive work environment, you need other self-care strategies to carry you over the finish line. You likely already know the basics: Adequate exercise, nutrition, and sleep are necessary for anyone’s mental and physical well-being. But identifying confidants—a counselor, spiritual advisor, or even close friend—outside your workplace as well as other reinforcements can bolster your resolve. For instance, Katherine Brown-Saltzman, RN, MA, co-director of the UCLA Health System Ethics Center and an assistant professor at the UCLA School of Nursing, conducts workshops to help health providers address their moral distress, whether it’s already occurred or just a potential. The retreats are not only part of UCLA’s extensive ethics focus, but also a reflection of research she and her colleagues are pursuing to create healthier environments for addressing such issues. Their goal is to move beyond the links between moral distress and quality of care to prevention and coping strategies. By using ethics assessments to identify risk factors for conflict, they hope to give nursing team leaders early indicators for engaging staffers daily. “It’s quite profound how long people hold on to moral distress,” says Brown-Saltzman. “It can accumulate, escalate, and become extraordinarily isolating over time. But coming together, engaging, speaking out, and even writing can be very helpful.”
3. Be detailed.
If you want to make your point, be as prepared as possible, especially for an ethics consult or family meeting. When the topic is end-of-life, for instance, complete charting can be your best ally. It’s not only to your advantage to make sure that a formal advanced directive is noted clearly, but also that you’ve documented spontaneous conversations with the patient over his or her wishes. If this person lets you know in a moment of complete clarity, “I’m just so tired. I don’t want to do this anymore,” you have what constitutes a verbal advanced directive in many states. By detailing it, you also can make a case that your patient is ready to go, even if someone has a different plan.
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