Moral Distress
According to a peer-reviewed article in Nursing Ethics, moral distress has become an increasingly serious concern in the nursing profession. The implication is that moral distress is associated with "ethical climate"; in other words, when a nurse knows full well the right thing to do in any particular healthcare situation but finds that "institutional constraints make it nearly impossible to pursue the right courts of action," that nurse is exhibiting signs of moral distress. Of course moral distress can and does also result from burnout (Pauly, 2009, p. 562).
In approaching this question through research the authors discovered -- through a survey of 374 nurses in British Columbia -- that morally distressing experiences "may not be frequent, they may have significant impact when they do occur" (Pauly, 569). Indeed, some nurses had "vivid memories of morally distressing situations that had occurred many years previously" (Pauly, 569). Pauly also reports that the "accumulation of unresolved moral distress" is known as "moral residue," which can have a "profound negative effect" (569).
The Implications from an Advanced Practice Nurse's Perspective
The initial response to conducting the research on nurses, burnout, ethical dilemmas and moral distress is that healthcare administrators, educators and executives have fallen down on the job in terms of preparing nurses for a stressful position in the workforce that can't help but create high levels of stress, based on the information and data previously presented in this paper. Another peer-reviewed article in Nursing Ethics points to the research that shows moral distress is "similar to burnout," which is defined by Ohnishi as "…an excessive stress reaction to one's occupational or professional environment" (Ohnishi, et al., 2010, p. 728).
From the perspective of the psychiatric nursing milieu in Japan -- using the MBI-General Survey (MBI-GS) scale, which is employed as a way to measure burnout -- the three subscales...
Exhaustion occurs first, and then it evolves into cynicism, and finally into professional efficacy, Ohnishi explains (728).
Ethical Reasoning Perspective
In the first place it is difficult for a nurse or other professional in the medical and healthcare field to embrace ethical reasoning if he or she is suffering from burnout that takes a moral toll on the individual. The role of ethical reasoning is to bring special attention to two kinds of human actions: a) those that are beneficial for the well being of others (that deserves praise from observers); and b) those human actions that harm others or diminish the well-being of others in some way. Are competent, respected nurses capable of fully embracing ethical reasoning if their own moral standards are being whittled away by the stress of the job and by the subsequent onslaught of burnout? The answer from this paper's perspective is no. In fact asking a nurse that has suffered from burnout -- the accumulation of stress from all the challenges mentioned in this paper -- to competently, intelligently perform ethical reasoning practices is difficult at best and folly at the worst end of the spectrum.
Works Cited
De Casterle, Bernadette Dierckx, Izumi, Shigeko, Godfrey, Nelda S., and Denhaerynck, Kris.
(2008). Nurses' responses to ethical dilemmas in nursing practice: meta-analysis, Journal of Advanced Nursing, 63(6), 540-549.
Ohnishi, Kayoko, Ohgushi, Yasuko, Nakano, Masataka, Fugii, Hirohide, Tanaka, Hiromi, Kitaoka, Kazuyo, Nakahara, Jun, and Narita, Yugo. (2010). Moral distress experienced by psychiatric nurses in Japan. Nursing Ethics, 17(6), 726-740.
Pauly, Bernadette, Varcoe, Colleen, Storch, Janet, and Newton, Lorelei. (2009). Registered
Nurses' Perceptions of Moral Distress and Ethical Climate. Nursing Ethics, 16(5), 561-571.
Wlodarczyk, Dorota, and Lazarewicz, Magdalena. (2011). Frequency…
