Ethical-Legal Nursing Discussions - Part II Moral Distress and Moral Integrity Comment by Ileana: OverviewMoral Distress in Advanced Practice NursingThe meaning of moral distress has been changing in nursing. No definition fits all dilemmas. Moral distress includes cultural beliefs, religious beliefs, educational level, and outside forces that influence thinking. It is important to learn that moral distress is an emotion managed by coping and emotional intelligence.

Analyze the difference between moral distress and moral integrity providing one example of each that relates to the role of the advanced practice nurse

When it comes to moral distress, it is viewed as a contested and evolving concept; it has been defined as a major issue when it comes to the nursing profession (Harris, 2002). Rizzo (2005) is accredited with first recognizing the thought of moral distress. For instance, he labeled moral distress as feelings that are looked at as being painful, and as a mental imbalance or disequilibrium that happens when nurses finding themselves in circumstances where they feel that they are just unable to do the right thing. Rizzo goes on to explain that moral distress ascends when one knows the right thing to do, nevertheless institutional restraints make it practically impossible to follow the accurate course of action. Staff educational level and peer backing have been discovered to effect moral distress (Toiviainen, 2007). Furthermore moral distress has been found to influence the health of nurses and their provision of care, job retention and satisfaction.

However, moral integrity can also be observed as a personal and social virtue, highlighting the point that integrity is made up of diverse values. "Acting with the virtue of integrity does not threaten the respect for life, integrity, well-being, and flourishing of others." (Ulrich, 2004) Integrity is considered to be living up to one's own ethics and also it means having some form of character. "Integrity is considered to be a noun... One acts with integrity; integrity is detached from the act in a way that truthfulness, honesty, courage and so on are not." (Munin, 2012) For example, integrity is observed when a person goes beyond what the rules and codes state and see's that acting outside of these strategies will better patient safety and outcomes, and in their interpretation is the "right thing to do." (Toiviainen, 2007)

Topic 2: Ethical Models to Resolve Moral Distress

Evaluate one that you can use as a nursing leader to resolve moral distress and post the information and website to the class. Tell the class why you chose the model with an example of how the model would solve the distress.

As a nursing leader, the rational Model is based upon principle ethics and one that can be used to resolve moral distress. The rational Model is important because when a counselor/professional is an ethical problem; they actually think over the issue, rationalizing diverse ways that the dilemma can be dealt with, and picks the most proper one. Richards, Tiffany and Bertolotti (1995) states that this model follows the following seven steps: (a) recognizing the problem (b) denoting to the code of ethics and professional rules (d) determining the dimensions and nature of the problem, (e) bearing in mind the potential concerns of each course of action chosen, (f) assessing the courses of actions: cons and pros (g) applying the best course of act (p. 270).

This model was selected because one strength of this model is that it permits a person to really examine the ethical issue, along with different choices of action, permitting them to choose the best one. Another reason why this one was selected was because it clearly describes the use of referring back to the code of ethics and professional guidelines which are very important when trying to back up a point.

An example of how this model will solve the stress is because it will involve all the parties and not just one person. In other words everyone will have their part. In this way, a decision can be made that everyone will be satisfied with. The other strength is that it allows everyone to understand each other point- of-view of the difficulties and different solutions that are being spoken to.

Topic 1: Incivility and Resolution Using an Ethical-Reasoning Tool

Explain three examples of incivility and choose an ethical reasoning tool that would help you resolve the behavior. Include the steps in the tool that lead to a solution to the behavior.

Incivility is one stint used to illustrate intimidating, rude, disruptive, and undesirable behaviors that are focused toward another person. One example of incivility would be racial and ethnic slurs. There are some nurses...

This behavior can be shown on the job while dealing with staff and patients. The second example is refusing to help others on the job. This could possibly be due to the fact that they may not get along with the staff or even the patients. The third example would be threatening or even being intimidating to faculty or even staff.
The following are the steps that lead to solution of the behaviors.

1. Clarify -- examine each option to determine which ethical principles and values are involved with racial and ethnic slurs, refusing to help others and threatening or intimidating to staff.

2. Evaluate -- If any of the options requires the sacrifice of any ethical principle, evaluate the facts and assumptions carefully

3. Decide -- consider the worst case scenario.

4. Implement -- Develop a plan of how to implement the decision

5. Monitor and modify -- be prepared and willing to revise a plan, or take a different course of action.

Topic 2: Ethical-Decision-Making models Used to Solve Incivility Comment by Ileana: OverviewEthical Decision-Making and Incivility Ethical decision-making and incivility have become a global, pervasive practice in nursing and health systems. Incivility can be any behavior from simply being rude to deadly force. Evaluating the development of incivility, assessing how stress affects the ability of an advanced practice nurse to be able to manage the behavior, and understanding how to de-escalate incivility are important tools for nursing leaders to know. The use of an ethical reasoning tool to guide resolution in steps and the knowledge of models used successfully to intervene when the behavior appears may be lifesaving and are sound team building tools and strategies for all nursing leaders.

Explain one ethical decision -making model that you can use to resolve the moral distress caused by incivility. Include why you chose the model and provide an example of how the model would solve the moral distress. Plan to use the information in your Unit 7 presentation.

One ethical decision making model to be used is the Collaborative Model which is based on a group's viewpoint. Davis (1997) decided that his model should be founded on standards of inclusion and cooperation (p.296). This model has four steps when exchanging with an ethical decision (a) recognizing characters who are affected by the problem (b) accepting the worldview of each person (c) accepting each individual's perspective (of the dilemma) (d) recognizing, and applying the influence that each person has made in respects to the end choice (p. 270)

One example of how the model will dissolve the stress is has a lot to do with- the strength of this method. When strength is talked about, it is just saying that one individual does not have to be on their own in coming up with the answer and in actual fact this form of modal really involves all parties. In this fashion, a conclusion can be made that everyone will be satisfied with. It will help dissolve the stress because it allows everyone to understand each other's point- of-view of the problems and different solutions that are being addressed.

Topic 1: Three Recommendations to Resolve Moral Distress

Explain three recommendations you plan to list in your Unit 9 Case Study Part 3 assignment that will resolve the advanced practice nurses' moral distress for peer review and instructor comment. Comment by Ileana: RecommendationsAdvanced nurse practitioners should build support networks by identifying persons that support their nursing practices or those that Act or address the moral distress.Advanced nurse practitioners should focus on changes in the nursing field. Focusing on the nursing environment is more productive that relying on an individual patientAdvanced nurse practitioners should take part in moral distress education.

Moral distress takes place when a nurse is not able to take the ethically proper action, regardless of knowing it. It also ascends when the act in such a manner, which is opposite to their personal and professional values; in that way, weakening their honor, integrity, dependability and genuineness.

Recommendation 1: Talking to a Liaison Psychiatrist

Wilder (2000) makes the suggestion to the nurses that they should regularly talk to a person, who may be called as a "Liaison Psychiatrist." In this case, the person can also act as a counselor on individual patient management. The individual will need to be experienced and emotionally classy. Communication must be repeatedly absorbed on moral distress instead of expanding into more general self-exploration; the tradeoff cannot be…