Page 332 - Encyclopedia of Nursing Research

MORAL DISTRESS n 299

include the burden and mental health impact for nursing involvement, particularly in the
of caring for someone with increasing depen- areas of health promotion and in the provi-
dency (Garand et al., 2005). Significant losses sion of evidence-based interventions for both M
also accrue to society, chief among which is care recipient and caregiver alike.
the loss of productivity if the person has to
take early retirement, and in time, the addi- Mark P. Tyrrell
tional economic burdens of caring for some- Geraldine McCarthy
one with progressive cognitive impairment
(yeuh-Feng et al., 2007). These and other
hidden costs of MCI need to be explored
and also need to be targeted with evidence- Moral distress
based interventions to diminish the adverse
social and economic consequences of MCI
(Molinuevo et al., 2010). Moral distress occurs when a person is aware
Given that people with MCI generally of a moral problem, acknowledges moral
continue to function with a good degree responsibility, and makes a moral judgment
of independence, they usually live and are about the correct action yet is constrained
cared for at home. Nursing practice there- from the self-determined morally correct
fore primarily involves supportive interven- action. Moral distress is not a response to
tions such as the provision of education and a violation of what is unquestionably right
information; maximizing independent liv- but rather a violation of what the individual
ing; assisting clients and family members in judges to be right. Moral distress has been
planning for the future, in particular the for- studied in a number of settings and with
mulation of advance directives and nominat- several professions. It is acknowledged as a
ing enduring powers of attorney; monitoring serious problem, and researchers are begin-
and intervening in the physical and mental ning to identify implications for education,
health status of both the person with MCI research, and practice.
and their family caregivers; monitoring MCI Ethicists define an ethical or moral
progression; promoting health, in particular dilemma as a moral problem for which
nutritional and vascular health; running sup- two or more solutions carry equal weight,
port groups for both care recipient and care- thus making decisions very difficult. In the
giver; and in collaboration with other health early 1980s, ethicist Andrew Jameton (1984)
professionals, the provision of cognitive stim- asked a group of nurses to relate their per-
ulation, physical, and other evidence-based sonal stories of moral dilemmas. The nurses
therapies (Hodson & Keady, 2008). in Jameton’s study did not identify “dilem-
MCI represents a transition state mas” according to the common definition
between normal aging and dementia. but consistently described situations with
Although the proposed diagnostic criteria compelling moral problems for which the
are still too broad and experts have thus far morally correct action was clear, yet each
failed to agree on a definition, clinical evi- felt constrained from following personal
dence has shown that many patients with convictions (Jameton, 1993). Jameton con-
MCI will progress to some form of dementia. cluded that nurses were compelled to tell
Accordingly, early diagnosis and interven- these stories because of their profound suf-
tion in MCI would seem prudent as this may fering and their belief about importance of
delay the onset of dementia. The advantages the situations. Identifying this new category
of this are apparent. Currently, despite the of moral problem, Jameton wrote, “Moral dis-
disagreements in the literature about the sta- tress arises when one knows the right thing
tus of MCI, there appears to be great scope to do, but institutional constraints make it