Page 333 - Encyclopedia of Nursing Research

300 n MORAL DISTRESS

nearly impossible to pursue the right course lead to moral distress. Moral distress, in turn,
of action” (Jameton, 1984, p. 6). Further refin- causes nurses to leave the workforce, thus cre-
M ing the concept, Jameton (1993) added that in ating a self-perpetuating downward spiral.
cases of moral distress, nurses participate in Moral distress occurs in high stress situ-
the action that they have judged to be mor- ations or with vulnerable patients. Areas that
ally wrong. On the basis of Jameton’s work, engender high overall stress levels, such as
Judith Wilkinson, a nurse, defined moral critical care or other areas with very vulner-
distress as “the psychological disequilib- able patients, harbor a greater proportion of
rium and negative feeling state experienced moral problems (Corley, 1995; Fenton, 1988;
when a person makes a moral decision but Forchuk, 1991a; Hefferman & Heilig, 1999;
does not follow through by performing the Kelly, 1998; Krishnasamy & Plant, 1998;
moral behavior indicated by that decision” Liaschenko, 1995; Millette, 1994; Perkin,
(Wilkinson, 1987–1988, p. 16). Further refin- young, Freier, Allen, & Orr, 1997; Powell,
ing the definitions or offering examples for 1998; Redman & Fry, 2000; Rushton, 2006;
clarification, nearly every subsequent source Solomon et al., 1993; Sundin-Huard & Fahy,
relies on either Jameton’s or Wilkinson’s defi- 1999). In the studies listed above and others,
nitions of moral distress. moral distress has been documented in the
Reports of the number of nurses who following specific situations: prolonging the
experience moral distress vary. Redman suffering of dying patients through the use
and Fry (2000) report that at least one third of aggressive/heroic measures; performing
of nurses in their study (n = 470) experienced unnecessary tests and treatments; lying to
moral distress (2000). Nearly 50% of nurses in patients or failing to involve nurses, patients,
another study (n = 760) report that they had or family in decisions; and incompetent or
acted against their consciences in providing inadequate treatment by a physician.
care to the terminally ill (Solomon et al., 1993). Institutional setting also contributes to
Possibly heralding the present nursing short- moral distress. Health care institutions, par-
age, Wilkinson’s, Millette’s, and Nathaniel’s ticularly hospitals, are high tech and fast
studies indicate that 45% (n = 24), 50% (n = 24), paced, patients are older and sicker, and
and 43% (n = 21) of nurses in their respective reimbursement is problematic. Many nurses
samples left their units or nursing altogether view themselves as powerless within this
because of morally troubling situations. type of hierarchical system (Corley, Elswick,
Loss of nurses from the workforce is Gorman, & Clor, 2001; Davies et al., 1996;
an indirect but strong patient care threat Krishnasamy, 1999; Liaschenko, 1995; Perkin
that may perpetuate moral distress. In 2001, et al., 1997; Sundin-Huard & Fahy, 1999;
nurses reported poor working conditions Wilkinson, 1987–1988). They perceive little
such as inadequate staffing, heavy work- support from nursing and hospital admin-
loads, increased use of overtime, and lack of istration. Nurses may experience moral dis-
sufficient support staff (General Accounting tress as a result of being socialized to follow
Office, 2001). In 2005, Buerhaus et al. (2005) orders, having experienced futility of past
reported that more than 75% of registered actions, and having a fear of losing a job.
nurses believe the nursing shortage dimin- Other organizational factors contributing to
ishes the quality of their work life and the nurses’ moral distress include their views
quality of patient care. Nearly all nurses sur- concerning the quality of nursing and medi-
veyed predicted that the continuing nursing cal care, the organizational ethics resources,
shortage will increase stress on nurses (98%), the nurses’ satisfaction with the practice
lower patient care quality (93%), and cause environment, and the law and/or lawsuits.
nurses to leave the profession (93%) (Buerhaus Relationships with physicians are the
et al., 2005). Thus, the nursing shortage may most frequently mentioned institutional