Navigating Moral Distress

Caring for an Unconscious Transgender Patient at the End of Life

“…Comments made about Ashley generated negative events that affected several nurses, particularly as they fostered moral distress and residue. Moral distress is “an experience where a moral decision has been made about what to do in an ethically challenging situation, but the desired action cannot be carried out.” 36 (p1) “Moral residue is often experienced as pain that is lasting, powerful, and felt deeply, and it may remain after values and ideals have been compromised.” 36 (p5) Moral distress is prevalent in nursing and is associated with unsupportive health care systems, poor leadership, bullying, incompetent colleagues, and poor care practices 37 . The ethical obligation to make amends arises in this case to self, to the patient, and to the team.…”

“…Within Ashley's case, the nurses' moral distress may have stemmed from (1) the perception that the physician's comment reflected biased care and (2) fears of the adverse ramifications of speaking up. Many strategies have been proposed to mitigate moral distress and bolster ethical capacity 36 . Reflective practice, guidance on ethical care and fostering a growth mindset, and adequate use of nurse self-care practices can mitigate moral distress 36 .…”

“…Many strategies have been proposed to mitigate moral distress and bolster ethical capacity 36 . Reflective practice, guidance on ethical care and fostering a growth mindset, and adequate use of nurse self-care practices can mitigate moral distress 36 . Staying silent about the ethical dilemma led to moral distress and lingering moral residue that would require time and honest reflection to understand, without making progress toward a more trans-inclusive health care system.…”