Nurse Moral Distress: a proposed theory and research agenda

Corley, Mary C.

doi:10.1191/0969733002ne557oa

Cited by 582 publications

(706 citation statements)

References 46 publications

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“…Almost all of the participants in our study, including companions, spoke about the increasing pressure on health professionals in LTC to compensate for low staffing levels by performing more tasks more quickly. The tension between cost and quality care has been welldocumented in literature on health care restructuring (Armstrong & Armstrong, 2010;Fine, 2006;Tudor Hart, 2006) and its impacts are addressed in the literature on the relationship between low staffing levels and the potential for moral distress (Austin et al, 2003;Cocco et al, 2003;Corley, 2002). LTC staff members have large numbers of residents, with greater care needs, and less time to spend with each of them.…”

Section: Limited Health and Human Resources: Cost Vs Carementioning

confidence: 99%

Experiences of moral distress by privately hired companions in Ontario’s long-term care facilities

Brassolotto

Daly

Armstrong

et al. 2017

QAOA

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Purpose-To explore long-term residential care provided by people other than the facilities' employees. Privately hired paid "companions" are effectively invisible in health services research and policy. This research was designed to address this significant gap. There is growing recognition that nursing staff in long-term care (LTC) residential facilities experience moral distress -a phenomenon in which one knows the ethically right action to take, but is systemically constrained from taking it. To date, there has been no discussion of the distressing experiences of companions in LTC facilities. This paper explores companions' moral distress.Design-Data was collected using weeklong rapid ethnographies in seven LTC facilities in Southern Ontario, Canada. A feminist political economy analytic framework was used in the research design and in the analysis of findings.Findings-Despite the differences in their work tasks and employment conditions, structural barriers can cause moral distress for companions. This mirrors the impacts experienced by nurses that are highlighted in the literature. Though companions are hired in order to fill care gaps in the LTC system, they too struggle with the current system's limitations. The hiring of private companions is not a sustainable or equitable solution to under-staffing and under-funding in Canada's LTC facilities.Value-Recognizing moral distress and the impact that it has on those providing LTC is critical in terms of supporting and protecting vulnerable and precarious care workers and ensuring high quality care for Canadians in LTC.

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Section: Limited Health and Human Resources: Cost Vs Carementioning

confidence: 99%

Experiences of moral distress by privately hired companions in Ontario’s long-term care facilities

Brassolotto

Daly

Armstrong

et al. 2017

QAOA

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“…Others recommend that the structure of the management of the unit become more open via a shared governance model, thereby increasing feelings of autonomy and empowerment among health workers. [55][56][57] The actions taken on an organizational level are also similar to the tend and befriend model in a nursing work setting as they encourage nurses to tend and befriend one another by creating a supportive work environment. Examples of actions to be taken on an organizational level were presented previously.…”

Section: Actmentioning

confidence: 99%

“…Unit managers are recommended to create a positive care environment or culture where ethical practice is considered standard practice. 53,56 An ethical work environment is described as a unit where trust, respect, and open communication are used to create a sense of equality and shared decision making among members, thereby removing a sense of imbalance of power. 55 In the example with Nurse N, if she worked in what she considered an ethical environment, she would feel free to discuss openly her workload concerns with her nursing superiors and end-of-life decisions with the medical staff.…”

Section: Actmentioning

confidence: 99%

Tend and Befriend in the Intensive Care Unit

Ganz

2012

Critical Care Nurse

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Stress is a common phenomenon in the intensive care unit for both patients and nurses. Critical care nurses may experience many forms of stress, including physical, psychological, and moral stress or distress. The physiological stress response traditionally associated with the hypothalamic-pituitary-adrenal axis has been expanded to include a new model, called tend and befriend, that has been linked to females of different species, including humans. Studies have shown that stress also affects immune function. Although commonly associated with adverse outcomes, stress can lead to personal growth. The tend and befriend strategy is an intervention that was developed to help nurses increase their ability to grow from stressful situations, especially those related to moral distress.

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“…Despite the generalized preoccupations of researchers of the health field and their studies about work in care environments throughout the last two decades, many nursing professionals still face serious challenges in the performance of their duties (2,4) . Exhaustive routines, high demands for work and productivity, stress, precariousness in the cares rendered, lack of dialogue, banalization of death, and bureaucracy, among other characteristics, may influence the way nursing cares are carried out, resulting in feelings of impotence toward situations and apparent negligence to users (8) .…”

Section: Moral Distress In Nursing Practicementioning

confidence: 99%

“…When there are attempts to face conflicts, workers seem to be poorly answered in their requests, being often ignored by their leaders and heads, thus being insufficiently supported in the practice of their professional autonomy, and this may cause workers to feel angry, indignant, guilty, sad, hopeless, frustrated and impotent toward problems (2) .…”

Section: Descriptores Introductionmentioning

confidence: 99%

Moral distress: challenges for an autonomous nursing professional practice

Barlem

Lunardi

Tomaschewski

et al. 2013

Rev. esc. enferm. USP

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RESUMo AbStRActConstantly experiencing limiting situations that hinder a professional practice coherent with its principles -of autonomy and advocacy of users' interests -, and often conditioned to experience moral distress, the nursing profession plays a prominent role in the current health model because it has the characteristic of managing the care rendered to users in a perspective of social inclusion, both in the basic health network and in hospitals. Aiming at carrying out a reflection on the nursing practice and the difficulties present in its work routine, and considering its characteristics as a profession, this article sought to make a reflection between the practice of nursing and the numerous moral challenges imposed by the routine, resulting, in many cases, in a value crisis that can reverberate directly on the quality of the service rendered, and in abandonment of the ideals of advocacy for users RESUMEnEl profesional de enfermería presenta un rol destacado en el actual modelo de salud. Adquiere la característica de administrar los cuidados brindados a los pacientes en una perspectiva de inclusión social, tanto en la red básica como en las instituciones hospitalarias. Sin embargo, enfrenta constantemente limitaciones que dificultan el ejercicio profesional coherente con principios de autonomía de abogar por los intereses de los pacientes, lo que muchas veces lo lleva a experimentar sufrimiento moral. Objetivando reflexionar acerca de la práctica de enfermería y considerando sus características profesionales, el presente artículo procuró realizar una reflexión entre el quehacer de enfermería y los innumerables desafíos morales impuestos por el día a día; resultando, a menudo, en una crisis de valores que puede tener repercusión directamente en la calidad de la atención brindada y en el abandono del ideal de abogar por el bienestar de los pacientes. dEScRiPtoRESEnfermería Práctica profesional Ética en enfermería Estrés psicológico Defensa de la salud

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Nurse Moral Distress: a proposed theory and research agenda

Cited by 582 publications

References 46 publications

Experiences of moral distress by privately hired companions in Ontario’s long-term care facilities

Experiences of moral distress by privately hired companions in Ontario’s long-term care facilities

Tend and Befriend in the Intensive Care Unit

Moral distress: challenges for an autonomous nursing professional practice

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