Risking vulnerability: Enacting moral agency in the is/ought gap in mental health care

Musto, Lynn; Schreiber, Rita; Rodney, Patricia

doi:10.1111/jan.14776

Cited by 6 publications

(6 citation statements)

References 180 publications

(561 reference statements)

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Section: Mitigating Narrow Moral Distress By Promoting Moral Agencymentioning

confidence: 99%

“…One suggested approach to mitigating and addressing narrow moral distress is through the promotion of nurses' moral agency (Dudzinski, 2016; L. Musto et al, 2021; Robinson et al, 2014; Traudt et al, 2016). L. C. Musto et al (2015) suggest that one way in which nurses' moral agency can be supported is through the creation of ‘morally habitable environments' and they ‘propose that habitable environments are a space where internal and external constraints to moral agency are minimized, difference is embraced, and moral well‐being is promoted through shared understandings of responsibility’ (p. 97).…”

Section: Mitigating Narrow Moral Distress By Promoting Moral Agencymentioning

confidence: 99%

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Re‐examining the relationship between moral distress and moral agency in nursing

Morley

Sankary

2023

Nursing Philosophy

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In recent years, the phenomenon of moral distress has been critically examined—and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re‐examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re‐centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of ‘narrow' moral distress and the value of re‐considering moral distress. Finally, we provide an action‐oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency.

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Section: Mitigating Narrow Moral Distress By Promoting Moral Agencymentioning

confidence: 99%

Section: Mitigating Narrow Moral Distress By Promoting Moral Agencymentioning

confidence: 99%

Re‐examining the relationship between moral distress and moral agency in nursing

Morley

Sankary

2023

Nursing Philosophy

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“…For these authors, the social context is inextricable from our role as moral agents. Taking moral action does not guarantee an ethical end or outcome (Musto et al, 2021). While nurses are not necessarily able to repeat actions taken in unique situation for future success the outcomes of embodied moral agency in that particular experience can become part of a scaffolding to support future interactions.…”

Section: Introductionmentioning

confidence: 99%

“…While nurses are not necessarily able to repeat actions taken in unique situation for future success the outcomes of embodied moral agency in that particular experience can become part of a scaffolding to support future interactions. Moral agency in each situation is a ‘range of possible actions’ nurses can take (Musto et al, 2021). Teaching for this understanding of moral agency, and specifically moral imagination in the affective domain, requires pedagogy beyond learning moral theories and principles for ethical decision‐making.…”

Section: Introductionmentioning

confidence: 99%

Promoting moral imagination in nursing education: Imagining and performing

et al. 2023

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Moral imagination is a central component of moral agency and person‐centred care. Becoming moral agents who can sustain attention on patients and their families through their illness and suffering involves imagining the other, what moral possibilities are available, what choices to make, and how one wants to be. This relationship between moral agency, moral imagination, and personhood can be effaced by a focus on task‐driven technical rationality within the multifaceted challenges of contemporary healthcare. Similarly, facilitating students' moral agency can also be obscured by the task‐driven technical rationality of teaching. The development of moral agency requires deliberate attention across the trajectory of nursing education. To prepare nursing students for one practice challenge, workplace violence, we developed a multimodal education intervention which included a simulated learning experience (SLE). To enhance the realism and consistency of the educational experience, 11 nursing students were trained as simulated participants (SP). As part of a larger study to examine knowledge acquisition and practice confidence of learners who completed the SLE, we explored the experience of being the SP through interviews and a focus group with the SP students. The SP described how their multiple performances contributed to imagining the situation ‘on both sides’ prompting empathy, a reconsideration of their moral agency, and the potential to prevent violence in the workplace beyond technical rational techniques, such as verbal de‐escalation scripts. The empirical findings from the SP prompted a philosophical exploration into moral imagination. We summarise the multimodal educational intervention and relevant findings, and then, using Johnson's conception of moral imagination and relevant nursing literature, we discuss the significance of the SP embodied experiences and their professional formation. We suggest that SLEs offer a unique avenue to create pedagogical spaces which promote moral imagination, thereby teaching for moral agency and person‐centred care.

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“…In my research on maintaining ethical practice in psychiatric care, nurses frequently described impediments to ethical practice that included limited material resources and lack of leadership support, policies directed at improving efficiency at the expense of care, lack of political will to hold professionals accountable for unprofessional behavior, and unit practices that dehumanized patients (Musto et al, 2021). These same nurses also detailed their strategies to live out their nursing values.…”

mentioning

confidence: 99%