Defining and Addressing Moral Distress
AACN Advanced Critical CarePublished 1 April 2006
Cynda Hylton Rushton
Citations118
SJR quartileQ2
SJR score0.32
SNIP0.46
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
The AACN's Model to Rise Above Moral Distress is offered, describing four A's: ask, affirm, assess, and act, to help critical care nurses working to address moral distress.
Abstract
Nurse clinicians may experience moral distress when they are unable to translate their moral choices into moral action. The costs of unrelieved moral distress are high; ultimately, as with all unresolved professional conflicts, the quality of patient care suffers. As a systematic process for change, this article offers the AACN's Model to Rise Above Moral Distress, describing four A's: ask, affirm, assess, and act. To help critical care nurses working to address moral distress, the article identifies 11 action steps they can take to develop an ethical practice environment.
Keywords
MedicineHealth Professions
Journal of Advanced NursingDevelopment and evaluation of a moral distress scale
667 Citations2001Mary C. Corley, R. K. Elswick +2 more
The results support the reliability and validity of the moral distress scale and the framework guiding the development of the MDS included Jameton's conceptualization of moral distress, House and Rizzo's role conflict theory, and Rokeach's value theory.
JAMAEffect of Ethics Consultations on Nonbeneficial Life-Sustaining Treatments in the Intensive Care Setting
647 Citations2003Lawrence J. Schneiderman, Todd Gilmer +9 more
Ethics consultations in the intensive care setting were useful in resolving conflicts that may have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU.
Social Science & MedicineLiving with conflicts-ethical dilemmas and moral distress in the health care system
624 Citations2003Sofia Kälvemark Sporrong, Anna T. Höglund +3 more
The results show that the study of moral distress must focus more on the context of the ethical dilemmas, and that the work organization must provide better support resources and structures to decrease moral distress.
American Journal of Public HealthDecisions near the end of life: professional views on life-sustaining treatments.
588 Citations1993Mildred Z. Solomon, Lydia O’Donnell +7 more
Many physicians and nurses were disturbed by the degree to which technological solutions influence care during the final days of a terminal illness and by the undertreatment of pain.
Critical Care MedicineThe family conference as a focus to improve communication about end-of-life care in the intensive care unit: Opportunities for improvement
390 Citations2001J. Randall Curtis, Donald L. Patrick +4 more
The importance of communication about end-of-life care during the family conference is reviewed and specific recommendations for physicians and nurses interested in improving the quality of their communication with family members are made.
American Journal of Critical CareMoral distress of critical care nurses
275 Citations1995MC Corley
The range of responses revealed that some nurses experienced high levels of moral distress with the issues, and research is needed on conditions organizations must provide to support the moral integrity of critical care nurses.
Journal of Advanced NursingPreserving moral integrity: a follow‐up study with new graduate nurses
269 Citations1998Brighid Brooks Kelly
This follow-up study described, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation.
Palliative MedicineStaff stress in hospice/palliative care: a review
254 Citations1995Mary L. S. Vachon
Staff stress and burnout in hospice/palliative care has been demonstrated to be less than in professionals in many other settings, however, other studies have noted suicidal ideation, increased alcohol and drug usage, anxiety, depression, and difficulty in dealing with issues of death and dying.
Journal of Critical CareStudying communication about end-of-life care during the ICU family conference: Development of a framework
207 Citations2002J. Randall Curtis, Ruth A. Engelberg +9 more
A qualitative methodology to understand clinician-family communication during the ICU family conference concerning end-of-life care is described and provides a frame of reference that may help guide clinicians who conduct these conferences.
Nursing InquiryPerils of proximity: a spatiotemporal analysis of moral distress and moral ambiguity
201 Citations2004Elizabeth Peter, Joan Liaschenko
It is argued that nursing's tendency to define itself in relation to the closeness of the nurse-patient relationship leads to problems of moral ambiguity, and recommendations include moving others closer to the bedside and thus to the work of nursing in the literal and theoretical sense.
Research and theory for nursing practiceMoral Distress: The State of the Science
181 Citations2004Debra R. Hanna
The literature is discussed from several perspectives to show the current state of the science in this topical area, and its potential future.
Nursing EthicsNurses’ Ethical Conflicts: what is really known about them?
153 Citations2000Barbara K. Redman, Sara T. Fry
The purpose of this article is to report what can be learned about nurses’ ethical conflicts by the systematic analysis of methodologically similar studies.
American Journal of Critical CareCritical care nurses' perceptions of obstacles and helpful behaviors in providing end-of-life care to dying patients
153 Citations2000Karin T. Kirchhoff, R L Beckstrand
Nurses have difficulties with patients' families and physicians concerning end-of-life issues, especially when the behaviors remove the nurses from caring for a patient or cause the patient pain or prolong suffering.
The Hastings Center ReportFrom Loyalty to Advocacy: A New Metaphor for Nursing
108 Citations1984Gerald R. Winslow
An evolving transformation in nursing ethics is examined in terms of two basic metaphors of the nurse's role and its norms and virtues, supporting this change while cautioning that attention should be given to clarifying the meaning of advocacy.
Journal of Professional NursingMoral outrage and moral discourse in nurse-physician collaboration
99 Citations1991Adele W. Pike
The author describes a patient care unit dedicated to the study and development of collaborative relationships between nurses and physicians and reports an unexpected favorable outcome of such collaboration: the decline in incidents of moral outrage among nurses faced with moral dilemmas.
Cambridge Quarterly of Healthcare EthicsGiving “Moral Distress” a Voice: Ethical Concerns among Neonatal Intensive Care Unit Personnel
98 Citations1999PAM HEFFERMAN, Steve Heilig
Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component, and bedside personnel, particularly neonatal intensive care unit (NICU) nurses, have been relatively muted in this debate.
Journal of Clinical OncologyDealing with our losses.
94 Citations1986Balfour M. Mount
Strategies useful in the prevention and management of stress include the encouragement of increased awareness of stress in self and colleagues, the clarification of appropriate goals and priorities, encouragement of appropriate limit setting, and the mobilization of collaborative input.
Western Journal of Nursing ResearchUsing Gilligan's Framework to Analyze Nurses' Stories of Moral Choices
63 Citations1994Brenda E. Millette
Critical Care Nursing Clinics of North AmericaThe integration of palliative care and critical care: one vision, one voice
29 Citations2002Cynda Hylton Rushton, Michael A. Williams +1 more
Nurses in all practice settings and specialties are challenged to integrate quality palliative care into patient care, with help of the Nursing Leadership Academy for End-of-Life Care.
PubMedEthical dimensions of nurse-physician relations in critical care.
29 Citations1998M C Corley
This work states that differences in values, communication, trust, and responsibilities can precipitate conflict between nurses and physicians over ethical components of care and strategies to address these ethical conflicts are needed at both the organization and policy level.
The Hospice JournalReflections on the History of Occupational Stress in Hospice/Palliative Care
27 Citations1999Mary L. S. Vachon
The history of the hospice movement and the stress experienced by staff is traced from the early developmental days through to the present and some of the tensions that have always existed as hospice attempts to position itself within mainstream care with diminishing fiscal resources are escalated.
Dimensions of Critical Care NursingAchieving Collaboration in Ethical Decision Making
14 Citations1996Lucia D. Wocial
This article helps prepare critical care nurses to handle ethical dilemmas in crisis situations by providing them with specific strategies that help promote collaboration in resolving ethical dilempas.