Moral Distress and Choosing the Best Care Plan for Patients

A 65-year-old patient presents with a hematologic malignancy complaining of acute abdominal pain, lack of appetite, and diarrhea. He had an allogeneic transplant 9 months ago and has been admitted to the hospital 8 times over the last 6 months. The medical team and nursing staff have tried on multiple occasions to discuss code status and medical plans for the future. The patient diverts all medical questions to his wife, despite having capacity to make decisions. The patient has been married for 40 years and has expressed the desire to please his family. The nurses have often expressed their frustrations among each other saying:

“Was this patient the best choice for transplant? “

“Why didn’t the team tell this patient the truth?”

“Why is this patient still a full code?”

“Maybe we should call for an ethics consult?”

“Are we REALLY doing what’s best for the patient?”

This scenario represents moral distress that is often experienced by oncology nurses. Moral distress is defined as an emotional state that arises from a situation when a nurse feels that the ethically correct action to take is different from what he or she is tasked to do.¹ This concept has become one of the leading causes of nurses leaving the profession or their institutions. Nurses can experience lack of empathy and job dissatisfaction, while organizations may have increased turnover among staff as well as suboptimal patient outcomes. According to the literature, moral resilience reduces the prevalence of distress and creates an environment that promotes ethical reasoning within an organization.

Strategies to promote resilience must first begin with executive leadership creating a culture that supports their employees.² Education must be provided that promotes effective communication skills, mindfulness, and emotional intelligence. And finally, ongoing professional development across all disciplines must be implemented to recognize as well as address situations that staff to experience moral distress.

Stephanie Jackson is co-editor in cheif of Oncology Nursing News and a nationally board-certified clinical nurse specialist specializing in oncology and bone marrow transplantation. She is currently the clinical nurse specialist for the hematology/stem cell transplantation units at a large academic medical center in Los Angeles, California. She has over 2 decades of nursing experience which includes various positions such as acute care, ambulatory, academia, home health, and hospice. She is a member of several professional nursing and community organizations. Some notable mentions include the National Council of Clinical Nurse Specialist, Association of Clinical Nurse Leaders and Oncology Nurses Society. She is the former president of the Greater Los Angeles chapter of Oncology Nursing Society and is currently pursuing her doctorate at Grand Canyon University in Phoenix, Arizona. It is without doubt that her passion for oncology patient stems from her own experience and survival of childhood cancer.

References:

• Rushton, C. (2017). Moral distress and building resilience. Johns Hopkins Nursing. https://magazine.nursing.jhu.edu/2017/02/moral-distress-and-building-resilience/
• Rushton, C., Schoonover-Shoffner, K., & Kennedy, M. (2017). A collaborative state of the science initiative: Transforming moral distress into moral resilience in nursing. American Journal of Nursing, 117 (2), S2-S6.