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Navigating the Moral Distress of Nurses Who Care for Patients with Pain

Navigating the Moral Distress of Nurses Who Care for Patients with Pain. Helen N. Turner, DNP, RN-BC, PCNS-BC, FAAN Doernbecher Children’s Hospital/OHSU Portland, OR turnerh@ohsu.edu. Disclosure: Cadence Pharmaceuticals Pediatric Advisory Board Speakers Bureau . Objectives.

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Navigating the Moral Distress of Nurses Who Care for Patients with Pain

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  1. Navigating the Moral Distress of Nurses Who Care for Patients with Pain Helen N. Turner, DNP, RN-BC, PCNS-BC, FAAN Doernbecher Children’s Hospital/OHSU Portland, OR turnerh@ohsu.edu

  2. Disclosure: • Cadence Pharmaceuticals • Pediatric Advisory Board • Speakers Bureau

  3. Objectives 1. Define moral distress 2. Describe symptoms of moral distress 3. Explain impact of moral distress on patient care 4. Identify 3 strategies useful for developing moral courage

  4. Moral Distress You act in a manner contrary to your personal and professional values, which undermines your integrity and authenticity Occurs when you know the ethically appropriate action to take, but are unable to act upon it.

  5. Moral Distress ≠ Unethical

  6. Moral Distress “Feelings of frustration, anger, and anxiety when facing institutional obstacles and interpersonal conflicts about ones values” Unruh, 2010

  7. Moral Distress Inescapable—part of our practice Individual response Can spread

  8. Moral Distress • Impact on Nurses • Resulting distress • Personal • Professional • Ongoing obstacles • Organizational culture • Lack of courage • Group think • Redefinition of situation

  9. Moral Distress • Responses to moral distress • Physical • Emotional • Behavioral • Spiritual

  10. Moral Distress • Physical symptoms • Fatigue • Headaches • Impaired sleep • Lethargy • Nausea • Indigestion • Heartburn

  11. Moral Distress • Emotional symptoms • Anger • Fear • Guilt • Sorrow • Anxiety • Grief

  12. Moral Distress • Behavioral symptoms • Apathy • Indifference • Avoidance • Agitation • Hostility

  13. Moral Distress • Spiritual symptoms • Loss of meaning • Loss of control • Crisis of faith

  14. Moral Distress Leading to professional burnout

  15. Living with moral distress does harm!!

  16. Impact on Patient Care Safety Quality

  17. Turning the Tide • Navigating moral distress • Key is recognizing it • Intervening when appropriate

  18. AACN’s 4 A’s of Moral Distress American Association of Critical Care Nurses: The 4A’s to Rise Above Moral Distress.

  19. ASK • Am I feeling distressed or showing signs of suffering? • This is the stage where you become aware of your distress and its effects. • GOAL: Become aware of moral distress

  20. AFFIRM Your distress, your commitment to take care of yourself, and your professional responsibility to act This is where you validate your feelings and perceptions with others GOAL: Make commitment to deal with it

  21. ASSESS • Identify source of your distress, determine the severity of the situation, and contemplate your readiness to act • This is when you decide to take action or not • GOAL: Ready to make an action plan

  22. ACT Prepare to act or not, take action, and maintain desired change or accept the outcome This is stage for implementation of strategies to initiate change GOAL: Preservation of integrity and authenticity

  23. From Distress to Courage A Path Less Traveled

  24. Moral Courage “The willingness to stand up for and act according to one’s ethical beliefs” Lachman et al, 2012 Is a virtue

  25. Moral Courage Morally courageous professionals persevere to stand up for what is right even if it means they may do so alone.

  26. Attributes of Moral Courage Personal Professional Organizational

  27. Personal Attributes • Awareness of own beliefs and values • Take time for reflection—Choice Vs Judgment • Support • Strong skills in effective communication and advocacy • Advance your moral reasoning • Nurture your personal ethic of care

  28. Professional Attributes Debriefing—peer support Developing supportive environment Building consensus Promoting interdisciplinary collaboration Enhancing professional and cultural competence

  29. Professional Attributes • Follow a professional model of nursing care that exemplifies nursing’s goal of enhancing lives of patients & colleagues • Positively influence outcomes that support rather than oppose moral decision making • Safety • Quality

  30. Organizational Attributes • Administrative support of moral courage • Open communication at all levels • Policies and procedures supporting ethical practice • Staff empowerment and protection • Healthy work environment • Interdisciplinary engagement—“Just Culture” • Review • Education • Monitoring

  31. Resources ANA Center for Ethics and Human Rights ANA Code of Ethics American Society for Bioethics & Humanities Foundation for Moral Courage Institute for Global Ethics Moral Courage Project Nursing Social Policy Statement AACN Healthy Work Environment

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