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Resolving Moral Distress in Health Care by: Jill Ritchey BSN RN
Happy Nurses Happy patients Moral Distress Patient Satisfaction
Inspiration Vision/Mission Goals Infrastructure Relationship Based Care Education Magnet Forces Evidence Patient/Nurse Satisfaction
Objectives ,[object Object],[object Object],[object Object]
Who are the Stakeholders? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patients ,[object Object],[object Object]
Family of critically ill patients face: ,[object Object],[object Object],[object Object],[object Object]
Bedside Nurses ,[object Object],[object Object]
Nurses, continued: ,[object Object],[object Object]
Physicians ,[object Object],[object Object],[object Object],[object Object],[object Object]
Chaplains ,[object Object],[object Object],[object Object]
Social Workers ,[object Object],[object Object],[object Object]
Definition of moral distress ,[object Object]
How does it affect... ,[object Object],[object Object],[object Object],[object Object],[object Object]
How can nursing leaders impact moral distress? By empowering nurses ,[object Object],[object Object],[object Object],[object Object],[object Object]
Empowering and Inspiring Leaders...  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Strong Leaders provide opportunities for: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How else can hospitals impact moral distress? Magnet Force # 2  Organizational Structure Cultural Change ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Are Magnet Forces at play in your unit/organization’s culture?   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Picker Institute’s Eight Dimensions of patient centered care    Patient satisfaction, what patients want   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nurses experience less moral distress when they can advocate on behalf of their patients Magnet Force # 5 Professional Model of Care Relationship based or patient-centered care models promote patient and nursing autonomy
… it is well documented that nurses experience moral distress when they are given too much to do and too little to do it with ,[object Object],[object Object]
Nursing advocacy-power is important for: Vulnerable Patient/Family Populations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Magnet Force # 8  Consultations/ Resources Utilizing Hospital Ethics Committee can help stakeholders in addressing ethical issues, thus reducing moral distress
Catholic Health has begun an initiative to reintegrate ethics at the point of care     The  Next Generation Ethics Model ,[object Object],[object Object],[object Object]
Re-integrating ethics at the point of care ,[object Object]
Helping Nurses Reclaim their Traditional Role as Patient Advocates (otherwise known as the Professional Practice of   Nursing)   ,[object Object],[object Object],[object Object],[object Object],[object Object]
 “ Ethics is Everyone’s Business” ,[object Object],[object Object]
Integration of Ethics with  Patient Centered Care   ,[object Object]
Grand Rounds  Interdisciplinary daily rounds conducted in a manner that ensures input from non-physicians is one way to promote...    ,[object Object],Autonomy
Magnet Force # 12 Image of Nursing ,[object Object],[object Object],[object Object]
Dis-empowered ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Magnet Force # 13 Collegial Nurse/Physician Relationships ,[object Object],[object Object],[object Object]
More about collaboration ,[object Object],[object Object],[object Object],[object Object]
Empower by…Communication ,[object Object],[object Object],[object Object],[object Object],[object Object]
Moral distress can be a catalyst for change In part, vulnerability of patients and families bestows caregivers privilege of  caring for another fellow human being in need
 
Buresh, B & Gordon, S.  From Silence to Voice: What Nurses Know and Must    Communicate to the Public .  1 st  edition. Ottawa, Ontario: Canadian Nurses  Association, 2000.  California Thoracic Society.  “End-of-Life in the Hospital: Strategies to Improve Quality    Life-Sustaining Treatments and Limit Conflict through Identifying and Following Patient Wishes.”    Position Paper-  American Lung Association of California  2005. Corley, Mary Ph.D. RN et al.  “Development and Evaluation of a Moral Distress Scale.”    Methodological Issues in Nursing Research  33.2 (2001): 250 Davidson, Judy E RN FCCM et al.  “Clinical Practice Guidelines for Support of the    Family in the Patient-Centered Intensive Care Unit: American College of Critical    Care Medicine Task Force 2004-2005.”  Critical Care Medicine  35.2 (2007): 605  Duval, Gordon SJD et al.  “A National Survey of U.S. Internists’ Experiences with    Ethical Dilemmas and Ethics Consultation.”  Journal of General Internal     Medicine  19.3 (2004): 251 Elpern, Ellen and Silver, Michael.  “Improving Outcomes: Focus on Workplace Issues.”    Current Opinion in Critical Care  12.5 (2006): 395 Frick, S, Uehlinger DE and Zuercher, Zenklusen RM.  “Medical Futility: Predicting    Outcome of Intensive Care Unit Patients by Nurses and Doctors—A Prospective    Comparative Study.”  Critical Care Medicine  31.2 (2003): 456
Giganti, Ed.  “A New Center for Spirituality and Leadership at Bon Secours Richmond.”  Health Progress  87.1 (2006): 4 Hamric, Ann B Ph.D., RN, FAAN and Blackhall, Leslie J. MD, MTS.  “Nurse-Physician    Perspectives on the Care of Dying Patients in Intensive Care Units:  Collaboration, Moral Distress, and Ethical Climate.”  Critical Care Medicine  35.2    (2007): 422 Khatri, et. al.  “Relationship between management philosophy and clinical outcomes.”   Health Care Management Review   32.2 (2007): 128     McClendon, Heather RN, BSN and Buckner, Ellen B. DSN, RN.  “Distressing Situations    In the Intensive Care Unit-A Descriptive Study of Nurses’ Responses.”    Dimensions of Critical Care Nursing  26.5 (2007): 199 McManis and Monslave Associates.  “Healthy Work Environments: Striving for    Excellence.”  http://www. aone .org/ aone /docs/ hwe _excellence_full. pdf Murphy, Kevin Ph.D.  “A ‘Next Generation’ Ethics Committee.”  Health Progress  87.2  (2006): 26 Peter, Elizabethand Liaschenko, Joan.  “Perils of Proximity: A Spatiotemporal Analysis  of Moral Distress and Moral Ambiguity.”  Nursing Inquiry  11.4 (2004): 218
Ray, Daniel MD et al.  “Integrating Palliative Medicine and Critical Care in a    Community Hospital.”  Critical Care Medicine  34.11 (2006): S394  Schmalenberg, Claudia, MSN, RN et al.  “Excellence through Evidence-Securing    Collegial/Collaborative Nurse-Physician Relationships, Part 2.”  Journal of    Nursing Administration  35.11 (2005): 507 Silow-Carroll, Sharon, T. Alteras and L. Stepnick.  “Patient-Centered Care for Under Served Populations: Definition and Best Practices.”  Economic and   Social Research Institute .  Washington DC.  January, 2006.  www. esresearch .org Spence Laschinger et al. “  , A longitudinal analysis of the impact of workplace    empowerment on work satisfaction.”  Journal of Nursing Administration  35    (2003): 410 Taylor, Carol, RN Ph.D. “Dealing with Tough Situations: When Families and    Caregivers Disagree.” telecom Lecture MCSA Columbus, OH 2007 Treece, Patsy D RN, MN et al.  “Integrating Palliative and Critical Care: Description of    an Intervention.”  Critical Care Medicine  34.11 (2006): S380

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09Moral Distress

  • 1. Resolving Moral Distress in Health Care by: Jill Ritchey BSN RN
  • 2. Happy Nurses Happy patients Moral Distress Patient Satisfaction
  • 3. Inspiration Vision/Mission Goals Infrastructure Relationship Based Care Education Magnet Forces Evidence Patient/Nurse Satisfaction
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  • 21. Nurses experience less moral distress when they can advocate on behalf of their patients Magnet Force # 5 Professional Model of Care Relationship based or patient-centered care models promote patient and nursing autonomy
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  • 24. Magnet Force # 8 Consultations/ Resources Utilizing Hospital Ethics Committee can help stakeholders in addressing ethical issues, thus reducing moral distress
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  • 36. Moral distress can be a catalyst for change In part, vulnerability of patients and families bestows caregivers privilege of caring for another fellow human being in need
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  • 38. Buresh, B & Gordon, S. From Silence to Voice: What Nurses Know and Must Communicate to the Public . 1 st edition. Ottawa, Ontario: Canadian Nurses Association, 2000. California Thoracic Society. “End-of-Life in the Hospital: Strategies to Improve Quality Life-Sustaining Treatments and Limit Conflict through Identifying and Following Patient Wishes.” Position Paper- American Lung Association of California 2005. Corley, Mary Ph.D. RN et al. “Development and Evaluation of a Moral Distress Scale.” Methodological Issues in Nursing Research 33.2 (2001): 250 Davidson, Judy E RN FCCM et al. “Clinical Practice Guidelines for Support of the Family in the Patient-Centered Intensive Care Unit: American College of Critical Care Medicine Task Force 2004-2005.” Critical Care Medicine 35.2 (2007): 605 Duval, Gordon SJD et al. “A National Survey of U.S. Internists’ Experiences with Ethical Dilemmas and Ethics Consultation.” Journal of General Internal Medicine 19.3 (2004): 251 Elpern, Ellen and Silver, Michael. “Improving Outcomes: Focus on Workplace Issues.” Current Opinion in Critical Care 12.5 (2006): 395 Frick, S, Uehlinger DE and Zuercher, Zenklusen RM. “Medical Futility: Predicting Outcome of Intensive Care Unit Patients by Nurses and Doctors—A Prospective Comparative Study.” Critical Care Medicine 31.2 (2003): 456
  • 39. Giganti, Ed. “A New Center for Spirituality and Leadership at Bon Secours Richmond.” Health Progress 87.1 (2006): 4 Hamric, Ann B Ph.D., RN, FAAN and Blackhall, Leslie J. MD, MTS. “Nurse-Physician Perspectives on the Care of Dying Patients in Intensive Care Units: Collaboration, Moral Distress, and Ethical Climate.” Critical Care Medicine 35.2 (2007): 422 Khatri, et. al. “Relationship between management philosophy and clinical outcomes.” Health Care Management Review 32.2 (2007): 128 McClendon, Heather RN, BSN and Buckner, Ellen B. DSN, RN. “Distressing Situations In the Intensive Care Unit-A Descriptive Study of Nurses’ Responses.” Dimensions of Critical Care Nursing 26.5 (2007): 199 McManis and Monslave Associates. “Healthy Work Environments: Striving for Excellence.” http://www. aone .org/ aone /docs/ hwe _excellence_full. pdf Murphy, Kevin Ph.D. “A ‘Next Generation’ Ethics Committee.” Health Progress 87.2 (2006): 26 Peter, Elizabethand Liaschenko, Joan. “Perils of Proximity: A Spatiotemporal Analysis of Moral Distress and Moral Ambiguity.” Nursing Inquiry 11.4 (2004): 218
  • 40. Ray, Daniel MD et al. “Integrating Palliative Medicine and Critical Care in a Community Hospital.” Critical Care Medicine 34.11 (2006): S394 Schmalenberg, Claudia, MSN, RN et al. “Excellence through Evidence-Securing Collegial/Collaborative Nurse-Physician Relationships, Part 2.” Journal of Nursing Administration 35.11 (2005): 507 Silow-Carroll, Sharon, T. Alteras and L. Stepnick. “Patient-Centered Care for Under Served Populations: Definition and Best Practices.” Economic and Social Research Institute . Washington DC. January, 2006. www. esresearch .org Spence Laschinger et al. “ , A longitudinal analysis of the impact of workplace empowerment on work satisfaction.” Journal of Nursing Administration 35 (2003): 410 Taylor, Carol, RN Ph.D. “Dealing with Tough Situations: When Families and Caregivers Disagree.” telecom Lecture MCSA Columbus, OH 2007 Treece, Patsy D RN, MN et al. “Integrating Palliative and Critical Care: Description of an Intervention.” Critical Care Medicine 34.11 (2006): S380

Notas del editor

  1. title could've been--- chosen belief role patients/each other dim. obscured tenuous at best over the years