Professional Ethics and Law in California, 2nd Edition _ ____________________________________________
that, in addition to clinical situations, moral distress may result from internal and external factors. Internal factors include lack of confidence, fear, and personal safety concerns. Work environment, fiscal pressures, poor communication, and lack of support are examples of external factors. The resulting moral distress is a psychological response that negatively impacts physical health (Bressler et al., 2017). Some suggest there is a relationship between moral distress, compassion fatigue, and burnout. Each of these responses is a result of work situations. If not addressed, each response could lead to attrition and a negative impact on patient outcomes (Jones-Bonofiglio, 2020). According to Zuzelo (2020), there are inconsistent meth- ods to identify the reactions one experiences with moral dis- tress. Furthermore, educational activities have not adequately prepared healthcare professionals to address ethical situations, to recognize and manage moral distress, to effectively communi- cate and advocate for patients, and to use strategies to prevent or minimize moral distress (Rushton et al., 2021).
an individual’s involvement in an event or situation and may be caused by system barriers to ethical practice (Epstein et al., 2020; Jones-Bonofiglio, 2020). Moral distress may result in physical, emotional, cognitive, or behavioral response because of unmet professional accountabilities and responsibilities. Moral uncertainty may be associated with moral distress, which is not being certain how to proceed when confronted with an ethical dilemma (Jones-Bonofiglio, 2020). This could be attributed to not fully understanding the ethical dilemma and not trusting in one’s own judgment. Moral uncertainty is an internal conflict with outcomes such as silence, negative emotions, indifference, and powerlessness. Moral stress is generated when healthcare professionals are sensitive to ethical dilemmas (Jones-Bonofiglio, 2020). With the use of ethical decision-making processes, actions to take are determined, or more challenging events may require consultation with the ethics committee or an ethicist (Zuzelo, 2020). The right actions or those that cause the least harm are taken to mitigate the situation and the duty of care has been met. There is no lingering effect on the healthcare provider, which differentiates moral stress from moral distress. Observable justifiable anger or frustration is moral outrage that occurs when one believes there has been a violation of ethical standards (Rushton & Thompson, 2020). Ungrounded moral rage is a strong impulsive emotional response such as anger without defining the ethical issue or principle that has been violated. Principled moral outrage occurs when one has defined the ethical issue and responds with empathy and compassion, which may lead one to the use of an ethical decision-making model preventing moral distress (Jones- Bonofiglio, 2020). MEASURING MORAL DISTRESS Instruments have been designed to measure moral dis- tress. They include the Moral Distress Scale, the Measure of Moral Distress for Healthcare Professionals, and Moral Distress Thermometer (Epstein et al., 2020). Moral Distress Scale and the Moral Distress Scale Revised The Moral Distress Scale was a 32-item scale developed to study moral distress among critical care nurses in end-of life situations (Epstein et al., 2020). When the instrument was revised in 2012, it became known as the Moral Distress Scale Revised (MDS-R). The revision made the scale applicable to noncritical care nurses and other healthcare professionals. The scale included items to capture the root causes of the moral distress (Epstein et al., 2020). Measure of Moral Distress for Healthcare Professionals When the MDS-R instrument was revised again, it was renamed the Measure of Moral Distress for Healthcare Profes- sionals (MMD-HP). The revisions were based on root causes of moral distress identified during the review of literature. The instrument includes 27 items. The participants rank the
Self-Assessment Question
11. Which ethical theory emphasizes that the outcome is all that matters, and the best outcome is characterized as “the greatest good for the greatest number?” A) Consequentialism
B) Deontology C) Virtue ethics D) Principlism
MORAL DISTRESS Moral distress occurs when one perceives that the action or inaction is an undesirable compromise in one’s values, responsibilities, and/or obligations (Jones-Bonofiglio, 2020) or a threat to one’s integrity (Carse & Rushton, 2017). Moral distress is the manifestation of concern experienced when one senses one is not being faithful to one’s commitments (Carse & Rushton, 2017). It challenges an individual’s sense of moral agency, which is the responsibility, readiness, and ability to act (Jones-Bonofiglio, 2020). There is a relationship between an ethical situation and the occurrence of emotional distress that results in moral distress (Morley, 2018). Not all ethical issues result in moral distress. For moral distress to occur when confronting an ethical issue, the individual feels their moral obligations have been compromised and the individual experi- ences a “crisis of conscience” (Dudzinski, 2016). It may result when decisions are made to resolve an ethical dilemma that cannot be implemented or are not consistent with ethical prin- ciples. Morally challenging events may lead to moral distress, but not all individuals develop moral distress when exposed to the same ethical dilemma (Fourie, 2017). The development of moral distress is influenced by an individual’s values, beliefs, education, and experiences. Moral distress is closely related to
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