Nurse's Pocket Guide

moral DISTRESS
based on the individual’s personal viewpoint, increasing the
possibility of conflict with others, including healthcare
providers.
• Ascertain cultural beliefs/values and degree of importance to
client. Cultural diversity may lead to disparate views/expectations
between clients, SO/family members, and healthcare
providers. When tensions between conflicting values cannot
be resolved, persons experience moral distress.
• Note attitudes and expressions of dissatisfaction of caregivers/staff.
Client may feel pressure/disapproval if own
views are not congruent with expectations of those perceived
to be more knowledgeable or in “authority.” Furthermore,
healthcare providers may themselves feel moral
distress in carrying out requested actions/interventions.
• Determine degree of emotional and physical distress (e.g.,
fatigue, headaches, forgetfulness, anger, guilt, resentment)
individual(s) are experiencing and impact on ability to function.
Moral distress can be very destructive, affecting one’s
ability to carry out daily tasks/care for self or others, and
may lead to a crisis of faith.
• Assess sleep habits of involved parties. Evidence suggests that
sleep-deprivation can harm a person’s physical health and
emotional well-being, hindering the ability to integrate
emotion and cognition to guide moral judgments.
• Use a moral distress tool, such as the Moral Distress Assessment
Questionnaire (MDAQ) to help measure degree of involvement
and identify possible actions to improve situation.
• Note availability of family/friends for support and encouragement.
NURSING PRIORITY NO. 2.To assist client/involved individuals to
develop/effectively use problem-solving skills:
• Encourage involved individuals to recognize and name the
experience resulting in moral sensitivity. Brings concerns out
in the open so they can be dealt with.
• Use skills, such as active-listening, I-messages, and problem
solving to assist individual(s) to clarify feelings of anxiety
and conflict.
• Make time available for support and provide information as
desired to help individuals understand the ethical dilemma
that led to moral distress.
• Provide for privacy when discussing sensitive/personal issues.
• Ascertain coping behaviors client has used successfully in the
past that may be helpful in dealing with current situation.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
268 Cultural Collaborative Community/Home Care