Moral Distress in Palliative Care

Submission Instructions:
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.

My peers post:
Nurses working in clinical settings with complex ethical dilemmas are prone to moral distress. As they endeavor to meet both the medical and non-medical needs of the patients, nurses are regularly forced to make hard ethical decisions, even when verdicts contradict their values. Mealer and Moss (2016) report that moral distress is a common phenomenon in nursing practice, affecting nearly 80% of the workforce. Prolonged exposure to moral distress results in emotional exhaustion, withdrawal, disengaged nurse-patient relationships, burnout syndrome, reduced empathy, and other professional burdens (Mealer & Moss, 2016). These consequences have negative impacts on the quality and safety of nursing practice and patient care.
In my nursing career, I have had several encounters with scenarios that could potentially lead to moral distress. One of these encounters is when some patients refuse treatment and request to be discharged, claiming to seek spiritual healing, only for them to be readmitted later in critical conditions. These encounters have forced me to confront my spirituality, provoking an internal debate on the impacts of religious beliefs on impulsive behaviors, even when logic demands otherwise. Another collective experience occurs within the family relation domains. Some patients are too afraid to go against their family’s wishes and end up signing consent forms that are totally against their expectations and desires. It makes me feel powerless, knowing very well that the consent form is inaccurate because the patient’s freedom and autonomy are intricately tied to their husbands, parents, or financiers. Dealing with other healthcare professionals in a clinical environment could also cause moral distress (Purtilo & Doherty, 2016). If there is resistance from multidisciplinary health teams, the inability to fully exercise nursing advocacy responsibilities could lead to emotional distress among nurses.

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Although people have the right to accept, reject, or influence the choice of health, various incidents could diminish the patient’s autonomy. The lack of advanced directives among terminally-ill patients can reduce their right to self-autonomous, subjecting their family caregivers and health providers to stress (Duke et al., 2007). Besides, nurses are prone to frustrations due to interferences from the patient’s family (Ellington et al., 2012). These challenges are some of the common issues influencing moral distress in nursing practice. However, dealing with incidents that could result in moral anxiety necessitates the integration of both personal and professional approaches.

In these scenarios, I often initiate dialogue among the interested parties to promote a healthy discussion of the underlying problem, primarily through health education. Crafting educative lessons can empower patients and their family members to reconcile their religious and individual beliefs (Duke et al., 2007). Research further indicates that effective communication between nurses and terminally-ill patients promotes bereavement adjustment to all parties, reducing the risk of moral distress (Ellington et al., 2012). Educative discourses are also essential in interdisciplinary teams as they foster the patient’s ability to navigate through the everyday challenges by exploiting alternative approaches to treatment (Bockhold & Hughes, 2016). These techniques are crucial for obtaining satisfactory outcomes from interdisciplinary teams.

In summary, moral distress erodes therapeutic trust and relationships, severing effective communication between nurse, patients, and their families. These effects are detrimental to the nursing professional, patient care, and practice. However, educating patients about their rights could enhance their participation in the treatment process, increasing the possibility of reasonable outcomes and expectations in nursing care.

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