Moral Distress and YOU

Dr Cynda H. Rushton, PhD, RN, FAAN is the Anne and George L. Bunting Professor of Clinical Ethics and holds a joint appointment at The Johns Hopkins University Berman Institute of Bioethics and School of Nursing with an appointment in the School of Medicine (Department of Pediatrics). She is co-chair of The Johns Hopkins Hospital Ethics Consultation Service. Her scholarship focuses on moral distress, palliative care, caregiver suffering, and conceptual foundations of integrity, respect, trust and compassion. Melissa J. Kurtz, MSN, MA, RN is a practicing nurse in the neonatal intensive care unit and a doctoral student at The Johns Hopkins School of Nursing, where her scholarship focuses on the decision-making processes of parents of children with critical illnesses. She is particularly interested in exploring how parents’ spiritual and/or religious beliefs impact their functioning in the health care environment. Ms. Kurtz completed a two-year bioethics fellowship at the Montefiore-Einstein Center for Bioethics in 2013.

Approaching Moral Distress
Defining Moral Distress
Categorizing Moral Issues
Understanding Moral Distress
Incidence of Moral Distress
Consequences of Moral Distress
Contributors to Moral Distress
Individual Factors
Worldview/Perception
Past Professional Experiences
Degree of Mental and Emotional Stability
Perceived Powerlessness
Lack of Moral Sensitivity and Moral Reasoning
Organizational Factors
Scarce Resources
Ineffective Teamwork
Lack of Leadership and Peer Support
Institutional Values and Policies
Fear of Litigation
Building Capacities to Address Moral Distress
Individual Capacities
Self-Awareness
Self-Regulation
Moral Courage
Self-Reflection and Self-Care
Conscientious Objection
Organizational and Professional Capacities
Organizational Policies
Organizational Support Services
Identifying Supportive Leadership
Professional Standards and Guidelines
Engagement in Political Advocacy
Dealing with Moral Distress: Tools and Resource
References