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Year 2013, Volume: 35 Issue: 2, 318 - 325, 03.06.2013

Gülay Yıldırım , Dilek Özden , Şerife Karagözoğlu

Abstract

Moral distress is a common problem among professionals and managers working in the field of health care. Moral distress is the distress experienced by a professional when he/she cannot fulfill the correct action due to several obstacles although he/she is aware of what it is. Moral distress caused by several individual and institutional factors leads to important consequences among health professionals ranging from a sense of anger and frustration to a decrease in job satisfaction and burnout as a result of which they may leave the profession. Thus, health care professionals lose their interests in the patient and the patient’s family, and thus the quality of the treatment and care they provide decrease. This review article is intended to bring the issue of moral distress frequently experienced but not voiced by health care professionals onto the agenda in Turkish literature by analyzing the concept of moral distress, putting forward the causes of moral distress, discussing its reflections on individuals and institutions and drawing health care workers’ attention to the issue.

Keywords

Moral distress health professionals ethics dilemma

References

  • Faber-Langendoen K, Lanken PN. Dying patients in the intensive care unit: forgoing treatment, maintaining care. Ann Intern Med 2000; 133: 886-93.
  • Mobley MJ, Rady MY, Verheijde JL, Patel B, Larson JS. The relationship between moral distress and perception of futile care in the critical care unit. Intensive Crit Care Nurs 2007; 23: 256-63.
  • Rice EM, Rady MY, Hamrick A, Verheijde JL, Pendergast DK. Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital. J Nurs Manag 2008; 16: 360-73.
  • Huffman DM, Rittenmeyer L. How professional nurses working in hospital environments experience moral distress: A systematic review. Crit Care Nurs Clin N Am 2012; 24: 91-100.
  • Maluwa VM, Andre J, Ndebele P, Chilemba E. Moral distress in nursing practice in Malawi. Nurs Ethics 2012; 19: 196-207.
  • Pauly BM, Varcoe C, Storch J. Framing the issues: moral distress in health care. HEC Forum 2012; 24: 1-11.
  • Russell AC. Moral distress in neuroscience nursing: An evolutionary concept analysis. J Neurosci Nurs 2012; 44: 15-24.
  • Silén M, Svantesson M, Kjellström S, Sidenvall B, Christensson L. Moral distress and ethical climate in a Swedish nursing context: perceptions and instrument usability. J Clin Nurs 2011; 20: 3483-93.
  • Repenshek M. Moral Distress: inability to act or discomfort with moral subjectivity? Nurs Ethics 2009; 16: 734-42.
  • American Association of Colleges of Nursing (AACN). Moral distress. Available at: http://www.aacn.org/aacn/pubpolcy.nsf/vwdoc/pmp. Accessed January 23, 200 Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress. AJOB Primary Research 2012; 3: 1-9.
  • Hamric BL, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate. Crit Care Med 2007; 35: 422-9.
  • Elpern EH, Covert B, Kleinpell R. Moral dıstress of staff nurses in a medical intensive care unit. Am J Crit Care 2005; 14: 523-30.
  • Piers RD, Van den Eynde M, Steeman E, Vlerick P, Benoit DD, Van Den Noortgate NJ. End-of-life care of the geriatric patient and nurses’ moral distress. J Am Med Dir Assoc 2012; 13: 80.e7-13.
  • Radzvin LC. Moral distress in certified registered nurse anesthetists: Implications for nursing practice. AANA J 2011; 79: 39-45.
  • Corley MC, Minick P, Elswick RK, Jacobs M. Nurse moral distress and ethical work environment. Nurs Ethics 2005; 12: 381-90.
  • Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. Journal of Advanced Nursing 2001; 33: 250-6.
  • Cavaliere TA, Daly B, Dowling D, Montgomery K. Moral distress in neonatal intensive care unit RNs. Adv Neonatal Care 2010;10: 145-56.
  • Shepard A. Moral distress: A consequence of caring. Clin J Oncol Nurs 2010; 14: 25Lützén K, Cronqvist A, Magnusson A, Andersson L. Moral Stress: Synthesıs of a Concept. Nurs Ethics 2003; 10: 312-22.
  • DeKeyser Ganz F, Berkovitz K. Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care. J Adv Nurs 2012; 68: 1516-25.
  • Wiegand DL, Funk M. Consequences of clinical situations that cause critical care nurses to experience moral distress. Nursing Ethics 2012; 19: 479-87.
  • Meltzer LS, Huckabay LM. Critical care nurses' perceptions of futile care and its effect on burnout. Am J Crit Care 2004; 13: 202-8.
  • Özden D, Karagözoğlu Ş, Yıldırım G. Intensive care nurses' perception of futility: Job satisfaction and burnout dimensions. Nurs Ethics 2013.
  • Hamric AB. Empirical Research on Moral Distress: Issues, Challenges, and Opportunities. HEC Forum 2012; 24: 39-49.
  • Hamric AB. Moral distress and nurse-physician relationships. Virtual Mentor 2010; 12: 6-11.
  • Jameton A. Nursing practice: the ethical issues. Engle wood Cliffs, NJ: PrenticeHall, 1984.
  • Wilkinson JM. Moral distress in nursing practice: experience and effect. Nurs Forum 1988; 23: 16-29.
  • Webster GC, Baylis FE. Moral residue. In Sb. Rubin, l. Roloth (eds) Margin of error: The ethics of mistakesin the practice of medicine Hoggerstown:Unversity Publishing Group. 2000; pp: 217-30.
  • Kalvemark S, Höglund A, Hansson MG, Westerholm P, Arnetz B. Living with conflicts-ethical dilemmas and moral distress in the health care system. Soc Sci Med 2004; 58: 1075-84.
  • Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics 2009; 20: 330-42.
  • Hanna DR. Moral distress: The state of the science. Res Theory Nurs Pract 2004; 18: 73-93.
  • Canadian Nurses Association (CAN). Ethical distress in health care environments. http://www.cnanurses.ca/can/documents/pdf/publications/ethics_Pract_Ethical_Is sues_June_1998_e.pdf. Published June, 1998. Accessed January 23, 2008.
  • Atashzadeh Shorideh F, Ashktorab T, Yaghmaei F. Iranian intensive care unit nurses' moral distress: a content analysis. Nurs Ethics 2012; 19: 464-78.
  • Gutierrez KM. Critical care nurses’ perceptions of and responses to moral distress. Dimens Crit Care Nurs 2005; 24: 229-41.
  • Lawrence LA. Work engagement, moral distress, education level, and critical reflective practice in ıntensive care nurses. Nursing Forum 2011; 46: 256-68.
  • Lazzarin M, Biondi A, Di Mauro S. Moral distress in nurses in oncology and haematology units. Nurs Ethics 2012; 19: 183-95.
  • Raines ML. Ethical decision making in nurses. Relationships among moral reasoning, coping style, and ethics stress. JONAS Health Law Ethics Reg 2000; 2: 29-41.
  • Victor B, Cullen JB. The organizational bases of ethical work climates. Adm Sci Q 1988; 33: 101-25.
  • Pauly B, Varcoe C, Storch J, Newton L. Registered nurses’ perceptions of moral distress and ethical climate. Nurs Ethics 2009; 16: 561-73.
  • Austin W. Moral distress and the contemporary plight of health professionals. HEC Forum 2012; 24: 27-38.
  • Ferrand E, Lemaire F, Regnier B, Kuteifan K, Badet M, Asfar P, Jaber S, Chagnon JL, Renault A, Robert R, Pochard F, Herve C, Brun-Buisson C, Duvaldestin P; French RESSENTI Group. Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions. Am J Respir Crit Care Med 2003; 167:1310-5.
  • Fry ST, Harvey RM, Hurley AC, Foley BJ. Development of a model of moral distress in military nursing. Nurs Ethics 2002; 9: 373-87.
  • Nathaniel AK. Moral reckoning in nursing. West J Nurs Res 2006; 28: 419-38.
  • Sundin-Huard D, Fahy K. Moral distress, advocacy and burnout: theorizing the relationships. Int J Nurs Pract 1999; 5: 8-13.
  • Kelly B. Preserving moral integrity: A follow-up study with new graduate nurses. J Adv Nurs 1998; 28: 1134-45.
  • Erlen JA. Moral distress: A pervasive problem. Orthop Nurs 2001; 20: 76-80.
  • Cronqvist A, Nyström M. A theoretical argumentation on the consequences of moral stress. J Nurs Manag 2007; 15: 458-65.
  • Karakuş H. Hemşirelerin iş tatmin düzeyleri: Sivas ili örneği. Dicle Üniversitesi Sosyal Bilimler Enstitüsü Dergisi 2011; 6: 46-57.
  • Elçigil A, Bahar Z, Beşer A, Mızrak B, Bahçelioğlu D, Demirtaş D, Özdemir D, Özgür E, Yavuz H. Hemşirelerin karşılaştıkları etik ikilemlerin incelenmesi. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi 2011; 14: 52-60.
  • Eizenberg MM, Desivilya HS, Hirschfeld MJ. Moral distress questionnaire for clinical nurses: Instrument development. J Adv Nurs 2009; 65: 885-92.
  • Wocial LD, Weaver MT. Development and psychometric testing of a new tool for detecting moral distress: the Moral Distress Thermometer. J Adv Nurs 2013; 69: 167-74.
  • Corley MC. Nurse moral distress: a proposed theory and research agenda. Nursing Ethics 2002; 9: 636-50.

Ahlaki sıkıntı: Türkiye’de sağlık alanında gündeme gelmeyen bir boyut

Year 2013, Volume: 35 Issue: 2, 318 - 325, 03.06.2013

Gülay Yıldırım , Dilek Özden , Şerife Karagözoğlu

Abstract

Özet

Ahlaki sıkıntı (moral distres) sağlık bakım alanlarında çalışan profesyoneller ve yöneticilerde yaygın olarak yaşanan bir problemdir. Ahlaki sıkıntı, bir profesyonelin yapılacak doğru eylemi bildiği halde engeller nedeniyle doğru eylemi gerçekleştirememesi durumunda yaşadığı bir sıkıntıdır. Bireysel ve kurumsal birçok durumun neden olduğu ahlaki sıkıntı, sağlık profesyonellerinde öfke ve engellenme duygusundan iş doyumunda azalmaya, tükenmişlik ve meslekten ayrılmaya kadar önemli sonuçlar doğurmaktadır. Böylelikle sağlık çalışanları hasta ve ailesinden uzaklaşmakta, tedavi ve bakım kalitesi de azalmaktadır. Bu makalede sağlık profesyonellerinin sıklıkla yaşadığı, ancak çok da dile getiremediği ahlaki sıkıntı kavramını analiz etmek, nedenlerini ortaya koymak, bireysel-kurumsal yansımalarını tartışmak ve sağlık çalışanlarının dikkatini çekerek Türk literatüründe bu konuyu gündeme getirmek amaçlanmıştır.

Anahtar sözcükler: Ahlaki sıkıntı, sağlık profesyonelleri, etik ikilem

 

Abstract

Moral distress is a common problem among professionals and managers working in the field of health care. Moral distress is the distress experienced by a professional when he/she cannot fulfill the correct action due to several obstacles although he/she is aware of what it is. Moral distress caused by several individual and institutional factors leads to important consequences among health professionals ranging from a sense of anger and frustration to a decrease in job satisfaction and burnout as a result of which they may leave the profession. Thus, health care professionals lose their interests in the patient and the patient’s family, and thus the quality of the treatment and care they provide decrease. This review article is intended to bring the issue of moral distress frequently experienced but not voiced by health care professionals onto the agenda in Turkish literature by analyzing the concept of moral distress, putting forward the causes of moral distress, discussing its reflections on individuals and institutions and drawing health care workers’ attention to the issue.

Keywords: Moral distress, health professionals, ethics dilemma

Keywords

Ahlaki sıkıntı sağlık profesyonelleri etik ikilem

References

  • Faber-Langendoen K, Lanken PN. Dying patients in the intensive care unit: forgoing treatment, maintaining care. Ann Intern Med 2000; 133: 886-93.
  • Mobley MJ, Rady MY, Verheijde JL, Patel B, Larson JS. The relationship between moral distress and perception of futile care in the critical care unit. Intensive Crit Care Nurs 2007; 23: 256-63.
  • Rice EM, Rady MY, Hamrick A, Verheijde JL, Pendergast DK. Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital. J Nurs Manag 2008; 16: 360-73.
  • Huffman DM, Rittenmeyer L. How professional nurses working in hospital environments experience moral distress: A systematic review. Crit Care Nurs Clin N Am 2012; 24: 91-100.
  • Maluwa VM, Andre J, Ndebele P, Chilemba E. Moral distress in nursing practice in Malawi. Nurs Ethics 2012; 19: 196-207.
  • Pauly BM, Varcoe C, Storch J. Framing the issues: moral distress in health care. HEC Forum 2012; 24: 1-11.
  • Russell AC. Moral distress in neuroscience nursing: An evolutionary concept analysis. J Neurosci Nurs 2012; 44: 15-24.
  • Silén M, Svantesson M, Kjellström S, Sidenvall B, Christensson L. Moral distress and ethical climate in a Swedish nursing context: perceptions and instrument usability. J Clin Nurs 2011; 20: 3483-93.
  • Repenshek M. Moral Distress: inability to act or discomfort with moral subjectivity? Nurs Ethics 2009; 16: 734-42.
  • American Association of Colleges of Nursing (AACN). Moral distress. Available at: http://www.aacn.org/aacn/pubpolcy.nsf/vwdoc/pmp. Accessed January 23, 200 Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress. AJOB Primary Research 2012; 3: 1-9.
  • Hamric BL, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate. Crit Care Med 2007; 35: 422-9.
  • Elpern EH, Covert B, Kleinpell R. Moral dıstress of staff nurses in a medical intensive care unit. Am J Crit Care 2005; 14: 523-30.
  • Piers RD, Van den Eynde M, Steeman E, Vlerick P, Benoit DD, Van Den Noortgate NJ. End-of-life care of the geriatric patient and nurses’ moral distress. J Am Med Dir Assoc 2012; 13: 80.e7-13.
  • Radzvin LC. Moral distress in certified registered nurse anesthetists: Implications for nursing practice. AANA J 2011; 79: 39-45.
  • Corley MC, Minick P, Elswick RK, Jacobs M. Nurse moral distress and ethical work environment. Nurs Ethics 2005; 12: 381-90.
  • Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. Journal of Advanced Nursing 2001; 33: 250-6.
  • Cavaliere TA, Daly B, Dowling D, Montgomery K. Moral distress in neonatal intensive care unit RNs. Adv Neonatal Care 2010;10: 145-56.
  • Shepard A. Moral distress: A consequence of caring. Clin J Oncol Nurs 2010; 14: 25Lützén K, Cronqvist A, Magnusson A, Andersson L. Moral Stress: Synthesıs of a Concept. Nurs Ethics 2003; 10: 312-22.
  • DeKeyser Ganz F, Berkovitz K. Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care. J Adv Nurs 2012; 68: 1516-25.
  • Wiegand DL, Funk M. Consequences of clinical situations that cause critical care nurses to experience moral distress. Nursing Ethics 2012; 19: 479-87.
  • Meltzer LS, Huckabay LM. Critical care nurses' perceptions of futile care and its effect on burnout. Am J Crit Care 2004; 13: 202-8.
  • Özden D, Karagözoğlu Ş, Yıldırım G. Intensive care nurses' perception of futility: Job satisfaction and burnout dimensions. Nurs Ethics 2013.
  • Hamric AB. Empirical Research on Moral Distress: Issues, Challenges, and Opportunities. HEC Forum 2012; 24: 39-49.
  • Hamric AB. Moral distress and nurse-physician relationships. Virtual Mentor 2010; 12: 6-11.
  • Jameton A. Nursing practice: the ethical issues. Engle wood Cliffs, NJ: PrenticeHall, 1984.
  • Wilkinson JM. Moral distress in nursing practice: experience and effect. Nurs Forum 1988; 23: 16-29.
  • Webster GC, Baylis FE. Moral residue. In Sb. Rubin, l. Roloth (eds) Margin of error: The ethics of mistakesin the practice of medicine Hoggerstown:Unversity Publishing Group. 2000; pp: 217-30.
  • Kalvemark S, Höglund A, Hansson MG, Westerholm P, Arnetz B. Living with conflicts-ethical dilemmas and moral distress in the health care system. Soc Sci Med 2004; 58: 1075-84.
  • Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics 2009; 20: 330-42.
  • Hanna DR. Moral distress: The state of the science. Res Theory Nurs Pract 2004; 18: 73-93.
  • Canadian Nurses Association (CAN). Ethical distress in health care environments. http://www.cnanurses.ca/can/documents/pdf/publications/ethics_Pract_Ethical_Is sues_June_1998_e.pdf. Published June, 1998. Accessed January 23, 2008.
  • Atashzadeh Shorideh F, Ashktorab T, Yaghmaei F. Iranian intensive care unit nurses' moral distress: a content analysis. Nurs Ethics 2012; 19: 464-78.
  • Gutierrez KM. Critical care nurses’ perceptions of and responses to moral distress. Dimens Crit Care Nurs 2005; 24: 229-41.
  • Lawrence LA. Work engagement, moral distress, education level, and critical reflective practice in ıntensive care nurses. Nursing Forum 2011; 46: 256-68.
  • Lazzarin M, Biondi A, Di Mauro S. Moral distress in nurses in oncology and haematology units. Nurs Ethics 2012; 19: 183-95.
  • Raines ML. Ethical decision making in nurses. Relationships among moral reasoning, coping style, and ethics stress. JONAS Health Law Ethics Reg 2000; 2: 29-41.
  • Victor B, Cullen JB. The organizational bases of ethical work climates. Adm Sci Q 1988; 33: 101-25.
  • Pauly B, Varcoe C, Storch J, Newton L. Registered nurses’ perceptions of moral distress and ethical climate. Nurs Ethics 2009; 16: 561-73.
  • Austin W. Moral distress and the contemporary plight of health professionals. HEC Forum 2012; 24: 27-38.
  • Ferrand E, Lemaire F, Regnier B, Kuteifan K, Badet M, Asfar P, Jaber S, Chagnon JL, Renault A, Robert R, Pochard F, Herve C, Brun-Buisson C, Duvaldestin P; French RESSENTI Group. Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions. Am J Respir Crit Care Med 2003; 167:1310-5.
  • Fry ST, Harvey RM, Hurley AC, Foley BJ. Development of a model of moral distress in military nursing. Nurs Ethics 2002; 9: 373-87.
  • Nathaniel AK. Moral reckoning in nursing. West J Nurs Res 2006; 28: 419-38.
  • Sundin-Huard D, Fahy K. Moral distress, advocacy and burnout: theorizing the relationships. Int J Nurs Pract 1999; 5: 8-13.
  • Kelly B. Preserving moral integrity: A follow-up study with new graduate nurses. J Adv Nurs 1998; 28: 1134-45.
  • Erlen JA. Moral distress: A pervasive problem. Orthop Nurs 2001; 20: 76-80.
  • Cronqvist A, Nyström M. A theoretical argumentation on the consequences of moral stress. J Nurs Manag 2007; 15: 458-65.
  • Karakuş H. Hemşirelerin iş tatmin düzeyleri: Sivas ili örneği. Dicle Üniversitesi Sosyal Bilimler Enstitüsü Dergisi 2011; 6: 46-57.
  • Elçigil A, Bahar Z, Beşer A, Mızrak B, Bahçelioğlu D, Demirtaş D, Özdemir D, Özgür E, Yavuz H. Hemşirelerin karşılaştıkları etik ikilemlerin incelenmesi. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi 2011; 14: 52-60.
  • Eizenberg MM, Desivilya HS, Hirschfeld MJ. Moral distress questionnaire for clinical nurses: Instrument development. J Adv Nurs 2009; 65: 885-92.
  • Wocial LD, Weaver MT. Development and psychometric testing of a new tool for detecting moral distress: the Moral Distress Thermometer. J Adv Nurs 2013; 69: 167-74.
  • Corley MC. Nurse moral distress: a proposed theory and research agenda. Nursing Ethics 2002; 9: 636-50.
There are 51 citations in total.

Details

Primary Language Turkish
Journal Section Reviews
Authors

Gülay Yıldırım

Dilek Özden

Şerife Karagözoğlu

Publication Date June 3, 2013
Published in Issue Year 2013Volume: 35 Issue: 2

Cite

AMA Yıldırım G, Özden D, Karagözoğlu Ş. Ahlaki sıkıntı: Türkiye’de sağlık alanında gündeme gelmeyen bir boyut. CMJ. June 2013;35(2):318-325.