I discovered the term Moral Distress in the nursing literature. Hospitals are
hot spots for important issues and engage diverse vested interests in daily
interactions. Issues of life and death play out, often with conflicts among
stakeholders who have different views of what is the right thing to do.
Hospitals exist to serve the needs of sick or injured patients. Problems arise
when hospitals grow larger, involve increasingly complex technologies, and
employ different groups to fulfill the many functions that keep a hospital
running. The logistics of managing such a complex institution have routinely
overwhelmed patient care. You have armies of people running in all directions,
attending meetings, conferences, generating and receiving reports but if you
look in patients’ rooms, they are often alone and neglected.
Nurses remain the hospital group most directly involved in patient care.
Epstein and Delegado summarized the nurses’ point of view: ”Moral distress occurs
when one knows the ethically correct action to take but feels powerless to take
that action. Research on moral distress among nurses has identified that the
sources of moral distress are many and varied and that the experience of moral
distress leads some nurses to leave their jobs, or the profession altogether.“ [i]
They and others identified the cognitive dissonance involved generated from
several different sources; for example: power imbalances between members
of the patient care team, lack of communication among team members,
administrative pressure to reduce costs, fear of legal action and hospital
policies that conflict with patient needs. Even greater issues arise when
medical attitudes and methods are examined and questions are raised about
medical prejudices, excessive drug use, inattention to patients, neglect of
duty, technical errors and incompetence.
I have no doubt about the distresses nurses’ experience, but the description
moral distress is less than accurate. We have understood the humans are
critically disputatious and hyper critical of others so that conflict among
interacting individuals is common and inevitable. Ethical questions gravitate
toward the interfaces between individual freedoms and group discipline. Hospitals are interaction dense, so that anyone working in these
institutions will be distressed by the actions of others, at least, some of the
time. Coping mechanisms must involve submission to group interests and
willingness to compromise, even when I am right and they are wrong. We have also
recognized that there is no consensus about the common good, so if you claim
superiority by having an ethical position better than others, be prepared for at
least a debate, if not a dangerous fight.
Elizabeth G. Epstein, Sarah Delgado . Understanding and Addressing Moral
Distress. The Online Journal of Issues in Nursing. 2010;15(3)