Moral distress

Domain 10. Life principles
Class 3. Value-belief-action congruence
Diagnostic Code: 00175
Nanda label: Moral distress
Diagnostic focus: Moral distress

Introduction to Nursing Diagnosis: Moral Distress

Nursing diagnosis is a dynamic, problem-focused process for data collection and problem identification that is used by nurses to identify a patient’s actual needs. It is a formal process within the nursing profession that assists nurses in recognizing, analyzing, and treating various patients issues. Nursing diagnosis plays an important role in health care settings by promoting safe, quality nursing practices and helping develop plans of care that will improve patient outcomes. One particular type of nursing diagnosis is moral distress.

NANDA Nursing Diagnosis Definition of Moral Distress

Moral distress is defined by the North American Nursing Diagnosis Association (NANDA International, 2018) as a “feeling of disquiet and plagued conscience, due to conflicting actions, which go against one’s beliefs”. When nurses are confronted with circumstances where they believe their values or ethics have been compromised, they experience moral distress, resulting in mental and emotional turmoil.

Defining Characteristics

Subjective characteristics of moral distress include an inability to accept a situational decision as well as feelings of helplessness, guilt, anger, and loss of trust towards the healthcare system. Objectively, nurses may display signs of outspoken agitation, avoidance of the conflict, and decreased engagement with the patient, among other symptoms.

Related Factors

The factors contributing to moral distress can be divided into two categories, intrinsic and extrinsic. On an intrinsic level, moral distress can stem from anxiety about making the right choice, lack of control over a situation, and rigid ethical code on personal values. Extrinsic factors include external pressure to reach a certain conclusion or difficulty in accessing pertinent organizational policies when making decisions.

At Risk Population

Certain patient populations are more likely to experience moral distress than others - those who belong to underrepresented or minority groups, those receiving poor quality care due to financial or logistical constraints, or those facing ethical quandaries related to end-of-life care are all at an increased risk.

Suggestions For Use Of Nursing Diagnosis: Moral Distress

When using this diagnostic tool, nurses should first assess the patient’s individual reaction and circumstances in order to best determine how to proceed. If a nurse finds himself in a position where he is able to effectively address and resolve the source of his moral distress, then he should take action in accordance with his ethical code. If a patient is unable to resolve the cause of moral distress, the nurse should document and report the incident, taking appropriate action if necessary.

Suggested Alternative NANDA Nursing Diagnosis

If the nurse is unable to resolve the cause of his moral distress, certain alternative NANDA diagnoses can help to better articulate the issue. For example, if a nurse is feeling overwhelmed due to too much responsibility, the appropriate diagnosis might be Anxiety and/or Ineffective Coping. If the underlying issue is related to the patient and not the nurse, Potential Delayed Growth and Development or Anxiety might be more appropriate.

Usage Tips

When utilizing moral distress as a nursing diagnosis it is important to remember the following tips: clearly communicate to patients the sources of the distress, seek legal advice and support when needed, refer conflicts to direct supervisors or professional committees if necessary, and ensure that the patient’s opinion is respected and taken into account.

NOC Outcomes

The Nursing Outcomes Classification (NOC) has identified the following desired outcomes related to moral distress: Improved Well-Being of Patient, Resilience, and Self-Efficacy.

Improved Well-Being Of Patient

The nurse can assess the patient’s improved wellbeing through monitoring physical and psychological symptom changes and proactive communication with the patient that recognizes and respects their opinions, values, and beliefs.

Resilience

Resilience refers to a patient’s ability to adapt under stress and recover quickly from adversity. An effective nurse-patient relationship facilitates this process throughout the duration of care.

Self-Efficacy

Self-efficacy increases when the nurse demonstrates his capability to solve problems and make proper decisions on behalf of the patient. This outcome can also be improved through evaluation of the patient’s own self-efficacy beliefs.

Evaluation Objectives and Criteria

The nurse should monitor the patient’s improved wellbeing through physical and psychological symptom changes, while providing proactive communication with the patient that values their opinion, values, and beliefs. Nurses should also be able to evaluate a patient’s resilience by looking for their resilience in the face of adverse situations, as well as improvement in the patient’s self-efficacy.

NIC Interventions

The National Interdisciplinary Council on Aging (NIC) developed a list of interventions to help assess and manage moral distress. These interventions primarily focus on patient-centered approaches, specifically involving autonomy-promoting activities, social support and advocacy, moral dialogue and discernment, moral case deliberation, and restorative practices.

Nursing Activities

When treating the patient suffering from moral distress, the nurse should ensure that she follows the NIC Interventions as closely as possible. These activities will vary from case to case and depend on the individual needs of the patient. However, it is important for the nurse to always keep the patient’s autonomy and dignity at the forefront of her considerations.

Conclusion

Moral distress is an increasingly common concern among nurses, and one that requires thoughtful consideration in order to properly assess and manage the issue. Understanding the defining characteristics and related factors, as well as the usage tips and suggested alternative NANDA diagnoses, are important steps in addressing moral distress both efficiently and effectively. Finally, the nurse should take into account the NOC outcomes and NIC interventions as they pertain to their individual patient cases when developing their plans of care.

5 FAQs

1. What Is Moral Distress?

Moral distress is the feeling of disquiet and plagued conscience, due to conflicting actions, which go against one’s beliefs. It commonly arises in healthcare settings when faced with a moral decision that the nurse feels compelled to act, but cannot due to constraints.

2. What Are The Defining Characteristics Of Moral Distress?

Subjective characteristics include an inability to accept a situational decision as well as feelings of helplessness, guilt, anger, and loss of trust towards the healthcare system. Objectively, nurses may display signs of outspoken agitation, avoidance of the conflict, and decreased engagement with the patient, among other symptoms.

3. Who Is At Risk For Experiencing Moral Distress?

Patients belonging to underrepresented or minority groups, those receiving poor quality care due to financial or logistical constraints, or those facing ethical quandaries related to end-of-life care are all at an increased risk of experiencing moral distress.

4. What Should A Nurse Do In The Event Of Moral Distress?

First, the nurse should assess the patient’s individual reaction and circumstances in order to best determine how to proceed. If the nurse is able to address and resolve the source of the distress, then he should take action in accordance with his ethical code. If a patient is unable to resolve the cause of moral distress, the nurse should document and report the incident, taking appropriate action if necessary.

5.What Are Some Of The Interventions Recommended To Address Moral Distress?

The NIC intervention list includes autonomy-promoting activities, social support and advocacy, moral dialogue and discernment, moral case deliberation, and restorative practices. Above all else, the nurse should ensure that the patient’s autonomy and dignity is kept in mind when designing a plan of care.