moral distress and compassion fatigue

Question 1

moral distress occurs when…

Answer 1

• You know the ethically appropriate action to take, but are unable to act upon it
• You act in a manner contrary to your personal and professional values resulting in an undermining of your integrity and authenticity
• turned heroin addict away bc there was no clinic for her
• knew it was wrong but had to do it cause that’s what the dr said

Question 2

moral integrity is compromised when…

Answer 2

• You are unable to act in accordance with core values and obligations
• Attempted actions failed to achieve the desired outcome

Question 3

causes of moral distress

Answer 3

• Caring for patients with “controversial” procedures, cultural requests, etc…
• Witnessing others give inadequate patient care
• Inability to advocate
• Lack of knowledge or experience dealing with ethical issues
• Forced to provide care without input
• Lack of support from management
• Misuse or lack of resources
• Unnecessary tests or treatments
• Conflicting desires between family and healthcare team

Question 4

causes of moral distress pt 2

Answer 4

• Provision of false hope
• Conflicts between disciplines
• Lack of/impaired communication
• Necessity of delivering truthful information
• Pressure to deliver cost effective health care with limited resources
• Emphasis on cost savings
• Lack of support or bullying from colleagues
• Personal values are not aligned with organizational values – don’t go into L&D if you are against circumcision

Question 5

physical manifestations of distress

Answer 5

• Crying, headaches, GI disturbances, fatigue, exhaustion, lethargy, weight gain/loss

Question 6

emotional manifestations of distress

Answer 6

• Anger, guilt, low self-esteem, fear, frustration, impaired job satisfaction, isolation, depression

Question 7

organization costs

Answer 7

• High rates of absenteeism
• High turnover rates
• Staff burnout
• Lower quality of patient care
• Nurses choosing to leave the profession
• High cost of training new nurses

Question 8

moral residue

Answer 8

• Results from having experienced moral distress
• Lingering feelings after experience
  
  • Left-over feelings
  • Experience “stays with you”
• Can create long-lasting negative moral consequences
• May result in difficulty reconciling experiences
  
  • Inability to put the past into perspective
  • Can result poor quality of patient care

Question 9

what can you do?

Answer 9

• Advocate for self
• Speak up
• Seek help from nursing regulatory board
• Accept responsibility
• Peer support
• Mentorship
• Seek education
• Look at whole picture
• Collaborate with other disciplines

Question 10

AMERICAN ASSOCIATION OF CRITICAL CARE NURSES 4A’S TO RISE ABOVE MORAL DISTRESS

Answer 10

• ASK- Become aware of moral distress by asking self if moral distress is present in your life
• AFFIRM-Validate feelings, make a commitment to address moral distress
• ASSESS-Identify sources of stress and how serious it is. Make an action plan
• ACT-Prepare to take steps to change and maintain the change
• process is cyclical
• each stage may happen repeatedly before change is maintained

Question 11

compassion

Answer 11

• The sympathetic consciousness & desire to help those that have
  experienced emotional or physical distress
• an integral foundation of nursing

Question 12

A basic component of the nurse-patient relationship

Answer 12

• Foundation of Watson’s theory of human caring
  
  • Authenticity
  • Caring is central
  • Being present
  • Supportive of positive and negative feelings
  • “Being” the caring environment

Question 13

compassion in nursing

Answer 13

• Why is compassion important?
  
  • Necessary component of nurse/patient relationship
  • Deserve care that is compassionately delivered
  • Development of therapeutic relationships
  • Nurturing

Question 14

compassion fatigue defined

Answer 14

• Unconscious absorption of the distress, trauma, feelings, and experiences of patients (Henry, 2014)
• A result of continued exposure to stressful or traumatic events and violence
• Similar to post traumatic stress disorder
• “Vicarious trauma” or “secondary trauma”

Question 15

compassion fatigue

Answer 15

• Nurses are witnesses to traumatic events, physical and emotional pain, suffering, and loss
• Caring relationship leaves nurses vulnerable to high levels of emotional and mental stress
• Present in all nursing specialties
• Most common in critical care, ER, ICU, hospice, oncology
• Blurring of lines between professional and personal life

Question 16

signs and symptoms of compassion fatigue

Answer 16

• Loss of empathy
• Uncaring “attitude” toward patients
• Memory loss
• Anxiety/ depression
• Anger/rage
• Physical symptoms (GI distress, n/v, headaches, cardiac)
• Detachment and emotional withdrawal (protection mechanism)
• Increased work absence
• Sleep disturbance
• Avoidance behaviors
• Addictive behaviors
• Isolation
• Frequent crying
• Compulsive behaviors
• Questioning the meaning of life
• Feelings of futility

Question 17

define burnout

Answer 17

• “prolonged response to physical or emotional stressors that result in
  feelings of exhaustion, being overwhelmed, self-doubt, anxiety, bitterness, cynicism, and ineffectiveness”
• Compassion fatigue is a factor

Question 18

negative effects of burnout

Answer 18

• Personal & emotional health
• Patient satisfaction
• Organizational cost
• Mortality

Question 19

patient effects of burnout

Answer 19

• Memory loss=more errors in patient care
• Loss of empathy=patients receive less than optimal care
  
  • Nurses “don’t care about me”
• Burnout=loss of nurses causes staffing shortages
  
  • patient care errors, low staff morale, poor patient care
• Caring foundation of nursing is damaged

Question 20

additional factors of burnout

Answer 20

• Workload
  
  • Heavy patient loads
  • Inadequate support
  • Skipping lunch & breaks
• Control
  
  • Helpless to control pt outcomes
  • Futile care
• Reward
  
  • No cost of living raise due to hospital financial status
  • “you should be happy to just have a job”
• Community
  
  • Outsider, don’t fit in
  • Isolated
• Fairness
  
  • Unequal treatment
  • Managers favorites
• Values
  
  • Focus bottom line, not patients or staff
  • Organizational factors

Question 21

resiliency

Answer 21

• The ability to “bounce back” from difficult situations
• The process of adapting well in the face of adversity or significant sources
  of stress (APA)
• Can be taught
• Influencing factors
• External support
• Individual temperament

Question 22

nurses are perceived to be what?

Answer 22

• resilient
• studies don’t support this
• reality is lower resiliency than general pop
• we’re more stressed

Question 23

RESILIENCY AND NEW GRADS

Answer 23

• Barriers to work transition
  
  • Relationships with peers/preceptors
  • Communication with physicians
  • Frustrations in the work environment
    *Organization/prioritizing skills
  • Lack of confidence in skills, critical thinking, clinical knowledge
  • Depending on others while wanting independence
• Combined with long shifts and patient mortality and morbidity

Question 24

BUILDING RESILIENCY

Answer 24

• Formal educational programs
• Social support – debriefing session
• Meaningful recognition – saying someone is doing a good job

Question 25

externally building resiliency

Answer 25

• Developing problem-solving skills
• Engagement in external
  activities
  
  • Prayer
  • Exercise
  • Play
  • Art
• Relationships
  
  • Personal
  • Professional

Question 26

internally building resiliency

Answer 26

• Adopting ways of thinking to decrease the impact of
  traumatic experiences
  
  • Cognitive reframing
• Cultivating hope
• Strong relationship between hope and resilience

Question 27

what to do?

Answer 27

• Stress reduction
• Peer support
• Trauma training
• Debriefing
• Educational programs targeting compassion fatigue