moral distress and compassion fatigue Flashcards
1
Q
moral distress occurs when…
A
- 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
2
Q
moral integrity is compromised when…
A
- You are unable to act in accordance with core values and obligations
- Attempted actions failed to achieve the desired outcome
3
Q
causes of moral distress
A
- 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
4
Q
causes of moral distress pt 2
A
- 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
5
Q
physical manifestations of distress
A
- Crying, headaches, GI disturbances, fatigue, exhaustion, lethargy, weight gain/loss
6
Q
emotional manifestations of distress
A
- Anger, guilt, low self-esteem, fear, frustration, impaired job satisfaction, isolation, depression
7
Q
organization costs
A
- 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
8
Q
moral residue
A
- 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
9
Q
what can you do?
A
- 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
10
Q
AMERICAN ASSOCIATION OF CRITICAL CARE NURSES 4A’S TO RISE ABOVE MORAL DISTRESS
A
- 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
11
Q
compassion
A
- The sympathetic consciousness & desire to help those that have
experienced emotional or physical distress - an integral foundation of nursing
12
Q
A basic component of the nurse-patient relationship
A
- Foundation of Watson’s theory of human caring
- Authenticity
- Caring is central
- Being present
- Supportive of positive and negative feelings
- “Being” the caring environment
13
Q
compassion in nursing
A
- Why is compassion important?
- Necessary component of nurse/patient relationship
- Deserve care that is compassionately delivered
- Development of therapeutic relationships
- Nurturing
14
Q
compassion fatigue defined
A
- 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”
15
Q
compassion fatigue
A
- 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
16
Q
signs and symptoms of compassion fatigue
A
- 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
17
Q
define burnout
A
- “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
18
Q
negative effects of burnout
A
- Personal & emotional health
- Patient satisfaction
- Organizational cost
- Mortality
19
Q
patient effects of burnout
A
- 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
20
Q
additional factors of burnout
A
- 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
21
Q
resiliency
A
- 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
22
Q
nurses are perceived to be what?
A
- resilient
- studies don’t support this
- reality is lower resiliency than general pop
- we’re more stressed
23
Q
RESILIENCY AND NEW GRADS
A
- 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
24
Q
BUILDING RESILIENCY
A
- Formal educational programs
- Social support – debriefing session
- Meaningful recognition – saying someone is doing a good job
25
Q
externally building resiliency
A
- Developing problem-solving skills
- Engagement in external
activities- Prayer
- Exercise
- Play
- Art
- Relationships
- Personal
- Professional
26
Q
internally building resiliency
A
- Adopting ways of thinking to decrease the impact of
traumatic experiences- Cognitive reframing
- Cultivating hope
- Strong relationship between hope and resilience
27
Q
what to do?
A
- Stress reduction
- Peer support
- Trauma training
- Debriefing
- Educational programs targeting compassion fatigue
