Moral Resilience against Moral Distress in Nurses: Definition, Components and Development

Year 2022, , 132 - 138, 06.04.2022

Emel Bahadır Yılmaz

https://doi.org/10.38108/ouhcd.900195

Abstract

This article is aimed to examine moral distress, its causes and consequences, the definition of moral resilience, its components, and practices to improve moral resilience. Nurses may experience moral distress when faced with ethical problems in clinical settings. Moral distress is defined as “a form of moral suffering that reflects suffering in response to moral harm, wrongdoing, or failure, and often creates a feeling that one's integrity has been compromised.” Moral problems cause nurses to experience physical and psychological health problems such as anger and guilt, stress response, and gastrointestinal disorders. In addition, it causes low self-worth, burnout, intention to leave the profession, and desensitization to patients among nurses. This impairs the quality of nursing care. Improving moral resilience is considered a solution so that nurses can cope with their moral distress, recover and restore. It is defined as the capacity of an individual to maintain or restore integrity in response to moral complexity, confusion, distress, or setbacks. Moral resilience consists of personal integrity, relational integrity, buoyancy, self-regulation, self-stewardship, and moral efficacy. Ethical education, development of coping and problem-solving skills, mindfulness-based interventions, and addressing the concepts such as self-regulation, self-awareness, and moral courage are important in developing moral resilience. In conclusion, in this review article, it is recommended to improve moral resilience to increase the quality of health care and reduce nurses' moral distress in the face of ethical problems. Keywords: Morals, resilience, ethics, nursing, nursing ethics.

Keywords

Nursing, Morals, resilience, ethics, nursing ethics

Hemşirelerde Ahlaki Sıkıntıya Karşı Ahlaki Sağlamlık: Tanımı, Bileşenleri ve Geliştirilmesi

Abstract

Bu makalede ahlaki sıkıntı, nedenleri ve sonuçları ile ahlaki sağlamlığın tanımı, bileşenleri ve ahlaki sağlamlığı geliştirmeye yönelik uygulamaların incelenmesi amaçlanmıştır. Hemşireler, klinik ortamlarda karşılaştıkları etik sorunlar karşısında ahlaki sıkıntı yaşayabilmektedir. Ahlaki sıkıntı; “ahlaki zararlara, yanlışlara veya başarısızlıklara tepki olarak yaşanan acıyı yansıtan ve genellikle kişinin bütünlüğünün tehlikeye girdiği hissini oluşturan bir ahlaki acı çekme biçimi” olarak tanımlanmaktadır. Ahlaki sıkıntılar hemşirelerin öfke ve suçluluk duyguları, stres tepkisi ve mide-bağırsak rahatsızlıkları gibi hem fiziksel hem de psikolojik sağlık sorunları yaşamasına neden olmaktadır. Ayrıca, hemşireler arasında, düşük benlik değerine, tükenmişliğe, mesleği bırakma niyetine ve hastalara karşı duyarsızlaşmaya yol açmaktadır. Bu durum verilen bakımın kalitesini bozmaktadır. Hemşirelerin ahlaki sıkıntıları ile baş edebilmeleri, toparlayabilmeleri ve yenilenebilmeleri için ahlaki sağlamlığın geliştirilmesi bir çözüm olarak düşünülmektedir. Bir bireyin ahlaki karmaşıklık, kafa karışıklığı, sıkıntı veya aksaklıklara yanıt olarak bütünlüğünü sürdürme veya eski haline dönebilme kapasitesi olarak tanımlanmaktadır. Ahlaki sağlamlık; kişisel bütünlük, ilişkisel bütünlük, toparlayabilme, öz düzenleme, öz yönetim ve ahlaki yeterlilik gibi bileşenlerden oluşmaktadır. Ahlaki sağlamlığın geliştirilmesinde, etik eğitimi, stresle baş etme ve sorun çözme becerilerinin geliştirilmesi, bilinçli farkındalık temelli girişimler, öz düzenleme, öz farkındalık, ahlaki cesaret gibi kavramların ele alınması önem taşımaktadır. Sonuç olarak, bu makalede, sağlık bakım kalitesinin artırılması ve hemşirelerin etik sorunlar karşısında yaşadıkları ahlaki sıkıntının azaltılması için ahlaki sağlamlığın geliştirilmesi önerilmiştir.

Keywords

hemşirelik, Ahlak, sağlamlık, etik, hemşirelik etiği

References

• American Nurses Association. (2017). Exploring moral resilience toward a culture of ethical practice. A Call to Action Report. Erişim tarihi: 04.02.2021, https://www.nursingworld.org/get-involved/share-your-expertise/pro-issues-panel/moral-resilience-panel/.
• Amiri E, Ebrahimi H, Vahidi M, Jafarabadi MA, Areshtanab HN. (2019). Relationship between nurses’ moral sensitivity and the quality of care. Nursing Ethics, 26(4), 1265-73. https://doi.org/10.1177/ 0969733017745726
• Burston AS, Tuckett AG. (2012). Moral distress in nursing: contributing factors, outcomes and interventions. Nursing Ethics, 20(3), 312-24. https://doi.org/10.1177/0969733012462049
• Polivka BJ. (2020). Resilience, moral distress, and work place engagement in emergency department nurses. Western Journal of Nursing Research, https://doi.org/10.1177/0193945920956970
• Defilippis TMLS, Curtis K, Gallagher A. (2020). Moral resilience through harmonised connectedness in intensive care nursing: a grounded theory study. Intensive Ciritical Care Nursing, 57, 102785. https://doi.org/10.1016/j.iccn.2019.102785
• Duarte J, Pinto-Gouveia J, Cruz B. (2016). Relationships between nurses’ empathy, self-compassion and dimensions of Professional quality of life: a cross-sectional study. International Journal of Nursing Studies, 60, 1-11. https://doi.org/10.1016/j.ijnurstu. 2016.02.015
• Fang L, Hsiao LP, Fang SH, Chen BC. (2021). Workplace bullying, personality traits and health among hospital nurses: the mediating effect of social support. Journal of Clinical Nursing, print of ahead. https://doi.org/10.1111/jocn.15881
• Helmers A, Palmer KD, Greenberg RA. (2020). Moral distress: developing strategies from experience. Nursing Ethics, 27(4), 1147-1156. https://doi.org/10.1177/0969733020906593
• Holtz H, Heinze K, Rushton C. (2018). Interprofessionals’ definitions of moral resilience. Journal of Clinical Nursing, 27(3-4), 488-494. https://doi.org/10.1111/jocn.13989
• Iacono MV. (2019). Nursing integrity: a moral imperative. Journal of Perianesthesia Nursing, 34(1), 220-222. https://doi.org/10.1016/j.jopan.2018.12.002
• Jeong IY, Kim JS. (2018). The relationship between intention to leave the hospital and coping methods of emergency nurses after workplace violence. Journal of Clinical Nursing, 27, 1692-1701. https://doi.org/10.1111/jocn.14228
• Kathryn S. (2017). Ethics in practice: from moral distress to moral resilience. Journal of Trauma Nursing, 24(5), 290-291. https://doi.org/10.1097/JTN.0000000000000317
• Keskin-Kızıltepe S, Koç Z. (2019). Hemşirelikte ahlaki sıkıntı ve nedenleri. Türkiye Biyoetik Dergisi, 6(1), 5-12.
• Kieft RAMM, de Brouwer BBJM, Francke AL, Delnoij DMJ. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Services Research, 14, 249-259. https://doi.org/10.1186/1472-6963-14-249.
• McCarthy J, Gastmans C. (2015). Moral distress: a review of the argument-based nursing ethics literature. Nursing Ethics, 22(1), 131-152. https://doi.org/10.1177/0969733014557139
• Mealer M, Moss M. (2016). Moral distress in ICU nurses. Intensive Care Medicine, 42, 1615-1617. https://doi.org/10.1007/s00134-016-4441-1
• Oh Y, Gastmans C. (2015). Moral distress experienced by nurses: a quantitative literature review. Nursing Ethics, 22(1), 15-31. https://doi.org/10.1177 /0969733013502803
• Range LM, Rotherham AL. (2010). Moral distress among nursing and non-nursing students. Nursing Ethics, 17(2), 225-232.
• Reuvers JA. (2017). Moral distress and resilience in nursing: the code is the cor. Nursing Scholarly Projects, St. Catherine University.
• Rushton CH. (2016). Moral resilience: a capacity for navigating moral distress in critical care. AACN Advanced Critical Care, 27(1), 111-119. http://dx.doi.org/10.4037/aacnacc2016275
• Rushton CH. (2017). Cultivating moral resilience: shifting the narrative from powerlessness to possibility. American Journal of Nursing, 117(2), 11-15. Sadooghiasl A, Parvizy S, Ebadi A. (2018). Concept analysis of moral encourage in nursing: a hybrid model. Nursing Ethics, 25(1), 6-19. http://dx.doi.org/10.1177/0969733016638146
• Sastrawan S, Newton JM, Malik G. (2019). Nurses’ integrity and coping strategies: an integrative review. Journal of Clinical Nursing, 28, 733-744. http://dx.doi.org/10.1111/jocn.14702
• Shapiro SL, Jazaieri H, Goldin P. (2012). Mindfulness-based stres reduction effects on moral reasoning and decision making. Journal of Positive Psychology, 7(6), 504-515. http://dx.doi.org/10.1080/ 17439760.2012.723732
• Vermeir P, Blot S, Degroote S, Vandijck D, Mariman A, Vanacker T, ve ark. (2018). Communication satisfaction and job satisfaction among critical care nurses and their impact on burnout and intention to leave: a questionnaire study. Intensive & Ciritical Care Nursing, 48, 21-27. https://doi.org/10.1016/ j.iccn.2018.07.001
• Young PD, Rushton CH. (2017). A concept analysis of moral resilience. Nursing Outlook, 65, 579-587. http://dx.doi.org/10.1016/j.outlook.2017.03.009