With the increasing complexity of health care, mortal distress in
nursing has risen to unprecedented levels. These conflicts threaten
nurses' core values and moral integrity, contributing to burnout and
staff shortages and endangering safety and quality of care.
Nurses in all roles and specialties face complex ethical situations
that challenge their values, giving rise to moral distress. New
approaches to overcoming the challenges of moral distress by increasing
moral resilience are presented in a supplement to the February issue of
the American Journal of Nursing
. The journal is published by Wolters Kluwer.
‘Recommendations on essential steps for addressing moral distress and supporting the cultivation of moral resilience among the nursing staff have been discussed in a new study.’
Based on the proceedings of a recent expert symposium, the special
report outlines strategies to mitigate the harmful effects of moral
distress in the health care workforce and to create healthy work
environments - with the goal of providing safe, high-quality care for
patients and families.
The supplement, titled "State of the Science: Transforming Moral Distress into Moral Resilience in Nursing,"
is now available on AJN's website. Cynda Hylton Rushton and Kathy Schoonover-Shoffner are the guest editors of the
Addressing Moral Distress by Building Moral Resilience
Moral distress occurs when nurses and others "recognize their
responsibility to respond to care situations but are unable to translate
their moral choices into action." For example, an oncology nurse may
know that a cancer patient wishes to refuse treatment, but doesn't do so
because his physician and family want him to "fight on"; or nurses on a
geriatric unit may know they are not providing needed care to patients
because of poor staffing.
At an invited symposium held in Baltimore in August 2016, 46 nursing
researchers, clinicians, ethicists and organization representatives met
to discuss moral distress and to develop strategies to address it.
Following a consensus process, the participants approved recommendations
on essential steps for addressing moral distress and supporting the
cultivation of moral resilience in individuals; and for building systems
that support ethical practice. In both areas, priorities for education,
practice, and policy are identified.
The project was a four-year collaborative effort of The Johns Hopkins School of Nursing and Berman Institute of Ethics, the American Journal of Nursing
, and the Journal of Christian Nursing
along with the American Association of Critical Care Nurses and the
American Nurses Association. Funding support came from Johnson &
Johnson, the Heilbrunn Family Foundation, and Nurses Christian
"We hope clinicians, administrators, educators, and researchers will
use this report to initiate conversations, plan strategies and
curricula, and conduct research toward creating effective ways to
respond to situations that provoke moral distress," according to an
introductory editorial by Maureen Shawn Kennedy, Editor-in-Chief of American Journal of Nursing
The Editors voice the hope that the information presented will lead
to new approaches to lessening the occurrence and harmful effects of
moral distress. They write, "With determined action, we can help nurses
and other providers mitigate the effects of moral distress, enhance the
ethical environment in which they practice, and improve the quality of