7 Tips for Nurses to Beat Moral Distress

April 30, 2020
Patricia Jakel, MN, RN AOCN

The pandemic model of patient care is necessary, but exhausting, which leads nurses to moral distress.

The COVID-19 crisis creates unprecedented challenges for nurses around the world, including shortage of ICU space and equipment, staffing shortages, insufficient supplies of personal protective equipment (PPE), compromised standards of care, and a conflict of professional duty with personal safety. This new situation is a cause for great moral distress.

Moral distress is as “when one knows what to do, but institutional constraints make it nearly impossible to pursue the right course of action.”1 Nursing is a professional that strives on building relationships. But sadly, the ability for relationship building has dramatically changed in the last 2 months. Patients are dying without loved ones by their side, first-time chemotherapy patients are scared and alone and they’re facing difficult conversations with no one to hug or hold them, just to name a few examples. Patients can’t see our smiles, feel our touches, and they often can’t even hear us. It is tough times for patients with cancer.

As nurses, we all want to provide compassionate, safe care while placing the patient and family in the center of care — no matter where you practice. The pandemic model of patient care is necessary, but exhausting, which leads nurses to moral distress. Healthcare workers, especially nurses, are struggling to provide safe, effective care as we leap over and around so many barriers. As a result, our spirits are low. The constant action filled with stress lowers are resilience and leaves us open to distress and depression.

How do we protect ourselves from further moral distress? Below is a summary from studies that share recommendations for avoiding moral distress.2

  • Remember, there is a community obligation to patients for safe, high-quality care.
  • Voice your concerns and take action.
  • Be deliberate — know who to speak with. This is critical during the swift changes of the pandemic.
  • Open opportunities for dialogue.
  • Collaborate across disciplines/views.
  • Develop evidence-based policies and standard operating procedures (SOPs), which are critical to drive practice and keep collaborative. This could help calm frustration with the many daily changes.
  • Be kind to yourself. The good of many is more important during a pandemic. Practice self-care every day, whatever that looks like for you.

Most importantly love your family and friends (via phone calls and video chat) and live everyday with gratitude, even during these difficult times.

Be well my friends.

References

  • Jameton A. Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice Hall. 1984. http://hdl.handle.net/10822/800986
  • Pavlish C, Brown-Saltzman K, Fine A, Jakel P. A culture of avoidance: voices from inside ethically difficulty clinical situation. Clinical Journal of Oncology Nursing. 2015. DOI: 10.1188/15.CJON.19-02AP