Kalvemark et al. (2004) defines moral distress as painful emotions triggered by institutional constraints that renders the nurse unable to do what he/she considers as the morally necessary or right thing to do. According to Kalvemark et al. (2004), moral distress therefore results from moral responsibility perceptions and connects with perception of individual responsibility in the face of situational constraints to execute such responsibility. However, Kalvemark (2004) distinguishes moral distress from moral uncertainty and moral dilemma. According to Kalvemark (2004) moral uncertainty arises when a nurse is unsure or uncertain about the existence or inexistence of an ethical dilemma, or when the assume perceives existence of an ethical dilemma he/she is unsure or uncertain about what values or principles applies in such ethical conflict. On the other hand, moral dilemmas arise when at least two values or principles conflict or when at least two principles apply there is convincing reasons to follow mutually inconsistent paths. Also, in ethical dilemma whereas it appears grave to substitute either value or principle, a failure is inescapable. Unlike moral uncertainty and moral dilemmas, moral distress ultimately occurs when a nurse is surer than an ethical dilemma is at hand as well as the morally correct course of action but the institutional limitations makes pursuance of the right course of action impossible.
Kalvemark (2004) therefore distinguishes moral distress experience of a nurse from his/her moral dilemmas experience, whereby although the foundation of the distress in identification a dilemma, moral uncertainty doesn’t cause moral distress. Kalvemark (2004) therefore precisely defines moral distress as the negative feeling and psychological discontent state experienced when an individual arrives at a moral decision, but fails to pursue that decision by executing the moral behavior prescribed by that moral decision due to institutional limitations. According to Kalvemark (2004), moral distress cannot result from an uncertainty state. Instead, moral distress is an outcome of a serious moral dilemma when the correctness or incorrectness of alternative course of actions has already been rationalized.
Delegate your assignment to our experts and they will do the rest.
Describe the role of emotions in moral distress and ethical dilemmas
Multiple emotions accompany moral distress, including a sense of anger, frustrations, and anxiousness experienced by nurses in the face of institutional conflict and hurdles with colleagues about values. Nurses further experience reactive distress when they ignore their original moral distress. In particular, reactive distress results from failure of nurse’s strategies to cope with morally distressing situations. Reactive distress is characterized by nightmares, worthlessness feelings, depression and headache. Chronic reactive distress causes nurses’ burnout and their decisions to quit the nursing profession (Jameson, 2017) .
Frustration and anger, feelings associated with reactive distress further exacerbate sorrow, helplessness, resentment, anxiety and powerless as reported from case study interviews of nurse practitioners (Jormsri et al., 2005) . NP suffering from reactive distress also reports feeling shameful, grieved, miserable, sad, disgusted, compromised, embarrassed, heartbroken, painful, fearful, and anguished.
Philosophers also point out the antagonistic relationship between rationality and emotions as betrayed by the maxim that “nothing fogs the mind as thoroughly as emotion. In such context, philosophers advises healthcare providers faced by an ethical dilemma to engage their rational thinking in making decisions on how to resolve the dilemma rather than their emotions. However, some rationalist points out the inescapability from the instinctive emotional intuitions in the face of ethical dilemma, but counsel on reliance on a few of those emotional instincts after critical evaluation. Philosophers further recommend consideration of critical emotional intuitions as secondary to rational explanation and argument.
Describe a type of ethical dilemma that challenges a professional’s desire and duty to treat everyone fairly and equitably
Evidence-based researches identify ethical dilemma situations encountered by healthcare providers as well as the moral distress ramifications contributed by those dilemmas. For instance, Kalvemark et al. (2004) study identifies categories of situations pointed out as ethical dilemmas by multidisciplinary healthcare providers. The categories include resources-specific situations, rules versus Praxis situations, and conflict of interest situations. Resources situations are particularly challenging healthcare providers’ responsibility and desires to treat everybody equitably and fairly. Resources-specific ethical dilemma situations faced by healthcare providers include lack of staff or time that pits present patient against future patient as well as patient care against administrative work. Other resource-specific dilemma scenarios include limited inpatient beds that present ethical dilemma in the fair and equitable allocation of beds for patients. Economic concerns also present an ethical dilemma to healthcare providers.
Most of ethical dilemmas revealed by case studies reports result from resources limitations. Resource limitations present an ethical dilemma to healthcare providers in making decisions on fair and equitable allocation of the scarce resources between the clinic and pharmacy department as well as the expenditure of the money in each of the two departments (Kalvemark et al., 2004). In particular resource-specific ethical dilemma revolves around four scenarios, including staff and time allocation between present and future patients, patients and administrative work, bed allocation to patients, and economic concerns.
Most of ethical dilemmas to healthcare providers relates to time limitation or prioritization of time among equally important tasks. For every patient requiring provider’s attention, another one is equally in need of the same attention. Similarly, a decision to immediately attend to a particular patient will deprive another patient off the effort and time spent on the prioritized patient affecting his/her care outcomes (Pope, Hough and Chase, 2016) . Also, most interactions between healthcare providers and patients should take a specified period of time and investing more time in particular, patient-care outcomes of the rest of unattended patients. The rule-of-thumb in such ethical dilemma situation is to prioritize on the patient at the counter rather than future patient.
Healthcare providers also face multiple tasks to handle besides attending to patients. In particular, healthcare personnel face an overwhelming ethical dilemma in the delicate balancing between their administrative workload and their patient-care duty (Pope, Hough and Chase, 2016) . As confessed by most healthcare personnel, patient-care is paramount over administrative tasks. Consequently, healthcare personnel feel morally distressed when their administrative workload constrains their capability to attend to patients.
Lack of enough beds to cater for an overwhelming population of patients in need of inpatient healthcare services also constrains healthcare personnel from offering care they consider necessary for patients (Pope, Hough and Chase, 2016) . Decision-making on choice among patients requiring inpatients services present overwhelming ethical dilemma to healthcare providers. To cope with such ethical dilemma, healthcare personnel prioritizes acutely ill patients over less serious health cases. However, the healthcare personnel properly inform the less ill patient about why he/she has to wait for a longer time.
Economic concerns also overwhelm healthcare providers with moral dilemma, especially in the allocation of limited money between staff salaries and patient-care resources. In particular, healthcare administrators express frustrations with the gobbling of healthcare budget by high healthcare personnel cost at the expense of healthcare services provision and infrastructure maintenance. Economic situations are also limiting delivery of quality healthcare to patients as stipulated in global and national standards due to exorbitantly high cost of healthcare procedures and medicines. Similarly, healthcare providers face ethical dilemma in offering quality, expensive healthcare procedures and medicines against a large population in need of healthcare services. In particular, delivery of expensive care services to patients requires sacrifice of other care services needs due to the scarce budget allocations to the healthcare sector.
Lack of money to pay for out-of-pocket healthcare services also overwhelms healthcare personnel with an ethical dilemma. A typical case is delivery of care services to illegal immigrants uncovered by healthcare social security program. In such circumstances, economic situations forces healthcare providers to deny patient-care to poor patients against their conscientious convictions of the patient’s need for care services.
Moral Distress Scale (MDS further identifies six scenarios that principally precipitate morally distressing emotions as identified by the). The first scenario is when a nurse’s duty forces him/her to continuously care for a patient who is hopelessly sick under a ventilator life-support system when nobody has the courage to make decisions for switching off the life support. Secondly, is when a nurse follows the wishes of a patient’s family to continuously deliver life support when it's not in the patient’s best interest. Thirdly, is when the nurse starts long-term life-saving procedures which he/she knows will simply delay the patient’s death rather than helps in his/her cure. The fourth scenario is when forced to follow the wishes of the patient’s family on patient-care when he/she does not support such care but administer due to the institution fear of the family’s lawsuit. Fifth is when a nurse implements doctor’s orders for unimportant tests or medication for patients suffering from terminal illness. Lastly, is when a patient delivers care that fails to alleviate the suffering of the patient due to the doctors worry that further prescription would kill the patient.
References
Jameton, A. (2017). What Moral Distress in Nursing History Could Suggest about the Future of Health Care. The AMA Journal of Ethic, 19 (6), 617-628.
https://journalofethics.ama-assn.org/article/what-moral-distress-nursing-history-could-suggest-about-future-health-care/2017-06
Jormsri, P., Kunaviktikul, W., Ketefian, S., & Chaowalit, A. (2005). Moral Competence in Nursing Practice. Nursing Ethics, 12 (6), 582-594. Retrieved 2005.
chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/https://pdfs.semanticscholar.org/3f7b/1ef5827bc5347c19f327bf0cb23b77992240.pdf
Kälvemark, S., Höglund, A. T., Hansson, M. G., Westerholm, P., & Arnetz, B. (2004). Living with conflicts-ethical dilemmas and moral distress in the health care system. Social Science & Medicine, 58 (6), 1075-1084.
chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/http://www.ipts.org.il/_Uploads/dbsAttachedFiles/Livingwith.pdf
Pope, B., Hough, M., & Chase, S. (2016). Ethics in community nursing. Online Journal of Health Ethics, 12 (2), 1-10.
chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/https://aquila.usm.edu/cgi/viewcontent.cgi?article=1172&context=ojhe
