Department: Think About It
In this issue of JCN, you'll find a report on a project NCF initiated over four years ago: A Collaborative State of the Science Initiative: Transforming Moral Distress into Moral Resilience in Nursing. Wolters Kluwer's Chief Nursing Officer, Anne Dabrow Woods, suggested I work with the American Journal of Nursing and orchestrated that collaboration. The executive summary and full report were published in AJN February 2017 and can be found full-text free at http://journals.lww.com/ajnonline/Pages/Moral-Distress-Supplement.aspx. It was a tremendous honor to work as project codirector with Shawn Kennedy, AJN Editor-in-Chief, and Cynda Hylton Rushton, the Anne and George L. Bunting Professor of Clinical Ethics at the Johns Hopkins Berman Institute of Bioethics, and Professor of nursing and pediatrics at the Johns Hopkins School of Nursing, Baltimore, MD. I learned much from these two brilliant nurses and am grateful for the collaboration.
What is the significance of this project for Christian nurses? Moral distress is huge in healthcare. We encounter moral distress when we believe that an action is right, but because of real or perceived constraints, we either cannot, or do not, take the action. As I worked on this project, I was struck again and again at underlying spiritual aspects of moral distress. Spiritual, as in that search for what is right action (i.e., correct, true), how we figure out what is right, what helps us do right, and how we deal with the distress of not doing right.
As Christians, God calls us to do the right thing. In the Bible, God delineates what is right. Being in right relationship with God, called righteousness, leads to doing right. The action of doing right is righteousness. Kings in ancient Israel were appointed by God “to execute justice and righteousness for all his people” (1 Kings 10:9; 1 Chronicles 18:14). How did they know what was just and right? They studied God's laws and instructions and walked in fellowship with God. As they sought wisdom and insight, God led them in paths of righteousness (Psalm 23:3). Proverbs 2 explains (and many other Scriptures!) how seeking skillful and godly wisdom leads to doing right:
If you seek skillful and godly wisdom as you would silver and search for her as you would hidden treasures; then you will understand the [reverent] fear of the Lord [that is, worshiping Him and regarding Him as truly awesome] and discover the knowledge of God. For the Lord gives [skillful and godly] wisdom; From His mouth come knowledge and understanding. He stores away sound wisdom for the righteous [those who are in right standing with Him]; He is a shield to those who walk in integrity [those of honorable character and moral courage], He guards the paths of justice; and He preserves the way of His saints (believers). Then you will understand righteousness and justice [in every circumstance] and integrity and every good path. For [skillful and godly] wisdom will enter your heart. (vs. 4-10, AMP)
At the risk of oversimplifying complicated morally distressing situations, Scripture teaches that being in right relationship with God and seeking him will help us know the right thing to do, how to do it, and give moral courage. This isn't about being dogmatic; it is about the small steps involved in taking right action in everyday and crisis situations. Countless times in my nursing work in Intensive Care to Behavioral Health to being NCF Director, I have been grateful for time spent in Bible study and prayer that helped me learn what God teaches about right thinking and action and drew me close to Jesus. As I encounter moral decisions, I ask myself, Does Scripture shed light here? When I need to speak up or advocate, I ask the Holy Spirit what to do, and for courage to do the right thing and speak right words (instead of walking away or reacting negatively). When I do the wrong thing, I ask forgiveness from God and colleagues. I don't do the right thing every time, but God continues to teach me.
I am aware that complicated systems and relationships interfere with being able to do the right thing. I know figuring out the right thing to do is not always clear. But as Christian nurses, we have a Source to go to for wisdom and moral courage.