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In Touch
A forum to discuss the latest news and ideas in nursing and healthcare.
Tuesday, June 23, 2015
When I think about moral distress, I’d describe it as a gnawing, distraught feeling born of perceived injustice. The underlying catalysts are highly variable and include lack of essential resources necessary to provide the standard of care to patients, interpersonal or inter-professional conflict, especially involving ethically challenging situations with patients, families, providers, or co-workers, as well as errors and disturbing treatment decisions. It encompasses a constellation of emotions that nurses have likely felt since the dawn of our profession. If left to fester without effective intervention, moral distress can lead to disillusionment, disenchantment, and even disengagement with the nursing profession. 
 
Over 30-plus years of practice, I’ve not only observed moral distress in colleagues, but have experienced it personally on several occasions. Until relatively recently, I didn’t have a name for it. My earliest memories of what I’d now term moral distress typically stemmed from being a party to treatment decisions that I simply couldn’t fathom--they involved care that was either too aggressive (and seemingly abusive) for patients who had no hope for any type of recovery, or care that wasn’t aggressive enough for patients who did. These were the days before evidence-based care pathways or palliative care services existed. I felt outraged that the hospital I worked for at that time didn’t seem to address these issues with the medical staff.
 
A nurse, seasoned and hardened by her own years of enduring ethically challenging assignments, brushed off my distress as reality shock. “Just do what’s ordered; that’s our job,” she advised. But my own professional framework wouldn’t allow me to be satisfied with that advice because I felt the patients deserved so much more.
 
As this situation recurred repeatedly, I felt something had to change, but I didn’t know how to effect change at that point in time. Simply being mad wasn’t constructive.
 
Sadly, the way many nurses, especially those in their formative years, handle this type of challenge by jumping ship in their search for calmer seas or greener pastures. The true reality shock, in my opinion, is that no sea is always calm or pasture always greener. The challenge is learning how to cope with resilience and fortitude, and at the same time, derive effective strategies to tackle the root causes of the situations that lead to moral distress. 
 
Mentoring and supportive relationships are essential among colleagues, nursing educators, and leaders to help individuals in the throes of moral distress to sort out their feelings, identify the causative factors, plan the resolution, and regain their own healthy emotional balance. Sometimes employee-assistance programs are the best options to help nurses deal with the emotional toll in highly sensitive and confidential matters when discussions with colleagues or leaders wouldn’t be conducive to the open dialogue needed to sort out feelings and develop potential solutions.
 
For nurse leaders, listening and observation skills are key to identifying problem situations and the impact they have on the staff. Ongoing vigilance and diligence are necessary to deal with the issues in our healthcare facilities that cause moral distress in nurses.
 
Frankly, these issues should be very visible in the priority scheme of all healthcare leaders. The solutions aren’t always straightforward, quick, or easy, but they’re essential to preserving quality and safety in patient care--as well as nursing itself as a long-term career choice.

Tuesday, May 19, 2015
Have you ever worked with someone whom you counted on to complete a task or project only to discover that the person totally dropped the ball, leaving you to pick up the pieces? It’s even worse when that individual isn’t up-front about it, doesn’t seem to care, or refuses to discuss the matter.
 
My guess is that this scenario resonates with most of us as a result of similar distasteful experiences in our personal or professional lives. These types of incidents can leave a trail of destruction–tempers flare, relationships are strained or broken, and reputations suffer potentially long-term consequences.
 
Not surprisingly, some nurses in our ranks dislike working in groups and prefer to be accountable only for themselves because they’ve been burned at some point by a ball-dropper. But more often than not, working in healthcare is a team sport. It’s awfully hard to go it alone without the cooperative efforts of team members to share the workload.
 
To prevent these unfortunate experiences, consider using a few tried-and- true project management strategies. First, openly discuss the task or project with all members of the work group. Assure clarity around expectations, including individual responsibilities, timelines, deadlines, the specifics about the work product to be completed, resource availability, and the consequences of late or incomplete deliverables. Set up touch points for status updates or progress reports to enable timely action to get the assignment back on track if needed. Consider formulating a “Plan B” as a fail-safe if you experience significant barriers with the original approach.
 
What if you find yourself in the difficult position of not being able to follow through on a commitment? Everyone has had times when life takes an unexpected turn, such as a health or family crisis. Let the parties involved know that you can’t deliver as early as possible. Offer to help problem-solve or suggest resources to assist those left to accomplish the work.
It’s best to always remain self-aware about how much you can realistically take on given your current obligations. Rather than saying yes when you’re overextended because you feel guilty about saying no, politely turn down projects rather than overcommitting and then coming up short. Honest communication is key. Don’t fumble or make an error–keep your eye on the ball!
 

Tuesday, April 28, 2015
Deprivation and suffering--do these words describe the thoughts that people harbor when we educate them about healthy diet and exercise? There’s a very good chance the answer is yes more often than not. That doesn’t bode well for success. Advising individuals to consider a change in the foods they consume and to increase their activity level has deeply personal implications. Yet, with the national focus on improving population health, these are the cornerstone strategies for developing a healthy population culture.
 
Personal choices about lifestyle, food, activity level, and habits are key determinants of health. But how do we motivate people to change embedded patterns of behavior and personal beliefs that may have childhood or even cultural roots? They’re the blockades in the tough road ahead that we must successfully navigate to achieve desired population health outcomes.
 
The popular media doesn’t make our job any easier. It’s actually part of the problem. You can’t thumb through a typical magazine or newspaper without seeing ads for weight loss products that promise dramatic results without dietary changes or exercise. How easy it is to believe that simply taking a pill will somehow neutralize all detrimental lifestyle choices.
The big commercial food industry, including the fast food chains, isn’t an innocent bystander either. The abundance of cleverly packaged convenience foods labeled “healthy” is often anything but. Low fat doesn’t always equal low calorie. Many popular processed foods sport a lengthy list of chemical food additives, too much salt, and added sugars. These “foods” also may lack the beneficial micronutrients and antioxidants that real food provides. Unfortunately, a lot of people have forgotten (or never learned) what a diet containing real food looks like. Here’s a hint: Garden-fresh fruits, vegetables, grains, nuts, and legumes form the foundation (with appropriate modifications, of course, for food-allergy sufferers).
 
The work we need to do as nurses is multifaceted. It includes discovering more effective approaches to health education that motivate healthy lifestyle choices in children and adults; making low cost, healthy foods available to low-income communities; and influencing the food industry to remove harmful additives and improve the nutritional value of processed foods. Yes, we have a heavy lift, but what other choice do we have? The scales are definitely tipped in the wrong direction!
 
What do you think? Share your thoughts below!

Tuesday, April 14, 2015
April is Sexual Assault Awareness and Prevention Month. Nurses can make a difference in the lives of survivors by understanding the facts, the effects this violence can have on mental and physical health, where to find information for themselves and their patients, and how to properly care for a survivor. Statistics are grim: About 1 in 5 women and 1 in 71 men have been sexually assaulted in their lifetime.
 
Nurses should be aware that survivors may experience myriad physical and mental problems beyond the damages of the actual assault, such as irritable bowel disorder, alcohol or drug abuse, post-traumatic stress disorder, asthma, and more.

We recently published a CE article on sexual assault to help bring awareness to our readers. You can read it for free:
 

Tuesday, April 07, 2015
The mother of a nursing colleague was hospitalized recently. My colleague e-mailed me to ask what Ithought about nurses calling patients “hon” or “dear” and the like. She expressed her amazement at how often nurses seemingly everywhere referred to her mother that way. She began to wonder whether her negative reaction just stemmed from being “old school.”
Do you think that my colleague is overreacting to the very common, innocent use of terms of endearment? If so, I’ll ask you to imagine for a moment that your nursing supervisor or perhaps even the CEO of your healthcare facility becomes one of your patients. Would you be inclined to refer to him or her as hon or dear? I sincerely doubt it. To use any term other than the individual’s name would be unthinkable for vast majority of us in a scenario like this. Why? It’s a matter of respect.

Granted, some patients don’t seem to mind and might even respond positively under certain circumstances, but really good judgment is needed here. More often than not, these terms can come across as trite, condescending, or paternalistic to patients who are trying hard to preserve their sense of dignity in a healthcare setting, where maintaining dignity is a significant challenge.Patients might feel a loss of personal identity and may suffer a greater sense of powerlessness during and after the interaction. And if the nurse—or another member of the healthcare team—reverts to hon, dear, or even (heaven-forbid) sweetie because he or she can’t remember the patient’s name, now we could also have a patient safety risk.

In our basic nursing education program we learned to always initially address patients by their formal names, generally preceded by Mr. or Mrs./Ms. as a way to confirm identity and establish a professional connection. After the formal introduction, the patient then might ask us to call him or her by a first name or nickname—or we can ask for a personal preference. Once we know the patient’s wishes, we can respond accordingly. The level of respect that we receive is often a reflection of the respect that we give to others. How would you like to be addressed?
 
Share your thoughts below!
About the Author

Linda Laskowski-Jones
Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM, is editor-in-chief of Nursing and vice president of Emergency, Trauma, and Aeromedical Services at Christiana Care Health System in Wilmington, Delaware.