Moral Distress?

Yup. So I'm now discovering the joys of ethical/moral distress in nursing. Not that I haven't had nursing experiences in other areas of work that pushed me morally.. but this past week of work has been especially trying.

My last few shifts have really started to weigh on me heavily. To the point where I have come home crying and upset with family for no reason. So what is moral distress? The American Association of Critical-Care Nursing (AACN) says moral distress happens when:

• You know the ethically appropriate action to take, but you are unable to act upon it.
• You act in a manner contrary to your personal and professional values, which undermines your integrity and authenticity.

Certainly, I encountered patients and situations in my years on the Medical floor that I had moral and ethical issues with. Doctors and nurses withholding pain medication from palliative patients, confused patients being restrained in Geriatric chairs in the hallway, etc. You know, stuff we have all came across in some form or another during our nursing careers. But since starting my job in ICU, my eyes have been forced open. Wide.

A patient who has been sedated on a short term sedative infusion for almost 2 weeks longer than what is recommended by best practice guidelines.. and now starting to show signs of long term neurological effects from this. A patient whose significant other is being kept in the dark by physicians, since they don't want to admit they've screwed up on several things during their stay with us. Physicians who, after doing your job and advocating for your patient, ignore your concerns to spare their egos... not caring that the patient is suffering because of their arrogance. Not caring that this patient may never experience a quality life off of a ventilator because of their neglect and ignorance to concerns. It really speaks to our tendencies as human beings to cover our tracks to spare ourselves.

My other patient, an elderly patient who has made it clear they did not want to be intubated, now finds them-self restrained to a bed with a ETT down their throat. With only PRN Benzos for sedation... when presented with the option of intubation, was never given an honest picture of what this would mean for them for the rest of their days. That the ventilator will be what they will now depend on to help them breathe. That they will probably never leave the hospital and go back to their home...

Something that really bothers me is when we allow family members to make decisions for perfectly competent patients. Some days I even wonder why I bothered with all of those stupid Ethics courses in University. I mean seriously, they mean nothing in the real world of the workplace it seems. I know in my heart that what is happening to these patients is cruel and nothing short of a crime.. yet, no matter what, somebody needs to look after those patients and provide quality nursing care. The physicians at our facility have the gonads the size of peanuts when it comes to having honest conversations with patients and families about risks and major decisions about their care. Is it some kind of secret that discussing these things with patients and families is a crazy hard thing to do? Or that it will constitute a large part of your time as an ICU physician?

I found the article linked about from the AACN very helpful in helping me sort through my moral distress. Please give it a read and share your thoughts on the subject if you have any!

Keep it real. Until next time,
Nurse Shotgun

PS - Voila! The newest addition to my collection - my Browning BPS!!