Skills Resources in Ethical Decision-Making 2022 PDF

Dr/ Aida Ahmed Mohamed  Identify and discuss four responses to ethical situations.  Describe personal, professional, and organizational causes of moral distress  Analyze current interventions and strategies to address moral distress.   INTRODUCTION moral distre...

Dr/ Aida Ahmed Mohamed  Identify and discuss four responses to ethical situations.  Describe personal, professional, and organizational causes of moral distress  Analyze current interventions and strategies to address moral distress.   INTRODUCTION moral distress can occur when a nurse or other provider believes he or she know what ethical action is needed but is unable to act on that knowledge. for developing ethical skills or competence in nursing practice: sensitivity, judgment, motivation, and action. Moral distress inhibits motivation.  Responses to Ethical Situation  Moral uncertainty : uncertainty about which ethical principles and/ or provisions from the Code of Ethics apply in an ethical situation.  Moral dilemma: two ethically viable principles or goals are in opposition to each other in an ethical situation and only one may be chosen.  Moral conflict: stakeholders in an ethical situation have opposing views about how it should be resolved.  Moral distress: a nurse or other provider believes he or she knows what ethical action is needed but is unable to act on that knowledge.  Moral residue: painful feelings that remain after experiencing morally distressing situations  definition of moral distress : the discrepancy and shock like reactions that follow their professional values and identity were not congruent with or supported by the immediate practice environment or employing organization.  CAUSES OF MORAL DISTRESS A. Personal and Professional Factors: these include perceived powerlessness, past experiences, and emotional stability. 1-Perceived Powerlessness : hierarchal nature of the health care system contributes to power differentials based on work may be considered more important, As a result, nurses may feel that they have little influence on directing patient care or on decision making in general.  2- Past Experiences : nurses can have a response associated with dread, helplessness, and disengagement. These recurrent ethical situations may or may not be resolved. Frequent situations associated with moral distress and residue include providing aggressive, prolonged futile care, working with incompetent clinicians, and conflicts with other health care providers poor nursing practice and experiencing bullying. Students and recent graduates may not have sufficient experience  3- Emotional Stability :  nurse’s ability to remain mentally and emotionally stable, Feeling helpless or unable to act in these circumstances can initiate stress responses. The experience of emergency department (ED) nurses working in resuscitation rooms provides a graphic example of struggling to maintain emotional control in these situations The stress and pressure to endure in such scenarios may cause frustration.  B- Organizational Factors :  include lack of ethical, supervisory support, inadequate and/or incompetent staff, excessive workloads, and bullying, lateral violence, incivility, and workplace violence. 1. Lack of Ethical, Supervisory Support :  Effective, supportive leadership is essential to ethical nursing practice and is associated with a healthy work environment, improved patient safety and satisfaction, and decreased nurse turnover. Lack of such leadership can contribute to or directly cause moral distress. 2- Inadequate and/or Incompetent Staff :  Continued work is needed to develop an optimal staffing model that integrates site specific variables such as acuity, provider preparation, and the relational work of nursing, among other factors.   Recognizing and Addressing Moral Distress in Nursing Practice : Recognizing and Addressing Moral Distress in Nursing Practice: Personal, Professional, and Organizational Factors : 1. Nurses maintain professional, respectful, and caring relationships with colleagues and are committed to fair treatment, transparency, integrity preserving compromise, and the best resolution of conflicts.  2- The nurse creates an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect.  3- This standard of conduct includes an affirmative duty to act to prevent harm.  4-Disregard for the effects of one’s actions on others, bullying, harassment, intimidation, threats, and violence are always morally unacceptable behaviors.   Protection of Patient Health and Safety by Acting on : 1. Nurses must be alert to and must take appropriate action in all instances of incompetent, unethical, illegal, or impaired practice or actions that place the rights or best interests of the patient.   Assignment and Delegation of Nursing Activities or Tasks : 1. Nurses in management and administration have a particular responsibility to provide a safe environment that supports and facilitates appropriate assignment and delegation. 2. This includes orientation, skill development; licensure, certification, continuing education, competency verification; adequate and flexible staffing; and policies that protect both the patient and the nurse from inappropriate assignment or delegation of nursing responsibilities, activities, or tasks. .   Promotion of Personal Health, Safety, and Well- Being : 1. Fatigue and compassion fatigue affect a nurse’s professional performance and personal life. 2. To mitigate these effects, nurses should eat a healthy diet, exercise, get sufficient rest, maintain family and personal relationships, 3. engage in adequate leisure and recreational activities, and attend to spiritual or religious needs.   Preservation of Integrity : 1. nurses have an obligation to express their concern to the appropriate authority or committee. 2. Nurse administrators must respond to concerns and work to resolve them in a way that preserves the integrity of the nurses. 3. They must seek to change enduring activities or expectations in the practice setting.   The Environment and Ethical Obligation : 1. Nurses in all roles must create a culture of excellence and maintain practice environments that support nurses and others in the fulfillment of their ethical.  Recognizing and Addressing Moral Distress in Nursing Practice: Teamwork and Collaboration : 1. Definition: Function effectively within nursing and inter- professional teams, fostering open communication, mutual respect, and shared decision making to a achieve quality patient care. 1. Act with integrity, consistency, and respect for differing views. 2. Appreciate importance of intra- and inter-professional collaboration. 3. Value the perspectives and expertise of all health team members. 4. Initiate actions to resolve conflict . Personal and Professional Competencies: Ethics Education :  1- The necessity of ethics education for nurses to influence moral confidence and action.  2-The inclusion of a specific course on ethics in undergraduate or master’s programs, however, does not universally exist.  3- nurses should have an adequate understanding of these components to be able to identify and engage in situations with ethical content from the day-to-day.  4-Recognizing that additional education in ethics and moral distress may be beneficial,.  5-identifies addressing moral distress as a strategic initiative in creating a healthy workplace.  Effective Communication and Conflict Engagement Competencies :  1-As a result of this lack of improvement, several programs have been developed to strengthen communication and conflict resolution skills and decrease the incidence of moral distress among health care providers.  2-These skills are based on scripting and require actual practice, as with developing any technical competency. Ideally, they should be practiced in a group setting using role play but can also be applied by the individual nurse.  3-The support of nurse managers in establishing an open, ethical environment that encouraged nurses to voice their concerns was also recognized as essential to speaking up by these participants  Self-Care Competencies :  1-experiences of moral distress can have a positive effect by increasing awareness of personal and institutional obstacles to ethical practice.  2-This awareness can initiate a learning process that may contribute to a proactive approach as demonstrated by the nurse.  3-A positive and proactive attitude may be enhanced by developing self-care competencies that address cognitive, somatic, and affective dimensions.  4-. These self-care competencies may also mitigate the physical and psychological symptoms associated with moral distress including headache, insomnia, and depression.  ethical challenges may require a change in how nurses think about their roles and responsibilities, for example:  Accepting change as a part of living  Keeping things in perspective  Avoiding seeing crises as insurmountable problems  Looking for opportunities for self-discovery  Maintaining a hopeful outlook  Getting needed social support.   Organizational Competencies :  Supportive, Ethical Leadership : 1. Formal nurse leaders and administrators have a particular obligation to recognize and respond to issues of ethical environment and contribute to moral distress among nurses. 2. These leaders can preserve the moral integrity of nurses by developing and implementing policies and protocols that address identified concerns. 3. They can also ensure that nurses are aware of and have access to ethics resources, continuing ethics education, and consultation services. 4.They can support and respect those nurses who choose to exercise conscientious objection and serve as a representative voice in forums with other providers and health care administration. 5. provides strategies for nurse leaders to simultaneously develop nurses’ ethical skills and team based on standards of healthy work environments. 6. Encourage early family meetings between days 3 and 5 of the patient stay to begin discussions about the goals of care. 7.provide frequent, consistent communication with patients/family members.  8- Provide education to the inter-professional team regarding how to recognize and speak up about moral distress. 9- Empower all team members to initiate ethics consults and/or seek assistance to work through situations of moral distress.  10-Encourage communication and collaboration with palliative care services.  11- Strengthen the unit ethical climate.  12- Identify root causes of moral distress and develop strategies to address the. Thank you