Nurses use the Four A's plan as a guide to identify and analyze moral distress: • Ask appropriate questions to become aware that moral distress is present. Affirm your distress and commitment to take care of yourself and address moral distress. Assess sources of your moral distress to prepare for an action plan.
As a systematic process for change, this article offers the AACN's Model to Rise Above Moral Distress, describing four A's: ask, affirm, assess, and act. To help critical care nurses working to address moral distress, the article identifies 11 action steps they can take to develop an ethical practice environment.
Turner and Rushton created a potential solution built on 4Rs: recognize, release, reconsider, and restart. Recognize. The first thing nurses should do is recognize the situation for what it is; not what it represents.
Type A ethical distress describes the situation in which a person can identify the barrier to his or her course of action. In Type B ethical distress, a person knows the course h/she wants to take but cannot identify with certainty the barrier that restricts the course of action.
Signs and symptoms of moral distress include feelings of anger, frustration, hopelessness, isolation, and suicidality. Practitioners also feel belittled, unimportant, or unintelligent. They may contemplate leaving their jobs or leaving their profession altogether.
Moral distress is the emotional state that arises from a situation when a nurse feels that the ethically correct action to take is different from what he or she is tasked with doing. When policies or procedures prevent a nurse from doing what he or she thinks is right, that presents a moral dilemma.
Key Points. There are four components of moral behavior: moral sensitivity, moral judgment, moral motivation, and moral character.
Moral distress is an umbrella term for the stress responses (e.g., the physical, psychological, emotional, spiritual, or social/relational symptoms) healthcare workers may experience in relation to an event, decision, or patient case that challenges deeply held personal or professional values.
These are assessment, diagnosis, planning, implementation, and evaluation.
Focusing on the process of understanding and resolving an ethical dilemma, James Rest (1994) developed a theoretical model of ethical decision making that involves four distinct psychological processes: moral awareness, moral judgment, moral intention, and moral action.
According to those philosophers who affirm this condition, one needs to be "aware" of four things to be morally responsible: the action (which one is doing), its moral significance, consequences, and alternatives.
The Fundamental Principles of Ethics. Beneficence, nonmaleficence, autonomy, and justice constitute the 4 principles of ethics. The first 2 can be traced back to the time of Hippocrates “to help and do no harm,” while the latter 2 evolved later.
The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team.
Nurses are advocates for patients and must find a balance while delivering patient care. There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence. Each patient has the right to make their own decisions based on their own beliefs and values.[4].
Create safe spaces for discussion: Developing an ethical environment and creating safe places for discussion can prevent and reduce moral distress. Wocial, Bledsoe, Helft, and Everett suggested providing a framework to identify ethical concerns and discuss them proactively before they lead to moral distress.
Moral disengagement can be further broken down into four categories: reconstructing immoral conduct, diffusing responsibility, dehumanizing the victim, and misrepresenting injurious consequences (1).
It is thought to occur when an individual has made a moral decision but is unable to act on it, often attributable to constraints, internal or external. Varying definitions can be found throughout the healthcare literature.
When meeting with family members, remain patient and understanding. Explain the dilemma in detail and offer insights into it. You should listen to what family members have to say and how they feel about the dilemma. Together, you and family members can explore potential solutions.
There are different ways to approach decision making by considering four key elements, or rules: the utilitarian rule, moral rights, justice rule, and practical rule.
4. Implementing phase. As the nurse, what are the action items you will take to see that these goals are met? During the implementation phase, you'll create a few nursing interventions to help achieve the patient's goals.
Implementation Stage
The fourth step in the nursing process is implementation. In this stage, the nurse focuses on doing the actual interventions, activities, or actions indicated in the care plan.
The difference between the two kinds of moral distress, constraint and uncertainty, does appear to have moral relevance, although each stems from concern about a similar primary moral value—the well-being of the patient.