Nursing diagnosis – MORAL DISTRESS

MORAL  DISTRESS

DEFINITION

Response to the inability to carry out one’s chosen moral/ethical

decision/action

DEFINING CHARACTERISTICS

Expresses anguish (e.g., powerlessness, guilt, frustration, anxiety,

self-doubt, fear) over difficulty acting on moral choice

RELATED FACTORS

• Conflict among decision makers

• Loss of autonomy

• Conflicting information guiding

• Physical distance of decision

ethical and/or moral decision
making

maker
• Time constraints for decision

• Cultural conflicts

making

• Decisions involving end-of-life

• Treatment decisions

matters

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Roles/relationship

• Coping

• Communication

• Values/beliefs

EXPECTED OUTCOMES

The patient and family will

• Understand medical diagnosis, treatment regimen, and limitations

related to extent of illness.

• Identify ethical/moral dilemma.

• Describe personal and family values and conflict with current situ-

ation.

• Identify healthcare ethics resources to assist in resolution of con-

flict.

• Verbalize relief from anguish, uneasiness, or distress.

SUGGESTED NOC OUTCOMES

Acceptance: Health Status; Client Satisfaction; Communication;

Decision Making; Family Integrity; Family Functioning; Family

Health Status; Family Integrity; Knowledge; Spiritual Health

Interventions and Rationales

INTERVENTIONS AND RATIONALES

Determine: Assess patient’s and family’s understanding of the diagno-

sis and prognosis, limitations, treatment options; description of their

personal values; and their physical expressions of suffering. Assess-

ment factors assist in identifying appropriate interventions.

Perform: Establish an environment in which family members can

share comfortably and openly their issues and concerns.

Enlist assistance of healthcare ethics resources such as ethics com-

mittee or consultants. Including experts in healthcare ethics will

assist in identifying the patient/family values and reason for the

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dilemma. By identifying the source of the conflict, the process of

resolution may begin, thus leading to better understanding by all

parties and partial or full relief from moral suffering.

Enlist assistance of chaplain or personal clergy to assist in the

process of resolution through clarification of values related to

religious views. Chaplains and personal clergy may provide a more

neutral “third party” that can help defuse the situation. Personal

trusted clergy might recognize or facilitate patient/family verbal and

physical expressions of suffering or relief.

Inform: Educate patient and family about medical diagnosis,

treatment regimen, and limitations involved in to help both patient

and family understand the limits of and read on for medical treat-

ment related to medical diagnosis.

Attend: Provide or set aside ample time for patient and family to

express their feelings about the current situation. Open, honest com-

munication may clear misconceptions on both sides and facilitate

relief from suffering in the mid of dilemma.

Acknowledge ethical/moral position of the patient/family who may

feel that their positions or views will go unrecognized in the mid of

serious illness and high-tech treatments; they may not want to

“bother” nurses and physicians with these concerns. Acknowledging

their concerns, values, and moral position allows for holistic care.

Manage: Refer, where requested, for follow-up for a family member

who needs exercise, weight management, diet assistance, health

screenings, and so forth. Assisting patient to make referrals will help

ensure continued efforts on the part of the patient to live a healthier

lifestyle.

SUGGESTED NIC INTERVENTIONS

Active Listening: Anger Control Assistance; Anxiety Reduction; Con-

flict Mediation; Consultation; Counseling; Documentation; Family

Integrity Promotion; Family support; Multidisciplinary Care Confer-

ence; Spiritual Support Family Support; Family Integrity Promotion;

Family Maintenance; Truth Telling

Reference

Kopala, B., & Burkhart, L. (2005). Ethical dilemma and moral distress: Pro-

posed new NANDA diagnosis. International Journal of Nursing Terminolo-
gies and Classifications, 16(1), 3–13.

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