Response to the inability to carry out one’s chosen moral/ethical
Expresses anguish (e.g., powerlessness, guilt, frustration, anxiety,
self-doubt, fear) over difﬁculty acting on moral choice
• Conﬂict among decision makers
• Loss of autonomy
• Conﬂicting information guiding
• Physical distance of decision
ethical and/or moral decision
• Time constraints for decision
• Cultural conﬂicts
• Decisions involving end-of-life
• Treatment decisions
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
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-
• Identify healthcare ethics resources to assist in resolution of con-
• 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
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
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
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.