One month ago, a doctor who serves as an ethical consultant talked to me about an evergrowing worry in her hospital. Doctors and nurses feel cornered, she said, by the competing demands of administrators, insurance companies, lawyers, patients’ families and even one another. And they are forced to compromise on what they believe is right for patients. She titled the problem moral distress. Since she and I had that discussion, I’ve not been able to stop seeing moral distress.
Just the other day, for instance, I went to see one of my best friends, a genius and articulate nurse whom I’ll call Mary. During the years that we worked together, I learned that Mary’s assessments of different clinical situations were nearly always correct. But I also noticed that over time, she would often resort to enigmatic and noncommittal statements when expressing her opinions to doctors and supervisors. Shortly after we met, for instance, Mary began taking care of a transplant patient brought in with an infected abdominal hernia repair. By the time I had come to be one of the residents on this patient’s surgical team, he had been in the I.C.U. for a month and his abdominal wall, or what was left of it, had become a beehive of festering bacterial pockets.
One morning, after yet another attempt in the O.R. to empty the infected pockets, Mary pulled me aside. How much more can a person take? she asked. Over the next few days, Mary popped the same question to the rest of the surgical team.
When it finally became clear that not everyone on the team was listening to her concerns, Mary’s question changed. If a doctor asked her to prepare the patient for yet another trip to the O.R., she would ask back, What do you want me to do? Or she would reply, Say that again? Or she would step away, her response trailing behind. O – kay. As time went on, Mary didn’t answer at all. She just simply went about her routines in the most perfunctory of ways, and her usually bright personality turned flat.
I finally asked her what was wrong. If I say anything at all, I get reproved, she explained, looking up from her chart. Doctors think I am out of line, and I get warnings from my superiors about being unprofessional. But if I don’t say anything, I fear that the patient might suffer. Her eyes drifted over toward our patient. What can I do? she asked.
Moral distress, knowing what is ethically appropriate but not being able to act on it because of obstacles inherent in a situation was first described in 1984 in a book on nursing ethics. Subsequent researchers focused primarily on the experiences of nurses and found that those who suffered from moral distress often became reluctant to interact with patients and other providers. In one recent study, 15 percent of nurses left their jobs because of moral distress.
It’s now apparent that doctors caught between ethical obligations to patients and the demands of insurance companies, administrators and even, occasionally, patients’ families are feeling increasingly cornered and not able to do what they believe is ethically right. Researchers from the University of Virginia recently studied I.C.U. doctors and nurses and found that even though doctors on average are not as frustrated than nurses, they can also suffer from intense moral distress.
This finding doesn’t shock me. It is very, very disheartening to haggle with heartless insurance reps over the phone over insurance approval for operations to remove cancers, to struggle to do everything that should be done for the rising numbers of patients a single doctor must see, and to follow the wishes of estranged relatives who swoop into the hospital during the last days of life and demand aggressive treatment.
What can we do?
I spoke with Ann B. Hamric, a registered nurse and the lead author of the research on I.C.U. doctors and nurses. There are many different reasons why a clinician can sometimes feel that he or she is not able to do the ethically appropriate thing, Dr. Hamric said over the phone. Many of the reasons for moral distress come from the environments where we work. Are we working as respectful partners or are we afraid? Doctors feel that the risk managers or the lawyers are telling them what they can and cannot do for patients, and that affects doctors. We talked about the implications of moral distress for the current nursing shortage and the impending primary care shortage. I asked her if there might be any way to change the work environment. Part of what we have to do, Dr. Hamric answered, is to start acknowledging moral distress and deliberately talking about it in health care settings. Otherwise, we will fail to recognize the damage to the integrity of the provider. We can’t expect an individual to work in this kind of highly intense, emotional, intimate space and then expect them to tolerate threats to their professional integrity. She added, No one’s going to stay otherwise. It’s just too heartbreaking.
There are so many times you should investigate the morality of an individual, especially if you need to trust him/her with your money or life (such as an attorney). Looking for someone’s federal records or maybe you’re in search of someone’s civil records? We may be able to help you find what you’re looking for. This knowledge may reflect the way you do business for the better.
Are you looking for one way links FREE to launch your site up the Google ladder to the top slots so that you will receive unlimited quality FREE traffic? Sign up for free now and let us help you climb the Google Ladder!
Read about boosting immune system.