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Moral Resilience as an Antidote to Moral Distress

Analysis  |  By Jennifer Thew RN  
   May 31, 2016

Nurses can cope with challenging situations better if they've developed the ability to sustain or restore their integrity in the midst of moral complexity. But they can't do it alone.

Those within the nursing profession are well-aware of the presence of moral distress among nurses.

The reality of healthcare is that the difficult situations that challenge nurses' ethical and moral integrity are part of the job and they are not going away.

Developing moral resilience and creating a culture of ethical practice, however, can provide nurses with the support they need to function in today's healthcare environment.  

"The idea of moral resilience is pointing to this capacity, that I think we all have in varying degrees, to sustain or restore our integrity in the midst of moral complexity, confusion, moral distress, or setbacks that we experience when we really feel like we can't do the right thing," says Cynda H. Rushton, PhD, RN, FAAN.

She is the Anne and George L. Bunting Professor of Clinical Ethics in the Berman Institute of Bioethics and the School of Nursing at Johns Hopkins University.

So how do nurses develop moral resilience? The American Association of Critical Care Nurses provides resources and Rushton offers a few suggestions of her own:

  • Be in tune with your body
    • Don't discount those gut feelings you may have about something, Rushton advises. "Our bodies have a lot of wisdom," she says.
    • "If you think about what happens in your gut, 'You know it in your gut.' The body is a great sort resource to help us detect there's something here that's challenging or threatening my integrity."
  • Notice your emotions
    • Rushton says nurses should identify what emotions occur when they're in a challenging situation. "There's a whole range of emotions. They can be anger and frustration or people could be depressed and totally shut-down in response to these type of situations," she says.
  • Identify your assumptions and biases
    • Jumping to conclusions—for example, saying, "I've been here before," or "I know how this ends,"—can limit creative solutions to a problem.
    • "Immediately, there's a set of assumptions about the people involved and the context of the situation that can lead us down a path where it obscures other possibilities of what might happen in that situation," Rushton explains.

These techniques all contribute to what Rushton calls self-regulation.

"The importance of regulating our nervous system is so we can recognize what's happening. We can pause and reflect and think clearly," she says. "We can't do that if our nervous system has gone bonkers."

Supportive Practice Environments Required

Nurses can't be expected to develop moral resilience without organizational support, says Rushton.

"Being morally resilient individually requires individual capacities, and it requires an ethical practice environment," she says.

Chief nursing officers can support an ethical practice environment by ensuring that decisions are being made and priorities are being set, that reflect the organization's values.

Related: Moral Courage an Obligation, Says CNO

Also, the organization should have mechanisms in place to make it possible for others to speak up about practices that are challenging their sense of integrity without fear of retaliation.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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