Disparity. Inequity. Futility. Barriers. Miscommunication. Unacceptance of the inevitable. Ethical and moral challenges perpetuate throughout practice for today’s healthcare workers, particularly oncology nurses in cancer care. As those burdens build up, nurses struggle to sustain their resilience and risk developing burnout or even leaving the profession entirely.
Nurses can use evidence-based strategies to respond to morally distressing events. In an article for the February 2023 issue of the Clinical Journal of Oncology Nursing (CJON), Joaquin Buitrago, PhD, MS, RN, OCN®, outlined how oncology nurses can take a resilience approach to anticipate and manage moral distress in their cancer care practice.
What Moral Distress Looks Like
Anticipating situations that may produce moral distress can help you prepare with the tools to proactively respond. Buitrago cited examples such as:
- Uncertain goals of care
- Unclear or conflicting information about treatment effects, prognosis, and hope
- Uncontrolled pain
- Timing of the transition to end-of-life care
- Futile procedures, including invasive treatment and resuscitation efforts
- Unsafe working conditions, including nurse-patient ratios and supplies
- Lack of leadership support
Respond With Resilience
Mitigating moral distress is a two-factor process, Buitrago said. The first part takes place in the moment, when you can respond cognitively using the four R’s:
- Recognize that the situation has conflicting options that are affecting your well-being
- Release the situation or parts that cannot be controlled
- Reconsider all stakeholders’ points of view to find new alternatives
- Restart your approach to the situation with a different point of view and different questions about the dilemma
Through a detailed case study, Buitrago illustrated how an oncology nursing team applied the four R’s to respond to an unsafe staffing situation (read it in the CJON article).
After you’ve alleviated any preexisting moral challenges, Buitrago advised adopting a resilience approach to prevent future moral distress and maintain, enhance, and restore your moral integrity. The strategies and factors you’ll want to consider for your resilience approach include:
- Developing a deep conviction for your values and beliefs so that you can courageously advocate with confidence in what is right
- Using organizational resources (e.g., ethics committees, the American Nurses Association’s Code of Ethics, membership in professional organizations such as ONS)
- Seeking out support from colleagues and supporting them in return
- Practicing general well-being strategies (e.g., balanced diet, exercise and relaxation, rest time)
“Moral distress negatively affects oncology nurses,” Buitrago concluded. “Incorporating strategies to prevent or manage moral distress can strengthen resilience in managing ethical and moral dilemmas. Strategies such as practicing self-care and using ethics committees and support systems may empower a resilience approach and sustain and restore integrity during ethical dilemmas.”
Learn more and earn 1.0 NCPD contact hour by reading the full CJON article and completing the evaluation as directed in the instructions in the box at end.