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July 9, 2019

Nursing & Healthcare

4 ways to address moral fatigue in nursing.

A young woman holds two cartoon faces; one happy, one sad.

Navigating the nursing profession can be tricky. No matter your specialty, you'll have to deal with delicate situations involving patients, family members, and coworkers. Many nurses struggle with these interactions, and that can lead to moral fatigue.

There's no quick fix for this problem. Counteracting moral fatigue means thoroughly evaluating your work environment and identifying how you can improve your practice. Empowering yourself to make positive changes helps reduce levels of moral distress on your unit and improves the quality of care provided to patients.

What is moral fatigue?

Moral fatigue—also known as moral distress—refers to situations in which a nurse recognizes the right thing to do but can't pursue it because of unit policies or other rules, according to a Bioethics Forum article.

Nurses encounter all kinds of situations that can lead to moral distress. You may find yourself morally fatigued when dealing with end-of-life patients and their families. Even everyday clinical situations, such as witnessing substandard patient care due to inefficient medical teams or insurance policies, can lead to moral distress.

A 2017 study published in Nursing Education Perspectives identified several common situations that contribute to moral distress, specifically among nursing students. While this study focused on those still receiving a nursing education, the situations described by study participants are also frequently encountered by more seasoned nurses, including:

  • Compromised best practices. Lack of adherence to infection control procedures, unsafe workarounds, and other similar situations wherein nurses disregard or are ordered to disregard the latest evidence in their practice can significantly contribute to moral distress.
  • Disrespect for inherent human dignity. Disrespect targeting the patient, the patient's family, or other nurses and healthcare provider colleagues can cause moral distress.
  • Perceived constraints. You might experience moral distress if there aren't enough nurses to handle each patient properly, if you work under strict time constraints, or if your facility or unit has only limited financial resources.

Combating the problem.

Fortunately, you can take steps to combat moral distress in your practice and on your nursing unit. There is no one-size-fits-all answer, but you can work with your colleagues to identify issues and implement solutions that benefit both patients and healthcare providers. Here are a few strategies to consider.

  • Examine your work environment. In many cases, moral distress results from problems at the structural level of your organization. Your leadership team might expect certain standards of care even though staffing is inadequate. Or you might have to use outdated medical equipment to provide patient care because there isn't enough money for upgrades. Identifying problems at the organizational level can be the first step toward enacting system-wide changes that reduce moral distress.
  • Debrief with your team. Certain patient care situations cause greater psychological distress than others. If you witness or are involved in a clinical incident or another major event, it can be helpful to discuss your experience with colleagues. Debriefing, according to a study in the Journal of Clinical Nursing, can help address psychological distress in clinical practice. It allows you to process your feelings about your actions in the situation and can help others recognize ways they might be contributing to distress.
  • Further your education. Many nurses feel morally fatigued because they lack knowledge or training in specific patient care situations. It's important to continue your education so that you're always basing your care on the latest evidence. Education increases your competency, and that can provide a big boost to your confidence.
  • Take time for yourself. It's also important to set aside time to care for yourself, especially after a challenging situation. Exercise, meditation, eating healthy foods, and spending time with close friends and family can help you recharge your batteries. Choose healthy ways to cope and find productive alternatives that bring about transformative change. Managing stress can go a long way toward reducing the impact of moral fatigue.

Counteracting moral fatigue isn't impossible, but it takes planning and action. Start by identifying the factors at your workplace that contribute to this problem. Then advocate for and work with your colleagues to develop solutions that decrease distress.

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