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The concealed cost of immorality

Researcher attempts to measure and combat what happens to nurses who feel they are prevented from doing the right thing.

Moral distress could be a significant hidden issue for the Australian aged-care workforce.

“A number of years ago, I encountered a series of personal experiences with morally challenging situations, primarily related to changing care delivery models and a move towards team nursing,” said Adam Burston, lecturer in nursing at the Australian Catholic University, who is investigating the presence of moral distress.

“At the time, I was not able to clearly define what this experience was. A short while after this I was introduced to the topic of moral distress by a colleague, and when I began reading the literature I quickly recognised that moral distress was what I had been experiencing.”

Moral distress arises from the inability to pursue what a nurse believes to be the morally correct course of action in any given situation. Workplace constraints – such as staffing, skills mix or experience – or broader external influences such as resource allocation or access to care, can get in the way of doing what seems to be the right thing, contributing to the distress.

This can have a range of effects on workers, Burston said.

“Nurses have been shown to experience a range of adverse consequences, such as diminished confidence, self-doubt, loss of self-esteem, feelings of demoralisation and hopelessness, emotional detachment and diminished sense of purpose,” he said. “Additionally, feelings of guilt, anger, frustration and bitterness are commonly experienced.”

Burston believes addressing this issue is an important element in the battle to retain experienced, skilled aged-care workers.

Through a two-part study, he hopes to provide the first validated instrument to measure moral distress specifically for aged-care workers, in order to inform the development of interventions. These interventions will be targeted towards managing the experience and reducing incidence.

“This is an opportunity for our aged-care nurses to express their understanding of the concept, share their experiences and influence the development of appropriate interventions to improve their working situation,” he said.

Workers interested in participating in Burston’s study can get involved by completing a short survey at http://bit.ly/1cJLZO6

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