How to stop the Moral Distress of Healthcare workers leading to Burnout

When healthcare workers cannot meet patients’ needs to the appropriate standard, they can often feel moral distress.

Moral distress is an emotional state that can arise from a work situation when a healthcare worker can feel ethically compromised because they feel the ethically correct action, they want to take is different from the action they have had to take due to limited time, support or resources or the task they have been instructed to carry out.

Moral Distress causes personal suffering often manifesting itself in anxiety, poor sleep, misplaced anger, frustration or a sense of powerlessness. These symptoms can lead to burnout – a state of physical, emotional and mental exhaustion, caused by a prolonged involvement in situations that are emotionally demanding. In May 2019, the term ‘Burnout’ was included in the 11^th Revision of the International Statistical Classification of Diseases and Related Health Problems described as a ‘state of vital exhaustion’ under the category of ‘problems related to life-management difficulty’.

Often policy or procedures can stand in the way of a healthcare worker and prevent them from doing what they believe is right and that presents a moral dilemma. Corley (2002) cites examples such as; continued life support even though it is not in the best interest of the patient; inadequate communication about end-of-life care between providers and patients and families; inadequate staffing or staff who are not adequately trained to provide the required care or inadequate pain relief provided to patients.

The American Association of Critical Care Nurses (AACN, 2005) has targeted moral distress as a priority area and developed the 4 A’s approach to address and reduce moral distress; ASK, AFFIRM, ASSESS, and ACT.

1. ASK: Review the definition and symptoms of moral distress and ask yourself whether what you are feeling is moral distress. Are your colleagues exhibiting signs of moral distress as well?
2. AFFIRM: Affirm your feelings about the issue. What aspect of your moral integrity is being threatened? What role could you (and should you) play?
3. ASSESS: Begin to put some facts together. What is the source of your moral distress? What do you think is the “right” action and why is it so? What is being done currently and why? Who are the players in this situation? Are you ready to act?
4. ACT: Create a plan for action and implement it. Think about potential pitfalls and strategies to get around these pitfalls.

You could also talk to a professional or find a creative outlet for your distress, focusing on positive authentic relationships. It would help to recognise that you are not alone because in challenging times when workforces are stretched you won’t be the only person feeling like this. Talk to a trusted colleague about it or create time with your colleagues or team over coffee for a 30-minute de-brief and create a narrative and recognition about the situation to express how you feel and help to gain perspective of the situation. Validate your feelings and experiences by talking with others and consider starting a reflective practice group.

The Bottom line is…if you just cannot align your morals and values with the organisation you work for and you feel you have done everything you can to rectify the situation, then find the courage and consider creating an exit plan which can give you a sense of freedom and choice.