Bold Voices - April 2014 - (Page 22)

FROM THE PRESIDENT Vicki Good M oral distress. It's what happens when you know the ethically correct action to take and can't. Or when you act contrary to your personal and professional values, undermining your integrity and authenticity. During our last few monthly conversations we talked about how each of us steps forward in unique ways that support our core beliefs. Moral distress is the pain we experience when our steps collide with those beliefs. Or when our steps are blocked. The pain can be emotional, intellectual or spiritual. Sometimes it's all three. We struggle to uphold our beliefs because of constraints such as organizational policies, legal requirements, personal beliefs and power imbalances. (When it comes to power imbalances, by the way, it's easy to think conflict or disagreement represent moral distress.) I learned that courage was not the 22 absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear. - Nelson Mandela Moral Distress: It's Not Going Away Some situations that create moral distress have become so commonplace we can see them coming from a mile away. For example, end-of-life choices, treatment decisions and staffing. But other challenges are making the list longer. Here's an example: It's a busy day on the unit, and I'm already behind on giving several medications. There's also a newly admitted patient to assess, and her central line dressing is due to be changed. I reprioritize my work and forgo the dressing change, because other tasks are more pressing. Four days later I learn the patient developed a central line-associated bloodstream infection. Did my decision contribute? Let's face it. Moral distress isn't going away. If anything, it will become more common. But moral distress isn't necessarily bad as long as we don't give into our fear and we address it with courage. Think of it as an alarm signaling a disconnect between a situation and our beliefs. Moral distress calls out our personal struggle. It challenges us to step forward and rise above by reaffirming our commitment to establishing and sustaining a healthy work environment, and our promise to help patients and their families achieve optimal outcomes. Have you seen AACN's free online toolkit on moral distress? It can be downloaded at and guides us through the four A's: Ask: Am I feeling distressed? What is the source of my distress? Affirm: Validate my feelings and affirm my commitment to take care of myself by addressing the moral distress. Assess: What is the source of my distress? Is it personal? Environmental? How severe is my distress? Do I need outside help? Act: Preserve my integrity and authenticity by implementing strategies to change and rise above the moral distress. Are you joining me at this year's National Teaching Institute & Critical Care Exposition in Denver? Consider preregistering for the May 21 summit on moral distress where you can join facilitated conversations with experts to understand why moral distress isn't going away, and how to address it when you're faced with bullying, workarounds and disaster situations. Most of all, your colleagues and I would like to learn from your experience addressing moral distress. Please post a note on my wall at, or email me at step.

Table of Contents for the Digital Edition of Bold Voices - April 2014

Another Angle
President’s Note (Teaser)
NTI2014: You Have to Come! An Unmatched Experience in the Mile High City
AACN Clinical Priorities 2014: Clinical Topics for Bedside Clinicians
NTI Network: Connect Online to Plan Your Week
Step Forward! Vote in AACN’s Election 2014
You May Inherit Atherosclerosis From Your Mummy
Pain, Agitation, Delirium Guidelines Expand Nurses’ Toolkit
Pediatric Flu Deaths Still a Concern, Expanded Vaccinations Advised
Are Senior-Specific EDs Worth the Investment?
‘Stop Sepsis’ Program Reduces Mortality Rate 40 Percent
Better Relationships Between Nurses, Cleaning Staff Can Improve Patient Care
Patient Outcomes Improve With Surgeon-Led Mortality Reviews
Reducing Cross-Contamination from Healthcare Personnel Attire
New Biomarker Could Improve Outlook in Esophageal Cancer
Long-Term Survival of Kids After Out-of-Hospital Cardiac Arrest
Tight Glycemic Control Could Shorten Children’s Hospital Stay
Web-based Patient Portals Improve Self-Management
In Our Journals
Nurse-Patient Communication Enhanced in AACN CSI Academy Projects
Link Between Shingles and Stroke Risk?
In Utero Exposure to Dyslipidemia Heightens High LDL Risk in Offspring
Palliative Care: Conversations Matter
Improving Communication About Chronic Critical Illness
Certification Capsules
April 16: National Healthcare Decisions Day
New Editorial Consults, Other Publishing Events at NTI 2014
AACN Scholarships for August EBP, Research Methods Institutes
Early-Bird Registration Ends April 3
Attend the Chapter Leadership Development Workshop at NTI 2014
Vote Now!
‘I Am a Critical Care Nurse’
President’s Note

Bold Voices - April 2014