http:/www.hotessay.net/ 留学生论文专业定制代写网站留学生Essay写作限制护理中道德困境的影响Make recommendations on how the impact of moral distress on nursing staff can be limited.What is moral distress?Moral distress is the state of psychological discomfort and distress that arises when an individual recognises that they have moral responsibility in a given situation,make a moral judgement regarding the best course of action but for a range of reasons are unable to carry out what they perceive to be the correct course of action.In reference to nursing,it specifically refers to the psychological conflict that occurs when a nurse has to take actions that conflict with what they believe is right,for example,due to restrictions in practice policies within institutions(Fitzpatrick and Wallace,2011).Studies in this area usually use the original definition by Jameton in 1993“moral distress arises when one knows the right thing to do,but institutional constraints make it nearly impossible to pursue the right course of action”(Jameton,1984).Further work by Wilkinson in 1987,who published an account of moral distress(Wilkinson,1989)refined this definition to relate it directly to“psychological disequilibrium and negative feeling”(Wilkinson,1987).Common causes cited by nurses for not being able to fulfil their moral responsibility include a lack of confidence in the ability of colleagues,negative attitudes of colleagues towards patients and a team decision on care that does not follow the patients expressed wishes,or fear of reprisal resulting from the course of action they feel is best for the patient(Wojtowicz et al.,2014).For example,a nurse working in post-operative ward might experience a patient dying as the result of refusing a blood transfusion following surgery due to religious beliefs.The nurses personal judgement may be that the patient should receive the blood transfusion to give them the best chance of surviving the surgery.However,because the patient did not consent,the nurse could not carry out the action they perceived to be correct.When the patient died,the nurse may have experienced emotional and psychological distress in the form of guilt and anger that they had not saved a life that may have been possible to save,as well as feelings of helplessness that they could not overrule the patients wishes(Stanley and Matchett,2014).What situations are more likely to cause moral distress?In 2015,Whitehead et al carried out a large scale questionnaire based study in the USA on moral distress amongst nurses and other healthcare professionals(592 participants,395 of which were registered nurses).The most common causes of moral distress in nurses included frustration at a lack of patient care due to inadequate continuity(rated 6.4 by nurses on a Likert scale of 0-16),poor communication(5.8)or inadequate staffing levels(5.7).Additionally,nurses reported that giving life supportive therapy when not in a patients best interest(6.0),or resuscitation only to prolong the process of death(5.8)were also rated highly.This study also showed that physicians and other healthcare professionals also rated these factors highly,but overall their scores were less than those of nurses.The authors concluded that nurses are more likely to experience moral distress than other healthcare professionals,possibly due to a discrepancy between levels of responsibility for patient welfare and the required autonomy to make the decisions they believe should be made,as well as feelings of accepting treatment protocols from physicians which they feel are incorrect but unable to challenge or overrule.Poor team leadership and poor communication was also cited by nurses as a cause of moral distress(Whitehead et al.,2015).Moral distress appears to be more likely amongst nursing staff who are involved in patient care protocols that are considered to be aggressive and futile e.g.prolonged end of life care,or care protocols that the nurse does not consider to be in the patients best interest.For these reasons,moral distress is thought to be particularly prevalent amongst nurses treating patients in palliative care(Matzo and Sherman,2009),paediatrics,intensive care(Whitehead et al.,2015;Wilson et al.,2013;Ulrich et al.,2010)and neonatal environments(Wilkinson,1989).Additionally moral distress is also prevalent amongst psychiatric nurses due to increased feelings of responsibility for vulnerable patients,particularly as these patients are at risk of suffering from ethical mistreatments,e.g.misinformation about drug side effects(Wojtowicz et al.,2014).Other studies have also identified that issues with the institution itself can cause moral distress,such as inadequate staffing,depersonalisation of staff,inadequate supply of resources and overloading of work(Dalmolin et al.,2014).How does it affect nursing staff?Moral distress can have psychological consequences that affect the nurses performance and wellbeing.For examp