Transcript Moral Distress in the Context of Systemic Change

Moral Distress
Patricia (Paddy) Rodney, RN, MSN, PhD
Associate Professor
& Undergraduate Program Coordinator,
UBC School of Nursing
Faculty Associate, UBC Centre for Applied
Ethics
PHC Ethical Reflection Conference
April 2, 2009
This presentation is based on research and writing done
by P. Rodney, C. Varcoe, J. Storch, B. Pauly
and G. Hartrick Doane
Ethical Musings…
IS
OUGHT
Moral Agency
• Personal enactment of ethical responsibilities
• Action is intentional and directed towards “the
good”
• Action is experienced as embodied
• Action and reflection hold significant meaning for
the moral agent
• Effective moral agency requires authenticity,
connectedness and trust
Health Care Workplaces
Over the Past Decade
Growing shortages of providers and
resources
Increasing patient acuity, family stress
Growing workloads, casualization
Ongoing restructuring and
reorganization, loss of practice leaders
Increasing stress, illness, injury, and
attrition of nurses and other providers
Decreased patient satisfaction
Increased morbidity and mortality
Moral Climate
Patient Safety
Provider Safety
Safe Moral Climate
The safety of patients is linked to the safety of
nurses and other members of the health-care
team.
Both depend on a safe moral climate in which
the required organizational, material and
interpersonal resources are available and the
values for safe, competent, ethical care are in
place.
(Rodney, Doane, Storch, & Varcoe, 2006)
The Moral Context of Practice
Moral Choice
Moral
Distress
Moral Action
Moral distress “is when there is
incoherence between one’s beliefs and
values and one’s actions, and possibly
also outcome”.
(Webster and Baylis, 2000)
Moral residue “is that which each of us
carries with us from those times in our
lives when in the face of moral distress
we have seriously compromised
ourselves or allowed ourselves to be
compromised”
(Webster and Baylis, 2000)
Environment:
Structural and
Interpersonal
Challenges (unit,
agency, region)
WHAT WE HAVE
LEARNED…
Self:
How People See
Themselves and
Their Own Action
Self in Relation to Environment: How
People Respond to Others and to the
Challenges in Their Environment
SITE FOR ACTION AND EVALUATION
Leadership for Ethical Policy and
Practice:
Using an Ethics Lens to Improve
Healthcare Workplaces (2004-2007)
Co-PIs: Jan Storch, Paddy Rodney
CoIs: Colleen Varcoe, Rosalie Starzomski,
Bernie Pauly, BC CNOs, National Nurse Leaders,
BC Nurse Leaders & Direct Care Nurses,
Other Health Care Professionals
RAs: Kara Schick Makaroff, Lorelei Newton, Cherry
Curry, Gladys McPherson, Laura Housden, Elaine
Moody, Olecia Klotchkova
OUR THANKS TO FUNDERS…
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Canadian Health Services Research
Foundation (CHSRF)
Health Canada
Associated Medical Services, Inc
Each CNO & Region/Agency
Providence Health Care
First Nations and Inuit Health Branch
BC CNOs/Leaders
Fiona Bees
Lynnette Best
Anne Cooke
Kim Dougherty
Tom Fulton
Heather Mass
Amy McCutcheon
Barbara Mildon
Lynne Stevenson
Cathy Ulrich
National Nurse Leaders
Sandra MacDonald-Rencz
Judith Shamian
PLUS CONSULTANTS
AND NUMEROUS
PROJECT SITE LEADERS!
Sample Strategies…
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Yearly conference with regions together
Site-based retreats/workshops
Unit-based councils
Interdisciplinary networking
Formal research proposals
Links to other initiatives (eg. patient
safety)
Changes to related structures/processes
(eg. rounds, staff meetings)
Involvement of other resource people
(eg. ethicists)
Our Insights………..
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An ethical lens can enhance research on
health care workplaces
The moral climate shapes patient and health
care safety
Nurses and other health care providers need
support to use the language of ethics
Including other disciplines in this proactive
work is important
Nurses in advanced practice and other
leadership positions are crucial
Our Insights continued………..
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Nurses and other health care providers in
direct care roles MUST be able and enabled
to be more actively involved
Health care providers from every facet of
their profession need more time for selfreflection
There is a pressing need to move away from
“us-them” stances
Collective action from all facets of health
care professions is essential
(Rodney, Doane, Storch, & Varcoe, 2006)
PROJECT ACTIONS to
consider………..
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Start with hope
Create an initial steering group
Negotiate leadership
Reflect on power dynamics
Seek support from others who can help
Convene an initial retreat/workshop
Work out short-term and long-term goals
Expect skepticism and be honest
Build in regular evaluation
Share with other providers and agencies
Consider research funding
Maintain hope!
(Storch & Rodney, 2007)
Building Relational
Capacity
(Hartrick Doane & Varcoe, 2005)
Individual,
Organizational,
Regional, National,
International