Comité SST

And if it was more than stress?

For some time now, I have not felt a feeling of accomplishment at the end of my work day. On the contrary, I feel completely discouraged and empty. Despite a frantic pace of work, I can only accomplish half of what I would like to do for my patients. I feel stressed and guilty at the same time that I am unable to give care in a more humane fashion. My patients are not items on an assembly line! I have to complete a lot of paperwork, which means less time with them. Furthermore, I am not convinced that all those notes are taken into account. Instead, I have the impression that my observations and my expertise don’t count for much. It’s very frustrating! And, although I get home totally exhausted, I can’t sleep. There are days when I feel like quitting!

Clearly, this healthcare professional is presenting symptoms of moral distress, like many of her colleagues working in the health network. On the edge of burnout, she is in danger of quitting her job and her profession if nothing is done.

Defined in the mid 1980’s, moral distress is a little known concept by the healthcare professionals and the managers. The scope of its consequences and its damage is still misunderstood today. Dr. Andrew Jameton, Ethicist, was one of the first authors to deal with this subject. His definition of moral distress is: “Moral distress is a phenomenon in which one knows the right action to take or the right thing to do, but organizational obstacles and constraints prevent one from acting in this respect”.

Among the many constraints existing in the care settings, the many organizational transformations combined with budget restrictions are at the top of the list. A finger can also be pointed at the shortage of care-giving personnel, as well as its repercussions on the stability of the care teams, and patient follow-up, just like the lack of adequate material resources and equipment. Similarly to that, the health setting sees technological advances that keep pushing the limits of care interventions and the abusive use of mandatory overtime increase the fatigue felt by the healthcare professionals and contribute to their distress.

Thus, moral distress caused by the gap between the ideals beliefs and deep values of the healthcare professional and the hard reality she must face in the health network raise ethical problems that can have an influence on her morale. For example, the healthcare professional may feel moral distress if she witnesses aggressive therapy, or if she must participate in painful treatments that she feels are useless or in treatments given in an unethical or improper way, or if she has to hide the truth from the patients or their families. As for burnout, this can happen when the adaptation strategies used by the healthcare professional turn out to be ineffective and do not succeed in removing her initial distress.

In conclusion, the concept of moral distress makes it possible to name a malaise that is still too often suffered in silence, while talking about it is part of the solution. A time-out is needed. The healthcare professional must be aware that she has the same duty to herself that she has for her patients, to try and preserve her health and her integrity at all costs. As the managers, the decision-makers in the network and the professional orders, they have the responsibility of taking into account all the impacts of their decisions on the health, safety and integrity of the care personnel. When all is said and done, the healthcare professionals are at the heart of the network!

This OHS editorial was inspired mainly by the article “La détresse morale – Comprendre la détresse morale des infirmières en milieux de soins pour pouvoir mieux y faire face” (Moral distress – Understanding moral distress of nurses in care settings in order to be better able to face it), written by Sylvie Dorris, in Perspective Infirmière de l’OIIQ, November-December 2013, Vol. 10, No 5, p.29-31 http://www.oiiq.org/sites/default/files/uploads/periodiques/Perspective/vol10no5/10-ethique.pdf

Do you know ?

L’épuisement professionnel (burnout) est un état dépressif causé par le travail. Diagnostic associé aux professions de relation d’aide (soins infirmiers, travail social, médecine, enseignement) dans les années 70, il est désormais reconnu que les travailleur-euse-s de tous les secteurs d’activités socioéconomiques peuvent en souffrir un jour ou l’autre.

Moral distress can affect both the healthcare professional and her patients. Thus, a healthcare professional who suffers from moral distress may resort to a defensive avoidance mechanism and reduce contact with her patients to a minimum, to the point of neglecting their basic needs.

The healthcare professional who does not react with compassion to her own distress risks lowering her capacity to respond to the suffering and distress of others

4. Certain solutions may be considered for combatting moral distress. One of them is to request training on learning to recognize the symptoms of moral distress and to know how to apply the proper adaptation strategies to get rid of it.

Another solution consists of organizing regular debriefing sessions so that the members of the team have the time to express their emotions, exchange among themselves and improve their mutual support, particularly following a difficult moral experience.