What is moral distress?

What is Moral Distress?

Moral Distress occurs when we

take an action or witness an action

that violates our personal values.

🙊🙉🙈

In 1984, Andrew Jameton defined “moral distress” as a phenomenon in which one knows the right action to take, but is constrained from taking it.

🥺

Veteran's Affairs (VA) psychiatrist Jonathan Shay coined the term “moral injury” in the 1990s.

The VA says that moral injury can occur in response to acting or witnessing behaviors that go against an individual's values and moral beliefs.

👉Ex. 1: A healthcare leader advocates for or approves a zero visitor policy, resulting in loved ones being separated at the time of death.

Or

Being required to abide by that policy without the authority to override it

👉Ex. 2: A bedside nurse is required to do CPR for a patient she knows is not going to survive. The physical experience violates her values of allowing a peaceful death.

🫵What examples would come to mind for you?

#moraldistress #moralinjury #healthcareworkerburnout

My Burnout Journey Begins

Moral Distress and Burnout are personal for me

Here's why...

⬇ Read to the end to discover what I did this week

My first overnight on-call (nearly 10 years ago)

I was called in at 2am

🏥 A young man lay alone in a small ER room

He drove his car off a bridge

🚑 The first responders fished him out of the water

They did CPR on the short ride to the hospital

As I stood, alone, in the thin rectangle of a room with him

Only one of us was breathing

😥In fact, we didn't even know who he was

John Doe

So, I knew

Working in health care is hard

It has been hard for ten years

😷 Except the last three have been...

Extra

🕖 60-80 hour weeks

Overwhelm, rising death tolls

😣 Ethics consults and committee meetings were more intense

Writing ethics policies about scarce healthcare resources

🙅‍♂️ Restricting visitors (against my beliefs)

Leading a team that responded to as many as a dozen deaths in one day

😠 Leadership conflict

Personal tragedies large and small piled on top of the mountain of workplace stress

Bad things happen

But when you feel helpless

Powerless.

It's different

In the middle of it all, I watched a good friend die on the same day she gave birth to her first child

We took the lead in support of her young husband and the baby

💔 Brokenhearted

Earlier this year, our son came down with appendicitis while we were in Puerto Rico

The remote island of Vieques, to be specific

🛩 Midnight airlift to San Juan

Emergent flight back home for surgery (he's fine)

🌊 Our house flooded in July, and was just recently fully repaired

It's fair to say that life has sucked since March 2020, at work at outside of work

So, I woke up on September 5, 2022

My 44th birthday

And something was wrong

With me

My heart was out of rhythm

💓 The Apple Watch confirmed--AFib

My first time

In the ER, I was cardioverted (shocked with 250 joules)

Without sedation (my choice)

All the follow up you expect

Then, a month later, another first

😐 I was diagnosed with depression 😐

My first time

I beleived everything was unrelated: AFib, work and life stress, and depression

I said as much to my counselor

She cocked her head, smiled a bit and said, "Really?"

Stress

Became moral distress

Became burnout

🛣 There is no straight road back from all this

But I've leaned on my team, and they have helped

I have adjusted my expectations of myself

I have listened to my doctor and therapist (and bride)

And I took this week off

🗓 A mental health week (not just day)

I made a list of rest-and-rejuvinate activities

📉 I honored the fact that my energy is low

I made a point to enjoy good things

I journaled and prayed

And I made a list of everything I wish had not happened over the last few years

Every line began with "I am sorry that..."

Then

😞 I forgave myself

I took some deep breaths

⌛ And recognized that "getting better" takes time

#mentalhealth #ethics #healthcare #hospital #workplacewellness #burnout