Question

Mrs. R., an 87- year- old patient, has a past history that includes coronary artery disease, a previous stroke, and advanced Alzheimer's disease. Ten days ago, Mrs. R. was hospitalized for aspiration pneumonia and has been ventilator dependent since being admitted to the intensive care unit in a small rural hospital. Family members visit daily and have repeatedly voiced their concern to the nursing staff about the continued ventilator support that Mrs. R. is receiving, most notably the fact that Mrs. R. would never have wanted such care. They also note that Mrs. R. has not recognized them in past months and that they plan to visit less in future days, but can be contacted should any change in Mrs. R.' s condition occur. Her primary physician has practiced in this community for multiple years; he is well known for his reluctance to discontinue any type of life support for any patient. When questioned, Dr. G.' s consistent response is, if this were his frail 92- year- old mother, he would prescribe the very same treatment for her. Dr. G. has now requested that the nurses talk to the family about moving Mrs. R. to a major medical center, where she can receive more advanced care, including vigorous rehabilitation and physical therapy, so that she may eventually return to a long- term nursing care facility. How might the nurses in this scenario respond to the physician's request? How would this scenario begin to cause moral distress among the nursing staff, and what are the positive actions that the nurses might begin to take to prevent moral distress?

Answer 1

Nurse should have a moral resilience i.e the ability to sustain, deepen, restore their integrity in state of confusion or distress. Nurse should have a moral courage to speak up the unethical standards of care and practice.

Moral distress occur if she is in the place where she could not support in their patient centered care approach as seen in this scenario, they dont want to continue the life support as they are not interested in the vigorous intervention and physical therapy. eventhough, doctor asked for moving the patient to major medical center for vigorous therapy.

Nurses needs to be speak up, accountable, have to build support systems, educated to handle the moral distress, organisation have to find the root cause and foster policies and workshops to handle the occupational distress to promote job satisfaction and quality of care.