Moral distress occurs when a person “knows the right thing to do, but institutional and/or environmental constraints make it nearly impossible to pursue the right course of action”
Moral distress occurs when a person “knows the right thing to do, but institutional and/or environmental constraints make it nearly impossible to pursue the right course of action” (Andrew Jameton, PhD). The shift created by a public health crisis, from a patient-centered approach to a community-focused approach, can cause great tension for those on the front line. This conflict creates feelings of anxiety, powerlessness, disgust, shame and depression.
Moral distress can result from dilemmas that:
- impact the well-being of the person being cared for
- impact the well-being of the provider
- involve role constraint and lack of authority or decision-making power
Some examples of moral distress include:
- Feeling forced to choose between the well-being of self or family and work duties
- Feelings related to loss of family and/or friends, including lack of closure. These “survivor guilt” feelings may lead to self-criticism, disgust, depression, and/or feelings of shame.
- Situations where there is an imbalance between resources and needs. For example: Working in a small rural hospital where needs are high but there are fewer resources than a larger urban hospital
- A shift in normal duties and focus. Providers are trained and accustomed to providing support during times of need and crisis. A dilemma can be created when time and resources to provide personalized care are scarce. During COVID-19, many family members are unable to visit critically ill or dying individuals. This is a significant source of moral distress.
- Financial issues, including issues around limited sick leave or health insurance, can create a dilemma when the frontline worker is faced with the need to work. Especially when social distancing sheltering at home have been indicated, and risk to self is high.
What you can do:
- Utilize your organization’s supports and resources.
- Acknowledge your experiences, feelings, and reactions.
- Have the courage to speak up and speak out.
- Seek support from your colleagues. Chances are good they are feeling similarly!
- Take time for yourself.
- Be aware of your own triggers or stress points. Take a break before you need a break.
- Adhere to routines and schedules as much as possible
Resources that can help:
- Check out the other topics and pages on this site! There is a lot of overlap between topics and you may find something helpful where you least expect.
- SAMSHA Disaster Distress Hotline (1-800-985-5990): 24/7 resource for emotional support and crisis counseling. They have resources for non-English speaking and/or deaf or hard of hearing. You can also text “TalkWithUs” to 66746
- Employee Assistance Program – within your facility/organization
- Stress management: VA Center for PTSD